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Welcome to the Healthy Brain Toolbox. I'm Dr. Ken Sharlin, neurologist, speaker, author, and host for this show. In each episode, I interview influential people whose work impacts how we live and how we think. My guests are leaders in the health and fitness industry, physicians, scientists. Authors and public servants. Here, you'll find conversations that break down barriers, expand your horizons, and give you the tools you need to protect your health and nourish your aging brain.

Dr. Ken Sharlin: 0:33

Welcome to the Healthy Brain Toolbox Podcast. I'm your host, Dr. Ken Sharlin. Today I have the pleasure to welcome Dr. Kultar Garcha, a family physician and chief medical officer at Flow Neuroscience. This is a pioneering company bringing transcranial direct current stimulation that's TDCS into accessible evidence-based use for mental health. With a unique background bridging clinical practice and neuromodulation innovation, Dr. Garcha translates the science of brain stimulation into practical tools for mood, cognition, and performance. In our conversation, I'll explore with him the fundamentals of TDCS, what it is, how it works, and what the research reveals and we trace its evolution from early clinical use to the development of the Halo Sport and the new Halo device shaping the future of Brain Health Technology. Dr. Garcha, welcome to the Healthy Brain Toolbox Podcast.

Dr. Kultar Garcha: 1:40

Thank you. Delighted to be here, Dr.Sharlin

Dr. Ken Sharlin: 1:43

Uh, well, Dr. Garcha, just to get started, you've worked extensively in neuromodulation, and I'm curious what first drew you to exploring the brain through electricity rather than chemistry. The traditional pharmacology of a drug approach.

Dr. Kultar Garcha: 2:00

That's that is how I started. So as a family physician, my day-to-day toolkit for mental health, in fact, for most physical health conditions, is heavily weighted towards the medication, the pharmacology. And I want to be clear, those drugs, if we talk about mental health, SSRIs, SNRIs their life-saving medications for many people, but they are by nature. A systemic intervention. So you alternate, you are altering the neurochemical environment of the entire brain, the body where it gets absorbed. And that's to target a problem that we are now really understanding is a circuitry problem. And that's then what drew me to neuromodulation to electricity because it was specific, it was specificity, it was targeted. And the brain is an electrochemical organ. Uh, it runs on electricity, it's action potentials on gradients and ions, and we've every thought we have, everything we do is just based on those electrical signals. Knowing that and knowing the precision just felt right. This is the space. I think there's so much more. We don't yet know. There's a lot of research in the area and I was fascinated by this increasing precision and form factor.

Dr. Ken Sharlin: 3:17

Yeah, I've been interested in really a whole variety of forms of energy and how they impact brain function and brain health. But specifically TDCS really going back to when I opened my doors here at Sharlin Health and Neurology 10 years ago, and I was telling you before we started, I had attended a very interesting conference in the NAPA area of California. Neuromodulation conference several years ago now. And there were lots of biomedical engineers there, as well as clinicians really making the point that this may be a very new topic for folks, but I want everyone to understand that it's actually been around for a while and while it is a subject of ongoing research, there is plenty of peer reviewed publication, plenty of studies from our top universities. There was a really strong presence from Stanford, which is I think where the guys who started Halo came from. So this, while this may seem new to a lot of folks I want to reassure you that, this is a technology in my opinion, as time has come and there's been a tremendous interest in this for a long time.

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Dr. Ken Sharlin: 6:16

But for someone who's hearing about this for the first time, exactly is transcranial direct current stimulation?

Dr. Kultar Garcha: 6:24

Let's break down the name. I think it does sound quite intimidating when you do hear it for the first time, transcranial simply means through the scalp. So it's a non-invasive form factor direct current, and this is the key way the technology work. It's a very weak constant, that's a direct bit constant stable Flow of electricity, like from a battery, like what we would get when we put those in devices. And the current we're talking about is very tiny, one to two milliamps. And then the stimulation. I almost think that might be a bit of a misnomer. I prefer the way a word modulation. We're not zapping the brain. We're not forcing neurons to fire, but it is, it's a neuromodulation technique. It's non-invasive and it just uses a weak current to gently nudge the resting membrane of the neurons.

