Balance Your Health From Square One with Dr. Joseph Maroon, Internationally Renowned Neurosurgeon, Team Neurologist Of the Pittsburgh Steelers and Ironman Triathlete

Balance Your Health From Square One with Dr. Joseph Maroon, Internationally Renowned Neurosurgeon, Team Neurologist Of the Pittsburgh Steelers and Ironman Triathlete


Watch the episode here


This week, Corinna Bellizzi invites you to learn from her longtime friend and former colleague, Dr. Joseph Maroon, a neurosurgeon and Ironman Triathlete that has a few first place finishes under his belt, and who has been the team neurologist for the Pittsburgh Steelers for more than 40 years. He has advocated for better concussion protection in the sports of football, wrestling and sports in general, throughout his career. He joins us today to talk about his most recent book, Square One: A Simple Guide to a Balanced Life. Before they conclude the episode they cover the 3 most important things in life - a healthy mind and body, healthy relationships and lastly, carpe diem - seize the day.

Topics discussed with time stamps:

  • 08:14 Danforth's checker
  • 12:15 Our endogenous endocannabinoid system
  • 13:00 What Dr. Maroon needed to reset and balance his life
  • 16:40 Learning from the centenarians (people who live to be more than 100)
  • 18:00 The problem of chronic stress... it destroys your brain cells
  • 20:30 "I want to die young, as late as possible and the way is the four square life."
  • 23:10 Unpacking inflammation and returning your system to homeostasis (AKA balance)
  • 24:40 Algae-sourced omega-3s to support return to homeostasis
  • 26:50 The problem of so-called "Atlantic" salmon, subliminally marketed as wild
  • 28:11 The Longevity Factor, resveratrol and red wine
  • 30:00 Former episode with Dr. William Li on his work, Eat To Beat Disease
  • 30:50 Combatting the problem of sarcopenia (muscle atrophy), which becomes an increasing problem as we all age
  • 33:45 The importance of checking in with oneself -- awareness is critical!
  • The 3 most important things in life - #1 healthy mind, healthy body #2 relationships #3 carpe diem


    Balance Your Health From Square One with Dr. Joseph Maroon, Internationally Renowned Neurosurgeon, Team Neurologist Of the Pittsburgh Steelers and Ironman Triathlete

    Thanks for joining me for another great discussion around nutrition and health, without compromise. Today, I'm joined by an incredible world-class neurosurgeon and elite athlete. Dr. Joseph Maroon. Dr. Maroon is vice chairman and professor of the department of neurological surgery at the university of Pittsburgh medical center.

    He's an authority in sports medicine and concussion management. Dr. Maroon serves as a team neurosurgeon for the Pittsburgh Steelers and medical director of the World Wrestling Associates. He has authored over 300 peer reviewed scientific articles and numerous books. He ranks as an iron man triathlete and is frequently asked to lecture on wellness and the benefits of exercise and healthy living.

    He joins me today to talk about his most recent book Square One, A Simple Guide to a Balanced Life. Dr. Maroon, welcome to the show.

    What a pleasure to do and share experiences with. And your audience happy to be here.

    Well, thank you for joining me. We've known each other since, um, as I clock it the early two thousands, when we connected through work at Nordic naturals.

    So for me, this book square one felt like a bit of a walk down memory lane and a refresher course of the many times that I saw you speak at conferences and trade shows, special events, even like Wildfest. People remember the Wild Oats days. So I'd love for you to just start by telling me what inspired you to finally sit down and write this after all of these years?

    Well, obviously an excellent question and very provocative. And I gave a talk in 1986, Corinna to the Congress of neurological surgeons, which was the largest group of neurosurgery. At the time, uh, as a presidential address and the title of the talk was from Icarus to echo iniquitous. And as you may recall, was the mythological individual who, uh, was mourned by his father.

