Welcome to the Dr. Gabrielle Lyon show. In this episode I sit down with Dr. Eric Wan, President and Chief Medical Officer of WAVE Neuroscience Biotechnology. Now I met Dr. Eric at Global Special Operations Week and why was I so interested in the things that he was talking about? If you are someone who struggles with brain fog, energy, depression, PTSD, someone who struggles with traumatic brain injury as if you’ve gotten hit in the head or been exposed to things that might jar your brain and you’ve tried everything. This episode is for you, it’s for anyone and everybody that is suffering with anything related to their brain. I hope you enjoyed this episode. I hope you learned as much as I have. As always this information is free to the public. Please, please take a moment to share it, spread the good word, rate, subscribe so you don’t miss an episode and if you are interested in information like this to make you the better and best version of yourself, take a moment to go to the website, subscribe to our newsletter. This is free content delivered directly to your inbox without having to do anything because remember friends together we are forever strong.

Dr. Eric Wan, thank you so much for coming on the show. Very excited to be here, thanks for having me. Yeah and so people should know a little bit about our history. We met at Special Operations Week, it was Global Special Operations Week and it was really incredible. All the operators from around the world got together, well they all didn’t get together but the people, the medicine, the community got together to really move the needle and you were one of the individuals there. Yeah, yeah it was very much an honor and privilege to be able to speak there. It was run by an organization called GlobalSoft, Stu Braden and Kenan Yoho are good friends who are running the operation but yeah I was able to speak and provide some updates on some of our clinical trials and of course the community is very interested in emerging data with traumatic brain injury and post-traumatic stress so I was able to provide an update to the community there. Yeah and you were former Navy I’d love to hear a little bit about your background especially the listener. Oh sure yeah so I was a I was a Navy flight surgeon, was attached to a Marine Corps unit HMM 268 and we deployed as the 11th Marine Expeditionary Unit. We had a somewhat unfortunate distinction, we had some of the first casualties of Operation Iraqi Freedom and as a byproduct of that I’ve always been looking for something that could help the men and women that I served with which is a big part of why I ended up kind of in the organization that I’m with but I left a military service finished up my medical training at the Harvard Occupational Medicine Program and ended up at the Boeing Company where most people know we build planes and satellites but we have emergency rooms at all of our heavy manufacturing sites and I took on a different role as your Chief Technology Officer for Medical Services which is how I interface with this technology and was hearing how it could help men and women who are struggling with a variety of conditions and specifically it was a post-traumatic stress and concussion type symptoms that really drew me in. So fast forward a few years I did quite a bit of diligence, joined the company about eight years ago. And this is this wave neuro? Yeah yeah. Yeah. Exactly so it’s really been a full sprint ever since. Hmm the war is never pretty for anybody for the the families the individuals there and I can only imagine that that really impacted your trajectory of how you even thought about medicine. Yeah it’s hard to articulate the type of impact that can have on the whole community and you know the mission for me at least changed quite a bit from one of force readiness and support to how do I help all these men and women not just in the near term but long term because the conflict was very kinetic a lot of traumatic brain injuries a lot of post-traumatic stress and those tend to be more long-term lingering conditions. And people might not see them. That’s right that’s right and so it’s it is one of those challenges to try to find clinically meaningful therapeutics that can help people through these issues and it is one of those things that we’ve learned that there is this secondary effect to families where both spouses and children can struggle both with not having the service member at home but also some of the trauma gets shared and so so that’s been a big part of our effort as well. The reason I asked you about that is you know we were talking about my husband who is now in his urology residency. He was in the SEAL teams and he was a medic in the teams. I don’t know if I told you that again he had been to war and there was a lot of things that he couldn’t help with and that actually saw a lot of lower blast injuries and there was a lot of just experiences that he wished that he was able to do more within that moment and that’s why he actually went into urology or in part one of the reasons he went into urology. Wow. Yeah so that that’s that’s where my questions were coming from because again he had been a medic at war and there’s only so much that can be done and when you experience that it seems as if you take that experience and do really good work in the world. Yeah it certainly drives a different level of passion you know when the motivation is about mission and purpose you can work long hours grind through a lot of things and not even think about it it just it ends up being kind of a labor of love and I would say that the science and the evidence around traumatic brain injury and post-traumatic stress has evolved kind of at an unmatched pace I would say over the last decade and so it’s a fascinating time to be in this arena and to see the types of developments that are happening both from a neuropathologic perspective but our world when we’re talking about electrophysiology and functional brain imaging there’s been a lot of knowledge gained even year-over-year seems month to month we’re learning new things. That’s so rapid that’s so rapid and to give people a background you did you told me that you had done environmental medicine environmental and occupational medicine and then emergency medicine found this then obviously were a flight surgeon and found this you know as you went back to re-examine what you were doing you found wave neuro which I’d love for you to explain a little bit about the technology and the the treatments and what it is impacting. Sure so the basic technology it’s merging three different capabilities one is a functional neuroimaging technology called quantitative EEG or electroencephalogram so much in the same way an electrocardiogram is an electrophysiologic picture of the heart these EEGs are electrophysiologic pictures of the brain and we’re specifically looking for disruptions or dysregulations in brain activity and neural networks and we can identify that we can with a fair amount of precision target those areas and try to restore function to the circuit and we use another technology that’s FDA cleared for depression but we’re using it kind of agnostic to the diagnosis and looking to restore function to a specific circuit most commonly the default mode network and when we see that type of function return we also see concurrent improvement in symptoms and we can talk a little bit more about that but to give you an idea it’s about 30 minutes a day the treatment and it’s usually between four and six weeks depending on the severity of the injury that we see and just to share kind of my first experience with this technology I was very