Dr. Ken Sharlin: 7:16

At my level of understanding of this, that's really key. And so maybe we can just even break that down further for folks listening so that they understand, and please correct me if I'm wrong that n nerve cells have what is called a resting potential. And that's measured, it's a negative rest resting potential. The stimulation to fire an electrical signal, an action potential. And I'm even separate from TDCS, how did nerve cells fire their action potentials? It has to reach a certain threshold, so we think of. The ocean or a body of water that's moving and you can see that wa it's not flat going up, down. It has parts that are high, coming up. There's a certain Flow to it, thus Flow, neuroscience. But that, in other words, at any given moment in time, there will be a subpopulation of nerve cells that are closer to reaching that action potential. And so my understanding of TDCS is that. Although you're applying a small current and generally it should not be painful folks, and if it's painful, something's not right here. And we could certainly talk about that, but it's just enough to reach those nerve cells that are close enough to that threshold of firing an action potential push it. Push them over the edge, get them to fire that action potential and thereby activate specific networks of nerve cells in the brain to achieve an outcome that depends on what part of the brain you're stimulating. Would you, is that reasonable in terms of an explanation?

Dr. Kultar Garcha: 8:55

It really is. I think that's that's spot on. It is about the, this there are two. Yep. It's the resting membrane potential, which you just talked about and then reaching that point, say of that fire firing threshold where they then. Activate. And so when you target with any form of neuromodulation, but say even with this one, you're getting more of those cells to over time increase their resting membrane potential. So that is that much closer to the firing threshold when that signals there. And then when that's in a network, of course, then the pathways are just more active over time.

Dr. Ken Sharlin: 9:31

The brain is such an eloquent organ. It's really responsible for everything we think and do and feel, and there's a lot of work that's already been done in understanding the functional neuroanatomy where, what part of the brain is responsible for moving your leg. What part of the brain is responsible for your emotional self your, where we can treat depression or potentially treat memory. And that's how we learn, okay what part of the brain needs to be stimulated? So if I were using a TDCS device, Dr. Garcha, and I wanna, if it's okay, I'd like to start with a more, it's a generic device, if you will, meaning that we're gonna, we have the flexibility to place the leads. on the head. And generally it's my understanding there are two leads, a positive and a

Dr. Kultar Garcha: 10:23

Mm-hmm.

Dr. Ken Sharlin: 10:23

Could you walk us through what that would look like if I, if you were, if I handed you or you handed me a TDCS device and, people can buy these things. They're not necessarily FDA cleared but they are available. But it might be very confusing to use unless you have some clarity on what you're supposed to do with it.

Dr. Kultar Garcha: 10:41

I think there are, what we talked about earlier is affecting the resting membrane potential of those cells. But of course, which cells are we targeting and that we, that's where, when we do those placements, so yes, we do have two electrodes. We have the positive one, the anode that causes a, it is the positive field and that causes then the resting potential slightly less negative. It's raising them up, it's getting to the threshold, to the firing threshold. So the current is going in on that side, on the anode. I'll talk about targeting wear, and then on the cathode, the other, the secondary lead, the opposite happens, so actually makes the neurons there slightly less excitable. So anode, more excitable, cathode left less excitable. And therefore, depending on which side you want to stimulate, you might then have. Wherever you want to get more cells firing. More neuron, more neuronal activity, that's where you would put your anode. Then we talk about where in the brain, so the. We have all the different areas. If we maybe just separate it into maybe the four lobes, right? And so then we can talk about then the frontal, parietal, temporal, and occipital lobes. So again, and all of those, within those lobes, different regions, we can again, target to see what intervention, see what activity we want to try and modulate and try and increase. Many devices will have where you can move those electrodes around. Some devices, like the Halo, for instance, is quite fixed and we're targeting some areas where they can be responsible for many different things.

Dr. Ken Sharlin: 12:21

So if I happen to have one of these things, perfectly legal to purchase one in the United States. Although I think you and I probably agree just because something is over the counter doesn't mean that we should just go out and put this electricity on the head and play around with it. It, to me, it's still a serious, very serious device. Although if used properly, there could be a lot of benefit. But if I were to buy one of these and apply these. Really how safe is it when it's used correctly, and what does it feel like, if anything, what should I be doing with it in general?