    The greatest architect in nature in Greece when they were imprisoned and elaborate the prison they list made wings made of feathers in wax. The caution has. When they assumed flight, not to look down with a disdain at the mortals below or, or acquire hubris overinflated, ego, and pride. Or soar too near the sun, lest, the wax melt and a plummet into the city. Nor fly too low, lest the waves wet the feathers and pull him into the sea. In other words, it's to hit the mean between extremes as Aristotle recommended 2,400 years ago. In other words, it's about balance. It's about escaping or surviving burnout in the culture, in the environment in which we now live.

    As you know, we have a pandemic or had a pandemic, but the Corona virus, but we have another pandemic, of  mental health -- depression, anxiety, apprehension, fear is absolutely rampant epidemic and so destructive to families, to individuals. So, basically I wrote the book because of my own personal experiences with adversity.

    And how I was very fortunate to overcome adversity by following a formula that involves balancing one's square. So what I would suggest the audience do -- right now -- draw a square in your mind, or with a pencil now at the top. Put work on the right side, put family or social family, social, the bottom, which spiritual, and on the other side for physical now, I want you to draw the length of each line commensurate with how much effort, not

    necessarily time, but effort you put into each side of your square. So, at one point, my work line was very, very, very long. It was like a flat line EKG, if you would. There was no family, I lost spirituality and I was 20 pounds overweight, physically, physically obese. I was in the depths of a very bad, bad depression. One day I was doing neurosurgery at the university of Pittsburgh on a wake patients with brain tumors. My father died, my wife left and I had to quit her surgery because of burnout and literally moved into a farmhouse in West Virginia and worked in a truck stop that my father bequeathed to my mother, selling gas to 18 wheelers and flipping hamburgers for a full year.

    And, how I escaped suicidal ideation, terribly destructive thoughts and extreme depression was a message that I was able to convey to others and actually was urged by my colleagues to put down on paper.

    Book Image: Square One: A Simple Guide To A Balanced Life

    What would be useful in a situation like that? Hence the term Square One. Getting back to square one, get your life in balance and a successful guide to a balance life. So that involves four epigenetic factors that we can go into that as you would like diet, exercise, avoiding environmental toxins and factors, and the controlling stress and sleep and sleep as a fifth dimension, but controlling stress. So, those four epigenetic factors literally program your genes to form inflammatory agents or anti-inflammatory agents. So it's within our choice, what we eat, whether or not we exercise, whether we smoke, drink, abuse ourselves environmentally and how we control stress. So I suggest ways of handling each of those that can need to list a nearly balanced. So I've, I've talked to now I'll let you go ahead.

    Yes. Well, I have to say, just piecing through the book, you mentioned that Danforth checker. I hadn't recalled where it originated before.

    When I first drew my square years ago, when you brought up this very topic, it ended up looking a little bit like a trapezoid or a triangle because I conceived that I would draw each of the lines to meet at their ends. My life was all work, and not so much of the other things, not so much focus on family or spiritual life or being physical.

    And so the big way that you addressed this, Dr. Maroon, was your quest to become an Ironman triathlete, which is just an incredible journey for somebody to go through at any point in their lives. But especially as somebody who's in their forties and who is getting up off the couch for the first time in a few years.

    Well, Corinna, it was a serendipitous phone call from the banker who held the mortgage on the truck stop.

    And he called one day and said, Joe, that's go for a ride. You need this. And I said, run, I can't walk up a flight of steps without being short of breath. I'm 20 pounds overweight. I've never felt worse in my life. Do you want me to run? And that somehow he could show me. He wanted to see, I think if I'd be around long enough to pay off the mortgage on the trucks, but I got a pair of scrubs surgical scrubs pair of tennis shoes and went down to a local high school. And I made it around four times and I said at the end, um, I heard short of breath painful. I'll never do this again, but that night something very unusual happened. I slept for the first time in about four months.

    So the next day I went down myself and I made it a mile and a quarter and then two and then three. And then I kept increasing as I continue to feel that. My diet changed as the unintended side effect of getting a healthier body. And I discovered, and I'll ask the audience this, what is the single most effective anti-depressant Zoloft, Paxil, is it any of the SSRI’s? No. It's physical exercise. So what does physical exercise do?

