What’s Really Good, Perhaps the Best, Brain Medicine?
- 2 days ago
- 7 min read
“What's the single worst daily habit for your brain? Lack of connection. The single best daily habit for brain health? Connection.”—David Perlmutter
I recently watched a YouTube conversation between David Perlmutter, a neurologist and bestselling author (Perlmutter has a new book), and Mark Hyman, a physician and prominent voice in functional medicine talk about brain health. For most of the discussion, they talked about familiar brain-health concerns: toxins, food, exercise, inflammation; and moved to Perlmutter's latest contribution to the research - rogue microglia and immunometabolism.
Then, at the very end, the last minute of the interview, Perlmutter participated in a rapid fire round of questions. When asked to name the single worst thing for the brain, he answered, “Lack of connection.” When asked to name the single best thing for the brain, he said, “Connection.”
What? After all that talk about toxins, food, and exercise, and microglia, the big piece was relationships?
If connection is so important, why hadn’t they spent the entire hour talking about friendship, community, and belonging? I can’t answer that, but I can sketch out what I think he should have talked way more about in the interview.
Human connection is not merely an emotional bonus added to an otherwise healthy life. The brain is fundamentally a social organ. Relationships affect nearly every biological system. Let me repeat that. Relationships affect nearly every biological system.
For most of human history, separation from the group was dangerous. Alone, we were more vulnerable to predators, hunger, illness, and attack. Our nervous systems therefore learned to interpret secure connection as a sign of safety and prolonged isolation as a possible threat. Connection makes us feel safe.
When we feel safely connected, the brain’s alarm system can settle. Stress hormones such as cortisol are better regulated, and the parasympathetic nervous system—the body’s “rest and restore” system—can become more active. Blood pressure, sleep, immune function, and emotional regulation may all benefit. A warm conversation may look like nothing more than two people sitting together over coffee, but inside their bodies, many good things are happening.
I have personally experienced this intensely. One memory stands out of being totally stressed out, going to the family cabin, seeing John's family, getting hugs. I could feel my blood pressure drop. I could sense the oxytocin overpowering the cortisol.
Chronic loneliness can produce the opposite pattern. We feel unsafe. The lonely brain may become more watchful for danger, rejection, or betrayal. Sleep may become lighter and more disrupted. Stress responses may remain activated longer, and inflammatory processes may increase. Over many years, these conditions can affect the blood vessels and brain systems involved in memory, attention, and decision-making.
Secondly, connection and conversation exercise the brain. Okay, let me repeat that. Connection and conversation exercise the brain – yes, more than brain games. Consider everything that happens during a real conversation.
We listen to words while interpreting tone and facial expression. We remember what was said earlier, search for words, decide what is appropriate to reveal, regulate our reactions, imagine the other person’s point of view, and formulate a response—all within a few seconds.
Conversation activates language, memory, attention, emotional regulation, perspective-taking, sensory processing, and judgment. It is a kind of natural whole-brain workout. Other people also bring novelty into our lives: new stories, ideas, questions, problems, humor, and experiences.
These help us build what researchers call cognitive reserve—the brain’s ability to continue functioning despite age-related changes or disease.
Psychiatrist, Norman Doidge wrote about this almost twenty years ago. He made the case with real-life stories for previously unimagined malleability of the brain – neuroplasticity; his hugely important book was The Brain That Changes Itself. It’s still on my bookshelf.
Then there is inflammation. Brains on fire. Loneliness and isolation have been associated with changes in immune function and increased inflammatory signaling. There’s a lot of newer biology involved here, but the bottom line is chronic inflammation can damage blood vessels, interfere with communication among brain cells, and impair neuroplasticity, the brain’s ability to adapt and form new connections.
Perhaps the least considered power of connection is that it influences so many other parts of our lives. Researchers sometimes call this an “upstream factor.” It is something that affects numerous conditions farther down the stream.
People who feel connected may be more likely to walk with someone, attend an exercise class, eat regular meals, keep medical appointments, take their medications, and remain mentally active. They may also have more reason to get out of bed in the morning because someone expects them, needs them, or will be glad to see them.