skeptical but I had a marine buddy he wouldn’t mind me mentioning his name but let’s just call him Jay to keep him you know medical privacy but basically because he doesn’t want you he’s not calling him he’s a very dear friend he was really struggling and it wasn’t just him his friends were calling me saying hey can we do something and I’m worried that he was gonna commit suicide I was yeah and he he is sort of the classic polytrauma what the VA calls it polytrauma case he had post-traumatic stress traumatic brain injury and opioid addiction and the third was a byproduct of a failed back surgery he had pseudoarthrosis of L4 L5 and chronic pain and he was on about 170 more of an equivalence per day which is a very high dose for the audience that may not be aware anything more than a hundred more than equivalence per day will double your risk of all-cause mortality in any given year so that was through respiratory failure injury and that’s for a variety of reasons but respiratory failure is a common reason but there can be multiple organ issues that happen with chronic opioid use even it’s very common to see hypogonadism and low testosterone and so there’s multiple issues that happen that can with opioid use exactly okay yeah so it’s called opioid induced hypogonadism and so a lot of these people who are on chronic years of opioid end up requiring you know many different medications to manage their symptoms but you know when I met with him I talked to him I wanted him to give this treatment a try because one of the novel therapeutics that I’d seen at that time at that time because what you’re talking about is trans magnetic personalized trans magnetic stimulation yes that’s correct for the for the listener basically what dr. Eric and I are kind of framing up for you is why and if and you know when someone should use things to treat depression head injury tbi’s which then manifests in a whole host of ways including hypogonadism including depression including energy fatigue I mean you and I share patients together I I send not only have as my husband seen individuals that wave neuro bet I have patients that use these kind of protocols that that’s how impactful they are but anyway at the time how long ago was that this is around the 2015 2016 time so not that long ago because trans magnetic stimulation and I know that that’s only one of the modalities that you guys use it wasn’t so novel at the time right it was not as well known as it is now and I think it’s become more mainstream and accepted as a non-pharmaceutical intervention that can really help with depression and I’ve seen many cases of people who had given up hope you know they tried many of these antidepressants and talk therapy kind of behavioral therapy and this was the approach that seemed to help them the most and so I knew that TMS by itself was very promising and the question became could you personalize it in a way that could help other populations and we can take a deeper dive into that but just to finish the story about how my day my friend name right yeah so he came in and I have pictures where he’s very disheveled he looked nothing like the crew chief that I deployed with you know decades earlier and he came in grudgingly and within the first week we could see a change because he was showering again he was going to work out and at the two-week mark his wife sent me a picture and said I got my husband back and he shaved and you could see kind of life come back into his eyes and within a month he had given me a call and said hey doc I’m off my opioids and my initial reaction as most medically trained doctors would be hey that’s a little dangerous that’s a lot of opioid to come off of in such a short period of time but he had tapered himself down and kind of boggled my mind you know traditional medicine we don’t expect to see these kind of changes in such a short period of time but I knew this was my friend he’s not gonna lie to me and both him his spouse’s children were all saying that this was really quite transformative so I started paying attention I sent in about a dozen other Marines and it was a very consistent benefit that we’re seeing and so I still remember the day there’s a Navy SEAL Master Chief your husband may know I won’t mention him by name either but is he under 5’5″ he’s not but um but yeah at this point there was a lot of special operations operators who were coming in and the organization had asked me to come in as one of the leaders and I had declined several times I was just very happy in my role at Boeing and this the SEAL Master Chief kind of put his finger in my chest and said what do you stand for brother are you going to do this for the rest of your life stay at Boeing or you know get in the trenches and help out your brothers and sisters and really that resonated with me in a way that I was not anticipating because this was a different level of mission of purpose if we can help a vulnerable community not just patient to patient but a whole population of people that are struggling with a condition where there are very few effective therapeutic options that was worthy of a pretty significant career change and so spoke to my wife about it and she agreed she said this is all you think about this is all you talk about why why was it that that was the thing that caught you I mean you saw a lot of different kinds of injuries was it that the TBI what we’re talking about specifically the traumatic brain injury was it because the treatment seemed to do something why why was it that that caught your attention over say something else that’s a big piece of it because to this point there haven’t been a lot of therapeutics that were really helping in a meaningful way and I had spent the prior you know 15 years trying to help men and women who are struggling with this and we could see improvements but this was in a matter of weeks people having improved cognition having improved sleep these were secondary effects of the injuries that we typically didn’t see through traditional medical therapeutics the other part of this that I found really intriguing is it’s really the first time in the course of human history where we had the ability to predictably and with some level of precision modulate brain activity in a way that could be helpful so to me that was worthy of spending a life trying to advance the science and help these communities that were really struggling and I could see that both among close friends I deployed with but other people who are coming in looking for answers it’s it’s just it’s so meaningful especially with what you’re doing now when you started the technology or started using the technology you saw this you know with your friend Jay we talked about one component of it so it’s the EEG the other component is the trans-magnetic stimulation is that right and then there’s a third component well the third component is a computational analytics that go into designing the protocol for each individual and that’s what we’re trying to get FDA cleared right now we have a lab full of neuroscientists who are customizing protocols to each individual but to scale that we have an automated protocol generator that can now do 100,000 EEGs per second and so if we’re talking about being able to administer this treatment to millions of people and right now the estimate is 150 million cases of post-traumatic stress globally and I suspect that’s an underestimate just with Ukraine and Israel there’s growing numbers of trauma every day and for us a lot of my perspective as a military doc was about the veteran experience but I’ve learned sexual trauma survivors are a much larger population