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with joel totoro and wes barnett This episode
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I'll spell that to you because it's not as you
think, T -E -A -M -B -U -I -L -D -R .com. Welcome
to the Behind the Shield podcast. As always,
my name is James Gearing, and this week it is
my absolute honor to welcome on the show former
Navy flight surgeon and current president and
CMO of Wave Neuroscience, Dr. Eric Wan. Now,
in this conversation, we discuss a host of topics,
from his journey into the world of medicine,
his perspective of war through a medical lens,
working with Boeing, The veteran and first responder
mental health crisis. The breakthrough technologies
of magnetic e -resonance therapy and synchronized
transcranial magnetic stimulation they offer
at WAVE. How Ohio, Florida, and Missouri offer
this technology to their veterans and first responders
for free. The application of this technology
not only on mental health, but also on performance
and so much more. Now, before we get to this
incredible conversation, as I say every week,
please just take a moment. Go to whichever app
you listen to this on, subscribe to the show,
leave feedback and leave a rating. Every single
five -star rating truly does elevate this podcast,
therefore making it easier for others to find.
And this is a free library of well over 1 ,000
episodes now. So all I ask in return is that
you help share these incredible men and women's
stories so I can get them to every single person
on planet Earth who needs to hear them. So with
that being said, I introduce to you... Dr. Eric
Wan. Enjoy. Well, Eric, I want to start by saying
two things. Firstly, thank you to our mutual
friend, John Doolittle, for making the connection.
And secondly, I want to welcome you onto the
Behind the Shield podcast today. Well, thank
you so much. Yeah, JD is a very dear friend and
I'm really happy he made the introduction. And
of course, the honor is mine to be here. I'm
really excited to be able to talk with you. Absolutely.
Likewise. Well, we will get to the kind of the
fusion, how you met John and what you're doing
with his community and then how that applies
to the communities listening. But very first
question, where on planet Earth are we finding
you today? I'm in Newport Beach, California.
It's nice and sunny outside. And yeah, this has
been a home for quite a while for me. Beautiful.
My little boy, my son was born in Hoag Hospital.
So just down the road from you. Oh, wonderful.
Yeah, yeah, I know. Well, yeah, beautiful. All
right. Well, then very first question. Let's
go to your origin story. Tell me where you were
born and tell me a little bit about your family
dynamic, what your parents did, how many siblings?
Oh, sure. Yeah, I was born in Oakland, Alameda
Hospital. My dad at the time was getting his
PhD at Cal Berkeley. My parents are both first
-generation Korean -American immigrants. Both
came over based on academic scholarships. So
my dad was a chemist, and my mom got her master's
in librarian sciences and met that way, fell
in love. And then I was born at the Oakland Alameda
Hospital. We moved down to Orange County afterwards.
And growing up, we grew up very much kind of
a middle class family. They're wonderful parents.
I think adjusting to life in America, they were
coming out of the Korean War. So growing up,
my sister and I, I do have one sibling, an older
sister, who I'll get to in a moment. we were
raised very much to have a reverence and respect
for what america stood for and the opportunities
that were granted um because many of these things
you know the poverty that career was going through
at the time didn't allow for many of the things
that we were able to achieve here and so we uh
worked very hard to honor and respect that opportunity
and um my sister a wonderful human being. She's
a cardiothoracic surgeon and specializing in
lung transplants, but she retrained in plastics
and aesthetics and is now practicing up in Seattle.
And so I say half jokingly, I was really kind
of the underachiever in the family, but was really
appreciative for the opportunities that I had.
And yeah, so we grew up in Orange County, California,
predominantly. And I left for college. I went
to University of Notre Dame and had a wonderful
experience there. Took a scholarship with the
Navy to go to medical school and enlisted and
did an internship in emergency medicine occupation
or emergency medicine. And they called a transitional
internship, then did a tour as a flight surgeon
with the Marines. which we'll get to, I'm sure,
later, but it was really a great experience.
And to this day, some of my closest friends.
And then I finished up my medical training in
Boston. It was a combined program starting out
at Harvard Medical School, then Harvard School
of Public Health, and then many of the hospitals
there, Mass General, Brigham and Women's, and
the Cambridge Health Alliance. Finally ended
up back home in California. I was at the Boeing
company as their chief physician and took on
a separate role as their chief technology officer,
which is how I interface with this technology
and joined the company about eight years ago.
It's been been really a full sprint ever since.
That's an amazing story for an underachiever.
All right. Well, then. I'd love to go back to
your parents' immigration, because at certain
times in recent history, the immigrant has been
tarnished with a lot of negative connotation.
But this is the tapestry that this country was
founded on over and above, of course, the Native
Americans that were already here. And the incredible
immigration stories that I've heard and the power
of some of these conflicts that these people
were leaving, I think, are stories that need
to be repeated and need to be heard. So what
have you heard as far as the conditions in Korea
and why your parents decided to move to the U
.S., what they were leaving? Yeah, I always think
back to the sacrifices that they made to give
their children an opportunity. Yeah, there was
quite a bit of hardship at the time where, you
know, the separation between North Korea and
South Korea, many families ended up getting separated,
unfortunately. And that was a little bit of a
legacy that whenever I went back to Korea, you
know, I'd hear these stories. And it was really
only the best students who were able to make
it across the ocean to study in the U .S. You
know, I just knew them as my parents. But I know
when I go back to Korea, they always talk about
how hard they worked to get this opportunity
and to make good on it. And that I think I never
felt it as a burden, but I recognize that I was
given really a golden opportunity and I didn't
want to waste it. And so all the things you hear
about instilling work ethic and. kind of honoring
the sacrifices that all of our ancestors made,
you know, that kind of gets instilled in you.
And I felt very blessed. You know, they gave
me great opportunities. It wasn't a traditional
Asian family where, you know, there's a dragon
mom who was kind of crushing me with expectations.
It was more of a... kind of a healthy household
where we were allowed to explore our academic
curiosity and grow at our own pace. I wasn't
always a great student, but I did have a natural
curiosity. So yeah, my dad sadly passed away
about five years ago. My mom is still alive and
she lives close to us and so I get to visit with
her quite often. But yeah, very thankful. for
their journey and that I was afforded the opportunities
that I have here. Yeah. Well, that's amazing
to hear. I just had Dr. Venya on the show and
he is Mexican -American and his father was a
mechanic, if I've got this right, in Mexico.
Then he ended up becoming an engineer in the
US and then his child becomes a neurosurgeon.
So, you know, to me, there's some pretty incredible,
you know, immigration stories. And again, this
is this beautiful tapestry that is the United
States. And then also looking at the Korean story,
and I've got a veteran coming on soon from that
conflict, how close Korea came, South Korea came
to being completely dominated by the North Koreans
and then seeing the impact that the allies had.
I think that's a very undertold story as well.
It's the forgotten war. But what those brave
men and women of that period did to help. you
know the the korean people at that point the
southern korean people it needs to be spoken
about more as well i believe yeah yeah and if
you know america is viewed in such a um positive
light in korea even to this day you know now
that they've um kind of come out of that uh impoverished
state after the war it's become a fairly affluent
country but still anything that's american is
viewed as you know a super premium kind of brand
and uh there's a lot of um love for for what
america did for for korea at a time when they
were being oppressed so um so yeah that was uh
definitely part of the korean story and um When
I had the opportunity to give back and join the
military, I wasn't sure how my parents would
feel about it. But they were very proud. They
were excited that we were able to give back in
any way. And I ended up really enjoying and loving
that experience. That's sad. I think the career
at the moment, South Korea is going through the
most deadly wildfire that they've had in a long,
long time. I think they've lost 30 plus people
so far. Yeah. Yeah. It's interesting. And out
here in California, of course. the fires uh that
went through it just seems like these are kind
of unusual times but um but yeah definitely uh
saying prayers for um our folks in korea as well
absolutely well what about sports and exercise
what were you playing when you were a school
age oh yeah i grew up Mostly playing soccer and
then played a little bit of volleyball. It was
very popular in Southern California and then
kind of found a niche in track and was a runner
and a jumper and competed at a reasonable level
in high school and then walked on to the team
in college. I think the coaches may have just
been humoring me. My roommate was a thrower and
he... had me come with him to practice and I
ran and the coaches said, well, come back tomorrow.
And I kept going for a couple of years. I got
to travel with the team and felt very fortunate
to have that opportunity. But there was a day
I remember I was feeling pretty good about myself
training. It got great coaching. There was working
out with, you know, with at the varsity gym and
the day the football players joined the track
team. Some of your audience may know these names,
but Rocket Ishmael and Tom Carter, who went on
to have great careers in the NFL, came out and
they just crushed my PR without any training.
They just came out and jumped and beat me by
about three feet. So I realized pretty quickly,
while this was, I think, fun for me, it certainly
was not going to be my future. So I ended up
focusing very much on my studies. gave up my
running and jumping career pretty early on. My
son is following the veterinary route at the
moment, and he's considering doing the veterinary
actual vet school through the military. He's
not sure yet. Talk to me about your kind of medical
journey and why you chose the military route.
Yeah, it was actually a recruiter that came to
our medical school. I remember listening to them
and hearing about the different opportunities
that it afforded. And that really appealed to
me that we could have medical school paid for,
get our medical training, because many doctors
end up graduating from medical school with loans
and debt amounting to a quarter to a half million
dollars. It's just kind of a difficult financial
situation to dig yourself out of. And so to be
able to have that scholarship. work with the
military and lots of other really good men and
women seemed interesting to me. And it really
was a great experience. I deployed with the Marines.