Dr. Kultar Garcha: 12:59

And the operative phase there is used correctly. Now, it is used in that way extremely safe. At the same time, it's not a DIY experiment, it's not a battery experiment. You don't want to use it outside of too much. You want to make sure where you're targeting and so forth as well. And there are things, because this is still current, even though it's weak, it can have effects on the skin. Uh, it does cause changes in that activity. So we still want to make sure that it's very controlled, it is safe. Those devices do have that medical grade backing and research and safety behind them. Now the feeling itself is very mild. What happens? So if we think of the TDCS device for the first minute or so, 30 to 60 seconds, it doesn't immediately switch on to the one milliamp, to the two milliamps. It has to get there and rise up over time. That's when most people will feel a mild T tingling, a little itching sensation on the scalp where the electrodes are a. That's just where the nerve endings in the skin. It's not the brain. There's a nerve endings in the skin basically feeling that sensation when it reaches its stable. Current, the two milliamps. Typically, most people don't feel anything at all, and then at the end when it's ramping down, when it's coming back down to zero again, you might have a sensation similar to when it was starting. So that tingling, that slight itching sensation. When I use it, it's almost like something's crawling on my skin and I want to scratch it. I can't move it at the moment because I'm having a stimulation, but that's generally what they. Describe, and as you mentioned earlier, this should not be painful. This is not something the current is so weak that it shouldn't be. And if it is, that means either we're not using or people aren't using the pads properly. There's a bit too much resistance and so it should not absolutely be painful.

Dr. Ken Sharlin: 14:50

And there are both in the context of strictly the context of a research study that's been IRB approved where the investigators have written this protocol. There are specific ways, areas of the head that are gonna be, it's gonna be applied to how long, meaning 10 minutes, 20 minutes, whatever, how many days per week, et cetera. And then outside of that context, there are. Generally because we're in the age of the internet, so you can look stuff up. There are protocols that are published. They may or may not have as much evidence backing. But to my knowledge right now, there is no TDCS device that per se in the United States. And I think things are a little different in Britain and the European Union but in the United States it is approved, where the practitioner can say, this has an A disease specific indication, Alzheimer's, Parkinson's, MS, depression, schizophrenia, bipolar, whatever. We can use words like aid, support, evidence-based, what does the science tell us, et cetera. But I want to be clear, there are definitely devices currently in the United States, FDA-approved that have a little different approach, but in some respects do overlap with TDCS, such as transcranial magnetic stimulation or TMS. Also there's been some work done with. Transcranial alternating current versus direct current load. In my mind, that works more through brain entrainment, which is a little different than what we're talking about again, but there are overlaps. So with that in mind though, what were the early breakthroughs that really convinced scientists that this device has some real potential?

Dr. Kultar Garcha: 16:45

I think the single sort of the pivotal paper was around 2000. That was by Nietzsche and Paul in Germany, and research in TDCS had been done even prior to that. But I think it was that study really that. They, and they were applying current to the motor cortex, and what they found there was even after the stimulation, there was that effect beyond that. So it increased the excitability, but it was. Essentially that plasticity, that neuroplasticity, that it was having an effect after the stimulation had stopped. And that was a pivotal moment because it was if you then repeat that and you do that more, can you have a longer term effect? And basically a. Work with the brain's amazing plasticity that it has and there and modulate that. So influence the plasticity that it already has. And then a lot more research then was done following that in different brain areas. I think the majority has been around. More around the prefrontal cortex. We do have disease areas like you mentioned, which have a lot more research by them. I think major depressive disorder has a lot, but there's stuff around bipolar and addiction and Parkinson's stroke rehab. There is lots of indications. And again, this just speaks to the area of the brain that you're targeting. I absolutely agree with you too, around. The regulatory side as well. So at the moment there isn't an FDA approved device for TDCS at least in the UK and EU where Flow is where I'm based. It does have a licensed indication. It is for the treatment of. Major depressor disorder and their physicians are able to customize the treatment. In fact, the device is available over the counter again for that same indication, just owing to its safety and Flow. And the Halo device is there already. And even with Flow, working with the FDA to see can we get again, a licensed indication and we're hopeful. That just knowing how innovative the US is and really being at the forefront of technology that will adopt this very soon.

Commercial Break 2: 19:00

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Dr. Ken Sharlin: 20:56

Now we've touched on some different conditions, diagnoses, stroke, recovery pain, perhaps neurodegeneration. Any of these areas really stand out as having some of the most encouraging results.