    A college running track is pictured with grandstands around it.

    Physiologically and neurochemically to the human brain. So when we do aerobic activity, we're literally rebooting our computers, our brains, our brains have. About 86 billion neurons. Each of these neurons is connected with up to 5,000 different other neurons at a synaptic connection. And there are a hundred trillion syntaxes in our brain. And each of these synapses neurochemicals are made. One is serotonin, which is a mood elevator or not. Another is acetyl choline, which enhances a memory another is, dopamine, the feel good hormone, another modulates the endocannabinoid system. We have our own endogenous marijuana. We have marijuana receptors in our brain and we make a neurochemical neurotransmitter called anandamide, Ananda meaning bliss. So you talked about the Ironman triathlons and I'm obviously I'm pleased with what I've been able to do physically, but that's really not what I'm talking about. I'm not boasting at all.

    I discovered that I needed to maintain balance or homeostasis in my own brain. And to do that, I needed exercise. I needed a good diet. I needed to get rid of alcohol, drugs, smoking, and I needed to control stress. Doing those four factors. Those four epigenetic factors reset my neuro-transmitters and enabled me to come back much stronger after severe adversity, and be able to work with you and our colleagues. And I remember very vividly when I met you, your, your line, your work line, was pretty elongated too.

    I think I was pulling 70 or 80 hour weeks at that point. So it was my life.

    I remember very well. You were, you were stretched to your limits and obviously, you’ve reconsidered things yourself and have now with children, family, and, and all the good things in life that you've earned have come to the same type of realization about the new. For balance and homeostasis in our lives.

    Well, I have to tell you, I don't know if you know this or not, but I actually became a distance runner and marathoner as a direct result of our connection.

    So I have run several marathons and half marathons. Now I completed the Boston marathon in 2009. That was my peak kind of performance. But I had to take a step back because all of those, road miles gave me. Injury. I have bunions now, which have meant that distance running is no longer as much fun as it once was, but I am still out there every day, doing long hikes with my dog.

    I still do jog. And I personally find that if I don't get that hour a day, of pretty intense exercise. I don't feel my best. I don't sleep as well. I also am more likely in those cases. When I, when I miss my workouts, I will kind of retreat to some of the junk foods or the less good for you foods because it's, you know, it's almost like it's a slippery slope.

    So I feel like when I'm getting out there every day and enjoying the great outdoors. I enjoy exercising outdoors. That's one of the highlights of my life that I am more nutritionally focused on what nourishes my body. And I'm less likely to reach for the pizza at dinner time, so to speak.

    Excellent. I mean, that really is encouraging to hear that because basically you, I, and Chuck Noll, who was the Superbowl coach for the Pittsburgh Steelers and won 7 super bowls and brilliant Renaissance individual. And he used to say, football's not complicated, whoever blocks and tackles the best wins the game.

    Steelers' memorabilia page featuring greats from the past.

    It's about blocking and tackling what we're talking about. Life really isn't that complicated. Life is about the choices we make and it's about dying. Exercise, controlling environmental factors and family or controlling stress, the importance of family. If you look at the centenarians in the world where those individuals live, who have the most people living over a hundred years of age, you know, where is it?

    Oh, it's in Sardinia. It's in the island of Icarus where Icarus plummeted into the sea. It's in Costa Rica. It’s the seventh day Adventists. So what do all these people have in common besides a healthy diet hard work, which is that exercise and clean environment. They have very strong family units.

    So why is this important? Well, look at our country. If you want to know why it's important. Look at the 60% of kids who are living without a mother and father and ask what the key problem is. Socioeconomically in this country. Again, I'm proselytizing, but it's my opinion. It's the breakdown of the family unit.

    Why is it so important because it permits unmitigated stress, acting out and behavior that is damaging not only to the individual, but also to others in society. So the importance of family is a stress reducer. So what, you know, as well as I, what this chronic stress. The body and brain number one for the brain it's neurotoxic.