We were HM -268. It's a medium lift rotary wing
squadron. And we formed what's called a Marine
Expeditionary Unit. So we deployed to the Persian
Gulf as the 11th MEU, part of the 1st Marine
Expeditionary Force. And it's hard to describe,
and I think your audience probably understands,
but the camaraderie in that unit is something
I'll never forget. And, you know, we're all relatively
young. Most of the people are going to be between
18 to 30 years old. And you're going to all sorts
of foreign countries, sometimes difficult environments,
and ultimately, in our case, some combat environments.
Part of, I think, the story that's important
to mention is our unit had some of the first
casualties of Operation Iraqi Freedom. And that
was something, of course, that leaves a lasting
impact. And so we lost four Marines or eight
British Special Forces on board. The residual
of that is, you know, the mission changes from
operational readiness to making sure the men
and women who are grieving, you know, remain
kind of in the game, but years afterwards are
able to manage. And so the signature injuries
of that conflict were traumatic brain injuries.
It was a very kinetic conflict and then post
-traumatic stress disorder. My experience from
the clinical side was we were deploying every
modality that we could to try to help, whether
it was medication management, cognitive behavioral
therapy, ID sensitization. There's many different
modalities that we tried and many were helpful.
I'm not here to diminish the value of any of
those, but when I came across this technology,
which We'll walk through. It's called magnetic
EEG guided resonance therapy. It's a form of
transcranial magnetic stimulation, TMS for short.
But what our organization, Wave Neuroscience,
is doing is offering a personalization component
to it where we get an EEG brain map and we look
for some disruptions in activity in terms of
brain connectivity. And then we administer the
transcranial magnetic stimulation. in strategic
areas to try to restore the disruptive networks.
And we found that to be quite effective for PTSD.
And we're finishing up an FDA clinical trial.
We believe that'll complete this year. And we'll
be lobbying the FDA to get a full clearance for
that. In the interim, there are some state initiatives
where... This is being offered to veterans and
first responders, and we're allowed to do that
through practice and medicine. I should clarify
what we're trying to get FDA cleared is an automated
protocol generator, which will allow us to scale
very rapidly. We currently design these personalized
protocols manually through a full -service EEG
lab we have here in Newport Beach. But these
initiatives in Ohio, Missouri, and Florida have
gone spectacularly well. And we're seeing that
the treatment really we strive to optimize brain
function. But whether it's a firefighter, law
enforcement officer or a veteran, it's pretty
agnostic to your profession. It's really just
trying to tap into first order principles of
physics and our natural neurobiology and optimize
function. Well, let's jump ahead. We'll go back
to the kind of journey into Boeing and everything.
But while we're talking about this now, so you've
got the EEG, you've got the analysis, and then
you've got the TMS. So kind of walk me through,
let's say it's a soldier or a firefighter that
walks through the front door. What would that
look like as far as what they're actually experiencing
in each of these units and then the kind of timeline
that you're seeing? Sure. So the EEG stands for
electroencephalogram. It's a very simple study.
It's a neuro image takes about 15 to 30 minutes
to acquire. It's painless. You sit in a dark
room and they put kind of a cap on your head.
And we can see a lot of different things through
this capability. EEG went through a pretty quantum
change about 15 years ago when it got fully digitized.
And we can do very sophisticated discriminant
analyses now that we could not do before. So
much in the same way, an electrocardiogram is
an electrophysiologic picture of the heart. These
electron encephalograms are electrophysiologic
pictures of the brain. Our next step doing these
computational analytics, and there's some AI
augmentation to this. We can look for disruptions
in brain activity and show that to not just physicians
and scientists, but also our patients. And it's
been very illuminating to see the light go on
for many of our patients, whether they're veterans
or law enforcement or firefighters or paramedics.
Many of them have gotten MRIs and CT scans and
told everything looks normal. But when you see
a disruption activity, there's this realization
that, oh, you know, it's not just... my weakness
or uh you know it's not a lack of discipline
or fortitude there's a real neurobiological issue
that's leading to me um struggling and many of
them will say you know my healing journey started
once i could see that and it's been impressive
to see the kind of behavioral change that that
can engender people become their own best advocates
and They start protecting their sleep more. They'll
exercise more vigorously. They'll have cleaner
diets, which is all, I think, foundational to
this healing and human performance journey. But
we don't just rest on natural holistic methods.
We can use this transcranial magnetic stimulation
device to tune those areas and restore the functional
connectivity of the brain networks. And the way
that happens is there's a 15 minute session where
you sit in a comfortable chair. They place this
coil near the area where they see the disruption.
And there'll be about a six to 10 second pulse
train of it feels like a tapping on your forehead.
And that. process is in training brains and neuron
activity to become more coherent. And I'll explain
that more in a moment. But it's not painful.
You know, this is not like electroconvulsive
therapy or anything very aggressive. Many of
our patients say it feels like a brain massage.
The very first pulse may be catch you off guard
if you're not ready for it. But by the second,
third time you do it, it's very comfortable.
It does not require any anesthesia or anything
like that. It's completely non -invasive. But
many of our doctors say, you know, 15 minutes
a day for four weeks, we're asking for not a
lot of time to recover a lot of function. And
so that's fundamentally the process. To take
a step back in terms of one of the ways we look
at the EEG, every one of us has a unique signature.
And one of the dimensions we look at is something
called the alpha signal. And alpha is the dominant
rhythm in your brain, how many times per second
your brain can process information. And it's
generally between 8 and 13 hertz. And you may
have a 12 .4 hertz brain, a fast processing brain.
Other people may have a slower brain. We find
many people who are more creative may be a little
bit slower in the 9 .2, 9 .3 range. It doesn't
matter. It tends to be just where we're born.
But if we see an area of the brain that's misfiring,
let's say the prefrontal cortex is at 6 hertz,
while the rest of your brain is at 11 hertz,
that information mismatch may manifest as certain
symptoms to you. And that happens to be one of
the more common patterns that we see. If you've
had a mechanical injury, like some blunt force
trauma to the front, or even an over -pressurization
blast injury for some veterans, the neuron's
stereotypical response to injury is to slow down.
And so if we can start to speed those areas up
and provide it with the entrainment daily, the
body does a lot of the heavy lifting for us.
And that kind of taps into how we've been designed
as human beings. Whether you believe in Mother
Nature or God, we're healing organisms. And if
you put two ends of a broken bone together, it'll
heal, sometimes grow back stronger. If you put
two ends of a wound margin together, that will
also heal. And the brain sometimes just needs
a gentle nudge as well. And so we're looking
for these areas of disruption, and we're providing
a gentle stimulation. It is about a 1 .8 Tesla
magnetic coil. We provide a much lower intensity
than that, obviously. And for those who are academically
curious, the reason an MRI grade coil is used,
MRIs have unique property of being able to deliver
energy across a solid object. And so rather than
having to drill a hole in place, kind of an electrode
in the brain, we can use these coils. It'll traverse
the one centimeter piece of skull. between you
and the outside world. And it can cause an action
potential within the neurons that lie underneath.
So it's a beautiful capability. And I can't say
it's absolutely painless, but it's not, in my
experience, it wasn't particularly painful or
anything like that. It was actually a pleasant
sensation. And so we do that for generally four
weeks. Some people may take longer. Some people
can be shorter. It depends on the severity of
the injury. And we see pretty significant changes
in symptoms. What are the kind of commonalities
that you're seeing in the fire service? Because
when I think about the military, especially obviously
if they are infantry or some of the other units
that are going to be front and center, they're
going to be breaching them. The concussive force
is quite obvious. When it comes to law enforcement,
again, going hands -on with people, again, firearms
training, SWAT breaching, you can see there'd
be more of that. But with the fire service, We're
exposed to that less. Now, I was a martial artist
my whole life, so I've definitely been kicked
and punched way more than I probably should have
been. But that aside, you know, when I see my
profession, I see more damage from the sleep
deprivation, which what I'm told from many people
in your world has a similar effect to, you know,
the kind of traumatic effect as far as the demyelination
of the myelin sheath. So what are you seeing
as far as those imbalances in firefighters versus
maybe some of the other professions? Yeah, you
touched precisely on maybe the first thing people
notice is the restoration of deep restorative
sleep. And that is a common finding between the
different communities. And it's interesting.
I sort of thought of all of these professions
as being slightly different. I feel very privileged
to be able to help these communities. I realize
there's so much in common. All of these different
communities have raised their hand and said,
I'm going to sacrifice and serve my community
in this way. And each of them willing to go into
harm's way to protect and serve, which is kind
of unique. Not a lot of people are willing to
do that. But the sleep deprivation, whether it's
Going overseas, you know, 18 time zones away
and wearing night vision goggles to have a tactical
advantage at night. So you're intentionally inducing
kind of a sleep deprived state or whether you're
doing shift work in a local community. Sleep
disruption and circadian rhythm disruption tend
to be hallmarks of these professions. Although
we tend to think or assume that we will adapt
given some time off from a night shift, physiologically,
it doesn't happen as quickly or easily as we
might hope. So certainly we can walk through
all the different sleep hygiene, you know, tactics
we can use, whether it's kind of exercise and
at the right times or diet, nutrition, you know,
blackout curtains, these things. But what this
treatment is affording. in some ways is a bit
of a reboot. And we find when we see disruptions
in activity, because chronic sleep deprivation
certainly causes slowing in the prefrontal cortex.
