Andrew Hill, PhD is one of the top peak performance coaches in the country. He holds a Ph.D. in Cognitive Neuroscience from UCLA’s Department of Psychology and continues to do research on attention and cognition. Research methodology includes EEG, QEEG, and ERP. He has been practicing neurofeedback since 2003. In addition to founding Peak Brain Institute, Dr. Hill is the host of the Head First Podcast with Dr. Hill and lectures at UCLA, teaching courses in psychology, neuroscience, and gerontology. #Brain #Health with Dr. Nissen brings you advancements in #medicine, #neuroscience, #psychiatry, and #nutrition to help you live a better life. Dr. Nissen’s expert interviews reveal new, evidence-based approaches to enhancing #mental health, sharpening #cognition, and optimizing performance. With topics such as #optogenetics, #Alzheimer’s disease, #neuromodulation, #depression, the #Mediterranean Diet, and #psychedelics, this show is sure to expose listeners to new topics on the frontiers of medicine and neuroscience. Join our community at http://drnissen.com Subscribe to the podcast at https://podcasts.apple.com/us/podcast/brain-health-with-dr-nissen/id1510757864 Dr. Nissen is a medical doctor (MD) and TEAM-CBT Therapist. This show is intended for entertainment and educational purposes only and does not substitute personalized medical advice. Please speak with your doctor before attempting any medical or major diet and lifestyle changes. Check out Dr. Nissen's new children's book on empathy and emotional intelligence, Emily Empathy! http://bit.ly/emilyempathy
Episode Summary
This article is drawn from my conversation on Brain Health with Dr. Nissen. You can watch the original conversation. The ideas, mechanisms, and clinical observations below are mine, pulled from that discussion and expanded for the page.
What does a cognitive neuroscientist actually do with the brain?
I have a PhD in cognitive neuroscience from UCLA. Most people in my field stay in the lab and work on the base science: how the brain produces attention, sleep, stress, and learning. I took that training and flipped it into the practical world.
Before the PhD I spent about 20 years in human services. Crisis work, acute psychiatric populations, an autism center in Providence, addiction, aging. I ran a group home for adults who had no language and multiple disabilities. I saw people at the edge of their cognition, declining acutely, developmentally, or from drugs and alcohol.
At that autism center I started seeing things I did not think were possible. ADHD, autism, seizures, migraines, OCD, and PTSD getting alleviated in weeks or months. That ran against everything I had seen in two decades of health and human services. It sent me back to school.
When I finished, I built my practice like personal training. My job is to be your educator, your coach, and your scientist so you can take control of what is happening in your own head.
Why does seeing your own brain reduce stigma?
A lot of people grow up thinking depression, PTSD, or OCD means someone is overreacting or carrying a personal flaw. When I can show you the actual pattern in your brain, that interpretation falls apart.
Take PTSD. The back midline of the brain, the posterior cingulate, can get stuck in threat assessment mode. It clenches up in beta waves, and you see a hot spot of beta sitting in the back midline. That circuit handles orientation: the same one you use when you glance down at your phone while driving and then snap your eyes back to the road, or when someone yells "heads up" and you catch the frisbee. When it ramps up and stays stuck in high gear, it becomes uncomfortable.
You would not feel guilty about a shoulder that hurts. You would get an X-ray, find the separated shoulder, and address it with range of motion and ice. Most of what we call cognitive or mental health complaints work the same way. Nearly every category of anxiety is a natural resource that got stuck, a regulatory feature that switches like strength or alertness, and you can train it. This frame is the core of how I think about EEG phenotypes and the whole field of self regulation.
How does QEEG brain mapping work?
We do something called quantitative EEG, or QEEG brain mapping. You wear a cap with conductive gel, sit still for about 10 minutes, and we measure your brain at rest with eyes open and eyes closed. We also test your executive function and your performance on an attention task. Those three baselines get compared to a database of people your age.
The goal is to find the ways your brain is unusual, then ask whether those patterns are relevant to anything you care about. Anything that shows up clearly tends to be tractable. Nearly all forms of ADHD show up reliably. Most forms of anxiety and most sleep issues show up. Slowed brain waves can point to old concussions, mold, Lyme, or chemotherapy. I will not always know why the slowing is there, but I can tell the brain is metabolically sluggish in a particular region.