of trauma than what we see in the combat related arenas and so what do you mean can you tell me more I didn’t realize that yeah so so women or men who survived sexual trauma are living with PTSD many times and that can manifest in many different ways but as we opened up our clinical trial so the first phase of our FDA clinical trial was sponsored by US Special Operations Command and the second stage was picked up by Texas A&M with the idea that we needed to open this up to civilians and not just do military cases only and we saw the large influx of interest from sexual trauma survivors and one of the issues that we encountered was that an inclusion exclusion criteria for the study was that they should not have index trauma the first trauma should not happen before the age of 16 and sadly the majority of those sexual trauma cases the index trauma happened before the age of 16 so they didn’t qualify for the study which is a horrible reflection on society at large but it was one of those things where as a technology we forward and progresses we’re learning new communities that we can help and that has been a population where we’ve seen fairly significant and promising data so we’re still a year away from being able to unblind that data but but yeah it was one of those things that was challenging to learn but PTSD extends far beyond just the veteran and military community so to kind of summarize the wave neuro technology which is what we’re talking about and actually what we’re talking about is overall brain health and I’m we’re gonna learn all about how it works what people are looking for you and I have gone through cases and it’s just so fascinating the way that someone could potentially process information where they might be tired or where their brain might be I don’t remember what you called it but it was it was a bit it was somewhat overburdened or it wasn’t it was very elegant the way that you said it but essentially it was a non-optimized brain and that potentially things get a little bit worse before they get better or it’s not just this you know trajectory upwards of healing or improvement but the brain function itself you talked about traumatic brain injury which is a physical insult to the brain now you mentioned PTSD which is a non-physical it would be it manifests physically but it’s a external stimuli of of an event both PTSD can come in a number of ways whether it’s sexual trauma or war trauma any of those things and then is there another and then depression so you also mentioned depression is ways in which non-pharmaceutical ways in which we treat the brain are there any other potential subgroups subset of groups of things that we’re treating so if the listener is at home thinking why do I care about what dr. Eric is talking about you care because probably quite frankly everybody should go through this testing because you might have hit your head and your brain waves are functioning out of whack right but are there very other other specific domains of people that are listening out there that they should potentially get their brain checked yeah to your point I think it’s useful for everyone to get an EEG and to see how their brain is doing getting a baseline provides a reference point for which if there is some type of injury that occurs in the future you at least know how is my brain functioning back in 2024 but there are other subpopulations that are emerging as potential use cases for the technology not just what wave neuroscience is doing but the whole neuromodulation community is looking at can this be helpful for substance use disorder you know I talked about my friend Jay who was struggling with opioid use we’re seeing some use cases for autism and to be clear there’s a lot of large amount of research double-blind RCT is the gold standard of scientific evidence that needs to be done before we can make any kind of claims about this but I think it’s fair to say that we’re seeing some early signal that this technology may have some use cases that warrant further investigation and interrogation and I think when we talk about those different indications it’s worth spending a moment talking about network modeling and I think that may be the example that you were talking about earlier and this is I think a fairly exciting development in the neuroscience world and what is emerged is something that’s called triple network theory there’s a Stanford professor his name is Vinod you know I may be mispronouncing it but he proposed this triple network theory where there’s sort of three separate circuits that’s dominate neurocognitive function and every thought feeling and emotion we have is encoded three dimensionally in time and space and if we had the same exposure let’s just say we look at a cup of coffee you know how that would look in your brain in my brain may be quite different so there’s a lot of complexity to this we have 89 billion neurons each that are interconnected to 10,000 other neurons and how that picture shows up in an image can be very different but there are certain invariant components to that that you can image and see and potentially pick up neuropathology as well and so the three circuits are called the salience network that’s very closely associated with depression the default mode network which is sort of the area that we’ve been most intensely focused on and the central executive network or frontal parietal network is also called and these three interplay and have been researched with a really good amount of rigor and so there’s a Stanford researcher by the name of Nola Williams who looked at an accelerated protocol to treat depression and specifically was targeting the salience network our work is very focused on default mode network because dysregulation of the DMN has been strongly correlated to TBI and PTSD and before you go further default mode network can you define a little bit about what that is from my understanding it’s kind of the way in which the brain waves run in outside of cognitive control or cognitive thought process when I was at WashU there was a man named Marcus Reichel do you know who that is yeah I think he won the Nobel Prize or something something crazier was nominated for the Nobel Prize for some of his work and default mode network and I remember just talking to him because he is like this big brain imaging place there but could you explain and that’s kind of how I understood it from what he said but I’m sure that there’s a another way in which yeah yeah so so the DM will call the default mode network DMN it’s your resting state kind of an idol and a lot of neuroscientists would say that this is the specific network that deals with self monitoring and self-awareness and so any type of dysregulation here can manifest in a number of different ways the important part is that there appears to be a pretty linear relationship between disruption of the DMN and severity of post-traumatic stress and there’s some great work done by there’s a researcher at a Florida state named Kevin Clancy who has found that if we tune to that and we treat that we can see improvements in those symptoms as well and that’s part and parcel for our approach and so this network modeling allows us to take strategic approaches to these treatment protocols and so I mentioned the Stanford approach they’re treating in a specific area called the left dorsal lateral prefrontal cortex and they’re trying to tap into a circuit the salience network and specifically if they’re able to they call it anti-correlation reverse the communication between what’s called the sub geniculate anterior cingulate cortex and the left dorsal lateral prefrontal cortex