And if you ever wonder, you know, if I'm sleep
deprived, you know, my emotional resilience goes
down, my impulsivity goes up. It's not your imagination,
right? These are things that we can observe in
an EEG with great predictability. And if we can
help to restore that activity, Number one, you
may subjectively feel better, but you're likely
going to sleep better as well. So one of the
pieces of feedback we frequently hear is, I just
had the best night of sleep I've had in 10 years.
And those are usually the cases where we know,
okay, this is a person who's going to do well.
So yeah, sleep is really foundational. There's
second and third order benefits to sleep that
are critical in so many different ways. And I've
heard in some of your other podcasts, this is
covered in great detail, but chronic sleep deprivation
predisposes people to cardiovascular disease,
cerebrovascular disease, cancer, many different
types of conditions. And I believe now... Thankfully,
there's beginning to be some recognition and
proactive movement to try to correct that. Never
as fast as we want it to be. But I think the
first step is just to acknowledge this is an
issue and then work towards finding solutions
that can help. Well, we talked before we hit
record because you mentioned about listening
to some of the episodes prior. And I was explaining
how. I'm trying to make an industry standard
where we have at least a 72 hour period between
shifts. Right now it's a 48 hour period. What
is your perspective with this unique lens that
you have on the impact of giving first responders
more time between shifts to try and get closer
to that baseline? Yeah, I think it's a brilliant
idea to be able to make that change. And what
you're proposing. It's actually quite a simple
change. And the long -term impact of that, you
think about adding an extra 24 hours of rest
between shifts over a career, you know, 10, 15,
20 years. The amount of benefit that each individual
would gain not only would help the force of the
unit, but also the family. You think about how
that impacts your time at home, your ability
to be present with children and spouses. I think
that it would have quite a meaningful, potentially
profound impact on both an emotional and a physical
level. So I imagine there are logistical challenges
with making something like that happen. But I
think if there's will. To see these changes in
service to the community that's serving all of
us, it can be done. It's just a matter of recognizing
it and probably acquiring some data to demonstrate
what those benefits are at a quantitative level.
Yeah, well, it's interesting because, I mean,
we've got the sadly the reverse data where we
know what happens if we do it the way we do at
the moment. And it results in a recruitment crisis
and, you know, bleeding money through overtime
and lack of retention and all these things. Ironically,
the data is in the opposite direction, but it's
still data. We know this isn't working. Graveyards
are full of firefighters and other first responders.
But what's exciting is that money is already
downstream. So even, you know, financially, you
can just kind of front load that, invest in your
people. And then, you know, then you've got the
capacity to start sending people to all the other
areas that can help you level up. And obviously,
wave neuroscience is one of them. But there's
so many areas that we can get from trying to
get us not to die all the way to the other side
of performance. And I think this is what's become
very clear recently when I talk to nutritionists
and strength and conditioning coaches and people
like yourself. When you work with special warfare,
you're squeezing out performance. Like you said,
you're also trying to mitigate the impact of
war on the mental health side, but you're helping
these operators perform at the highest level.
In my profession, all the conversations are is
let's try and get us to die less. So we've got
a long way to go from where we are now to the
performance conversation. But it's an exciting
journey that we can travel because not only will
we improve our longevity and our relationships
at home, but we will simply be better paramedics,
police officers and firefighters. Yeah, I couldn't
agree with you more. You know, before joining
the podcast, I was doing some research on the
literature on shift work really across professions,
whether it's hospital workers or firefighters,
law enforcement, you know, long haul pilots.
And the weight of the evidence is pretty clear
that shift work, as it's currently administered,
is pretty harmful to health. And so anything
we can do to bend that curve. I think would be
of great service to these communities. So yeah,
I agree. And I think that your effort to spread
the knowledge that this is a simple intervention
that could help. um in many different ways i
think it is very smart and i hope uh the right
people will listen and start to make some of
these changes yeah well i mean it's been this
it's been people like you over a thousand conversations
not all of them are specifically about shift
work but you know it's just layers where i always
tell people the venn diagram has overlapped so
clearly that there is no denying because every
person from all these walks of life from neuroscientists
to neurosurgery to sports performance to whatever
it is back injury they all say the same thing.
So this is a beautiful thing. If you really get
outside your echo chamber and you challenge these
concepts and they come back as the truth over
and over and over again, then it's hard to then
turn your head. Now it's time to acknowledge
it and change. Absolutely. And it's probably
worth mentioning too, it was interesting, we
had talked before we hit record, some of the
work that... we were fortunate enough to do with
U .S. Special Operations Command. And their feedback
was earlier on, you know, we love what you're
doing for the men and women who are injured.
We actually view a lot of this benefit as being
a human performance benefit. And in fact, Air
Force Special Operations recently just published
the first brain optimization program. They measured
a bunch of different things. Some of the things
that were interesting and maybe interesting for
your audience, we saw improvements in reaction
times, sometimes in the millisecond range, but
for firefighter law enforcement or a Navy SEAL
or an Army Green Beret, that can be very important.
We were able to see quantitatively improvements
in sleep. um and then you know there's a number
of other things that were measured force plate
data that is a proxy for injury risk and it was
interesting to have a conversation with some
of the doctors in this area and one of my mentors
i should mention stephanos kales out of harvard
most of his research has been on firefighter
health and the question that was raised is are
those benefits completely due to the treatment
or is it a happy byproduct of improving the sleep
quality of these individuals. And I think an
argument can be made for both. It's really hard
to tease out the contribution of one or the other.
But I do think something that the whole audience
can learn, I think is probably, if it hasn't
been learned, can just be reinforced that sleep
is of paramount importance. And if you look at
the pillars of health, Diet and nutrition being
one, exercise activity being a second, but recovery
and sleep being the third. Strong arguments made
that recovery is really the foundation for all
of this. And we do have to give ourselves a time
to heal and to recover, especially if you have
a difficult shift. And I really like that three
-day concept. rather than two, because cumulatively
over time, the benefit people can get from one
extra night of good sleep in a four -day cycle
is quite profound. Absolutely. I had two military
sleep researchers on the show, Rachel Markwald
and Alison Brager, and they were talking about
not only reaction time when it came to sleep,
but also critical thinking. which is incredibly
important, you know, to shoot or not to shoot,
for example, or in my profession, you know, the
right drug, the right dose, the right part of
the body. And so, yeah, there was a direct correlation
between sleep deprivation and poor critical thinking.
And you look at a lot of these videos of these
police officers, for example, making the wrong
decision. No one ever really asked when did they
sleep? Were they forced to do an extra shift?
You know, so what was their stress level? So
I agree. Even when you look at the. The performance
side, as far as mistakes that we make, there's
hardly ever a kind of reverse engineering and
sleep deprivation. But if you look at Chernobyl
and the naval crash that we had not long ago
and the Exxon Valdez, sleep deprivation is behind,
not the sole reason, but a massive contributing
element when it came to those disasters and the
massive dollar amount that came along with them.
Yeah. Absolutely. And these things can actually
be measured in some creative ways, too. You know,
we're talking about performance gains, but even
in there's an interesting study that came out
of Australia in 2019, where they measured typographical
errors made by nurses and shift workers. And
there's a dose response relationship, like the
more sleep deprived you are, the more errors
that you make in your typing. And it was statistically
significant. And so we can see consciously or
unconsciously the number of mistakes that are
made. increases quite significantly uh the longer
and more chronically you're sleep deprived so
so yeah it's uh pretty clear based on based on
the data and the evidence well you mentioned
trauma as one of the the factors creating that
imbalance in the brain um when you know again
after all these years of having these conversations
it became very apparent through being educated
from a lot of guests how many of us have childhood
elements that contributed to trauma later in
our career. So aside from the actual physiological
trauma, how does it manifest in other ways that
you can still see in the EEG if it's more of
a kind of psychological traumatic element? Yeah,
it's interesting. As we dug into the science
and as the body of evidence has been growing
about PTSD, there's a few pretty clear physiologic
changes that occur, particularly in the adolescent
pediatric trauma population. We see reductions
in what's called hippocampal volume. The size
of the hippocampus decreases in size. Very objective.
This is not kind of a survey or a questionnaire.
It's a measurable difference that we see as these
patients grow. The other area that's pretty uncontroversial
is we see changes in brain network connectivity.
And specifically, there is a network that's of
interest for the PTS community called the Default
Mode Network, or the DMN. So there is some great
work being done at Stanford exploring the effectiveness
of a similar treatment as fMRI -guided for depression.
And they're studying the salience network. And
I won't bore your audience with a lot of the
deep science behind that. It's fascinating to
me, but I know boring for many. But the salience
network has been closely correlated with depression.
And when they treat these areas, the salience
network can flip the direction of some of the
pathways they call anti -correlation. The depression
remits. And so that's been very exciting to see.
Our group is very focused on restoring function
at the default mode network. And the disruption
in this pattern of connectivity, it's not just
our data. There's large population -sized epidemiologic
studies with hundreds of thousands where we can
see pretty consistently that this area gets disrupted.