What does ADHD look like in the EEG?
In kids under 18, the data is about 94% accurate for spotting ADHD in the absence of a sleep issue. You see high theta with eyes open and often low beta, so the theta-beta ratio climbs. Slow waves up, fast waves down. You can measure this at the vertex, a single electrode on the top of the head, and sort kids into ADHD and non-ADHD buckets with that 94% specificity.
The inattentive presentation looks different. Alpha gets stuck in neutral with the eyes open, and that marker runs around 80% accurate. I always pair the EEG with an actual attention test so the brain pattern and the performance line up before we decide anything. If you want the deeper version, I wrote a neuroscientist's guide to neurofeedback for ADHD.
How does neurofeedback retrain a circuit?
Neurofeedback is operant conditioning. Skinner's pigeon, not Pavlov's dog. I have never made anyone drool with a bell.
Say impulsivity shows up as high theta in the right-hemisphere supervisory attention network. I put a sensor there, a couple of ear clips, and measure your theta and beta moment to moment. On its own, your theta dips and your beta climbs whenever you focus. We have you watch a screen with a Pac-Man, a spaceship, or a dragon flying across a lake. The instant your brain moves in the useful direction for half a second, the game rewards it. The dots get eaten, the music swells. The next moment your theta surges and your beta drops, the Pac-Man stalls or the car drifts off the track. Your brain notices the input disappear and reaches back toward the rewarded state.
We are not adding anything foreign. You already produce these brain waves at these speeds. We applaud the trends that already exist and shape them. After 10 or 15 minutes of rewarding theta dropping, your brain decides it likes the input, and the next day it reaches for that state on its own. You notice you focus more easily. A parent notices the kid takes the trash out the first time they are asked.
The timeline is consistent. You start feeling changes around three to five sessions in. We map again at about 20 sessions. ADHD and anxiety usually take two rounds of 20. Concussions take three to four. For ADHD specifically, I run about 40 to 50 sessions over three to four months. People arrive two to three standard deviations on the wrong side of the mean and end up shifting four standard deviations on average, landing above the mean by the same margin they were below it. For the daily-use resources, those changes hold, because the thing you tuned is something you do every day. You can read more on the mechanism behind SMR neurofeedback and what the literature shows for neurofeedback and anxiety.
The point holds across complaints. An obsessive anterior cingulate stuck in beta, songs looping in your head, nail biting, hand washing, is the same circuit that lets a CEO hyper-focus and hold every detail at once. I would not know from the map alone whether you have OCD features or just useful focus. If it gets in the way sometimes, we train it down a touch. After that, you reach for the focus when you want it and put it down when you do not.
What protects the brain from cognitive decline?
There is no decline that is mandatory for the brain. You lose some speed of processing and some tissue with age, but on average it is about half a percent per year after age 62, and that figure assumes you are doing nothing to protect yourself.
Meditation is one of the clearest protectors I know of. The insula, on the lateral side of the temporal-frontal lobe, handles body awareness, appetite, and balance. In the average Westerner it thins by roughly 15 to 20% by the mid-60s, which is part of why elders lose track of their hunger and their balance. In meditators, the years of practice correlate with how much of that tissue you keep. About 20 minutes a day, and you can start at any age. Meditation also moves activity in the anterior cingulate over the years, from a hot spot on the top that tracks self-focus toward the underside, which corresponds to a more self-less awareness. I cover the structural side in the neuroscience of mindfulness training and the practice itself in Mindfulness: Don't Just Do Something, Sit There.
Resistance training, good muscle mass, challenging yourself, deep sleep stitched together across the night, and fasting all keep brain tissue fat, happy, and plastic. You want a fat brain. A thin brain is a problem, and the cortex starts thinning slowly after about age 15.
Sleep deserves a specific warning. When sleep gets sub-optimal in your 40s and 50s, the first thing that goes is slow-wave sleep, and that drags down your speed of processing. People think they are having memory problems when they cannot find words. Usually it is a speed-of-processing issue, not a storage issue. Protect sleep and you protect the thing most people misread as early memory loss.
