I curse you that you know something that is true that no one else believes.
—ROMANIAN cURSE
From the moment I got my own brain scanned for the first time in 1991, I developed brain envy. I had already scanned dozens of patients when I decided to get my own scan at age thirty-seven. When I saw the toxic, bumpy appearance, I knew it was not healthy. All of my life I have been someone who rarely drank alcohol, never smoked, and never used an illegal drug.
Then why did my brain look so bad?
Before I truly understood brain health, I had many of the bad brain habits discussed in this book. I played football in high school and got my bell rung on several occasions. I ate lots of fast food, lived on diet sodas, and would often get by on four or five hours of sleep at night. I worked like a nut, didn’t exercise much, and carried an extra 30 pounds that stubbornly would not go away by wishful thinking.
My last scan, at age fifty-two, looked healthier and much younger than it did fifteen years earlier, which typically does not happen with the aging process. Brains usually become less and less active with age.
Why did my scan look better? Seeing other people’s scans compared with mine, I developed “brain envy” and wanted a better brain.
Brain SPECT imaging literally changed everything in my life. It helped me come out of the darkness, both in my personal and professional life.
Never before being scanned had I thought about the physical health of my own brain, despite being my medical school’s top student in neuroanatomy, completing five years of postgraduate residency training, and becoming board-certified in both general and child and adolescent psychiatry.
For example, I had no idea that:
• Being overweight negatively affected the health of my brain
• High-fat, sugary foods worked on the addiction centers of my brain
• Spraying cleaning chemicals in a closed shower stall was a really stupid idea, as it was toxic to my brain
• Getting less than six hours of sleep at night lowered the blood flow to my brain. I rarely got more than five.
• The chronic stress from working so many hours was hurting cells in the memory centers of my brain
• Being around secondhand smoke damaged the blood vessels to my brain
• Drinking a 36-ounce caffeinated diet soda, not uncommon for me pre-SPECT, dramatically constricted blood flow to my brain
In short, what I didn’t know was hurting me. And not just a little. As I have learned from looking at over seventy thousand SPECT scans from real people who were suffering, having a less-than-healthy brain went with less-than-healthy decisions and a suboptimized life.
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My not-so-healthy SPECT scan at age thirty-seven 
Bumpy, toxic-looking pattern |
My much healthier SPECT scan at age fifty-two 
Fuller, more even, and healthier pattern |
Prior to my first scan I had no idea that I could actually change the health of my brain by changing my habits. I thought that some of my cognitive issues, such as dropping names or being unfocused and forgetful, were just a normal part of the aging process. After all, I was now thirty-seven years old. The dozens of decisions I made every day were being made without the knowledge of what I was actually doing to my brain.
As I learned about brain imaging and brain health, I put into practice all of the main principles in this book. I started to exercise more, improved my nutrition, got more sleep, monitored my bloodwork more often, and took targeted brain healthy supplements.
Over time, seeing the SPECT scans caused me to look at every aspect of my personal life, even the way I viewed the world, in a different way.
• Watching contact sports was definitely not as much fun. I realized that when I watched boxing or football, I was watching brain damage in process. I was witnessing athletes’ brains being ruined, which in turn would ruin their lives. I remain completely baffled as to why ultimate fighting is legal. Don’t the athletic commissions know that boxing dementia (dementia pugilistica) was first described in 1929, and that ultimate fighting is as bad, or worse, than boxing? These athletes get kicked or kneed in the head repeatedly.
• When I watched the news and saw natural disasters, I wondered how many survivors would develop emotional trauma patterns on their scans or would develop brain dysfunction secondary to the chronic stress.
• When I read stories about soldiers returning from war with brain injuries from IEDs I was horrified that the military was not routinely using functional brain scans to evaluate the state of their brains’ function and actively trying to rehabilitate them early. I was an enlisted infantry medic and then an army psychiatrist and knew our soldiers deserved the best care possible.
• When I saw stories of people who committed terrible crimes, such as murder, rather than just judging them as bad, as is so easy to do, I wondered if they had dysfunctional brains,. I have subsequently published professional papers on our work with murderers.