they see remission and depression so you can actually see this on fMRI how long does that take to happen and that protocol is just a week and you can actually see so you you put someone into an fMRI machine which is a machine in which you can actually see how would you describe an fMRI machine it yeah so the difference between an fMRI and a traditional MRI is taking over a time series and so you can look at function over a period of time and in this case pre and post treatment you could look at changes between how the brain connectivity is action kind of that’s right exactly so it’s more of a dynamic type of neuro image rather than a static still image EEG is similar instead of looking at metabolic activity it’s looking more at electrophysiologic function and so whereas they’re targeting depression in the salience network our approach has been to look at the default mode network so we actually stimulate in a different location the medial prefrontal cortex that is what’s been most closely associated with post-traumatic stress and TBI what’s interesting is that electrophysiologically TBI and PTSD look very similar there are some neuroscientists I would argue it’s almost indistinguishable and so you start to wonder is PTSD perhaps a secondary byproduct at least in veterans of some form of traumatic brain injury because we are learning just the training that a lot of service members go through is TBI inducing and when I talk to these operators and they talk about breaching doors or even one of the there’s two other populations where we’ve seen significant over pressurization blast exposures one is artillery men and the other is EOD explosive ordnance disposal but yeah do you guys have a rough job yeah because they have to practice exactly and I know that there’s ways in which they try to mitigate exposures yeah well yeah the men and women that we’re taking care of they’re taught you know you train how you fight and so the minimum safe distance when you breach a door they’re not always following that because they want to they want to get in they want to do their jobs but electrophysiologically we can see pretty clearly these kind of disruptions but to bring this full circle there are some great work done there’s a researcher out of uniformed services University Daniel Pearl who did autopsies on veterans who had significant blast exposures and they specifically found areas of the brain where there’s disruption he calls it astroglial interface scarring and this is where white matter turns into gray matter and as a blast wave comes to you it dropped his kinetic payload specifically at this junction and that’s where we see the scarring and the disruption if that rings a bell if astroglial rings a bell is because we’ve had this new discovery of the glymphatic system that’s been associated with brain health and specifically during the deep stages of sleep this is the system that washes away the oxidative stress that accumulates throughout the day and so when that system is disrupted through blast injury or scarring sleep disruption becomes part and parcel to that and it is a very common symptom constellation that we see and so you start seeing you had Chris Frouon earlier and he talked about operator syndrome the commonality to this our biology doesn’t care what the label is you know right you can call it PTSD you call it TBI you can call it operator syndrome but the types of injuries our biology is sustaining all of these are neurobiological issues and I think for the patients who come in and see their EEG it’s a very disarming conversation to have because they now realize okay I’m not just a jerk I’m not just out of control there’s a genuine neurobiological issue that we need to reconcile and that’s where you can really team up and partner and start doing some good work together yeah how so someone comes in they come into wave neuro they go through this process what would they expect what would you expect to see what are the things that are outcomes and lengths of time sure so we do 15 to 30 minute EEG it’s an ice-close resting EEG and that is processed by our lab and then there’s conversation usually with one of our doctors or neuroscientists and we have about a hundred different centers now that have been trained and and know how to use this type of capability and then there’s a consultation where the physician can tune the TMS device to treat the individual with some optimal parameters and so that entails a 30 minute treatment daily and the optimal parameters and people don’t feel this this is right do they do they you can so the TMS device does provide a pulsing sensation it’s a big magnet right it is it’s not it’s it’s generally about a one-pointed tussle coil but the stimulation itself isn’t painful it’s it’s feels like a mild tapping sensation and it’s generally there’s different protocols but between six to ten seconds of pulses and then there’s a period of rest and then the pulses start again and so you know there’s a protocol called theta burst that’s very short it can be between five to fifteen minutes but standard protocols are usually more around 30 minutes and that’s that’s our protocol as well although we are researching now in the state of Ohio a fifteen minute protocol so I think that this dialing in of ideal parameters is a work in progress and there’s a number of different ways that we can approach it but daily it’s the commitment is roughly 30 minutes a day for about four weeks some people will go up to six to eight weeks it sort of depends on how severe the symptoms are what’s interesting is usually people feel some improvement within the first couple of weeks in what in what way they sleep better usually sleep is the first thing people talk about and that’s intriguing to me is not necessarily quantity of sleep but the quality of their sleep seems to change and we’ve now had a group from the wounded warrior project this foundation very generously gave us some funding to do work with veterans who came into our San Diego office and all of them wore these oral rings and we can see roughly 25 improvement in deep sleep which is pretty meaningful and so that ability to get deeper more restorative sleep has many you know secondary benefits in terms of the ability to you know handle stress resilience managing information cognitive function we also saw improvements in heart rate variability which were interesting and HRV heart rate variability is something that isn’t always talked about necessarily in medical circles but in functional medicine and especially in kind of human performance you know the trainer world has become a metric that’s very much an area of focus as a proxy for emotional resilience so so it’s interesting to see those kind of changes as well yeah and when you think about the other things are there things that an individual well first of all what do you expect to see and we can talk about that one patient we won’t name him that we have together which seemed to have a very striking striking scan i don’t know how else to describe it but again you look at these scans so much more often than i do but how if we were to take that patient from what you remember how would you describe what you saw initially yeah there’s pretty significant disruption of activity in the prefrontal cortex and the prefrontal cortex is an area responsible for executive function organization of thought and impulse control and those symptoms were being exhibited totally by the individual and really within a few weeks of treatment subjectively he was feeling these changes and improvements kind of returning back to normal because he had a pretty significant head injury and