Dr. Kultar Garcha: 21:11

Depression major depressive disorder, I think, ha, it just has the most research behind it. That's not to say. doesn't affect all of those. It does. I think there's even more around addiction. We're seeing a number of things, chronic pain and other things as well. But here around depression, I think, and even in, since the early 2020s, there's class A evidence, there's metro analysis, very good quality, systematic reviews, a number of RCTs showing the effect that it has. And that's predominantly when they target the prefrontal cortex and what we know in depression. People who unfortunately suffer with that region is consistently hypoactive. It's just less active. And therefore, exactly what we talked about earlier, if we increase the amount of firing that happens in that region we can then modulate that, increase it, and then leading to improvements. The prefrontal cortex, as many of you will know, is responsible for that executive function. It isn't just in depression, there's so many more applications for it. So all of those things, working memory, we talk about inhibitory control, cognitive flexibility. You've talked about this with previous guests as well, about just how much of this. Region is responsible for, and I think that's where the most research is, and a lot more promising research coming up even for depression, but for those other disorders that you mentioned as well.

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Dr. Ken Sharlin: 24:12

Now there's a lot of folks out there who are just really interested in brain health. The term biohacking was coined several years ago by, well-known person in the health space. Dave Asprey. I think he actually was one of the promoters of the original Halo Sport. And, we listen to Huberman podcast and others people are, don't necessarily have a diagnosis, they're healthy, quote unquote. What do we know about the use of TDCS in healthy individuals, say for focused learning or even athletic training?

Dr. Kultar Garcha: 24:46

It is the other side of the same coin that we were talking about. It's exactly why it's the premise of Halo. The new Halo device, which has been launched So, and the principle is identical. It's used to depend on neuroplasticity, I don't think, and we don't as a company and nor should many people who are looking at this think that this should only be limited to when you have a disease. The name, and so much focus is around prevention and wellness and betterment. So why? Should you wait? If you can aware, and the evidence suggests this clearly if you can use neuromodulation beforehand, it's exactly what the original Halo Sport, again, the premise of that was you stimulate the motor cortex if you prime that region. If you look after if you look at athletes, and the evidence was very compelling that it did improve performance, you think of reps and practice swinging. We have musicians using them. That heightened plasticity basically stuck more effectively leading to that. Now, that was with the Halo Sport. If we look at the Flow device, and I'm fortunate enough to really be able to go into the data, we started to see very clear results. Even for those who didn't score as having depression. so they were using a depression questionnaire, but they were based on their score. They were well at the time, and we started to see very interesting insights. Interesting unsurprising because again, it's targeting the prefrontal cortex, but exactly what we talk about here,'cause we are on things like focus and emotional regulation, sleep, all those things which are all features within depression as well. But they are areas that we can then. Help to improve, and for many people, myself included, I can definitely benefit for stuff like that. When you are in the zone or in Flow, that is when the prefrontal cortex is in that high performance state. It's filtering out distractions. It's keeping you on task. If you're struggling to focus, it's probably moving. Its top down. Battle with the distraction. So why not prime that region? Why not give it that little boost? It needs just to be the conductor that it is for the rest of your, for the functions and for the brain.

Dr. Ken Sharlin: 27:05

Yeah. for folks who might have trouble visualizing a little bit of what we're talking about, of course I'm wearing a set of headphones and the original Halo Sport looked exactly like this. The nice thing about it is that for the most part is the whatever you would call the band that keeps the headphone, makes the headphone all one piece. As I put it over my ears, it, the position of this it pretty well approximates the location of the primary motor cortex of the brain so that the actual technology of the device really was not over the ear, although it's nice to have music come in and the second version of the Halo Sport allowed for that. Because I'd be on my bike. I was triathlon training and I'd warm up on my bike with, in a stationary trainer or what we call a Compu trainer. Those are not available anymore. But at any rate, they were at the time. And for 20 minutes I'd do my priming and then I'd be ready to get into the big part of the workout. But at any rate, the leads were act are actually embedded. And this is easier to see if you're watching this podcast on YouTube, but we're actually underneath the band or whatever you would call it the piece of metal or, maybe has some foam around it for comfort sake. But that connects the two ear pieces up over your head. So it's a right side and a left side, and it's all, controlled with an app on the phone, whether it's an Android or iPhone. That made it very user friendly. And then we will talk a little bit about the both of these devices, the Flow, the new Flow device, and how that's a bit different but largely also very similar as well. But I'm just want, when we talk about drugs people say is this gonna work for me? And of course the answer is there's not a single. Thing that, works for everybody all of the time, that as we, if we're data driven and the data maybe has been mixed or controversial is there anything that we need to keep in mind in terms of individual variability and who's the right candidate for this? I'll put it in quotation marks, treatment or approach.