• SPECT changed the habits within my family, because I wanted my wife, children, and grandchildren to have the benefit of a brain healthy life. If you dated one of my daughters for more than four months, you got scanned. I wanted to know about the health of the young men’s brains.
SPECT definitely shed light on my own brain’s “lack of health,” and as I gained more experience with SPECT, I realized it was possible that by changing my habits I could indeed improve the overall health of my brain and subsequently change my life. I got a burning desire to make my brain better. In a sense, I fell in love with the health of my own brain. The extensive experience I was gaining with patients’ scans before and after treatment convinced me even more that our habits accelerate the aging process—or they can decelerate it.
By the time I went to my first lecture on brain SPECT imaging in 1991, I had been evaluating and treating psychiatric patients for nearly a decade without the benefit of any brain imaging. I often felt in the dark on what to do for my patients, even though I was highly trained and certified competent. Whenever I saw an older person who was depressed or complained of memory problems, a treatment-resistant substance abuser, an aggressive teenager, or a couple who couldn’t get along, knowing what to do for them felt like shooting craps. I would do what I was trained to do, such as give an ADHD child a stimulant medication or a depressed patient an antidepressant, and sometimes it would work, but often enough it would make the patient much worse, sometimes homicidal or suicidal.
It felt as though I were throwing darts in the dark. Sometimes I got it right. Sometimes I hurt people.
And I spent a lot of time anxious, knowing I was practicing a very soft science at best. I often wondered how well my other medical colleagues—cardiologists, orthopedists, neurosurgeons, and gastroenterologists—would be able to diagnose and treat their patients if they were unable to image the organs causing the problems.
For me, everything changed professionally after attending that first lecture on brain SPECT imaging at a local hospital in northern California where I was the director of the dual-diagnosis program, which took care of psychiatric patients who also had substance abuse problems. (Dual diagnosis refers to a patient with two issues, such as bipolar disorder and alcohol addiction. Mood disorders and addictions, for example, often go hand in hand.) From the moment I ordered the first SPECT for a patient, it was as if I’d been given glasses to see what was happening in the brain. No more flying blind and guessing. Of course, having a SPECT scan does not always make a dramatic difference in patient care, but my first ten cases were so helpful that I was completely hooked. Here are several examples:
• Matilda, sixty-nine, had been diagnosed with Alzheimer’s disease but did not have the Alzheimer’s pattern on SPECT, which was already described in the medical literature in 1991. Her scan was more consistent with depression. Her memory was restored when I treated her for depression.
• Sandy, forty-four, had a clinical profile consistent with adult ADHD (short attention span, distractibility, disorganization, procrastination, and impulse control problems), yet she refused treatment. When she saw the evidence of ADHD on her scan she started to cry and said, “You mean this is not my fault,” and immediately agreed to give the medication a try. It made a dramatic difference in her life and her marriage. I already believed I knew her diagnosis, but the scan helped her believe it.
• Geraldine, seventy-two, was suicidal and suffered with resistant depression. On her scan she had two huge right-sided strokes in her brain that had previously been undetected. Knowing about the strokes helped us understand her depression better and also helped us prevent the possible third stroke that could have killed her.
• Chris, twelve, was hospitalized for the third time for violent outbursts. He had been seeing a psychoanalyst in the Napa Valley who wondered if the problem wasn’t his relationship with his mother. His scan showed very clear trouble in his left temporal lobe, an area underneath his left temple and behind his left eye. This area is often associated with violence. When put on an antiseizure medication, his behavior normalized and he subsequently thrived in a public school setting. Without the scan, he was on his way to institutional living in a residential treatment program or jail.
• Sherrie, fifty-two, had been diagnosed with bipolar disorder but refused to take her medication. She was in her third hospitalization for hearing voices coming from the walls of her home. She had tried to pull out all the wiring in her home to get rid of the voices. Once she saw the abnormalities on her scan she became compliant with treatment and quickly improved.
• Ken, fifty-nine, was abusing alcohol and cocaine, but was basically in denial about his substance abuse. After seeing his scan he developed brain envy and completely stopped his drug abuse and adopted a brain healthy lifestyle. A year later his brain was dramatically better.
