Dr. Krystal L. Culler, DBH, M.A. is the Founder of the Virtual Brain Health Center powered by Your Brain Health Matters, LLC. She is a Doctor of Behavioral Health and a Senior Atlantic Fellow for Equity in Brain Health with Global Brain Health Institute at Trinity College Dublin, Ireland, where she completed her residency training on dementia prevention.
Topics discussed:
- Entry into the field & background (why interest in brain health)
- What is brain health
- Why does brain health matter
- Review of lifestyle factors that impact brain health optimization and performance that are also linked to dementia risk reduction (head/body)
- Development/implementation of award-winning brain health in memory care programs and the recent launch of the Virtual Brain Health Center
Hanh Brown: [00:00:00] Today, I’d like to welcome Krystal L. Culler to boomer living podcast.
[00:01:16] Thank you so much for being here with us today. Could you start by having you share about your background information, where you’re from, where does your expertise lie and how did you get interested in this field ?
Krystal L. Culler: [00:01:29] Sure. Thank you so much for having me today.
[00:01:32] So I actually entered this journey into the aging care services during undergraduate school. I was looking like many students for a major wasn’t sure that you could major in aging and knew about the field of gerontology. I took a few classes and I absolutely fell in love with that. I was one of the first students from Youngstown state university to get my bachelor’s degree in gerontology.
[00:01:59] And also sociology cause they just went so well together and looking back on it, it was a way to find how my interest and also my life experiences at that time seem to align very well. And a career. I then went on to the university of Akron to get my graduate certificate in gerontology and my master’s degree in psychology of aging.
[00:02:22] And it was during that time that I had over health incident, where I had a seizure and it was through my own experience of learning how to navigate the us healthcare system and thinking about what aging adults goes through. Plus aging adults with some type of cognitive issue and how they are trying to navigate our systems or policies or procedures.
[00:02:47] And when I kept thinking back to my background, I thought. There has to be a better way to merge these areas together. So I actually ended up leaving my PhD program and switched to a doctorate of behavioral health, where I got to learn more about policy designing evidence-based programs and really how we treat chief the triple aim.
[00:03:08] So how do we improve population health for aging adults, lower healthcare costs and get better health outcomes. Not only for patients. But providers and those that are in the industry providing those services. And so it’s just been a nice way to have things unfold from an educational perspective, but also how a fluke lights experience can sometimes be a blessing in disguise when you embrace it.
Hanh Brown: [00:03:34] Wow What a journey and congratulations to you in the discovery and your path. And, and your passion. So explain to me, what does brain health really mean and why should we care about brain health?
Krystal L. Culler: [00:03:47] I appreciate you asking that question because for me it is something I believe that’s so important, but when we hear brain health, it seems to be a buzzword term or something that gets thrown around out there.
[00:04:00] People don’t necessarily understand what that means. And in some ways it’s really increased in popularity, especially here in the United States. The past decade or so, even though it was around before then, and it’s the idea of I come from the wellness model. So taking care of your brain and your body across the lifespan.
[00:04:21] So from younger years, all the way through adulthood and essentially the things you do, or you do not do matter to your brain. And that involves your lifestyle factors, which I know we’re going to get into, but the idea that we’re very resilient, the brain resilient, and we have lots of different ways to grow the field itself has shifted away from the mentality that to be brain healthy, you can still have some type of a disease, rather it’s a chronic health condition, or whether it’s a neurological or brain related condition that the brain house is for everyone.
[00:04:59] It doesn’t have to be disease, state driven, which we know is health in general, when we’re thinking about a definition for health or wellness. So it can be very encompassing of different things. The way I like to think about it very simply is it involves thinking, moving, and feeling. And so there’s lots of processes involved in that for the brain and the body.
[00:05:26] But that’s a simple definition. And one, the administration on community living also provided a few years ago through their brain awareness campaign that they were doing is the ability to remember learn, plan, concentrate, and maintain an active mind. And so I think that really helps people begin to understand.