    What do I mean by when you are under stress, you elevate your cortisol levels. You elevate your adrenaline and epinephrin levels, chronically elevated they're neurotoxic. They destroy literally destroy brain cells, particularly in the hippocampus, which is in the temporal lobe. The subserves primarily memory.

    So people who are under chronic stress clearly have impaired memory. They can't remember things as well. They don't process information as well. So that family unit, in terms of stress reduction and stress also literally destroys the lining of the blood vessels to your heart and your brain, and also leads to early Alzheimer's disease.

    So there ain't nothing good about it. So whatever we can do to mitigate stress and how do you mitigate it? The four things we talked about, diet, exercise, and mental factors in controlling stress. So it's not complicated, but how do you motivate people to do it? I was going down for the third time, when I discovered that exercise was my key to survival, literally. So, if there's a message that I want to get out to people it's not doing iron man triathlons, that's a secondary product for me. Yes. I'm pleased and proud. And I look back and I say, how did I do that? But it was the pursuit of homeostasis of body and brain that led me to continue now into a, uh, you know, I used to say I'm in the fourth quarter. I'm reading now in overtime.

    Yeah. Well, would that, we all get there, right?

    The principles are the same. Like, you know, I tell people I want to die young as late as possible. The way to do that. Is adhering to the, the four square life?

    Well, let's talk about homeostasis for a moment, from another perspective, because you've written other books in your time from Fish Oil, The Natural Anti-inflammatory to The Longevity Factor. And the reality is homeostasis. What is that? It's a return to normal or return to baseline of, of where your, your resting state of where you should be essentially.

    Correct? Yes. As we look at something like our inflammatory disorders, where people's inflammation is out of control through the practices they have in their diet through not exercising enough. And through living a very stressed life, they get overly inflated. Which destroys and erodes health as you've noted specifically neurologically, but in other areas as well and erodes our immune system, it increases our cortisol levels. The cortisol levels increase weight gain. So there's this kind of ripple effect, this domino effect of, of from bad to worse that we had down. And so there are a few key things that help us from a nutrition perspective. To manage that and to return to that so-called homeostasis. So I'd love to know more about what your current go-tos are, both from a dietary perspective to help support that health without compromising what you're really wanting to get from your life.

    Yeah, you know, I just read an article this morning that in those 65 years of age, approximately 60% have an insufficient diet. 65 and over too many processed foods, too much salt, a lot of sugar, a lot of sugar. And all of these are factors that I mentioned epigenetics. You have to recall that our genes are located on chromosomes and our genes do vary.

    They're like a blueprint that you put on the table. They didn't do anything to the actual. So when you eat a Big Mac infused with hormones and antibiotics in a, in a feed lot fed corn from Iowa sprayed with glyphosate, and then have trans fatty acids on your French fries and a bottle of phosphoric acid called Coke. What does that do? It tells your genes to make inflammatory agents inflammatory cytokines. It's like getting a splinter under your finger. What happened? Your body's rejecting it. It gets red, hot, tender, and swollen. So when you eat that kind of food consistently -- high sodium, high, fat, high sugar, you're creating inflammation in the lining of your blood vessels, in your brain, in your joints.

    Exactly. As your said. So you want an anti-inflammatory. Lean meat, fish, vegetables, fruits, nuts, whole grains. These are the kinds of things that you want to ingest and then appropriate supplements. You mentioned fish oil. I'm obviously a very big believer in omega three fatty acids and the anti-inflammatory effect of fish oil.

    Salmon with salmon roe pictured on a plate with broccoli.

    It's a natural anti-inflammatory. So for joining. And just for everyday good health, I think it's extremely important. And there are other things that we can talk about that I think are of importance that are in the book that I think.

    Yeah, well, one of the things that I've been leaning towards after, you know, a long stint of working in the omega-3 industry is going to now algae sources for omega3s because they don't necessarily need to come from the environment in a destructive way, and also offering the same beneficial EPA and DHA to the end user.

