Microglial cells are responsible for sensing and driving the immune response in the central nervous system. Their activity, be it supportive or destructive, can be at the root of many different neuroinflammatory conditions including diseases like MS, ALS, Alzheimer’s, Parkinson’s, and TBI (Traumatic Brain Injury), but may also play a large role in the vague hallmark symptoms of complex and chronic disease like brain fog, fatigue, pain, alertness and mood changes including OCD, ADD, and depression. Dr Singhal systematically walks us through an easily understood description of the types of cells in the brain (neurons, macroglia (astrocytes & oligodendrocytes), microglia) and their functions. The microglia are a fascinating type of neuroimmune cell that sense and act protectively in good times and then can change shape and release various cytokines, chemokine and neurotransmitters in response to the development of disease, which then impacts microglia function further. We used to only be able to see this on autopsy- there are no blood tests available to measure microglial activation (although neurofilament light chains (NfL) from neurons and glial fibrillary acid protein (GFAP) from astrocytes can reflect central nervous system cellular injury). But PET imaging can visualize microglial activation! Dr Singhal explains in elucidating detail the nature, function, and power of Positron Emission Tomography (PET) imaging, like starting with the Big Bang, anti-matter particles, medical cyclotrons and gamma rays. “PET brings physics, chemistry and biology together in real time to provide novel insights at a cellular and molecular level”, including microglial activation. “If you know yourself and know your enemy, you’ll win 1000 battles” is the way he describes what PET can do for neuroinflammatory conditions. We end the show with a discussion of treatment theories and options targeting microglial activation. It’s a combination of re-evaluating known therapies (even the old antibiotic minocycline!) for their impact on microglia as well as mention of some novel therapies, including a nasal spray ‘vaccine’ for MS. Of course, we bring up non-pharmacologic therapy potentials including exercise, the Ayurvedic perspective including panchakarma detoxification, the power of breathing to impact cerebrospinal fluid flow, ketogenic diet, and consideration of various adaptogenic herbs with the goal of supporting the immune system’s intelligence.