And part of that pathway and part of the way
we're able to... strive to restore function is
using this treatment to close that circuit and
to reactivate neurons that might be firing too
slowly. There's a paradigm in neuroscience they
call heavy in learning that as neurons fire,
they wire. And if we're able to induce these
neurons to fire at a rate that is consistent
with how other areas of the brain are working,
we can cause synchronization of activity. That
is believed to be one of the elements that allows
people to get more restorative sleep. There is
a pattern we see in sleep as we get into deeper
sleep, stage two sleep, which is the stage prior
to REM sleep. There's a phenomenon we call sleep
spindles, where there's these synchronous bursts
of activity. And that allows you to get into
your dream states of sleep. And we're seeing,
and we've had some sleep specialists tell us,
we're seeing a dramatic increase in the number
of sleep spindles when we administer this treatment.
And that aligns in the sense that we are trying
to restore synchronization of brain activity,
or something we call alpha coherence. And with
that, we're starting to tease out and pull the
curtain back on how are we getting people into...
more restorative sleep. And this may be one of
those modalities. We're doing some more research.
We're working with a group out of Virginia Tech
called the Frameland Biomedical Institute that
is doing full in -lab polysomnograms on patients.
And so I think we'll have a better idea of how
sleep is changing post -treatment over the next
six to 12 months. See, I have no problem getting
to sleep. But I find that I'm not getting that
deep quality of sleep. I don't wake up feeling
rested normally. So I do all the right things.
You know, I usually maybe not the device thing
or the TV thing, but I have blue blocking glasses.
I have the air down. I have all the lights, you
know, muted in the bedroom. And, you know, just
trying to get that sleep hygiene dialed in. And
it works to a point. I sleep, but I wake up normally
with my jaws real tight. My neck is tight because
I've been clenching the whole night. my fire
service career and then probably beyond that
you know i was in a house fire when i was four
years old that you know that might be one of
the reasons i almost died um but uh so it's interesting
because i'm doing the headspace and there's nothing
like there's not a thing that i feel like i need
to address um that's haunting in any way so this
is why this technology is intriguing to me is
like okay well outside of all the psychological
things outside of the sleep hygiene What are
other things that may be that missing link to
help me actually get a better quality of sleep?
Yeah, it's interesting. If it's possible, it
would be great to let you demo the technology
and see if it might help you to get kind of a
longer sleep duration and push you through sort
of those. periods where you may be kind of waking
up. It may be related to cortisol. That's a hard
thing to measure throughout the night, but there
may be some ways to measure that and see if that
might be one of the areas that could be tuned
up. But we can talk about it offline, but it
would be great if you could visit one of our
centers in either Ohio, Missouri, or Florida.
We could certainly let you try the technology,
see if that helps you sleep better. Yeah, I would
love to. Thank you. Well, you mentioned those
states. So let's talk about these initiatives.
Which one was first and how did that kind of
come about in the first place? Yeah, so. So Senator
Frank Hoagland was at the time, he's a retired
Navy SEAL. He saw what this technology could
do for many of the team guys, and he wanted this
to be in the state of Ohio. So we worked through
a group called JLC Services. There's a great
human being, a patriot named Joe Charles, who
saw what this technology could do and wanted
to operationalize it. So that bill passed around,
I want to say. 2020, 2021. And at that time,
it was predominantly for veterans. In year two,
they added first responders. And they've now,
I believe, treated over 1000 patients. And it's
been a great success. And we've been able to
create what's called the dashboard where legislators
and many of their stakeholders can actually see
in real time how their taxpayer dollars are returning
back to the community. And we get eight gold
standard scales measuring depression, post -traumatic
stress symptoms. And there were two scales added
a couple years ago that have been of great interest,
the opioid craving scale and the pen alcohol
craving scale. And we saw an interesting signal
that the same treatment seemed to be helping
to reduce cravings for substance use disorder.
And they launched a separate pilot. out of two
inpatient detox centers, Perry Behavioral Health
and Meridian Health. And they were able to replicate
this data. And so the goal being, you know, in
firefighters, law enforcement, veterans, they
may identify with different types of issues.
The number one cause of patients coming in was.
performance, and then sleep disorder. Whereas
in these inpatient addiction centers, their number
one cause for coming in was substance use disorder.
And so we were able to see these findings again
in that community, which was interesting. But
the success that was experienced in Ohio prompted
legislators in Missouri to replicate that same
bill. And so we're very excited. They've had
a very successful program as well. Senator Black
is leading the effort there. And then Florida
came online this year and actually the. legislator
that uh initiated the bill there is actually
somebody who's on your podcast danny alvarez
uh who is himself just an amazing guy i've uh
been fortunate enough to be able to spend some
time with him and he is the real deal like he
uh is i think what you would want every senator
and politician to be. He lives his word and is
really doing everything he can to help the community.
So yeah, it's been inspiring to see these initiatives
move forward and to be able to help these communities
and collect more insight into what's happening
has been pretty amazing to see. And so I would
just mention, too, if anyone in your audience
is interested, they can go to etmsohio .com or
etmsmissouri .com or etmsflorida .com. You can
actually enroll. There's a portal on those websites
where they can sign up and access the treatment
really at no cost to them. Thanks to, you know,
these these lawmakers who found it suitable to
provide the treatment to those populations. Beautiful.
So so those states are actually funding the treatments
for these first responders, military and veterans.
That's right. That's right. And, you know, paramedics
are part of that community as well. And yeah,
the the different it seems like the different
centers may have sort of different populations
that come into them. But it's been interesting,
you know, a tip of the hat to the firefighters
and law enforcement folks seem to be more, they
don't just get the treatment. They go out and
they tell their brothers and sisters that you
need to come in and get this. And so it's kind
of caught on in a way that's been really beautiful
to see. where if they see somebody who is struggling,
no longer do they have to say, just suck it up
or it's going to get better. There's an opportunity
for them. And these were specifically designed.
We don't necessarily have to diagnose you. There
are many people who are a badge who do not want
a diagnosis of major depression or PTSD. Interestingly,
our treatment, we don't necessarily look for
that label either. We're just trying to find
disruptions in connectivity. What a doctor or
therapist may call it isn't necessarily of primary
interest to us. We just want to help people.
And sometimes they come in for, gosh, I really
just want to get my sleep tuned up. Other people,
they want a performance bump. And we see that
in... Most of our clinics, we see CEOs and CFOs
from Fortune 500 companies. We see U .S. Olympians,
and we see a lot of elite operators, Navy SEALs,
Army Deltas. And so the saying is, you don't
have to be sick to want to be well. And so if
anyone in those communities is interested in
the treatment, I just encourage them to look
through those websites, and there's lots of studies
listed there. supported by really good, solid
evidence and science. But for us, the encouraging
part is just being able to provide access to
communities that otherwise may not have access
to it. One thing that's been apparent is just
how diverse the toolbox is for... someone who's
struggling you know it could be physically mentally
i mean those are usually interwoven anyway but
it used to be well talk therapy and psychiatric
meds were pretty much all you had to choose from
and you hear that a lot from the the military
members that go through the va i mean sadly i'm
sure there's some great great professionals within
that service but a lot of them you know probably
have a tiny window to see each veteran and so
that tends to be the kind of knee -jerk reaction
but then you actually learn about what's truly
out there i mean yes you have all those and emdr
and you know all these things that are very effective
and then you have what we're talking about today
and then you have equine and canine therapy and
then you have psychedelics and ketamine and mdma
and all of a sudden you realize how many tools
there are and so i could see how for example
using wave would then kind of bring that kind
of temperature down out of the red zone And now
maybe that person is able to open up more with
their counselor or they are able to reflect on
and even maybe which part of their body is actually
giving them trouble. So, you know, taking it's
not just, you know, the one one size fits all,
but taking all of these little pieces and finding
out what's best for you. And this seems like
such a great, you know, first step is like, all
right, well, let me get my brain to. kind of
downregulate and balance. And then let me assess
again and let me see, you know, what else would
be a great complement to this treatment. Absolutely.
That is something that we've seen encouragingly
in the community is when people come in for the
treatment, many times we'll get an unsolicited
call from a cognitive behavioral therapist or
a family member that, you know, whatever you're
doing. They're able to listen better. They're
able to talk better. What we're doing is more
effective. And so I think that's a fundamental
part of this is we're big believers in, you know,
it takes a village. So if you're getting benefit
from CBT or group therapy or art therapy, by
all means, like, please continue those things.
You know, it's all part of the healing journey.
And everyone come from. a different part of you
know they everyone has different risk tolerances
and so we see people are very aggressive about
how they want to treat themselves and we see
people are very conservative about it and uh
we're fortunate in that we can really take uh
just about all comers um but there are so i should
mention There are some preclusions to the treatment.
If there's any ferromagnetic metallic shrapnel
or other types of forms of metal inside the brain,
intracranially, that would be an absolute contraindication
to treatment. Some people, whether they have
a shunt or a surgical clip in their brain, they
wouldn't be candidates for treatment. A history
of seizures can also be a preclusion. It's what
they call a relative contraindication. The doctor
can do an assessment and decide whether the patient
is a candidate for treatment or not. The most
common side effect is a transient headache, usually
relatively mild, alleviated by over -the -counter
ibuprofen or Tylenol. Roughly 15 % to 20 % of
people may experience a headache in the first
couple of treatments. Typically, then it goes
away. But we always try to be very transparent
about any of those risks. We do kind of a full
informed consent where everyone who comes in
knows what all the risks, side effects, and potential
adverse events would be. But compared to many
other modalities, such as psychopharma, This
has a more desirable safety profile. Beautiful.