Connection, then, enables exercise, food, and sleep. It often helps make those healthy behaviors possible and sustainable.
I see this in the SAIL (Stay Active and Independent for Life) exercise classes. The participants receive aerobic exercise, strength training, balance practice, and stretching. Those are all good for the brain. AND people also greet one another, laugh, notice when someone is missing, offer encouragement, and share pieces of their lives. They have somewhere to be and people who expect them to arrive.
Someone exercising alone at home may perform exactly the same movements. Yet that person may not receive the recognition, conversation, routine, encouragement, and belonging that come from being part of a group. In SAIL, the physical exercise and social connection are not two separate medicines. They strengthen each other.
Though he didn’t expound on it in the interview with Hyman, I am grateful for Perlmutter’s unexpected brief final response because connection, because it is often missing from our conversations about health. We talk about carbohydrates, supplements, steps, blood tests, and waist to hip ratio. We may spend hundreds of dollars trying to protect our brains while overlooking the person walking by us or sitting on a bench at Pybus or in the park —or our own quiet need to feel seen and known.
Connection does not simply mean having many people around us. We can be lonely in a crowd, in a marriage, or even in a church. Healthy connection means having relationships in which we feel understood, valued, safe, and useful. It means having someone with whom we can be honest, someone who will notice our absence, and someone whose absence we would notice. It also means having opportunities to give, because our brains seem to need not only the feeling that we are loved, but also the knowledge that we matter.
Here are three simple ways to give our brains more of this kind of nourishment:
Turn one ordinary contact into a genuine encounter. Look up, use the person’s name, ask a real question, and listen long enough to hear the answer.
Brain-healthy action - turn an ordinary contact into a genuine encounter; the brain senses we are loved, safe, and we matter AND it gives the brain a good workout. Combine connection with another healthy behavior. Walk with a friend, invite someone to your place for dinner, join an exercise class, volunteer, or sing in a choir.
Become someone’s reason to show up. Invite a person who may be drifting toward isolation and let them know that their presence makes a difference. Do not merely tell them they are welcome; give them a meaningful place in the group.
Perhaps one of the most healing messages our brains can receive is not “I have followed every health rule,” but someone knows me. Someone needs me. My presence matters.”
How might we journey together toward the good life by helping keep our brains healthy.
Now let me add that even deeply forgetful people still are worthy, still matter.
A deeply forgetful person may lose the ability to remember what happened yesterday, follow complicated instructions, manage money, or tell a story accurately. But that does not mean the person has lost the ability to love, enjoy, contribute, choose, and comfort others. (Stephen Post has a lovely book on the beauty of deeply forgetful people.)
Memory is only one part of being human.
A person with dementia may still offer:
Warmth—a smile, touch, laugh, or affectionate greeting.
Companionship. Two people do not have to discuss important ideas to enjoy sitting together.
Emotional wisdom. People who can no longer explain much can still sense sadness, respond tenderly, and appreciate humor.
A lesson in presence. This is a big one! A deeply forgetful person may live more fully in the immediate experience—the taste of pie, sunshine on the face, a familiar hymn, or someone holding their hand. John’s mother became forgetful toward her later years (she lived to one month shy of her 100th birthday). On long drives, she would look at a tree and express her delight in it, quote a few lines of that Joyce Kilmer Trees poem, “I think that I shall never see a poem as lovely as a tree.” And repeat the whole sequence about a minute later. It struck me that I needed that as a much younger person. I had already let my worries run around like a hamster on a wheel in my brain and forgotten to be present to the beauty right in front of me.
All our efforts toward maintaining brain health should not make the mistake of measuring a person’s value primarily by productivity, independence, or mental sharpness. If those are our standards, every one of us becomes less valuable when we are sick, disabled, very young, or very old. Human worth must rest more deeply than that. And I must say that it never failed to impress me that until her dying breath, despite her deep forgetfulness, John's mother never lost her beauty, her love of poetry, and seemed to bring a dignified peace, dignity, and grace to a room just as she always had.
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