[00:05:50] What brain health is, and it’s the lifestyle factors, but the last piece of their definition, the idea of an active mind, and really the research has shown us that brain health is 70% lifestyle and 30% genetics. So depending how you view that. There’s many things that are tangible to you and in your own hands that you have some level of control.
[00:06:14] So for many people, once they start to learn those pieces, it seems to be very motivating. And so for me, it’s been an exciting time to be in the field, share the information as it’s becoming available and helping people realize the role of the brain, body connection and the choices that they’re making every day for the things they’re doing and how we can nudge it.
Hanh Brown: [00:06:41] A little bit more towards the health side or the, so you mentioned 70% is lifestyle factors. So we have control over that.
Krystal L. Culler: [00:06:48] Yes we do. And for many of them, it’s not just something to consider as we are aging, brain health is for everyone. And we see a lot of the push for educating children about breeding health.
[00:07:01] It’s the same lifestyle factors that. Once we start getting into it’s, what we hear for health. It is for everyone. But what has tend to happen is over the years for some reason, and we’ve done some level of awareness, I think, which has been great around brain health, but we tend to jump from brain health to memory care, to dementia.
[00:07:24] And there is a lot of things that happen in between there. And yeah, you can still be brain healthy living with dementia. And you can still be brain healthy living with the memory issues or chronic health conditions and other conditions related to the brain. And so I’m excited to continue that dialogue with you.
Hanh Brown: [00:07:45] Sure, So now what are some lifestyle factors that impact brain health optimization and performance? And then can you talk a little bit more? How lifestyle factors impacting brain health are also linked to dementia risk reduction.
Krystal L. Culler: [00:08:00] There have been two recent reports that came out over the summer, and I like to try to mesh them together.
[00:08:06] One was from the Lancet commission. Which puts out reports every couple of years. And another one was a meta analysis on lifestyle factors and the brain. And that the Lancet commission report had found 40% of dementia cases worldwide could be prevented by the lifestyle factors that we’ll chat about.
[00:08:26] And when I explain it to people, I like to think about it from the body to your toes. So if you were thinking top down and make it tangible for them. So if you were to think about issues that would affect your brain, one of the first things you would want is education as much as occasion early on in your life.
[00:08:46] And continue to be a lifelong learner. And so that leads to the second factor, which is cognitive activity. And for many of us that will vary a little bit, but the idea that you would want to engage your brain in meaningful ways, and it’s not something you can do passively, you actually have to think about it for at least 15 minutes a day.
[00:09:10] And so you want to try something that’s new, novel and challenging. And then you also want to protect your brain. And we hear a lot about that when we’re younger with the concept of wearing a helmet and those things, but really, even as we’re older to be aware of issues that can happen to our brain and how, whether it’s a health issue, maybe it’s an accident, a rough jar or falling, and to talk to healthcare providers and to monitor that.
[00:09:39] So to watch for traumatic brain injury. Or brain trauma that can happen. And that’s been an exciting field of research that has really taken off and letting us realize you don’t have to lose consciousness to have some type of brain-related issue or trauma, and small little traumas can actually impact your brain as well.
[00:10:02] Another one that came out to working your way down, the body would be hearing loss. That was one that came out in 2017 and it’s growing field of research, but recognizing that’s one that we can really take advantage of, we can check our hearing. We can have different types of interventions working with healthcare providers, but when that goes on, it can mimic issues of cognitive decline and other things.
[00:10:25] So to pay attention to that, the one that’s always been on your rated is the sleep well. In the evening, there’s a reason why they recommend seven to nine hours of sleep, but to really prioritize that for your brain and your overall brain function.
Hanh Brown: [00:10:41] Yeah. And I want to add to that. It’s okay. To take naps.
Krystal L. Culler: [00:10:45] Absolutely. When you need to, it is, they try to say rule of thumb is 20 to 25 minutes, so it won’t interfere with your evening rest schedule. So when you need to sleep, take a nap, it’s actually very, can be very rejuvenating for people. And so sleep has been one of our big underrated wise.