Dr. Kultar Garcha: 29:16

In my practice all the time. Again, there, there is nothing, as you said, there is nothing that will work for everybody. We know that for all medicines. We know that even for this technology, it's not. This, these, the Halo Sport, the new Halo, the Flow device. It's not a page passive sort of magic cap. You can't just put it on. Just expect to get some smarter learn faster. It can amplify what you're doing, but there has to be some effect. And even when you are doing those things, it won't work for everybody. We're seeing that with the early Halo users and things as well. What I would say is there is a lot of. A lot of people who do find some benefit, the degree of benefit that they will find similar to medicines varies. What the, one of the real pluses here is really minimal side effects at the same time. So with some medicines, again, they, you typically see when some things as the effectiveness goes up. Uh, at the same time, sometimes the side effects and the risk profile goes up a little bit as well, not quite what we are seeing with TDCS. Now. We are learning all the time. We want to learn and really understand who will it work for, have a level of prediction. We can see right now even with early Halo users, 70% of users are seeing benefits across mood, sleep, focus. What is it about those 30%? How can we increase that? How could we predict it before? The other great thing is we do tend to find these results pretty early, so this is between two and four weeks of starting. So again, this technology does work pretty quickly in the space, but we absolutely need to learn as does the wider field. Really getting better at prediction and understanding what is it about that individual variability that we've had. Is it around modeling? Is it just because some people won't respond? Is it because it's slightly different areas? Again, everybody's brain is unique. What if there are just other areas involved in some of those habits which are unable or don't get targeted quite as much with the technology?

Dr. Ken Sharlin: 31:20

It is also my understanding that even when in informal, rigidly controlled studies, there's a good signal of efficacy or benefit, then some of the questions are, okay, you did this five days a week for six weeks or eight weeks. What next? Is there a maintenance dose, so to speak, where you can back off and. Three times a week or whatever. And at that time at least there were unanswered questions in that arena.

Dr. Kultar Garcha: 31:47

There were, and I think that's generally it's expensive to run studies. You can't run these indefinitely. We find the same in pharmaceutical and studies as well. So the earlier studies, because the technology had to be delivered in a clinic setting, they were done for a few weeks at a slightly higher frequency as the technology. Was able, had the form factor that could be done at home, it could be done remotely, it could be monitored elsewhere. We can lengthen that time out. So with the Halo device right now, what this is backed off of users across in other regions across the uk, eu, and so forth. We find that the first three weeks does have a slightly more. Intense protocol. It's five times a week. Now that's only half an hour, so it's two and a half hours probably. I wouldn't myself term that as intense, but it's a little bit more involved. And then after that three week stage, you move that down to between two and three times a week, and you can use that long term. We do see that benefit. It's not. Exponential. It doesn't keep on increasing where you plateau and then you can see some incremental benefits over time. But at the same time, by using it, we don't see that it drops off. It doesn't build up this level of tolerance. That's what the data is suggesting. And the fortunate thing, again, with technology and digital devices, you can actually track them. You can track the usage so you know what's happening, if people are using it. When they're using it, if they stop using it, why that might be, we can understand what the reasons are and so forth. So really allowing the data to help inform what's next how it works, why it works, who it works for, and so forth.

Dr. Ken Sharlin: 33:28

Now as we segue toward talking about the newest iteration, the new Halo device from Flow, as I've mentioned, I'm. early adopter, very interested in the original Halo Sport and was my recollection that the team of people that conceptualized and ultimately created this device from an entrepreneurial perspective were had a background in bio biomedical engineering from Stanford. These were, pretty smart guys and women, I'm sure. But anyway. I'm just curious if you know a little background on that story. And, we always say if you're an entrepreneur, basically you're trying to solve a problem. And what type of problem do you think they were trying to solve when they launched the first Halo Sport device? And again, focusing in that case more on the motor cortex on the prefrontal cortex.