that was corroborated by the changes we were seeing on the EEG as well and so having what we’ll call longitudinal biomarker where you can see and track these changes over time i think is important for not just the physician but also the patient to see because they become their own strongest advocates and the individual we’re talking about is a highly motivated individual who takes great care of himself but other patients they may become inspired uh to be better advocates for themselves they may have a cleaner diet they exercise more and one of the areas we really enforce is protecting their sleep and using good sleep hygiene i hate hearing that i’m i’m a terrible sleeper because there’s just so much to do and uh i i now hate hearing that why sleep why would you prioritize sleep over say exercise or diet i don’t know that we have to pick one over the other you know just trying to make myself feel better no i mean i mean nutrition and exercise are foundational to any sort of um regiment right like everyone if you’re going to pick one foundational building block those two are really high on the list but recovery um and sleep i think deserves to be mentioned within that you know one of those foundational pillars and the reason for that is um there are many processes that happen during sleep that are important um and one of those we talked about the glymphatic system we have this structural scaffolding in our brain these glial cells that shrink during our sleep and we didn’t know that until quite recently there was a researcher at a university rochester making netter guard who used two photon microscopy dynamic imaging to see these glial cells shrink during the deep stages of sleep and cerebral spinal fluid rushes through those channels and washes away the opposite of stress that accumulates throughout the day and in a separate study done out of um uh university of washington they lumbar punctured uh i’m sorry washington university they in st louis yeah that’s where i was exactly exactly they lumbar punctured people after just one night of sleep deprivation and what they found was an accumulation of proteins that may sound familiar to you in your audience exactly they saw an accumulation of tau protein now that doesn’t mean you know tau proteins occur naturally right it doesn’t mean they’re phosphorylating and creating these neurofibrillatory tangles per se but what we learned is it’s not just an accumulation issue there’s a clearance issue as well and so if we’re trying to protect our cognitive health deep restorative sleep should be one of the areas that we’re really trying to protect there’s also a stage of sleep REM sleep where this is a stage of sleep where a lot of emotional convalescence happens and so our ability to manage the stresses of the day a lot of these things we benefit from during these deep restorative stages of sleep are there things that would um you see individuals cause backsliding for example cannabis use or alcohol so they’re on a great trajectory where you’re doing the EEG you’re treating them with a magnet you’re putting them on very specific protocols you’re matching their wavelengths i know that there’s certain brain waves that are active during sleep that are supposed to be slower during waking and those oftentimes there’s a reversal of that in a traumatic brain injury is that true yeah yeah unfortunately especially with cannabis being a bit more normalized these days we do see slowing of brain activity and i don’t want to be kind of a preachy guy or anything like that but there should be some awareness that both alcohol and cannabis um these are compounds that will slow down brain activity and uh it’s very hard for us to overcome that so we do see people backslide with regular use of these things what does it do when you say slowing brain activity with that but there’s speed processing speed or is there other things that happen it is processing speed and so we reinforce specifically alpha activity of the brain which is uh the cycle rate that your brain processes information generally between eight and 13 hertz which means we encode information eight to thirteen times per second um mine’s more like seven no i’m sure that’s not true but the slower brain waves kind of seven between like four and seven we call theta and then slower than that we call delta those are your sleepy brain waves and so when you’re stage one stage two sleep you’re generally in theta and then we move into delta and with the slower brain waves we’re able to restore our ATP and people get deeper more restorative sleep and are refreshed for the next day um now during our wakeful hours you should see mostly alpha and then beta activity is more of your fast wave activity that’s associated with complex thinking complex processes lots of sensory inputs but you will see in the wake flowers people who use alcohol and cannabis excessively more theta activity than we want to and so that’s where we talk about the slowing of the activity they may feel like they’re in a bit of a fog and and that’s what we’re trying to prevent if uh individual were to remove that without treatment from um additional stimuli from the magnet would so you remove the alcohol you remove the cannabis do their brain waves return to normal or it’s there’s no other way to flip the switch than or is there then trans magnetic stimulation right the the body doesn’t naturally go back to a normal rhythm does it so there’s a lot of variables involved and so the quick answer it depends on uh somebody’s age neuroplasticity uh and what are the other behaviors that uh are associated with the individual so if somebody’s taking really good care of themselves and they smoke a joint one night you know they’re probably going to be just fine if they’re heavy smokers over years the recovery may be slower or the brain may reorganize in a way or it’s just operating a little bit slower and so there are many things people can do to optimize brain function we’ve touched on some of them exercise very very few things are as useful to brain function as exercise um do you care what kind it doesn’t matter to me so much what kind i think you know movement is always um the key even you know for the elderly population even just walking is helpful we do push-ups before the podcast i heard that on your last podcast we didn’t do it today but we did push-ups so you did so i have a really good friend who um she’s amazing and she was a former secret service agent and she said i said you know like hey evy should we do push-ups together and she’s like gabrielle you want your guests to be relaxed and be able to be in the flow you and matt can do push-ups but don’t you dare rope that guest into it i think okay you’re right that’s impressive that’s impressive um yeah so i try not to be too prescriptive in terms of saying you know hit exercise is the best or uh i know resistance training is but i think intensity matters i think you know when it comes to blood flow and you know there seems to be different metabolic changes just looking at martin gabbala’s work and i think maybe intensity matters but anything is better than nothing yeah you did remind me of one of the things where we we had sort of clicked at soft week based on discussion uh this was george brooks’s work at uc berkeley where he was specifically he spent as a neuroscience who spent quite a bit of his career studying the lactate shuttle and so if there was any question about whether exercise helps brain function we can dispel that notion there’s a clear correlation and what they found is that you know growing up we always associated lactate and lactic acid as a negative by-product of