Why is blood sugar the biggest lever in brain aging?
Almost all diseases of aging are diseases of oxidation. Diabetes, cancer, the dementias, the Parkinsonian cluster including Lewy body dementia. They are driven by glycation, the rusting of cellular tissue when sugar oxidizes. In Alzheimer's the amyloid plaques get glycated and damage the brain faster. Lewy bodies glycate. Atherosclerosis is the same process in the vasculature.
Anything in the body that is supposed to oscillate causes trouble when it stops oscillating and stays high. Blood sugar is supposed to go up and come back down. Cortisol is supposed to pulse. When cortisol goes up and stays up, the hippocampus atrophies and you slide into the stress-driven depression process. The body is built for swings, not for a chronic ceiling.
I track the glucose-to-ketone index because it tells me whether I am burning fat and how metabolically flexible I am. As the ratio of ketones to glucose rises, you move first into fat loss, then into autophagy where the body cleans out dead and over-proliferating cells, then into a state that suppresses the metabolic drivers of cancer. We all carry some pre-cancerous cells. Autophagy is part of how the body clears them before they edit out tumor-suppressor genes. The body will not run autophagy if you are eating three times a day. It needs uninterrupted time out of the digest-and-burn mode to switch into clean-up mode.
This is the metabolic backbone under intelligence and cognitive resources and the reason I treat strategic fasting as a core tool rather than a fad.
What are the three rules for circadian regulation?
I frame eating around circadian signaling. Three rules keep your rhythm tight, your sleep deep, and your autophagy running when you want it.
Fast three to four hours before bed. Water and herbal tea are fine. If you go to bed with insulin elevated at all, you get no growth hormone release during sleep. Hormones are pulsatile, released in bursts so the body avoids tolerance. Until about 35 or 40, you get a large growth hormone pulse two to two and a half hours after you fall asleep. After that age, the one meaningful pulse you get is in the middle of the night, and only if insulin is low enough to let you drop into deep sleep. Go to bed hungry and wake refreshed. Go to bed full and you wake hungry and tired.
Get up at the same time every day, no later than an hour after sunrise. The suprachiasmatic nucleus sits on top of the optic chiasm, where the optic nerves cross. Its job is to read the temperature of light hitting your retina and broadcast the time of day to every other clock in the body. The color of early sunlight, even through clouds, is only there for the first hour before the sun climbs. Pick a wake time you can hold seven days a week. I do not care much about evening light, blue light, or screens. Morning light is the lever. Sort the morning and the evening tends to sort itself. The full version of this is in biohacking your morning.
Exercise in the morning before you eat. We evolved to leave the cave and hunt before we received energy. It does not need to be heavy. Stretching, a dog walk, sun salutations, anything that lifts your heart rate in those first hours while you ride your cortisol.
How should a normal person approach ketones and fasting?
A reasonably fit 30 to 40 year old carries 100,000 to 150,000 calories in body fat. We were built to go long stretches without food. We feasted and we famined.
The ketoacidosis that worries clinicians in the hospital is a different thing from nutritional ketosis. In a type 1 diabetic the danger is hypoglycemia. In a metabolically intact person, producing ketones from your own fat is anti-cancer, anti-aging, and protective.
You do not need a fat-heavy diet to get there. People picture keto as bacon and fried cheese, but if you are carrying excess fat, you are already walking around with the fuel. Your keto diet should be moderate protein and high leafy greens, not added fat. The body releases stored fat through lipolysis into triglycerides, cleaves the glycerol backbone off, and frees fatty acids to burn. The brain prefers glucose, so the liver runs gluconeogenesis, converting some of that fat or dietary protein into just enough glucose to keep the brain supplied with no hypoglycemia once you are keto-adapted.
That adaptation is enzymatic and takes time. If you have been eating sugar every day and you suddenly switch, the body has no idea what to do, and it can take weeks to drop insulin dependence and ramp up fat metabolism, especially if you are overweight.