Well, I want to circle back to med school because
this has been always an interesting conversation
with anyone who's gone through that system. As
we are talking now, we're having this 2025 conversation.
We're talking about sleep. We're talking about
nutrition. We're talking about exercise, talking
about TMS and all these other therapies. How
much of that, obviously not the current. technology
that you're working with. But when it comes to
the holistic human, how much education did you
get on that side as you progress through medical
school? Oh, wow. That's a great question. Very
little. Yeah. And, you know, I went to med school
at a time where it was a bit more barbaric in
terms of the type of hours that you worked. So
I remember our trauma surgery rotation. And I
had to do trauma again before I deployed. The
typical schedule, it's not supposed to be this
way, but the typical schedule was 36 on, 12 off,
36 on, 12 off. And we would do that for two months.
And it's a bit of a crucible in terms of the
pressure because you're literally many times
on the cutting edge between life and death for
a patient. And you're so sleep deprived. you're
really worried about making a mistake. And there's
always these stories about the resident who fell
asleep driving home and got into an accident.
So it is something we should have better understood.
I would say sleep science has come such a long
way over the last 30 years. It's been interesting
to see how it evolves. And, you know, early in
my career, I got to meet two of the legendary
sleep scientists, William Dement. and Christian
Gelmanow. They started one of the first sleep
labs at Stanford. And then my mentor, Stephanos
Kales, his dad's name is Anthony Kales, was a
preeminent sleep researcher at Penn State University.
And I just think about how exciting it must have
been to have discovered these sleep stages, how
humans as a species needed to sleep. But yeah,
when I was going through, I don't think we really
knew. too much about sleep and sleep architecture
and how important it was uh to us and we're right
around the same age but you know our generation
was when uh kind of bravado when it came to you
know i'll sleep when i'm dead uh was very much
uh the call you know ronald reagan and margaret
thatcher sadly they talked about how well they
could function without sleep, and both of them
passed away of Alzheimer's disease. So yeah,
to answer your question, we had almost no coursework
on sleep or sleep architecture. There's a slide
that I have on this presentation I do on the
2472, and it's not something I normally talk
about. I don't normally present, but I've helped
a couple of departments recently, you know, kind
of... help make the move in their area, hopefully
make the move. And there's this one photo, and
I said, does anyone know who it is? And I can't
remember his name now, but it is that the surgeon
from about, I think he was like early 1900s or
late 1800s, but he was the one that really created
up this insane residency week that you were just
talking about. And when they dove deeper into
who he was, he was a cocaine and heroin addict.
So, of course, he was able to stay up for days
on end. But that's really the origin story on
the medical side of why these residency weeks
were so long. And just like you said, how dangerous
in neurosurgery, surgery and ER to have a, you
know, a woefully sleep deprived physician working
under those conditions. Yeah, yeah, it's. And
they've actually instituted some regulations
where that kind of schedule is no longer permitted.
And so it's interesting to see the old school,
new school type approach where a lot of the doctors
who went through that pressure cooker feel like,
oh, you know, it's a rite of passage. They should
be required to go through that to prove themselves.
And I think other more common sense folks realize
that that's a very positive thing, that not only
are we jeopardizing. the young resident, but
patient care can be compromised as well. So I
think overall, those changes are real positive.
And to your point about trying to see this change
in the firefighter community, it always feels
impossible until it's not. And so sometimes it
feels like, are they going to adopt this? Are
we going to do the right thing? And I just encourage
you and others, because you clearly have the
conviction, these things are possible. If it's
serving the community in that way, eventually,
I think the right thing usually happens, not
always. But science converges on the truth. And
this is one where I think a pretty simple study
could illustrate that quite simply. But it's
common sense enough where maybe you don't even
need that. And I do hope that change comes about
sooner rather than later. Yeah, I've made that
very point. If we need to study to show that
56 hours a week is worse than 42, then do we
need to study for getting hit by a bus is going
to hurt? There's certain things that you know
you just don't need to study for. Well, as you
touched on, the holistic education, and I've
heard this so often from physicians either side
of your generation, being such a tiny, tiny part
of medical school education. If you were king
for a day and you could kind of rewrite the syllabus
for our young physicians that are entering schools
now, what would you change as far as the kind
of proactive, holistic health element of a physician
skill set? That's a brilliant question. You know,
I would require there to be some instruction
and study on circadian rhythm and just kind of
our natural biology that may be already incorporated.
There are two Nobel Prizes awarded for the discovery
of blue light. And so your audience may already
know, but just to walk through it, blue light
is 450 to 500 nanometer light. That's richest
in natural sunlight in the early morning. The
reason it's important is when blue light hits
your retina, there are specific receptors called
melanopsins that activate. And that is your first
biological cue to wake up. And so you think about
our ancestors thousands of years ago. They didn't
have smartphones or tablets or artificial light.
Their first biological cue to wake up was natural
sunlight. So what they call low -angle solar
light will activate this biological cascade,
where when the melanopsins are activated, it
sends a message to the suprachiasmatic nucleus
and ultimately the pineal gland to release melatonin
roughly 14 to 16 hours later. So the first bit
of advice would be get blue light in the morning,
at least 30 minutes. You can have a bowl of cereal
outside. You can walk the dog outside. Whatever
you need to do, just be outside without sunglasses.
Throughout the day, just common sense. Limit
your caffeine until maybe lunchtime. bit of data
that i found interesting is there's some research
that's suggesting there's a ceiling effect to
caffeine at right around 200 milligrams and you
can titrate that throughout the day but i see
some of these energy during swiss like 300 milligrams
of caffeine it's just overkill you really don't
need that amount um and there's some variants
like if you're a larger person you may need a
little bit more but just to be sensible about
stimulant and caffeine intake Last meal should
be around 6 or 7 p .m., ideally without too much
sugar. And then you begin the wind -down process.
This is the part that's tricky for people. I'm
guilty of it. It's very hard to put away your
phone and to put away your work. But your body
needs a ramp -down period, cool, dark environment
for sleep. The ideal time to sleep for most people
is between 9 and 10 p .m. And there's some people
who will say I'm a night owl. And there are some
people, there's different chronotypes, there's
no doubt. But for the vast majority of people,
they will get the deepest, most restorative sleep
between 9 and 10 p .m. And that is the closed
loop that starts in the morning with a blue light
exposure. There will be about a 30 to 40 minute
window of evening somnolence where you start
to feel very tired, usually signaled by a deep
yawn. that should be your biological cue that
I need to go to bed. And if you go to bed within
that window where your melatonin is spiking based
on the biological cue of having blue light exposure
in the morning, you should get deep restorative
sleep. Hopefully your cortisol levels will remain
low and you'll be able to sleep through the night.
And it doesn't always happen, you know, in the
fifth and sixth decade. the prostate starts to
enlarge, something we call benign prostatic hypertrophy
for men. Many times people have to get up at
night to use the bathroom. So we recommend don't
overhydrate right before sleep. There are some
good interventions for that. But fundamentally,
if I could construct the curriculum for medical
school, I would say that's a critical piece everyone
should know. And just one more anecdote I would
share. There was a subway stop in Tokyo that
sadly many people were committing suicide on.
And they actually installed blue lights in that
particular subway station. And almost miraculously,
they saw those suicide rates go down within the
first month. There's a publication on this. And
we don't always get that blue light exposure
as we should. And I'll admit for myself, I was
going from, because windows actually filter out
blue light. And for myself, I'd go from my bedroom
in an enclosed space into my garage, into a car
where I'm getting closed in glass. And I walk
about 10 feet into my office and I was getting
no blue light exposure. And it wasn't a surprise
that my sleep was terrible. And once I learned
these simple things, like these are simple, free,
available to everyone types of techniques that
can really encourage better sleep quality. And
that's the type of thing I think everyone should
know. Absolutely. I actually had Professor Russell
Foster on the show. He ironically had worked
with my dad. My dad's a veterinary surgeon, retired,
but they had crossed paths in, I think it was
King's College, one of those colleges in London.
he was actually the one who found the chronoreceptors
in the first place. And it's so interesting because
again, as I sit here getting a lot of resistance
from my profession and trying to make proactive
changes, he was laughed at by the ophthalmology
careers for suggesting there was another receptor.
They had rods, they had cones, that was it. But
it's a real kind of, you know, disruptor story
because he ended up proving it on rats. And now
it's all we hear about is, you know, when you
wake up and I get daylight on your eyes, reset
your chrono in a rhythm. And, you know, so still
relying on the way we did it, as you touched
on, you know, 30, 40, 50 years ago. is insanity
when you see technology and you watch science
constantly evolving we can't stay stuck back
then because we understand things completely
differently now so you know a 2025 medical school
i would hope would be talking about sleep and
nutrition and exercise and the importance of
community and some of these you know things outside
of pharmacology that i think would would forge
a lot more physical mental health in this country
absolutely One other similar discovery to that,
we used to believe the deeper stages of sleep
when brainwaves slowed down was just a time for
these neurons to restore their energy. Adenosine,
diphosphate, and monophosphate would rephosphorylate
and you'd get ATP again. But it turns out there's
a much more important activity that's happening
that we didn't even know about until probably
about a decade ago. And there was a researcher
named Megan Nettergaard who used a technique
called two -photon microscopy where they could
look at neurons in real time. And there's structural
scaffolding in the brain that was thought to
be just a support structure and not really have
any type of activity. They're called glial cells.