Dr. Kultar Garcha: 34:21

So look the founding team, as you said, they did have really deep roots in invasive neuro invasive neurotech, cochlear implants, neurostimulation for pain, and they really were experts in that field. But what they saw was that principle of neuromodulation, essentially was really trapped in these really expensive. In clinic, hospitals only devices. And what they wanted to do was take that core finding of that study in 2000 and beyond, uh, that non-invasive stimulation can induce plasticity, not just implantable, and then build a consumer product around it. Now, at the time, again, just referencing that early pioneering study. They targeted the motor cortex for that reason. It was the best understood at the time it was accessible. it wasn't that they were, people aren't training hard enough, but it was, it's hard to do learning learning motor skills that can be sometimes inefficient. So it was tool to basically accelerate that part of the brain's learning. One of the challenges, of course, was the interface, and that's why, again, it's just around the form factor. How can you get that technology, how can you make it into a form factor, which is easy to use? It's not all about moving leads and having exact placement, but something as you described. Very well, basically a headphone the second device did have those audio capabilities and then saying, how can we do that? Like you mentioned for your training, use that as a primer before you are doing that particular activity.

Dr. Ken Sharlin: 35:54

We of course, need to depend on ev evidence from studies, from trials. It's talk about trends and patterns and statistics. This device was marketed directly toward athletes and musicians. It again, did not, I saw the value as a neurologist, for example, in working with people with Parkinson's or other gait disorders. Anything that might in one way or another, directly or indirectly involve a motor cortex, even with Parkinson's involving what we call the extra peral motor system. But I'm just wondering, one thing that we do love are stories and wondering if there were, if you're aware of any particular breakthroughs with musicians or athletes that used the device and went on to excel in their area of specialization as a result.

Dr. Kultar Garcha: 36:44

We've got a number of use cases and stories that I read about, I both read about, I think I met some of them, but in both fields in track and field. We had some in the NFL, it was being used. We had some even. Although it was musicians and athletes predominantly but even those who'd had some injuries again, so they'd used this because of know, they'd been in some trauma and things as well. So learning those story, just reading about those stories again, it's just that inspiration. It's why we're in this field. It's why still practice as a physician. It is those, it's very easy to get caught up in numbers and look at percentages and look at populations. Every one of those numbers. Every one, that 1%. It is a story underlying that. so across the field field athletes, but just across the spectrum, both within disease and so forth, I guess look, some of the most memorable will always be your own patients those who you've seen through a journey. So I've got. I've got a number of patients who have really struggled with health overall with mental wellbeing as well and really seeing the challenge when the medications haven't worked, when therapy, what hasn't worked when they've got other comorbidities of physical health. The all the people around them when they've struggled with. ideation and seeing something which again, is just so safe, it can be added to these treatments. And just seeing that profound effect. I met with one of my patients last week. Now we do a score even in Halo. There is a scoring system. We use clinically validated scales to me to measure progress. And for this lady she's 46, but from starting and she's been using the device for around four months. But from the starting score to now, her mood scores had improved by 83%. That is just incredible. She's on two medications, two different antidepressants for mood, which now started tapering her off. We're getting her off one because of side effects. But when you, when I was, when I'm sitting there with her, talking to her about the profound effect it's made just on her day to day and what she's able to do, and she's able to go and socialize again. It hits you. It hits you, it, it makes it, it makes everything we're doing worthwhile.

Dr. Ken Sharlin: 39:01

That's lovely. for folks who didn't. this early on. The Halo Sport device is not commercially available anymore and or you be hopefully you can be a little candid in explaining it. Certainly didn't, to my knowledge, have anything to do with the technology itself or. The beauty of the device and what it offered people, it may have been more of a business model and the traction it was able to get to sustain the costs of running that business. out of, from the Ashes, rises of the Phoenix and we now have the new device. It's still, I believe, called the Halo device. But Halo Neuroscience as a company was acquired by Flow. Can you take us through that and really then we can start talking about what the new Halo device is all about.

Dr. Kultar Garcha: 39:53

Absolutely it wasn't about the technology at all. I think there were with any device or with any company so many. Great companies do sometimes struggle with the business models. The timing for the original Halo Sport was just really unfortunate. When the pandemic hit, there were some trials that were going to start to expand the use of the indications and actually. The new device, which they were going to start really focusing on and use for the next the next release was actually targeting the prefrontal cortex. So there was a device, the Halo mind which was going to, really look and go after some of these indications. So it really aligned well almost with again, what Flow was doing. So the very unfortunate demise of Halo's sport, but then Flow acquired that technology. And so now using again, the form factor, which Flow is used to the new Halo device has is born again, now it's targeting the prefrontal cortex. We know, we've talked about it already on this in this show that there are of course, many other regions, we hope, of course, in the future to see about other areas. Do we how do we, again, target the motor cortex and so forth? How do we target several areas? What is it and what is that combination? So that's all to come, but we have to be grounded. It's a core philosophy as we have to be grounded by the evidence, the research and what we know best, and then release something which is, has really got that. That good backing. We don't take the way of just releasing something and learning as we go. We're constantly learning, but this is the reason why. With Flow, we've gone after all the regulatory approvals, we've done all the clinical trials, invested a lot with them. It takes a lot to work and get the regulatory approval Flow is working with the FDA and going through that process so it can be approved device as well. But then New Halo is based on that principle. It's what we know most. It's all around the prefrontal cortex and this is how we're offering it and why we're offering it to users now. Cool.