• Sara, forty-two, and Will, forty-eight, failed marital therapy multiple times. When they were both scanned, Sara had an obsessive-looking brain (too much activity in the front of her brain), while Will had an ADHD-looking brain (too little activity in the front of his brain). On appropriate treatments to individually balance their brains, their marriage dramatically improved.
• Ted, seventeen, had failed a residential treatment setting. He suffered with several impulsivity and criminal tendencies. He was missing the left front part of his brain on SPECT, which means he had zero blood flow to this part of his brain. It turned out that he fell down a flight of stairs when he was four years old, was unconscious for a half hour, and no one remembered the injury or thought it could have been involved in his troubled behavior.
• Christina, sixty-two, had been diagnosed with chronic fatigue syndrome. Her primary care doctor said she had depression and a personality disorder and sent her to me. On her scan there was a clearly toxic pattern, consistent with a brain infection. She was depressed and had a disordered personality because the organ of mood control and personality was damaged, which completely changed the treatment plan and our approach to Christina.
In a few short months SPECT completely changed how I practiced medicine. How could I practice without imaging? How did I know what was going on in my patients’ brains unless I looked? My anxiety with my patients went down and my excitement about being a psychiatrist went up. My effectiveness and confidence also went up. I was more willing to take on complex and treatment-resistant cases.
• In order to effectively treat patients, I knew it was essential to look at their brains before I went about trying to change them. You cannot change what you do not measure.
• SPECT helped me make more complete diagnoses for my patients and not miss important findings, such as a past head injury, infection, or toxic exposure.
• SPECT helped me be more targeted in my treatments. I have learned through the imaging work that illnesses like ADHD, anxiety, depression, addiction, or obesity are not single or simple problems in the brain; instead, they all have multiple types and the treatment needs to be targeted to the specific type of brain, not a general diagnosis like depression.
• SPECT made me considerably more cautious in prescribing certain medications or using multiple medications, because they often appeared toxic on scans. I had to be more responsible in my use of medications.
• SPECT directed me to use more natural treatments, as they are often effective and appear less toxic on scans.
• SPECT help to break denial in substance abusers. It is hard to say you do not have a problem when faced with a scan that looks toxic.
• SPECT decreased stigma, still so rampant in psychiatric illnesses, because patients see their problems as medical, not moral.
• SPECT increased patient compliance, as patients wanted to have better brains.
• SPECT led me to work with patients to slow down and in many cases reverse the brain aging process.
Over time, the imaging work led me to create a brain healthy business for our employees at the Amen Clinics and for other businesses. The collective health of your employees’ brains are a business’s most important asset. It also has led me to work on creating brain healthy churches, such as I am doing with the Daniel Plan at Saddleback Church. It has even helped to change the culture of our sports, as evidenced by our work with active and retired professional football players demonstrating very high levels of brain trauma.
Through our brain imaging work we have been able to see which factors hurt the brain and which ones help. Without directly looking at how the brain functions, we are just guessing at what is wrong with our patients and making way too many mistakes. How would you know about the health of your brain unless you looked?
I think of SPECT like radar. Our Newport Beach clinic is very close to the Orange County / John Wayne Airport. On sunny days the pilot does not need radar to land the plane, because he can see the runway. But on days that are stormy, radar is an essential tool to safely land the plane. In the same way, when the clinical picture is clear a scan is not necessary. But for unclear or treatment-resistant cases, SPECT can provide useful, even lifesaving information.
Susan, forty-seven, came to see me for resistant depression. She had seen six other doctors and had tried ten different medications. She was suffering with severe depression, panic attacks, headaches, dizziness, and tremors. Everyone was treating her as a psychiatric case and changing her antidepressant medication and encouraging her to continue with psychotherapy that had no effect on her condition. She was feeling hopeless and suicidal, even though she had a large loving family, a supportive husband, and three teenage girls she adored.
Her SPECT scan looked awful. It showed overall severe decreased activity in a pattern that was consistent with an infection or toxic exposure.