Hanh Brown: [00:11:06] I’m a firm believer of that.
[00:11:09] Implement that every day. It’s great. We often go back to that. Even during this lockdown mode. I know we’re easing back into our schedule, but it’s still a back-to-back lifestyle, especially with family. And it’s okay to take that 20 minutes, 30 minutes. Rejuvenation for your brain. And then I think that allows you to go until 11 or midnight in a still healthy way.
[00:11:34] So I’m a firm believer of that.
Krystal L. Culler: [00:11:36] Yes. And it’s a nice way to give a health and a lot of people, when you try to push through, you’ll find that taking brain breaks throughout the day, just like you said, small intervals or a nap can really give you an uplift and you’ll feel even more energized in the evenings.
[00:11:52] And so when you get into bed, you’re more likely to go to rest. In a way that promotes the proper sleep that your brain and body are trying to get for that night. And so that’s excellent point to take into consideration. And it’s one of the things we encourage people to do. Another one that impacts the brain is the idea of low mood.
[00:12:13] And so watching depression, when that can be a lifestyle factor to really monitor. And then this is the factor that I think switches from the brain down to the body. And it’s stress because stress is a mind and body system function. And so you have to be able to monitor your stress, realize how stress is impacting you.
[00:12:35] I know we’re in unique times for many people finding new tools to add to your toolbox things that you could do to support your overall health and wellbeing, especially so you can sleep well at night and manage these other types of things. And so that kind of takes us from the head. Down to the body and then you hit your heart.
[00:12:54] So we hear that messaging. If it’s good for your heart, it’s good for your brain. So you want to take care of those things. You want to monitor your blood pressure, watch for hypertension, keep your weight and balance and your BMI. And so to pay attention for those things, because the higher those numbers get the greater your risk for, for brain health and other, even chronic health conditions will all increase.
[00:13:20] And things were to hurt for a long time, since we were likely younger and hearing messaging is not to smell and limit alcohol intake, the Lancet report had put out that the alcohol intake is limited to 21 units per week. If you were thinking about how, how to manage that for yourself. And then of course we know forgotten to the body, we have to move the body.
[00:13:44] And so some type of physical activity. Or formalized exercise program. It seems to be a fairly worldwide standards, not just our U S standard of 150 minutes of moderate movement, but to keep in mind, even five minutes of exercise can show health benefits. So I think that leads back to just how you said you can plan in your naps for the day.
[00:14:10] If you can plan in small breaks for movement, whether it’s natural movement or small walk, those things you’ll begin to see some overall health benefits and move that in. And then the last area, if we were to put your brain and your body into the environment, which you live, there’s been two risk factors that have emerged in the last couple years as things to pay attention to.
[00:14:33] The first one I think really hits home during the time of COVID-19 is social connections, staying connected to other people, making sure you’re not isolated through having feelings of loneliness to reach out to others, to work with your healthcare providers and those types of things. We know that can be as detrimental to our health as smoking 15 cigarettes a day.
[00:14:58] Now. So if we were thinking, we really want to be able to monitor our social connections just as we would as if we were smoking. And then the last ones, our environment is air pollution. So that came out in the new report and it’s been a new risk factor is to pay attention to the quality of the air and where you’re living.
[00:15:18] I know that’s a lot to digest.
Hanh Brown: [00:15:20] No, no, that’s great. That’s great. Let me quickly summarize what I hear. I think one, you mentioned adequate sleep. Social engagement, proper diet. So that’s only three and you meant, Oh, air quality.
Krystal L. Culler: [00:15:33] Yeah. So there’s a lot of moving pieces. And so those are really some of the big ones and the newer ones have been a hearing loss that air pollution and social connections, the other ones had been around in the literature for a while where we heard exercise take care of your mental health, especially if you’re starting to go low mood like depression.