exercise we get sore muscles but it turns out lactate is a preferred fuel for the brain and this lactate shuttle specifically not only is it providing fuel for the brain but it’s also increasing the amount of vascular endothelial growth factor so it’s increasing vascularity through the blood-brain barrier someone called veg f which also increased the amount of brain-derived neurotrophic factor which is a proxy for neuroplasticity and so we’re learning at a cellular level how exercise can improve and up regulate brain function so and to develop lactate to your point the intensity actually matters quite a bit yeah i mean again i think that that’s fascinating i’m so glad that you pointed that out because we think about exercise as medicine there are lots of things that someone could do that wouldn’t be good for their brain like stacking drinking and no sleep and smoking a lot of pot and not exercising but the thing that sounds like a terrible don’t do that but the things that we can do that really make an impact are working really hard physically to the point where you’re producing lactate and allowing that to be fuel for the brain choosing a really good healthy diet sleeping which i’m guilty that i don’t i i know i need to but again i have two little kids they like to come and wake us up a million times a night uh just might not be a realistic thing but when you think about improving individuals cognitive function that that’s part of it the uh when my husband went and by the way so he didn’t have any no i’m sure he had blast injuries um you know they there’s just because uh breaching and doing all that stuff and you know even micro injuries when you you shoot guns there’s like micro trauma that happens one of the things that they had told him was to be very particular about sunlight was to be very particular about being outside something about melatonin something about blue light i don’t know if any of that has changed this is this was a couple years ago when he got treated were are there certain other things that you recommend for patients and brain health yes i love that you brought that up because there were two noble prizes awarded for the discovery of blue light and uh were you one of them no no i wish no i wasn’t yes uh you know i wasn’t privileged enough to be part of that team but blue light specifically is 450 to 500 nanometer light its richest in morning sunlight and this is our first biological cue to start our circadian rhythm and so the advice is to be outside sometime during your first waking hours and to get natural unfiltered blue light into your eyes and when you do that there’s a specific receptor in your eye called a melanopsin that sends a signal we just learned about this yesterday by the way yeah so it sends a signal to your supracasmatic nucleus that will tell your pineal gland to release melatonin roughly 14 to 16 hours later so the second part of that is you have to listen to your biology and the first sign of nighttime somnolence usually between 9 and 10 pm you do actually have to get into bed because when your melatonin spikes you know there’s a short window and if you fall asleep at that time you’ll get very deep restorative that’s amazing and if you miss that window you may stay up quite a bit quite a bit now that all makes sense yeah does that happen to you that happens to me all the time so basically i get really tired and i’m like i just gotta read this one more article just this one more thing yeah and then i’m like i’m up even though i just i fight it so hard yeah okay matthew walker he’s one of the he he’s sort of one of these podcast heroes that every time i list to him like that guy’s really good but he has mentioned that we’re one of the we’re the only species in nature that voluntarily deprives itself of sleep and it is usually the overachiever that’s doing that and so i’m guilty of it as anyone so to the degree possible yeah we have to be vigilant to it and try to get ourselves to sleep yeah you’re absolutely right um so i think that before i kind of got down the path of of um brain function brain waves flipping backwards the reason i brought that up is because my husband there was no way i don’t think that so basically when he did his scan he was awake but his brain waves looked as if he was asleep it was almost as if they had flip-flopped i don’t think that there would be any way for him to fix that or redirect that naturally without some kind of electrical impulse is that would that be fair to say that that that this may be that eventually this EEG of the brain this treatment of the brain would be as common as going for your annual physical and getting an EKG yeah so each case is individual your husband was in a pretty kinetic environment and so um i don’t want to speak in absolutes uh because it’s hard to predict um what may or may not have happened but brain stimulation certainly allows people a quicker path to recovery and if we were seeing theta and delta waves in the prefrontal cortex that is specifically a scenario that we do very well with um and it’s a really common pattern in our operators in general what we noticed among this cohort speaking specifically of um service doesn’t matter it can be an army delta green beret you know air force get those berets out of here i’m totally kidding i’m an av Wi-Fi the first thing we observe is they’re very fast brains they’re very fast processors they could be many of them have the profile of an olympic athlete don’t tell them that but we also see the similar signature where they’re slowing in the prefrontal cortex and i suspect some of that is they’re in an environment they go overseas they’re in a combat environment where they have to be hypervigilant they’re usually operating at night because they have the tactical advantage of night vision goggles 18 time zones away um it is circadian rhythm nightmare i did not know that with it because the night vision or just because they’re they’re awake when they should be asleep and we’re not nocturnal would that be yeah the reason why yeah they uh particularly in afghanistan and iraq the enemy didn’t have you know knobs and nvgs and so a lot of the operations happened at night yeah and shane and my husband was in afghanistan yeah yeah and so you take six months to a year of that kind of environment night after night after night many times multiple missions a night and you ask them to come back home it’s hard to get back into a circadian rhythm and many times without the knowledge of getting blue light in the morning our biology takes a little while to catch up and given enough repetition and chronicity of that type of environment there’s reorganization of brain activity that’s hard to move back not in a positive way is what you’re saying that there’s a reorganization it’s almost as if you get an injury a tendon injury and the collagen lays down cross linked in a way that it shouldn’t that’s right yeah now the happy part of that story is god or mother nature depending on whether you believe in god you know we’ve been engineered to be healing organisms and if we give the brain a friendly reminder and a stimulus that you want to be operating at this speed the body does most of the heavy lifting for us we don’t have to overpower the brain with lots of energy although electroconvulsive therapy is a modality and i don’t diminish the value of it i think it’s incredibly valuable so the sorry to interrupt you the um so that’s ect electroconvulsive therapy yeah which is you guys don’t do that or you do we don’t do that so that’s typically what you guys are thinking is was it um one flew over the cuckoo’s nest or clockwork orange or something