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Normal Brain SPECT Scan 
Full, even, symmetrical activity |
Susan’s Brain SPECT Scan 
Severe, overall decreased activity |
After an extensive workup we discovered that Susan had Lyme disease, for which she was able to get effective treatment. When I saw the scans it triggered more extensive questions that eventually led to the right diagnosis. Over time, with extensive brain rehabilitation, she did better. Susan later told me that the scan saved her life. Until she saw the damage in her brain she had just felt hopeless and helpless. Seeing her problem as medical and not moral made a big difference for her psychologically. It also pointed her medical team in the right direction. Too often when people do not get better, physicians diagnose them as “psychiatric” or with a personality problem. How would we know unless we looked?
Over the years it has become clear to me that the cost of having an ineffectively treated brain problem is much more expensive than a scan will ever be.
In our experience, more insurance companies are starting to pay for SPECT, especially for reasons such as memory problems, dementia, and traumatic brain injury. Initially insurance companies tend to deny new procedures, especially for mental health care. But the denial of SPECT for patients whose treatment may clearly benefit from it is a violation of the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 (the Parity Act), which does not allow insurance carriers to discriminate against patients for mental health issues. They need to provide the same coverage as they do for medical procedures. Both the American College of Radiology and the European Society of Nuclear Medicine (ESNM) have published guidelines for using SPECT with a number of indications relevant to mental health issues, such as in cognitive decline, dementia, and traumatic brain injury. The ESNM guidelines also specifically reference SPECT’s usefulness when evaluating psychiatric disorders. A recent analysis of 2,711 practice recommendations in cardiology, for example, found that only 11 percent were based on evidence from more than one randomized controlled clinical trial while 48 percent were based simply on expert opinion, case studies, or what was typically being done in practice. Similarly, a 2011 analysis behind the Infectious Diseases Society of America’s practice guidelines found that 14 percent of the recommendations were based on a high level of scientific evidence. Medicine, in most places, is clearly still an art, not a hard science.
Applying a higher level of scientific evidence for SPECT for mental health issues than to other covered medical procedures is a violation of the Parity Act. The Parity Act states: “The treatment limitations applicable to such mental health or substance use disorder benefits are no more restrictive than the predominant treatment limitations applied to substantially all medical and surgical benefits covered by the plan (or coverage) and there are no separate treatment limitations that are applicable only with respect to mental health or substance use disorder benefits.”
I have known for a long time that many people cannot get scans, either because of the cost or because they are not near a center that performs them. My books are translated into thirty languages, and if you read one in China or Brazil, odds are you are not going to get a scan. So based on thousands of scans, we developed a series of questionnaires to help people predict what their scan might look like if they could get one. Then, based on the answers, we give suggestions on ways to think about helping the brain with certain natural supplements, medications, or exercises. For uncomplicated cases, this questionnaire has proven to be surprisingly accurate, usually lining up with what we see on scan very well. The questionnaires can be found online at www.amenclinics.com or www.theamensolution.com and they are used by mental health professionals around the world. Of course, you should always talk with your own health care professional when considering treatment options.
Brain SPECT imaging has also taught me that I have to be a “brain warrior” for my own health. No one is going to do it for me. In fact, others will try to steal your brain health in search of their monetary gain: “Do you want to supersize your fries for only a few more pennies?” You would do well to be a warrior for your own brain health.
• Be a brain warrior by boosting your brain to dramatically increase the quality and consistency of your decisions.
• Be a brain warrior by always working to be more conscientious and thoughtful regarding your health.
• Be a brain warrior by protecting your brain from injuries and toxins.
• Be a brain warrior by saying no to the food pushers in your life who ask you to supersize, refill, have extra helpings, or eat more than you need to keep your body and brain healthy.
• Be a brain warrior by getting and keeping your weight at a healthy level.
• Be a brain warrior by only eating food that serves you rather than making food companies more profitable.
• Be a brain warrior by getting the sleep you need.
• Be a brain warrior by increasing your endurance and strength through smart exercise.
• Be a brain warrior by embracing constant mental exercise and new learning.
• Be a brain warrior by getting problems like ADHD, anxiety, depression, and other mental health problems treated. Start with natural treatments first if it makes sense.
• Be a brain warrior by killing the ANTs (automatic negative thoughts) that steal your happiness and make you old.