Dr. Ken Sharlin: 42:01

I mentioned earlier, I, I did in the earliest iterations of my brain tuneup protocol at Sharlin Health, I, we would actually. Hand, individual devices to our patients and educate them on proper lead placement. But I found that it was, it still was complicated and I was concerned about safety in general, about stimulating areas of the brain unintentionally and so forth. We eventually set that aside for another approach. What I loved about the Halo Sport is the integration with software that really made it very user friendly, and I'm sure, and hopefully you can tell us more, that the new Flow device integrates with user friendly software and data feedback and some degree of adaptive stimulation as well.

Dr. Kultar Garcha: 42:54

Oh absolutely. I'm really fascinated about where this is going and what we've already been built because we are not just making claims. We are measuring the results and we are learning and we are iterating so we can capture all the real world data as it's coming through from our users. And that really then guides us on what we're doing next. But it's exactly this. We're careful to look at this is beyond just looking at what historically almost always has done in clinical practice, which is for studying disease, studying an illness. We're now studying wellness. We're studying folk for a healthy population and what that looks like. so this is where we can be and increasing with the software, getting that feedback and not just right now, at the moment, it's all feedback from users. They're inputting it. But we are going to expand that, have integration. So showing if you are using the device well, what actually happens if you are using other wearables, what happens to your step count? What's happening to heart rate variability? What's happening to sleep cycles? What about calorie intake and what's happening to food and diet and how that influences in them Bringing that all together to say. clearly there is so much relationship between the body and the mind and then the external environment. And as we bring that in, learning from that and therefore personalizing it and using that data to say, this is how you may use it. What about customized protocols? For length of time when you should stimulate. For some people like myself, I find it best in the morning others, and I don't, I tend to find it, yeah, late morning or so is when I will have a session. It suits me really well. Others find it really helpful to do that an hour or two before they go to bed. Let's understand the data. Let's give. Individuals, the ability to find out what works for them best and learn along the way. And I think that's what's going to be really fascinating and we'll see. Look we're going to look, what about even neurofeedback? What about looking at those devices and learning even be more than integrations? What can we measure? And it's, again, it's exciting. We've got technology already that we're looking at and hopefully we'll release soon. But starting to get some of that neurofeedback as well to see what is it and how can we customize that protocol. What about TACS as well? And then modulating that and changing current fascinating area.

Dr. Ken Sharlin: 45:19

Wonderful. And in my own world as a public speaker for many years, some of my delivery, if you will, what I'm being asked to present on or the content of my PowerPoint deck, if you will, it's shifted somewhat from a very diseased, focused discussion. Still integrating holistic, functional, and regenerative medicine principles, but just, it might be a whole talk on Alzheimer's, a whole talk on Parkinson's, the now where things are going. And we saw this with one of the major organizations globally, the American Academy of Anti-Aging Medicine or so-called A four M, where in their longevity 2025 conference, their main, annual conference, although they have. Conferences throughout the year, but the attendance last year in Las Vegas was. Unbelievable. Completely unexpected. I think there were seven or 8,000 attendees, and they expect more this year, and they're breaking all records and it's at the Venetian and it's completely sold. Now, there's a tremendous, this is the age of brain health, and brain health is being linked to longevity. We could call it cognitive longevity. I call it. brain span, not just your lifespan. And in that context I was just wondering is I'm very interested in biological markers and you've brought up things like neurofeedback, but ways in which we can actively measure this cognitive longevity and know even all the way down to the cellular and molecular level. By putting this device on the head and stimulating with a low level electrical current, it's actually changing cellular behavior, inflamm inflammation markers, oxidative stress markers, and other things that we can easily measure in the blood, for example.