[00:15:56] Don’t smoke, drink in moderate amounts and work with providers on those types of things. And we know we should be moving her bodies and that can look very different for people depending on chronic health conditions, depending on their age. But finding some way to add movement to your day and as part of your life lifestyle, and of course education.
[00:16:19] And it doesn’t have to be the education where you’re issued a diploma or degree, some type of meaningful engagement that you’re stimulating your mind, and that continues throughout your life. And that looks very different from any people. But to put effort into, I like to think having the mental stimulation.
[00:16:39] So you want to make your brain and your body sweat in some ways for a few minutes, each day.
Hanh Brown: [00:16:45] All that you described. I don’t think that it is expensive and it’s only targeted towards people that only can be successful in that if they spend a whole lot of money, I don’t think so. I think as long as the person takes ownership of taking on those components, boy, you’ll live a lot longer and maybe even defer dementia right?
Krystal L. Culler: Yes. And I think that’s one of the nice things is. From my experiences in working in the field is once you get some of that education and understanding how the choices you make impact your brain and your body, and what’s the practical things you can do. So setting smart goals, things that you can achieve slowly.
[00:17:30] So if you’re not getting optimal sleep and you’re sleeping five hours a day, adding two hours to sleep as a lot. But over time, if you start 15 minutes, Let’s go to bed 15 minutes earlier for a week or two. And that does require adjusting your schedule for the whole day. If you think about it, of what you’re used to slowly over time.
[00:17:50] So over a couple of months, you can get to that seven hours of sleep. So helping people realize what’s the tangible things that they can do in a practical way. So when you’re hearing a recommendation, it’s not thinking. How is this important to me? How can I make it work? And it’s been very empowering to watch so many people hear it and then take their own actions, their own call to actions and take ownership of it, do it.
[00:18:21] But you can pick one area of your lifestyle at a time and make one better decision a day, eating healthy for your brain. So things that can be achievable and then moving on to the next thing. Each area of lifestyle would look a little bit different for all of us, but we’re all nudging towards those goals.
[00:18:40] And it leads to just what you said is the idea of cognitive reserve. When we’ve done all these things we boost and we build up our brain and we have seen that Dez can help people delay symptoms of dementia upwards of seven years. So even though you would have the underlying biological pathology, if we were to scan your brain, we may see the hallmark signs.
[00:19:03] Uh, Alzheimer’s disease or other types of things. You’re asymptomatic, meaning you’re not showing symptoms and it’s these healthy lifestyle things you’ve been doing. And we keep seeing more and more studies coming out like that. The hallmark studies where the non studies of seeing that post autopsy, but even now we have a group of super agers.
[00:19:25] Where, when we study their brains, they’re looking 20 and 25 years younger because of all the things they’re doing.
Hanh Brown: [00:19:33] the right way, but like you described. So I think what I heard is that taking ownership, right? Ownership of tackling on one component at a time, whether it’s exercise, sleep engagement, reducing your stress, all the components that you’ve laid out.
[00:19:51] So if you take on one at a time, And just get better, have a system down and integrate that into your daily, living one at a time.
[00:20:00] And why is it important?
Who’s going to care for you other than yourself. And especially like you mentioned, this can differ any type of symptoms for dementia, so it’s great.
[00:20:12] It’s great. What you’re doing. Thank you.
Krystal L. Culler: [00:20:14] Yeah. And it’s wonderful the way you said it. Cause I always encourage people. The notion you can take your brain health and wellness into your own hands. And it’s just, like you said, when you take the ownership and one small thing at a time, but we realized those small things have big and long lasting impacts and it’s never too early.
[00:20:35] And also it’s never too late to start doing something good for your brain and your body. And isn’t that a nice message to know. So we know. It’s, you’re not throwing everything out at one time. You can still start and still see benefits despite what your chronological age might be in, despite where your starting point is, everyone can make gains in different areas.
Hanh Brown: [00:20:59] That’s true. That’s true. Okay. So tell me more about the virtual brain health center that you founded and how did you develop your brain health in the memory care programs?