• Be a brain warrior by developing a consistent stress reduction practice.
• Be a brain warrior by rehabilitating your brain if it has been hurt or you have been bad to it up until now.
• Be a brain warrior by taking your simple supplements to give it the nutrients it needs.
• Be a brain warrior by building your own genius network of supporters. The health of the people you spend time with matters to your health.
• Be a brain warrior by knowing your important numbers, such as blood pressure, vitamin D level, and HgA1C, to make sure they are in the healthy range.
• Be a brain warrior by giving the gift of brain health to your children, grandchildren, family, and friends.
• Be a brain warrior by getting your inner child under control!
1. Brain envy often results from seeing your own brain SPECT scan. When I saw my scan for the first time in 1991, I realized that even though I never used any drugs, rarely drank alcohol, and never smoked, my brain needed help. I wanted a healthier brain. Determine to do whatever you can to give yourself the best brain possible, because when your brain works right, you work right.
2. Brains usually become less active with age. But they do not have to. With a brain-smart program, you can start to reverse the brain aging process.
3. When I exchanged my bad brain habits for good ones, my brain actually aged backward. I have seen evidence of this on my SPECT scans over the years: It looks functionally younger today than it did fifteen years ago. I’ve seen this happen to scores of our own clients. You too can decrease your brain’s functional age as you determine to trade bad brain habits for good ones.
4. Many “unexpected” things can hurt the brain, such as being overweight, eating lots of sugar, using household chemicals without proper ventilation, getting less than seven hours of sleep, overworking, being around secondhand smoke, and drinking diet sodas. Small changes over time can add up to big improvements in brain function.
5. Before I became aware of brain health, I thought that some of my cognitive issues, such as dropping names or being unfocused and forgetful, were just a normal part of the aging process. At thirty-seven! Dropping names or being unfocused or forgetful at any age is a sign of trouble.
6. Having a less-than-healthy brain goes with less-than-healthy decisions and a suboptimized life.
7. You cannot change what you do not measure.
8. Seeing a SPECT scan of your own brain or of someone you love increases understanding and compassion. If someone has a brain that is misfiring, they are literally working with an emotional and cognitive handicap. They deserve help and compassion, not condemnation. If the brain is balanced, better behavior tends to follow.
9. SPECT scans do not lie. If someone is in denial about the damage they are doing to their brain by drinking too much or using drugs or trying to hide their addiction, a scan will reveal truth. Getting a brain scan often serves as the impetus for going to rehab or AA, or simply making a once-and-for-all decision to quit harming their brain.
10. If you want to live a long time with your mind intact, it is critical to become a brain warrior for your own health. No one is going to do it for you. You have to take custody of your own brain health. Begin by building your own genius network of supporters. The health of the people you spend time with matters to your health.
11. Be a brain warrior by getting and keeping your weight at a healthy level. Eat food that serves you, exercise regularly, and give your brain simple supplements to nourish it well.
12. Be a brain warrior by getting the sleep you need, dealing with sleep apnea, and taking sleep-friendly supplements like melatonin and GABA for a good night’s sleep, and using sleep-inducing routines to prepare for bed.
13. Be a brain warrior by developing a consistent stress reduc-
tion practice with meditation or deep breathing or contemplative prayer. Kill the ANTs that steal your happiness and make you old.
14. Be a brain warrior by protecting your brain from injuries and toxins. Start a brain healthy rehabilitation program if you’ve damaged your brain or suffered any kind of brain injury.
15. Be a brain warrior by constant mental exercise and new learning. Keep your childlike curiosity and openness to new knowledge intact to stay young of mind and heart.
16. Be a brain warrior by being an example of good physical and mental health for your family and friends. Pass on the encouragement!
17. A true sign of self-love is how well you take care of your brain and body. If you are not doing it, why not? You are worth it!
18. Success breeds success. When you do the right things over time they become easier and easier to do.
19. The quality of your life is determined by the sum of all of the decisions in your life. With a better brain you are much more likely to make better decisions and dramatically improve everything in your life.
20. Even if you have been bad to your brain, you can literally improve your brain, and when you do you improve everything in your life.