Dr. Kultar Garcha: 47:10

Absolutely. I think that look, that the holy grail is that closed loop sim system, isn't it? It's at the moment, these devices, this device is delivering a set protocol. But the future has got to be read and write. so just imagine, a headset with a simple EEG sensor as an example. It monitors the brain in real time. It could start to detect when the prefrontal cortex activity is starting to wane perhaps, or when you are starting to lose focus and then deliver. stimulation it could look at stress and again, functions from that side. Or if you haven't slept well, what that looks like or say even when you are sleeping, what are the, what is happening to those waves and the activity waves? Is there a time where you could just do a stimulation to help people going to sleep? And then for even cognitive longevity, I think there's a lot of longevity, which is again, focused on the physical health. But what about that cognitive longevity? So pairing it with brain training to build up cognitive reserve of there. Absolutely. And I'm rightly, there is so much focus on Alzheimer's and dementia and everything else and all the reasons for it, but again. We have to think about, and there is a lot of focus on prevention, but let's get that cognitive longevity across the board for everybody. And this is why, again, I think it's, it is really important and exciting to work in wellness and health optimization and that prevention space because I see this as an adaptive partner to brain health. As common as things like heart rate monitors and some of those other trackers. This is where I think it really is that. Empowerment, that tool to help people understand what works best for them and get technology to help in that framework.

Dr. Ken Sharlin: 48:57

That is lovely. This has been a conversation with Dr. Ktar Garcha. He's a family physician and chief medical officer. At Flow Neuroscience and they are now launching their brand new Halo device, it stimulates the prefrontal cortex of the brain. It's very user friendly and right now targeting the health and wellness. Population those interested in cognitive longevity and optimizing their mental health and wellness. I know there's gonna be a lot of folks very interested in exploring this technology further. As we wrap up, Dr. Garcha, could you direct folks to where they need to be looking, what they need to be doing? What would be their next steps?

Dr. Kultar Garcha: 49:43

Absolutely. So I think look going on. If you are interested more in the technology, what this device does please do visit the website, haloneuroscience.com. The flowneuroscience.com website also has information Obviously, look, I work for the firm I want to say, but generally when you're looking at this space, go for where there is an evidence base. We're look where for where the research is. Don't always go for devices, may promise something. Just go and see actually what is it based on? Where is it grounded? Has it got that? Around there, is there an atmosphere and spirit of learning and so forth. But yeah, go onto those websites. I love speaking to customers, potential customers, patients. It's what keeps me going. I'm happy to be contacted too to learn more so is the rest of the team. If you've got questions and want to learn more, because it's a fascinating space. There's so much more we need to learn. Let's learn together.

Dr. Ken Sharlin: 50:40

And then, and for clarity on the website where people can go and they can purchase this device, should they choose, there are, there is an option to contact someone within your, maybe it's a general one, and then they're gonna, someone will reach out to them. So if they have questions, if they have concerns, if they just want a little handholding guidance that is available.

Dr. Kultar Garcha: 51:01

Absolutely. It's a cornerstone of our company's philosophy. We don't want to, these are considered purchases and we want to give as much information and the right information what this is or what you're buying. And then you, and we can answer those questions and we do that before purchase. We have a community even when you join, where you can carry on learning and asking questions, uh, as part of the user journey as well. It's a core, we set that up right from the beginning. We, we had learned all the way, let's learn before, let's learn after. We are learning as much from all of our users and potential users as we can.

Dr. Ken Sharlin: 51:36

Excellent. Again, Dr. Kultar Garcha, thank you so much for being a guest on the Healthy Brain Toolbox podcast. We hope to have you back in the future and get some follow up on this amazing device, the Halo headset from Flow Neuroscience.

Dr. Kultar Garcha: 51:52

Thanks Thanks so much Dr. Sharlin.

COMMERCIAL BREAK: 51:54

Hi everyone. Dr. Ken Sharlin here with the Healthy Brain Toolbox. I'd love to hear from you. If you have general questions about brain health, neurology, or the science of keeping your brain sharp. Send them to questions@healthybraintoolbox.com. I'll be reading your questions on the upcoming episodes. Please remember, these need to be general questions, can't answer personal medical questions, or provide individual medical advice. So if you've ever wondered about brain health strategies, lifestyle tips, new research, or the future of neuroscience, send those questions in. I look forward to hearing from you and who knows? You might even hear your question featured on the show. Thank you for tuning into the Healthy Brain Toolbox podcast. I hope today's conversation gave you new insights to protect and nourish your brain. Be sure to subscribe, leave a review and share this episode with anyone looking to take control of their health. Until next time, stay sharp and keep learning.