    But the fact of the matter is that those omega-3’s EPA and DHA. Are just incredibly good at helping our bodies to return to that natural state, right. That homeostasis. Because if we've had an inflammatory event, we've had a literal or figurative splinter, you want your inflammatory system to work, to push it out.

    It's not like we want to throw a wet blanket on that piece and just keep that sliver in. So it's important to understand also, I think for those listening, that inflammation is also needed in the body, even though it's just when it gets out of control. I would love to know what your perspective is on where we are in the world of nutrition, as it comes to plant-based versus animal nutrition.

    I'm personally of a mind that it's important that we all have balanced diets. And there are the CAFOs farmed meats that are, let's say, less kind to the animals. And then also those that are more kind. Um, but I'd love your perspective on, you know, whether or not you tend to support a more plant-based or a lean meat based diet at this particular time for your patients.

    Yeah. I'm, I'm clearly much more plant based, fruits, vegetables, nuts greens. However, I'm not a purist in saying that I, I never eat farm raised the. And I, I thrive on fresh caught Arctic salmon. There's a company that I have nothing to do with vital choice that has salmon from Alaska that I ship into and put in my freezer and very convenient to get my omega threes from not Atlantic salmon.

    Atlantic salmon is mostly farmed at this point when it's labeled Altantic. It’s like one of those things that, cause it's a species of fish. And so they're basically misleading people by saying Atlantic, then you think it's from the ocean, but they'll say it's the Atlantic.

    But ultimately that means farmed. And so it also could mean that there's things like colorant added to the flesh of the fish to make it look more. When it's actually a little bit more gray given where it's grown and how it's grown. So I mean, sources important, knowing everything is really, really hard.

    But at this point in time, I think, you know, working to know where your meat is coming from. If you're still meat, consumer is really key. I love that you are. You know, working to get your salmon from a responsible source in Alaska. And, you know, I too cannot say I'm a purist because I go out to eat sometimes, and I'm not sure where the meat is coming from.

    If I order something like it's just kebab. So, you know, that's, I think a reality for many people.

    The more we know the better we're able to make better choices. That's right by the business of fish and the fish industry and how you really have to be so very careful, particularly when you're using.

    Yeah. I mean, that's the reality. In your book The Longevity Factor, which I also happen to have on my bookshelf, you talk about how resveratrol and red wine can actually work to activate your genes. And I know some of that research has been called the question over the years specifically, um, that was conducted out of Harvard and, and whether or not it was as rooted in.

    What could be possibly achieved through even supplementation? Um, but there is continued research that shows that even just having one glass of wine a day can actually be beneficial to your health. So I wondered what your thoughts are presently about where we are. And the research has a, as it specifically relates to the longevity and consumption of things like red wine and fine cheeses and things along those lines.

    I just read another article saying any alcohol leads to brain atrophy study. I think in great Britain, they looked at thousands of patients and did brain scans over a period of time. I think, I mean, again, I drink red wine. I drink primarily peanut Anwar because it's a highest and it was virtual content.

    That's as thin as skin and resveratrol is the endogenous antibiotic, if you would, of the grapes and the rest they release resveratrol, which is a compound that's helpful, I believe to us. So, you know, I ingest a glass of wine now, and then any more than two, I think the cumulatively over time can be more harmful than.

    Yeah. And it's interesting because Dr. Li, who we recently interviewed on this podcast for his work eat to beat disease, he specifically says one glass of red wine or one beer, not both and not two a day is actually health promoting. And so I think that's interesting. He also went on to say, hard alcohol has no benefits.

    So, I recalled a moment in time when my grandfather used to say that he was prescribed two fingers of scotch every day. I think those practices are going the way of the Dodo.

    I agree.

    So, do you have any specific foods or supplements that you flock to after your distance runs your, your training sessions?

    You know, again, people over 40, 45, 1 of the negative side effects of aging is the development of sarcopenia. So not only you, you need resistance exercises as well as aerobic exercise. To maintain muscle mass. So after exercise, protein drinks, uh, carbohydrate and protein drinks to re-establish again, homeostasis and balance, and the muscles are things that I routinely do.