And what she discovered was that during the deep
stages of sleep the structural scaffolding would
change and it would contract and open up wide
channels in the brain that would allow cerebral
spinal fluid to rush through and wash away the
metabolic oxidative stress that accumulates throughout
the day so it's functionally many people call
this the sanitation system it's called the glymphatic
system And there was a separate study that was
done where, and we probably would not be able
to do these studies anymore because they actually
sleep deprived patients for a night or two and
they would lumbar puncture them and they'd measure
the amount of kind of metabolites in the cerebral
spinal fluid. And what they found was even after
just one night of sleep deprivation, they find
increased concentrations of tau proteins and
beta amyloid. And if those sound familiar, those
are the proteins that phosphorylate in your brain
and can lead to cognitive decline and Alzheimer's
disease called neurofibrillatory tangles. And
there is now emerging evidence that sleep may
be one of the causal agents, specifically sleep
deprivation, that may lead to cognitive decline.
And so if the audience didn't have enough of
a reason to want to protect their sleep from
a performance and. you know, kind of health and
energy and longevity perspective, cognitive decline
and Alzheimer's really strikes fear into a lot
of people. And if this is a simple step that
can be taken to ward off those effects and the
accumulation of these proteins, that should provide
some extra incentive and motivation. On the other
side of that, I don't want the audience to walk
away in fear that one night sleep deprivation
is going to cause them to get very sick. It's
not like that. But chronically over years, this
can be a concern. It's interesting because one
of my guests pointed out a while ago, he was
like, if you truly wanted to do a study that
actually replicates a firefighter shift in 2025,
which would be again, 24 hours with no sleep
or disruptive sleep. a 48 hour period, but every
week or two would be a forced overtime. So that
would be a 48 hour period with no sleep. He said,
ethically, no college would allow that. No research
facility would allow you to provide sleep deprivation
to the subjects for that amount of time. So when
people say, well, where's the data? It's like,
well, if you actually look at it, I don't think
any ethics committee would allow you to even
do that study in the first place, just like you
pointed out. Yeah, absolutely. And that's where
I think, as you mentioned earlier, you know,
science is not sort of a static process. It's
always evolving. We're always learning more,
some old paradigms end up being incorrect. And
we have to move in the direction of, you know,
what is arc of truth and where is it leading
us? And so that's where, you know, some of these
discoveries of brain function and neuroscience
should alter the way in real time of how we conduct
our daily lives. And part of that is information
transfer from the lab and from research into
kind of wider audiences like this. And so I think
it's important. to both understand that and to
track it and follow it because things we held
on to as truth 10, 20 years ago are no longer
valid. It's been a fascinating process to watch
and observe. When you talk about, for example,
cardiovascular disease and inflammation, if you
talk about diabetes, Again, old school was it
was irreversible. Now we know that many, many
cases, if you change your diet, if you change
your exercise level, your stress levels, that
we can reverse a lot of these. What about the
neurodegeneration side? Is the brain given a
good environment now, good hydration, good exercise,
good nutrition and solid sleep? Are you seeing
reverse of damage in some of these neurodegenerative
diseases? That's a great question. I don't think
we know the answer to that yet. I think there's
some studies that are being either planned or
launched that will give us some answers, but
that's going to be a bit down the road. In particular,
I'm aware of there being some initiatives in
the Department of Defense where they're looking
at... medical devices that may encourage activity
of the glymphatic system that we're talking about
to encourage clearance of some of the metabolic
debris that's accumulated throughout the day.
So I think this knowledge base, as we learn new
things, interventions can be innovated to try
to help the long -term health of all these different
communities. The goal, of course, would be to
be able to either arrest or reverse neurodegenerative
disease. I'm not aware of there being that intervention
at the moment. But given the option, of course,
we would encourage people, you know, if we believe
sleep may be one of the causal agents of cognitive
decline, it then follows that protecting your
sleep and making sure you're getting good restorative
sleep. may have some preventative capabilities.
Absolutely. I mean, one would think that if you
were able to get that glial activity during a
deep sleep and you haven't got that deep sleep,
so for example, you take fire service right now
and they're working these shorter rest periods,
the 48 hours, and they're getting forced to work
more. Now we progress to a 72 -hour period and
a fully staffed fire service because now people
are coming back. I would assume that that's more
baths for their brain. And so maybe every good
solid night's sleep using Wave and all these
other tools that we've talked about, there's
an opportunity for that brain to slowly start
taking out some of that trash that's been left
there from our career before. Yeah, absolutely.
I mean, really, you're talking about a 33 % improvement
in sleep quantity. What's harder to measure that
third day, I'd be willing to bet the sleep quality
will also be significantly better. Um, it takes
some time to sort of, uh, uh, restore function
after you've had, um, you know, pull an all nighter
or are significantly sleep deprived. So, um,
so yeah, I think there'd be multiple levels of
benefit there. One more area that I want to revisit
wave before we kind of go some closing questions.
I've heard Alzheimer's referred to type 3 diabetes
many, many times now. And so if we're talking
about an opportunity to hopefully either minimize
further damage or even reverse disease, that
seems to be another one that we can get to. The
Parkinson's side sounds like it's more trauma
and chemical insults. But what have you learned
as far as diet and Alzheimer's specifically?
Yeah. And this is another area of the science
that's rapidly emerging. Insulin sensitivity
clearly has a role to play in global health,
overall health. It can be a profoundly inflammatory
issue. And it sort of compounds upon itself where
you can have more adiposity, like increased belly
fat, which is itself inflammatory and cortisol
inducing. Part of, I think, the strategies that
are going to be interesting, especially when
it comes to diabetes and even this area, it's
emerging as a controversial area, but these GLP
-1s, Ozempic, Zetban, Manjaro, some of Glutide,
they're very good at improving weight loss. The
controversial area was, it seemed that it was
not. predominantly fat loss, we also saw some
lean muscle mass diminishing as weight was going
down. And the current advice is to, number one,
increase your protein intake on these GLP -1s,
but also to increase resistance training and
weightlifting. For your audience, that's probably
built in into their DNA. There's probably a fair
amount of resistance training. I know you're
carrying these heavy dummies and doing very physical
activity. But there's a next generation GLP coming
out that looks really interesting called retatrutide
that appears to preserve lean muscle mass in
a different way than the two earlier generations
of the medication. So I'm not a GLP -1 evangelist.
I think it definitely has a place, particularly
for type 2 diabetes. A lot of the studies are
very encouraging in terms of being able to reverse
type 2 diabetes. A few cases, people that I know
well, one in particular I'm thinking lost 100
pounds. And completely dramatic shift for this
individual where he's able to enjoy life in a
different way than he could have just a year
and a half ago. And so I'm neither a proponent
or enemy of GLPs. I think they just need to be
used responsibly. And I think that with proper
supervision and coaching, they can be very powerful
adjuncts to other more holistic methods. I will
say one thing that's interesting is listening
to some of these exercise athletic fitness podcasts.
It seems to really be proliferating the bodybuilding
world, which was not something I'd anticipate.
But it does make sense if somebody is entering
a cut. cutting phase to be able to reduce their
appetite would make sense. But again, to our
earlier discussion, it's a rapidly evolving area
of science. And I think how that plays out is
still to be seen. I had Johan Hari on the show.
He wrote a book about that. And to me, one of
the most exciting applications is obesity like
true obesity because i've lost two friends to
gastric bypass and you know again but the answer
obviously ideally is diet and exercise and clearly
some you know some mental health work too because
i think behind every you know any person who's
truly struggling physically there's going to
be a kind of origin story in in their their timeline
as well so we miss that piece a lot of times
the psychological piece but if you are already
at that point And you, the A, are going to have,
you know, parts of your digestive system clamped
and cut. Or you can take, you know, an azempic
-like drug for a while. I think that's a much
healthier alternative for that population. Do
I think that bodybuilders should be using it?
I mean, we keep losing influencers at the moment,
fitness influencers. And I'm sure, you know,
that's probably behind a lot of that too. Like
every drug, it can be abused. But just to underline
what you said, I think there is an application
for certain populations that it can just get
them back to a more healthy state. And then hopefully
then that will allow them to actually take a
deeper dive into their nutrition and their fitness.
And that will then allow them to sustain and
come off these drugs. Yeah. Yeah. It's interesting
to see sort of these off -label uses of different
compounds. We haven't even talked about peptides
yet. And I know that's its own area of interest
and controversy. But the GLP -1s, I think, to
have something that's genuinely effective for
obesity, I think, is really encouraging. And
certainly compared to a surgical intervention
like a gastric bypass, much safer. Any side effects,
you know, there are, you know, nausea is pretty
common. There is what's called gastric paresis
where your stomach can stop moving the bowels.
But my experience has been that's a relatively
rare side effect. So, yeah, compared to, you
know, an invasive surgical intervention, although
these can be minimally invasive now, they can
be done endoscopically. I think the GLP -1s are
a great option to consider before moving into
something more aggressive like that. What is
your perspective of peptides? I'm still taking
one at the moment, eclomiphene, which helps your
body make a little bit more of its own testosterone.
I think I've said this a lot on the show. The
old school, again, mentality was if you were
within that range. then you were fine. And you
had 30 -year -old tactical athletes being told
that their testosterone being at 251 was perfectly
within normal limits. Now we know that's not
the case. But then I think the pendulum swung
the other way where all these men's clinics are
opening up and they're giving young firefighters
TRT, not educating them the fact that they're
going to have all these side effects and they're
going to be on it the rest of their life. So
I think peptides are a good, happy medium for
this population when it comes to that. I know
you've got dihexa, which is supposed to be a
good nootropic. What is your perception, without
loading the question, what is your perception
of the world of peptides that we're seeing now?