Krystal L. Culler: [00:21:10] So I started in the field. And I spent about the past five years in executive level positions with health, nonprofit organizations, building out brain health and memory care programs.
[00:21:22] And so that’s been a wonderful learning experience from building out community based programming, up to memory care level programming and continuing care retirement community, as well as going and working with a social model adult day center. And really designing programming of putting brain health into memory care.
[00:21:45] So for those living with dementia, the engagement in a physical exercise program, having a lifelong learning program with the idea, the goal is adjusted. So for us lifelong learning, the goal might be to retain the information for those living, with some type of memory issue. It would be that it’s an enjoyable activity.
[00:22:08] They’re exposed to something new and they’re enjoying it. And so it’s an appropriate level. That’s tailored for them, but they can still be stimulated in ways that would look like lifelong learning and providing those opportunities, working with dietary to provide meals that would support people, living all of us would want to eat.
[00:22:31] The meals is the way I like to think about it. Whether you were having a memory issue or not. A healthy meal would look like and not the idea of multiple cookies and Sundays there’s times for your treats, but it’s not something you’re offering consistently. And then building out as well, a restfulness program so much, like you mentioned, it’s not uncommon as we’re needing time to nap or to restore, but actually purposely building that into programming.
[00:23:00] So at time to unwind. I like to say, calm the brain, rather that’s through meditation, yoga, relaxing music and lighter heart chats, but building and into programming in a meaningful ways for individuals. And so that’s been an exciting endeavor and I, I feel fortunate to have worked with those organizations, receive awards from the field for that work, but more importantly, my biggest joy has actually come from the participants.
[00:23:29] Because they take up these lifestyle habits and they do it and they continue to do it and they’ll ask for more. And when the challenge level is where it needs them, the days go so fast and it becomes much more enjoyable, not only for them, but for the staff and the whole program as well.
Hanh Brown: [00:23:49] So basically you’re taking your expertise in brain health and you putting it into some kind of itinerary of program, very dedicated tasks and tasks that they can take on day to day and then have them do that.
[00:24:03] Internalize it. And it’s showing results. Is it only for aging folks? I guess? Do the, do you have any other stakeholders involved too, or does it, I guess it can involve in the general public, right?
Krystal L. Culler: [00:24:15] Yeah. And so the organizations I have worked with it has been part of the organizational outreach. So what we were doing on campus or those living with memory loss or aging adults, we talked to active aging adults done similar programming with high school book club members and a few college.
[00:24:34] The student groups. And so really the notion that brain health is for everyone that the messaging remains the same, but the practice, how we can make it tangible for people varies a little bit on where they’re at in their environment, but it is very achievable. All of us likely wants to stay hydrated and drink water throughout the day, but purposely building an access.
[00:24:59] Water stations, water breaks, these types of things, but putting it around a fun activity, we used to do things out of sharing. Good news that people would have. So you could cheer and simply just making it a smaller cup. So it wasn’t so overwhelming to someone visually, like when you see a large pub would include increased fluid intake.
[00:25:21] So just small environmental changes can really have practical applications and increase the health outcomes you’re desiring to achieve. And so when I think you’re able to do that for people and support their health and wellbeing, that’s my goal as a doctor of behavioral health and a gerontologist.
Hanh Brown: [00:25:40] Well, that’s very admirable because it sounds to me that your expertise applies to the general at all age. And perhaps you’re working with the folks with dementia and helping them to continue to whether it’s thriving or putting the symptoms of dementia at Bay prolonging it. That’s great. And I do believe what’s good for the heart is good for the brain.
[00:26:04] And I think the younger folks should really not take their youth and their health for granted, because I think if they don’t own it, all these little bad habits can accumulate. And when you reach, let’s say fifties plus, it’s harder to break.
Krystal L. Culler: [00:26:22] it’s harder to break. It’s important for everyone. And if we start paying attention earlier, I believe you summarized it perfectly.
