What Can You Actually Do for Your Brain?
You have more agency over your brain than you think
BOOK UPDATE 👉
Come celebrate with me in DC! During publication week, I’ll be in conversation with my friend Franklin Foer on August 12 at 7 pm at Politics & Prose.
Just in! My first official review! "[A] smart debut guide to making informed health decisions... Patients will feel empowered." —Publisher’s Weekly
A patient in her sixties told me recently that she’d been losing words. She couldn’t summon the word “colander,” so she called it a sieve. Her daughter’s college friend’s name escaped her for half a day, then surfaced out of nowhere while she was brushing her teeth that night. She hadn’t mentioned any of it to anyone. When I asked why, she said, “I guess I feel like there’s not much I can do.”
I hear this all the time. For some reason, the brain is the one organ patients seem to view as fixed, as something that happens to them, rather than because of them. My patients will gladly swallow fiber tablets to improve their gut health and ditch red meat to optimize their cholesterol scores, but somehow people seem to assign their brain to fate.
But the truth is you have more agency over your brain health than you may think! Two things have me thinking about this, and I want to share both with you.
YOUR BRAIN HAS A SCORE
Last week I sat down with Dr. Jonathan Rosand—a neurologist at Harvard and Massachusetts General—in a live conversation hosted by Allison Aubrey. Dr. Rosand is the mind behind something called the Brain Care Score, and I’d love to point you to it.
Most of us have no real idea what “take care of your brain” means. Patients are accustomed to hearing advice from doctors to “Eat well.” “Get more sleep.” “Cut back on the booze.” But these can feel vague enough not to action. The cool thing is that the Brain Care Score turns the abstract into twelve specific, modifiable things—and a number, from zero to twenty-one, that you can actually move.
Some of them you’d expect: blood pressure, blood sugar, cholesterol, weight. Some you’d recognize from any conversation about a healthy life: how you eat, how you move, how you sleep, how much you drink, whether you smoke. And then three that rarely make it onto a medical checklist at all—your stress, your relationships, and whether your life feels like it has meaning.
Check out that list again! There’s almost nothing on it you can’t influence.
What’s particularly powerful is that the same score that predicts your risk of stroke and dementia also predicts your risk of depression. Raise it, and all three risks fall. That points to the fact that brain health, mental health, and heart health aren’t three separate projects. They’re one system, and it’s largely in your hands.
You can check your own score in about a minute here, and watch or listen to my conversation with Dr. Rosand here: Your Brain Has a Health Score.
YOUR BRAIN AND YOUR HEART ARE PART OF THE SAME SYSTEM
I wrote a guest post this week for physician and chef Annie Fenn, MD over at Brain Health Kitchen, on what the new cholesterol guidelines mean for your brain. It turns out your heart and your brain are fed by the same plumbing system.
In it, I describe a patient whose LDL cholesterol had climbed. On paper, it looked like her statin had quit working. But when I asked what was going on in her life, the real story came out: her mother, who has Alzheimer’s, had moved in after a bad fall. Diane had dropped her morning walks, swapped dinners for takeout, and was pouring a little more wine each night to take the edge off. Her cholesterol wasn’t rising because her medication failed. It was rising because her life had changed.
And here’s the part that’s stayed with me: every one of those changes was quietly raising Diane’s own risk of the very disease she was caring for in her mother.
Her labs weren’t the problem to fix. They were a signal, pointing back to a life under strain.
The new cholesterol guidelines themselves are good news: screening starts earlier, there’s a once-in-a-lifetime test for a powerful genetic risk factor called Lp(a), and better tools for estimating your lifetime risk rather than just the next ten years. But a guideline can tell you what your numbers should be. It can’t tell you why yours are moving, or what to do about the life behind them.
You can read the whole piece here: The New Cholesterol Guidelines and Your Brain. Annie kindly took down the paywall for you till the end of the week. (Thanks, Annie!)
So—what can you actually do for your brain?
More than you’ve been told. You can know your numbers and move them. You can treat a rising lab value as a question, not a verdict. And you can tend to the parts of brain health no scorecard fully captures: the stress you’re carrying, the people around you, whether your days feel like they mean something.
Remember the patient I opened with, the one losing words who figured there was nothing to be done? This is exactly what I told her: the belief that you’re powerless is the one thing worth letting go of. We started looking together. That’s almost always where it begins.
So much of health—and frankly, so much of life—comes down to taking action where you have it, and making peace with what you don’t. Your brain is far more within your reach than anyone led you to believe.
Welcome to the many new readers who’ve found their way here—there are 40,000 of you now, and I’m so glad you’re here!
Lucy
My book, Beyond the Prescription, comes out on August 11! I wrote it with you in mind.
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What can one actually do for the brain? My take is Back to Basics. What are you eating and drinking, and how much? How active are you? Do you use tobacco or so-called recreational drugs? How many hours of sleep do you get? How do you manage stress? As a physician, I'm sure you're asking patients about these things.
Great articles! The Diane story is what makes this piece land. Caregiver burnout has its own well-documented physiological signature (elevated cortisol, disrupted sleep, weakened immune function), so what's happening to Diane isn't just lifestyle drift, it's a measurable stress response that compounds the very risk she's trying to manage.