It's a great question. So I should preface this
by saying I don't know a lot about peptides.
I haven't prescribed them or used them. But I
find myself having to be somewhat knowledgeable
because so many of my patients come into the
discussion using these, and they'll ask me, is
it safe to proceed, whether it's in clomiphene
or PPC -157, or I'm having to learn these acronyms.
SLUPP332, I think, is a new one. It's supposed
to be a good anti -inflammatory. And so I don't
have enough background on the science. Certainly
to recommend or endorse them, but I see them
enough and people have told me enough that at
least anecdotally, they seem to hold some promise
without as many of the side effects that may
be common with other interventions. But my encouragement
is always wait until there's more data. I recognize
I'm probably more risk averse than others, but
I still like to see. you know, hard science and
empirical evidence before recommending a lot
of these things. But, you know, I've seen these
become much more common and ubiquitous, particularly
in like the high performance world. I'm seeing
a lot of people using these. So yeah, it's certainly
a rapidly emerging area. And yeah, I'd be interested.
You've had, it sounds like a pretty good response
on the enclomaphene. Yeah, well, it's interesting
because they gave me a bunch and I naturally
had at 50, almost 50, I had a testosterone of
around 700 after all that shift work, which is,
you know, but I just felt, you know, very drained.
I was like, well, if that's after 14 years of
not sleeping, because I did the 24 -72 for most
of my career, I had the mandatory overtime, you
know, can I take a little tweak? Well, what they
gave me. I'm sure was probably more for the person
with the 300, you know? And so I went through
the roof and I, my nipples hurt and I started
crying and I'm like, okay, this is too much.
So I've been tapering off ever since. And the
clomiphene has been good, but again, I just have
my bloods taken and I'm on, you know, the lowest
dose I've got just to the single peptide. And
again, my testosterone was like a thousand. I'm
like, okay, this is still probably too much.
So now I'm in the process of actually coming
off everything. Cause this is my whole thing
is like a bolus might be good for a while to
help you kind of get back on your feet. Just
like the, maybe the Zen pick is for someone,
but then how can you sustain without any of it?
Because your body is a miracle and it should
be able to perform at a higher level. Um, but
now I'm not on shift, you know, and I'm, I'm
doing a lot of things, right? So this is always
my, my ethos, whether you're on blood pressure
medication or a peptide. Is there an exit strategy?
It's getting you to a certain point, but then
when are you going to come off? Are you going
to take this for the rest of your life? And I
don't think that is the right answer. So I think
for me, as a crutch, when you're in a hole, then
absolutely, I think they're fantastic. But for
example, the anti -inflammatories are right.
You've got the pain to stop hurting in your joint.
Well, now what are you doing to PT it? What are
you doing to reduce the inflammation so you don't
need to take BPC -157? the rest of your life
either so i think just again it's that if there's
an application but um you know the further you
get away from the the holistic um way that man
has existed for the longest time and thrived
on this planet i think you know that you ask
yourself why do you need this pill this potion
you know the rest of your life so that's that's
kind of my my philosophy i've kind of self -experimented
i've titrated to effect and that effect is literally
Now it's going to be zero. I'm like every other
day and I'm going to be off it probably in a
couple of weeks. So it'll be interesting to see.
But it's had a great effect up to this point.
But you got to be careful because too much is
bad too. No, that's brilliant. Especially I like
your comment about there should be an exit strategy.
And I think that's probably where the GLP -1s
will emerge. And I think the paradigm that I'm
seeing... more and more. And this particular
case I was talking about that lost 100 pounds,
part of the goal should not just be, I mean,
a principal goal, of course, is to maintain insulin
sensitivity and hopefully reverse some of the
type 2 diabetes. But if the goal is weight loss,
I would try to reframe that discussion as being
something along the lines of changing body composition.
Because if you're reducing, let's just say somebody
starts with a body fat percent of 28%, if you
can get that below 20%, there's a concordant
increase in basal metabolic rate where they can
maintain that weight loss and do it in a healthy,
naturalistic way and not take GLP -1s indefinitely.
Where I start to get worried is when people enter,
particularly as it relates to TRT, a scenario
where they may not realize it's indefinite consumption.
Um, because TRT unopposed, uh, over a long period
of time, uh, can cause a destruction of the endogenous
production of testosterone. And you end up needing
that long -term. Um, my understanding is N -clomphene,
uh, is the opposite effect of that is you do
maintain your natural production, uh, of testosterone.
So a much safer, um, and, uh, natural way of
approaching it. Yeah, absolutely. That's what
I found myself. All right. Well, then let's go
back to WAVE. So just kind of underline if someone
listening wants to find a place to experience
this themselves, what is the best way? And then
also, if someone's in a state other than Missouri,
Ohio and Florida, what moves can they make to
try and get this a statewide initiative in their
home? Yeah, so the websites that I mentioned,
etmsohio .com, etmsflorida .com, and etmsmissouri
.com are probably the easiest way to engage those
initiatives. And you should get a call within
24 hours typically. We also have other clinics
around the country. If you look up, I believe,
braintreatmentcenter .com slash locations, it'll
give you a list of, we have over 100 centers
nationwide. And those centers can certainly take
you in, get an EEG, and get you started on all
of this. If there are other people who are interested
in just standard TMS, it's more of a one -size
-fits -all approach without the EEG. Those are
locations, too. You can really just do an internet
search and find some of those locations. It's
become a fairly common mainstream procedure.
And so they can look into all those different...
access points and clinics. Many people will focus
on the quality of the doctor at the different
sites. I've been impressed with the quality of
the physicians who are going into the space.
Many psychiatrists, others, kind of functional
medicine doctors or primary care doctors. But
generally speaking, we've seen pretty good quality
of medical care being delivered through these
different locations. Beautiful. And then what
about if someone wants to try and get it as a
statewide initiative? How would you suggest they
go about it? Have you heard of how Florida, Ohio,
and Missouri made it happen? There's quite a
process to go through. And so I don't know that
it happens simply. But in the cases that I've
seen, usually there are a handful of people who...
are lobbying the state to provide access to this
treatment. There should be a handful of legislators
who want to carry the flag and provide access
to the treatment. You can either go through a
bill process or a direct appropriation. It is
lengthy. This is not a quick cycle, usually over
months and years rather than weeks. But yeah,
for us, Part of our goal and objective is to
help as many people as possible. When I saw what
this could do for my friends and the people that
I deployed with, it reminds us of all the good
reasons we go into medicine. I haven't seen something
that could really move the needle in terms of
how somebody felt and how they are engaging with
their communities and society quite like I saw
with this treatment. And that's part of why I
joined the cause is, you know, for the people
who are struggling and don't have good interventions
available, this can be life -changing. And so,
you know, in the military community, we talk
a lot about mission and purpose, and this really
checked the box in terms of that. So, yeah, I
can share lots of stories about, you know, people
who... benefited from the treatment. But ultimately,
I know data speaks the loudest. And so we're
engaging in all kinds of clinical trials, both
looking at this treatment versus sham placebo.
And there's another study that was funded by
Special Operations Care Fund and Tomahawk Charitable
Solutions, where some veterans were getting,
they called the trifecta study, where some veterans
were getting hormone management through a functional
medicine specialist. And then they would either
come to our center in San Diego to get our treatment,
or they'd go to Mexico to get a Ibogaine 5 -MeO
-DMT session, and then they would come to our
center in San Diego and get treatment. And the
goal of this study was to see whether it was
preferred to get the psychedelic session before
or after our treatment. And so we're still blind
to that data. I don't have the answers yet. But
I think perhaps one thing to mention is This
is a pretty unique time in history where there's
so much emerging science that should give vulnerable
communities hope that there's going to be really
meaningful interventions coming on the horizon.
And what we've seen initially from this trifecta
study, the feedback has been, this is not a case
of one plus one plus one equals three. These
people are saying it's like an eight or a 10.
And they really feel like. This kind of stacked
therapy where you're combining modalities may
be the future. And I think there's a lot of science
to do before we can endorse or recommend one
or the other. But it's encouraging to see some
of these studies starting to happen. I just returned
from a trip from UT Austin and met with some
brilliant scientists. Greg Fonzo and Chuck Nemiroff
were talking about some of the studies being
conducted there where they're doing a TMS psilocybin
study. And again, the data is very early, but
it's encouraging to see this kind of science
starting to emerge. So if there are people out
there who feel like there's no hope or that nothing
is working, my encouragement would be just wait.
I think that the next decade is going to be just
a fascinating time where new therapeutics. are
going to get their FDA clearances and there'll
be new interventions that can really help in
a profound and meaningful way. Well, it's so
beautiful because we've talked about, you know,
evolving with the science, but there's also,
you know, at least this is my personal opinion,
there's been a lot of arrogance in science and
medicine when you reflect on certain areas. And
sadly, some of that obviously is coming from,
you know, professions that make a lot of money
on the stasis, you know, the way it is with chronic
disease. But now you look at this kind of revisiting
of ancient, you know, medicine and plant medicine
and, you know, therapeutics, and now it's marrying.
So you've got, as you said, psilocybin and TMS
side by side now. And I think this is this beautiful
kind of full circle that we're coming, of course.