[00:26:32] You can make those smaller habits and you’ll see the larger. Benefit or reward over time. And I’m excited to see where research will be going in these areas. Now that we have more of the staff, the clinical trials, we have multimodal interventions, including lifestyle intervention that will be done longer term.
[00:26:52] And so I think we’ll, our research will be catching up to the idea of what we’ve been saying. We know from different areas of health and it will be great to see how the whole picture will be coming together. I personally find it an exciting time in the field. But regardless, we already know that when we make those changes in our own lives, we feel better when you get a good night’s sleep.
[00:27:15] When you’re properly hydrated, your mind is more clear than it is when you don’t do those things. And so when we’re starting to able to pair the education to the brain and understanding behaviors and lifestyle, it really does, like you said, empower people to keep those things up and then find those other areas where.
[00:27:35] Hey, maybe I can make a little improvement there. I could move a little more or I need to take time to unwind. Like you said, develop a habit that supports the notion of restfulness, which we know is just as important for the brain as being active and engaged. You need a nice balance.
Hanh Brown: [00:27:54] Absolutely. Yeah.[00:27:56] These are, it’s a very powerful message. Again. I think the general public, anyone can benefit from this and the sooner that you take on these, the ownership, the responsibility of your own health. Your heart, your brain, my gosh, it’s a flourish life. So how has COVID impact the brain health in general and how has it affected your practice?
[00:28:19] So I imagine many of your classes have gone online. So is it hard to have the same impact with clients over zoom?
Krystal L. Culler: [00:28:26] What we’ve realized is with COVID and watching what happened. That was really the start and Genesis of the notion and idea of the virtual brain health center was seeing the faucet. So to speak of community-based services for aging adults shut off very rapidly and knowing how many people rely on senior centers, adult day centers, lifelong learning centers, and it’s not only the programming they provide.
[00:28:53] It’s that opportunity to stay socially connected. Which then involves your mental capacities and keeps you stimulated in so many ways, as well as volunteer opportunities for so many people that I always think could work two or three full-time jobs with the multiple places they volunteer. And so our idea and concept that the virtual brain health center was to create a space where we could provide people purpose.
[00:29:20] For brain health optimization, but do it in a virtual community, realizing that many people are missing that opportunity to connect with others, a place where they can come in, meet a variety of experts around the different areas of brain health that we’ve talked about. So offering exercise programs, but a variety of them breaking down these areas of up brain health and education into meaningful segments that they can learn more about.
[00:29:49] But get the practical tips and advice for how they can use it in their daily lives. And so it really has opened up a new world for me because before I was always thinking brick and mortar, you’re limited to the area of which people could drive or come to. Well, we used to catch people willing to come a little garnish, seven emails or so, which I was always grateful for.
[00:30:12] But virtual in our launch week, we caught people from multiple States and in the U S and Canada. And so as long as the time zone fits people, it lends a great opportunity to spread the message about brain health and raise the awareness, which is our overall goal. And so I’m excited to see what this can do.
[00:30:32] But also realizing the people that have been finding us are those that have been isolated at home because of COVID that were actively engaged in those previous services have limited family or a widowed and are really looking for someplace to come and build a community. So I feel so grateful for their gift of presence, as well as our instructors.
[00:30:55] To have the opportunity to create this for other people.
Hanh Brown: [00:30:58] Wow. What a blessing in the midst of this crisis, they have a place, an online place to get connected, engaged, and educated, and taking ownership of their health, their brain, their heart in the midst of this mess. So bless you. That is wonderful. And then you, obviously you gather a lot of expertise within the profession, this profession to collaboratively support the different centers.
[00:31:24] So that’s awesome. Yeah. So do you, you have anything else that you would like to share with the audience?
Krystal L. Culler: [00:31:30] No. I appreciate your time in this conversation. And if anyone’s interested in learning more about what we do at the virtual burning health center. We’re found online virtual brain health center.com.
Hanh Brown: [00:31:44] Great. Thank you.
Krystal’s LinkedIn: https://www.linkedin.com/in/klculler/