    Dark chocolate chopped and spread on a large counter.

    And there's a recent article coming out of Harvard called The Cosmos Study, in which they looked at flavanols primarily from dark chocolate. And drinks with high flavonol content are particularly beneficial in reducing the inflammation associated with cardiovascular disease. This study is just going to be published soon. We're going to hear a lot about dark chocolate and flavonols in the right and high concentrations as a very therapist. Either bar or drinks, uh, this is going to make a lot of headlines in the next few months.

    Yes, the dark. Chocolate's not the, Hershey's

    Not Milky, not Milky chocolate and with high flavonol content, which is hard to.

    Wow. Yeah. Well, I do enjoy a square of dark chocolate now, and then I have my favorites and I will say for me, the darker, the better I've even been known to add cacao, nibs to yogurt or cereal and things along those lines, because I just like it all. Uh, the dark chocolate is, is incredible. It's really health promoting.

    There don't seem to be any downsides unless you've packed it with sugar.

    Well, I think in summary, it's going back to Arizona. He said hit the mean between extremes in diet, you know, not, not access or even an exercise, listen to your body. One of the things that got me into trouble is I was unaware of what I was actually doing in my work and how I was electing the other things. Of critical importance is the Buddhist philosophy of mindfulness, and awareness. Every day when I get into my car to head to work. I have tachometer, there's a red zone in the tachometer. When your engine is overheated in going too fast and I take 30 seconds and I looked at my tech butter and I try to take a mental thermometer check if you would have my stress level, how Ikea, where I am in terms of anxiety, stress.

    First be aware of it and then do what's necessary to mitigate it. So it must be aware of what we're doing. And then finally I'll leave with the three most important things in life. So if I asked you Corinna, why did the three most important things in life? I know two of them would be your children, but the three most important things in life.

    Number one is a healthy mind and a healthy. Number two is relationships with God, family, friends, and colleagues. And number three is carpe diem. Seize the day. We know not the time or the day or the hour, so that every day we should be aware, mindful of where we are. What would. And include that in your meditation.

    Well, I love that. I love thinking about your moment as you're getting into your car in the morning, as that check to, as a car lover and as someone who's even raced cars on track, I've often thought about that red zone. So thank you for that analogy. If you could leave our audience with any other message as we prepared a part, what might it be?

    Oh, I think just what I said, it's think of the three most important things in life to you, and also be mindful and aware of what you're doing. If you each moment of every day as best you can. And the significance of it, you know, it's said that the purpose of life is a life of purpose. So, what is your life purpose?

    What is your purpose in life?

    Very good. Well, thank you so much for joining me today, Dr. Maroon, this has been my absolute pleasure.

    I enjoyed it, thank you.

    To learn more about Dr. Maroon and his work visit You can follow him on Twitter and LinkedIn as well, links to all of his profiles, books, and more will be available in our show notes, wherever you listen to podcasts. For full transcripts and additional insights. Visit our podcast and blog pages at

    If you enjoyed our discussion today, be sure to subscribe to the show, so you're alerted when new episodes drop. Here's to your health!


    Important Links


    About Joseph Maroon, MD, FACS

    Dr. Joseph Maroon, Neurosurgeon, pictured in his white coat.

    Joseph Maroon, MD, FACS is a world-class neurosurgeon and elite athlete. He serves as Vice Chairman and Professor of the Department of Neurological Surgery at the University of Pittsburgh Medical Center and is an authority in sports medicine and concussion management. He has remained the team Neurosurgeon for the Pittsburgh Steelers for 40+ years and serves as Medical Director of the World Wrestling Association. He has authored over 300 peer-reviewed scientific articles and numerous books including Square One: A Simple guide To A Balanced Life and The Longevity Factor. Dr Maroon is a ranked Ironman triathlete and is frequently asked to lecture on wellness, and the benefits of exercise and healthy living.

    Back to blog

    Leave a comment

    Please note, comments need to be approved before they are published.