where they they it is exactly what it sounds like but that’s not what it it is it seems as if ect would be scary and shocking its electro current therapy like shock therapy but it’s not kind of how it’s that’s right that’s right and not really often used anymore and i’m sorry if i’m speaking out of turn for the psychiatrists out there but when i trained in psychiatry so i trained at the university of willavel in psychiatry for two years and out of all of the patients that we saw i think maybe only one or two in two years where was a candidate for ect which was really depression that was absolutely resistant to every kind of medication yeah well that is a population where ect you know is pretty effective and well yeah i don’t i don’t like the one flew over the cuckoo’s nest was that yeah but that is the move that is the procedure that they describe in the movie but these days it’s a fairly safe and fairly effective procedure and so i don’t want to diminish the value of that you know i’ve had the privilege of working with numerous academic psychiatrists and it definitely has its place definitely and there are patient populations who are served well by ect what we’re doing is much lower energy and um you know you don’t require any anesthesia or no anesthesia people are awake they stay awake maybe they get sleepy that’s right it’s very it’s very mild um but but that gentle stimulation you just need a little nudge and then the brain and our biology takes care of most of the work for us what do we know about children what do we know about children in hyperactivity what do we know about children and autism and again whether it’s wave neuro or these technologies because wave neuro what makes wave neuro so unique and by the way i am so grateful for what you guys did for my husband thank you and what you guys do for so many others out there um i i think that it’s really it’s really tremendous and the thing that makes you guys unique is that you use um eg so you use the electricity the electrocurrent uh imaging i don’t know how else you would say that with the trans magnetic stimulation with the program that then creates a protocol to implement um did i get that all right yeah yeah that’s impressive um and so i’ve seen it work well i’ve seen it work for my husband i’ve seen it work for my patients and it makes me think about children because we know that probably a lot of also hyperactivity originates in the brain again i’m not a pediatric or child specialist what would you say to that and are there any trials for brain function in yeah well so first as she mentioned it’s very much our honor and privilege to take care of military service members and especially folks like your husband who sacrifice so much for the country and it’s something that i’m very passionate about and i think our whole organization rallies around uh the community specific to kids it’s not as well researched um we’re still learning uh a lot of the um the science has a ways to go but um there are large population size studies with end end of the thousand end in the thousands of autistic spectrum children where we can see uh slowed and delayed development of prefrontal cortex and and these are not our studies they’re uh studies yale has one of the largest databases where we can see um and perhaps not coincidentally it’s a default mode network that develops uh that is dysregulated in many of the autistic children interestingly just because there’s an article published within the last week gut microbiome um dysregulation seems to be an issue in autistic development as well and so there’s so much heterogeneity in this population i don’t think at least for speaking for myself i can’t speak from any position of great knowledge i think we’re learning every day but that specific issue of an electro physiologic disruption seems to be pretty clear and they’re even listing sensitivities and specificities for asd in the 80 to 90 percentile using eg so i think in the future it may be i don’t know that it’ll be a diagnostic tool but i think it can be a clinical support study where if children are exhibiting these behaviors and we see these eg changes that may help lead us down the path of having a more accurate diagnosis do you or have they done studies where they anticipate improvement in certain symptoms or even not even with autism but with hyperactivity yeah so the studies so we would like to do a large double-blind rct on autism we do have a group in australia who has done two studies one that’s been published where they look at it’s an open label study they don’t have a sham placebo but in these children they noticed clinically significant changes in social behaviors meaning they they were making more eye contact their vocabulary increased um and many of the changes that we hear from the parents and we see in the children are difficult to quantify um and measure scientifically that’s been part of the challenge uh in terms of putting together a methodologically rigorous study that would pass with the fda uh there’s no universal scale or metric uh that is um that has been declared so we were using something called the car score there’s also an ada score there’s a number of different metrics that we can use but that’s one of the first issues that we need to be able to tackle before we invest you know these trials cost millions of dollars and so to be thoughtful stewards of any kind of funding that we receive we’d want to ensure that on the back end of such a trial that we would have good data that would convince the scientific community that this is a both safe and effective therapeutic so that is something we’re aspiring to do but we have some early pilot studies that are giving us some promising data and that’s reasonable you want to make sure that the money that you’re spending that firm from funding is is used well have you this might be another hard question um because again this is very difficult to control but have you had anyone go through this process on a ketogenic diet or some kind of diet that or take beta hydroxybutyrate or some thing or a neurotropic that we would believe or know depending on what the the literature is depending on the the input show improvements yeah it’s a great question and unfortunately i don’t think we document that specific type of diet but uh but yes we’ve had a number of and it’s interesting because i i can specifically remember the cases we did have a cohort of uh seals come through and three of them were on a ketogenic diet and they were specifically on that diet for purposes of um some of the neuroprotective qualities a ketogenic diet confers and they had great responses to treatment i wonder if they had better responses than another individual but it would be so hard to so hard to measure yeah it’s hard to parse out what contribution the diet would make but it does make sense that they would have some advantage in terms of the treatment being more beneficial yeah what is new i i mean i i totally agree with it that and it would be so fascinating to see eventually if maybe there is there has to be some synergistic effect yeah because the a ketogenic diet which is 70 fat was used was used for the treatment of seizures um in children yeah i’m sure there’s some kind of some kind of crossover um a few more questions are there any nutrients that you guys feel seem to really support treatment whether it’s fast potato choline or um any kind of dietary nutrient that’s a great question um we haven’t asked for supplementation with any type of dietary nutrient per se uh there there is a segment of the population it’s very controversial this um mthfr mutation there have been some