Medicine is incredible. And as people always
point out, yes, I would like anesthesia, please.
And I would like a sharp scalpel. So I'm all
for modern technology. But when you bring that
in with the holistic, not only proactive solutions
to obesity and some of these other things, but
the plant medicines and some of these other.
therapeutics that have been shown to work for
a long time. I'm seeing a lot more leaning back
into Chinese medicine and herbs and all kinds
of things. So the marriage of modern technology
with the humility of still acknowledging the
wisdom of our forefathers, I think, is the superpower
that we're going to see, as you said, the next
few decades. Yeah, it's been fascinating to see
that area emerge. And I have to admit, I'm by
no means an expert on psychedelics. You know,
we're involved in this one study. But trying
to learn about them, we can make sense of certain
neuronal circuits and restoring brain function
with electrophysiologic interventions. But many
of these operators who are coming back. Talk
about something very different, you know, rather
than, you know, in the science world, you know,
we can talk about the default bone network. We
can talk about the 5 -HT2A receptor and GABA
receptors when we talk about some of these psychedelic
compounds. But the manifestation of that, the
phenotypic expression of patients who are coming
back, I hear repeatedly that they feel the ability
to love again or they feel. the ability to have
self -love again. So they classify these in pathogens
and theogens. Some people will find their faith
and belief in God again. And that's something
that's very hard to explain with hard neuroscience.
It's just something that sometimes you take a
step back and you have to feel a sense of wonder
and awe at the types of therapeutics that are
starting to emerge and that these existed for
100 years and that we didn't have access to them.
There's a whole separate conversation we could
talk for hours about, you know, about the journey
of many of these compounds. And I think back
to, I had the good fortune of meeting Rick Doblin,
who's the founder of this MAPS institution. They
were doing MDMA -assisted psychotherapy. They
met the primary endpoint, but sadly, they didn't
get their FDA clearance. That made me very sad
for humanity. Looking at some of the critique,
there were some valid criticisms of the trial
design. But I don't think that's going to stop
the wave of therapeutics that are coming through.
You know, there's a trial called the COMPASS
trial that's looking at psilocybin. You know,
I'm seeing a lot of really promising data with
both psilocybin, ibogaine, and ayahuasca. And,
you know, the only current psychedelic that's
available is ketamine. And I've talked to a number
of people who had a really good benefit from
that as well. But this sort of plant -based therapeutic,
the emergence of these class of compounds, I
think is really exciting. And to your point,
I think that many people who get entrenched in
a certain way of practicing medicine can be very
resistant to innovation. And I sort of view things
a different way. Like if we're really in service
to our patients. We have to be open -minded to
the evolution of science. And ultimately, there's
going to be winners and losers. It's just the
nature of academically rigorous science and this
endeavor. But for humanity and for these markets,
there are going to be winners. And so that's
what makes me excited to see not just what is
coming, but how the different combination of
modalities might be effective. Absolutely. All
right. Well, I want to be mindful of your time.
So I'm going to throw some quick questions at
you, if that's okay. Quick closing questions.
Yeah, of course. Brilliant. All right. The first
one I'd love to ask, is there a book or are there
books that you love to recommend? It can be related
to our discussion today or completely unrelated.
It's a great question. It's just a book that
I've read recently called Tribe by Sebastian
Junger. And it's really... a little bit about
the military well a lot about the military experience
but um how you know being in um a highly effective
unit in the military and then coming back you
know this is your tribe and then coming back
to a society in america that maybe is a bit divided
um has led to you know a lot of um you know when
once you leave that unit and you're a bit more
isolated to not have the camaraderie of that
tribe can lead to a lot of um mental health challenges
so i strongly recommend the book i'm not doing
it justice uh but that's an excellent book one
of my favorites um is dated now but uh there's
a book called the road less traveled by scott
peck um where he talks about the psychology just
really kind of there's building blocks where
um He talks about the first building block for
our human experience is discipline. And through
discipline, we can achieve so many things. And
it ends with love and spirituality, that through
discipline, we can both love ourselves but love
others. And then the spirituality comes after.
But I bought that book for probably 100 different
people because I think that it's... very well
expressed so but those are the two books that
really come to mind brilliant yeah i can't agree
more about tribe especially i've had sebastian
on four or five times now i mean when i read
tribe i was like this is this is what we all
struggle with in uniform you know understanding
that cohesion that you have when you are you
know in this kind of selfless unit and then yeah
you find yourself on the outside whether you're
fired retired whatever the story was and why
you feel this suffering because you know as a
species you know we're a tribal species and you
know that meant death in ancient tribes so understanding
that you can have other tribes outside of what
you do and not to put your entire identity into
this particular calling i think it's again you
know a lesson that we need to be taught day one
Absolutely. All right. What about films and or
documentaries? Oh, boy. It's been a while since
I watched a film or a documentary for that matter.
Gosh, I don't want to leave a question unanswered.
I'm just kind of drawing a blank at the moment.
Well, let me ask you a question. Have you seen
that show? It's called The Pit. It's on HBO Max
at the moment. I have not. OK, so it's set. It's
actually one of the actors from ER, the old show.
But it's a very, very well. Well -written, well
-acted, very gritty ER show. So very different
than the other one. But every episode is an hour
in the ER. And so it's incredibly well done.
The technical advisors they've had are absolutely
amazing. So I always tell people they haven't
heard of it and they're in the medical field
that it's definitely worth watching because I
haven't seen a show like that before. And from
a technical point of view. They're as close as
they can be. Obviously, compressions on a live
person in one scene, they can't be just crushing
the chest. But aside from that, it's very well
done. Oh, great. I'm going to have to go and
watch that. You've got me very interested now.
All right. Well, the next question, is there
a person that you'd recommend to come on this
podcast as a guest to speak to the first responders,
military and associated professions of the world?
Ooh. That's a great question. Actually, when
I was coming on, I was thinking there are probably
quite a few. One of my mentors, Stephanos Kales,
I think would be a great one. He's a Harvard
professor who spent a career researching firefighter
health. And he's a brilliant guy and a wonderful
human being. I think that he'd be a good guy
to have on the podcast. I didn't look through
all of your episodes, but just, you know, we
talked about sleep a lot. Matthew Walker, I think,
is a brilliant guy to have on the podcast. He
spent his career researching sleep. And I would
say he's one of the real thought leaders in the
space. So he's another one that would come to
mind. Yeah, absolutely. I kind of connected pseudo
connected with him through one of my mutual friends
a while ago. And I think he's become quite busy
at the moment. But that was a few months ago.
So I need to circle around and see if I can bring
his attention again. Because I mean, that that
book obviously is the one when you mentioned
sleep, why we sleep is the one that most people
think of. Absolutely. All right. Well, then the
last question before we make sure everyone knows
where to find you, what do you do to decompress?
That's a good question. I still enjoy running.
I'm not as efficient as I used to be in terms
of kind of my times and whatnot. I enjoy exercise.
I've tried to take up swimming. Swimming has
always been a weakness of mine. Even in flight
school where you have to do survival swimming,
you have to tread water in boots and a flight
suit. I almost drowned when I was doing that.
But I've tried to get better at swimming. I have
a friend, Rich Hoagland, who's kind of given
me some tips on how to become a better swimmer.
So I've tried to take that up. For me, most of
my leisure time, I try to dedicate to my kids.
I have a beautiful wife and five amazing children,
two who are in college now, three who are at
home. And so a lot of my time is spent watching
them. play soccer or, you know, my number four,
her name's Emma. She's a ballet dancer. So some
of my time is spent watching her competitions.
But yeah, when you asked me about a documentary
or movie, I felt very sad that I haven't really
indulged in a lot of that lately. But maybe I
take some solace in that I'm investing a lot
of time in my kids and my family. I'd say so.
Absolutely. You get more value from that. You
can always watch movies when they left the home.
All right. Well, then the very last question
then, where are the best places to connect with
you, learn more about you? So Wave Neuroscience
has, we both have our website, waveneuro .com,
W -A -V -E -N -E -U -R -O .com. You can find
many of our publications in the National Library
of Medicine. And if people are interested in
those ETMS initiatives, you can find their websites
as well. And I can send you that and maybe it
can be in the show notes. I am on LinkedIn if
people want to reach out and we can connect that
way as well. Those are the predominant ways.
I think WaveNur also has a presence on Instagram
and what used to be Twitter X. There's lots of
different ways where people can learn and take
a bit of a deeper dive into what we do. Beautiful.
Well, I want to say thank you. Firstly, thank
you to John for facilitating this in the first
place. It's funny. I found you on LinkedIn and
sent you a connection. Some of the mutual friends.
There's Brant McCarthy, who lost his brother
to suicide. He has a nonprofit now. There's Brian
Hillard, who's a friend of mine that I'm working
with to make my latest book into a film. And
yeah, so it's funny how these circles overlap,
but it's been such an amazing conversation. I
mean, your background and your military service
and then all these comparisons as far as, you
know, what you're seeing in the special forces
and what you're seeing in first responders and
just that hope, as you touched on, the ability
to tell people. You haven't tried this. This
may well make a difference in your journey, I
think is imperative. And I'm sure the people
listening in those three states are really excited
now knowing that they can sign up and get this
for little to no money at all. So I want to thank
you so, so much for being so generous with your
time and coming on the Behind the Shield podcast
today. Absolutely. Really a pleasure of mine.
And it's an honor to be able to spend the time
with you. Thank you so much.