A simple on-ramp: hold carbs to no more than 50 total grams a day, split across two meals, roughly 25 grams per meal. Most people produce ketones within three days. If you have been metabolically poor, you will pee and breathe most of them out at first as acetone and BHB. After another week or so you start burning them, and blood ketone readings actually drop because your reservoir clears faster than your production replenishes it.
I am 50 in about six weeks, and for the past seven and a half weeks I have run an insulin-sensitivity reset, stacking 22, 44, and 66 hour fasts, refeeding with carbs, then dropping them again, watching how my body handles it. I track breath acetone with a meter, since finger sticks need to be repeated every two to three hours to be valid given how much the system oscillates. The management principle is old: what gets measured gets managed. You now have decision-grade data your doctor did not have in the 1950s, for your glucose, your lipids, your C-reactive protein, your beta waves, your alpha, your speed of processing.
My first port of call as a coach is always the thing you do every day. You are always eating and always sleeping. Fix those before you worry about blue-blocker glasses.
Why is the Mediterranean diet really a lifestyle?
We compare diets as if they were apples to apples, but they answer different questions. The Mediterranean diet mostly describes what you eat: leafy greens, vegetables, fewer refined carbohydrates. The evidence for cognitive aging is reasonable. What it leaves out is when you eat.
The French paradox is instructive. In the 70s and 80s the French chain-smoked, ate plenty of saturated fat and carbohydrates, and still had among the lowest heart disease rates of any developed nation. A large part of that is the two-hour lunch and the walk afterward. The post-meal insulin response drops dramatically if you walk after eating. They were not waking up to a bowl of cereal and orange juice. They had coffee, then a croissant a couple of hours later, walking to meet a friend with the paper. The structure of the day did real metabolic work.
What domains of cognition can you actually train?
As a cognitive neuroscientist I am a bit of a reductionist. The more I learn about the brain, the less I believe in a fixed self, and the more I focus on the measurable resources sitting one level below experience.
Executive function breaks into orienting to space, staying vigilant to change, and resolving response conflict, the moment when the car turns the corner as the sign says walk. Speed of processing ties tightly to memory access. Working memory is your ability to hold things in mind. Then there is creativity, mood, hyperactivity, rumination, and impulsivity. Each maps onto patterns I can see in the EEG. You can dig deeper into attention, working memory and learning, and memory itself.
I find where you are unusual, show you the pattern, and ask whether it is getting in your way. If it is, we train it.
Why combine neurofeedback with meditation?
I ran the brain side of an addiction center that did a lot of work around moderation and mindfulness, and the people who did both neurofeedback and meditation changed faster than people who did either alone. The effects were multiplicative.
I think of neurofeedback as the strength-and-conditioning coach in the gym, making you bang out the reps and build the resource. Mindfulness is the coach in the field, refining how you actually use it. It is pure mind, a voluntary set of experiences, and it shapes the same structures the training touches. I have CEOs six months into practice reporting absorption states, the jhanas, warmth and light suffusing the body, that classically show up 10 or 20 years in. Their meditation skill outpaces their expectations because the brain training primed the tissue.
I am not attached to which tools you use. Some of my clients meditate, some fast, some take nootropics, and many do none of those. As long as you have a goal and want to take control of your performance, incidental gains follow. My staff are 20- and 30-somethings who train in their off hours, and after a few months they carry the calm, kind, well-rested, attentive quality you would expect from someone decades older. Most of them had nothing wrong to begin with. They optimized before grad school because the gear was sitting there.
Where to start
Pick the thing you do every day and improve it. Hold your wake time within an hour of sunrise, seven days a week. Stop eating three to four hours before bed so insulin clears and growth hormone releases. Get some movement in before your first meal. If you want data, ask your doctor for a continuous glucose monitor or pick up a breath ketone meter and learn your own thresholds.
If you want to see the actual patterns, a QEEG brain map is the entry point. We run brain training out of centers in St. Louis, Los Angeles, Orange County, London, and soon Copenhagen, and about three quarters of clients now train from home with live remote support. You can find that at Peak Brain Institute, and you can find me at Andrew Hill PhD across the socials with your brain questions. The brain stays plastic. Apply the right pressure to the right resource and it moves.