families who have let us know that when they supplemented an autistic child with methylfolate they saw a better response i’ve spoken to some researchers both at upen uh and at children’s hospital la who are skeptical about the clinical validity of mthfr it’s kind of i think a space that’s the evidence is just starting to come in and so i can’t say with any um strong scientific evidence that that would be something i’d recommend uh to other populations but it was when we talk about supplements that’s one of the first that comes to mind one of the areas that i think is worth mentioning and it’s not a supplement this is actually um a dda tracked medication but we had a couple of operators who did not respond to treatment and uh they were some of the first that we saw not have any kind of response and the commonality between these two was that they had very low testosterone and so one of the secondary effects of blast injuries and tbi is neuroendocrine disruption and it’s very common to see not just really low testosterone sometimes zero and when they went out and got supplemented and came back after having a stable dose of trt they had great responses to treatment and so it seems that there there does need to be some degree of hormone balance that lends itself towards having a more effective response to treatment that’s fascinating any any thoughts as to why well yeah i mean the physiology of it especially in men this is kind of a it’s sort of a critical hormone to have and you think about all the biological pathways it impacts and especially in terms of cognitive function and brain function we need to have at least some amount of circulating and free testosterone and so when you restore that system it makes sense that we would see a better response to treatment and you could see as well those were people who were struggling with motivation and you know all the different things associated with you know testosterone replacement therapy they would benefit from so that has kind of led to there’s a group called the special operations care fund sock f and tom hock charitable solutions was another non-profit that contributed to something called we’re calling the trifecta study and so brandon wyse is a researcher out of john hopkins university designed to study where they’re first getting testosterone replacement therapy then they’re going down to mexico this is marcus capone’s group that’s they’re getting ibogaine therapy which is a psychedelic and then they’re coming to san diego to get our treatment and so that’s the trifecta with the conceptual framework of first balancing the neuroendocrine system then ibogaine is allowing for neuroplasticity and then our treatment is riding on top of it and reinforcing alpha and dmn restoration and the feedback that we’ve gotten thus far has been not that one plus one plus one equals three they feel that this is so synergistic you know we’re hearing one plus one plus one equals ten and uh we’re still blind to the results i can’t share that data yet but i’m excited to hear it but i think that’s where the future is going is uh different protocols and stack therapies if we’re truly in this to help these communities um you know no treatment works in isolation and there may be different regimens that help you know these populations recover faster and better has there been any pushback any criticisms of the technology the protocols the things that you guys are putting together again i mean medicine is interesting it’s it’s a science of uncertainty people think that you know medical science is certain it’s a challenge it’s human body just as you’ve been saying is incredibly complex that’s a great question i remember i attended a talk at the slough institute in san diego and and they said you can always uh find um the innovators and pioneers are the ones with arrows in their back yeah but um i have to tell you the neuroscience community psychiatrists neurologists have all very warmly embraced the approach and i think anytime we’re working together collaboratively to advance the science it’s been a very kind of warm environment to work with and there’s a lot of good information sharing i would say largely it’s been positive we may encounter naysayers here and there i think that’s part of the process but largely i would say i’ve been blown away by the collaborative environment and how this community whether it’s academic clinical or commercial is working together to try to find answers for the community and work together to you know advance the evidence base in the science well i love that the work that you’re doing what what is on the forefront for you guys well the first thing is we’d really like to complete this fda trial and we’re currently enrolling in plano texas uh philadelphia pennsylvania and columbus ohio we’re about to open in seattle and costa mesa so are you still recruiting for those those spots we are still all right go ahead give us this field knock it out yeah you can you can include in the show notes i’m not sure how much i’m allowed to share there are rules that govern sort of what we can say they’re interested in being part of the study yeah there is a link that they can go to to enroll in the study there is a second fda trial happening in Dayton ohio that is sponsored by the state of ohio i should mention that there were legislators in the state of ohio senator hoeghland and doc johnson who is himself an air force veteran who sponsored our treatment for any veteran or first responder in the state of ohio so part of that was to conduct an fda grade clinical trial as well we just finished phase one of that which was a safety study and then we’re embarking on stage two which will be the double-blind rct so we’ll have two separate studies that are ongoing that’s it’s incredible and people can find you well not find you but find wave neuro yeah at wave neuro will include all of the links and is there anything else that you wanted to share with the listeners or the viewers uh i guess the closing message would just be that there’s never been a greater time for hope if there are people struggling with any variety of mental health conditions neurologic conditions there’s so much exciting research happening innovation in this area that there is valid and incredible reason for them to have hope that in our lifetimes we’ll see really meaningful breakthroughs in this area so i hope that they will be encouraged to keep fighting for their health and if we can be of any benefit yes please reach out through you know our website or you know i’ll include my email and no you will not no friends we will not but um yeah yes anyway uh you are doing an incredible incredible job helping and we’ll put everything there so that they can find out more if they have any questions they can ask our team and we’ll we’ll get them over to you if they are military veterans where do they go uh there’s there’s a wave neuro landing page for veterans as well and um and so the treatment is covered by tricare and so uh we can fund through that mechanism but i know most of our clinics welcome veterans and then if someone is listening to this and they are civilian can they come and and find out about their brain learn how to get their brain better yes of course yeah most of our centers will just do eg’s for information educational purposes as well and if they want to treat but they could also get that there yes absolutely amazing dr eric one thank you so much for coming on it’s we could have gone for another probably hour and a half but once your trials come out and all of that stuff i would love to have you back and we can chat all about it absolutely that’d be great