SHOCKING SCIENCE On Preventing Alzheimer’s With YOUR FORK! | David Perlmutter

Welcome to the Doctor's Pharmacy. I'm Dr. Mark Hyman and that's Pharmacy with an F, F-A-R-M-A-C-Y, a place for conversations that matter. And today's conversation will matter to all of you because it's with my friend and colleague and groundbreaking neurologist, David Perlmutter, who you may know from the Grain Brain. He is a board-certified neurologist, four-time New York Times bestselling author. He's got his MD from University of Miami. He's had many awards. he has been on the editorial board of the Journal of Alzheimer's Disease. He's published extensively in peer-reviewed journals, including Archives of Neurology and a lot of other great journals. He lectures all over the world, including the World Bank, Columbia University, Scripps, NYU, Harvard, a few second-rate institutions there. And he has published some amazing books. In fact, they guided me in my early practice as a functioning medicine doctor, one that was called Better Brain. I think it might have been the first one. I don't know if it was self-published, but it was a great book. And then Grain Brain just hit the World by Storm. It's the surprising truth about wheat, carbs, and sugar with over a million copies in print. And he wrote another book about the gut and the brain called Brainmakers, which is also a very fascinating book. He is really an extraordinary guy and is coming up with a new book called Brainwash written with his son, Austin Perlmutter, who's also a doctor about the role of social media and the constant stresses on our brain and what they're doing to our brain and our world. So I am so thrilled to have you here, David.

Thank you for joining us on the Doctor's Pharmacy. Well, I'm delighted to be here. And, you know, the book was Brain Maker, but Brain Maker is actually makes me think about the gut bacteria more.

That they're building the brain. So that was a, I appreciate that. Sure. My wife's a standup comedian as one of her many skills. And she was recently going to do a skit on how her depression was caused by her gut microbes and how it wasn't that she was depressed because of some psychological reason, it was because there were these bugs in her gut that were causing depression. In fact, we had a very interesting experience recently, just to talk about that for a minute, where she was with our friend Alberto Villalobos, who's a shaman in Chile, and he taught her how to make saccharomyces using raspberries. You cook up the raspberries, you put the probiotic on there, and then you eat it. Well, we did it down there, it was great, but when she came back, she took it and she got severely depressed, like unusually physically depressed. And it was because she was eating a cocktail that she made that didn't turn out right. There was something wrong with it and it had a huge effect on her mood. So, yes, actually your brain makers is.

What'S going on in there. Dr. Amen Maher actually wrote a book about it and really brought to our attention the role that our gut bacteria are playing in mood, in how well our brains are working and how well our immune systems are working. So, it's a bit of a revelation.

It's pretty amazing. Now, David, you and I go back a long time. We do. 25 years maybe even. And I was chatting with you earlier, but I was so impressed by you and you were so smart, and I.

Was so nervous even going to talk to you. That's in the past tense.

Gee, that doesn't leave me much. I mean, you are smart still. I was so impressed by your thinking and your radical view of the brain that was so different than anything I heard. In fact, it partly inspired me to write my book, UltraMind Solution, 10 years ago. because I was so impressed that you framed the brain as something that is not fixed, that we can actually influence our brain. We talked about caring for our heart, but I want to talk about caring for our brain. And you've mapped out a strategy that not only makes sense, but actually works clinically. And I've used it on literally hundreds of patients with brain disorders. I've gone to almost every lecture you've ever given because I'm a kind of an acolyte and a fan. And I really find that using these principles of functional medicine for the brain is one of the most amazing breakthroughs that we've ever seen in medicine. In fact, the head of neurology at Cleveland Clinic said, Mark, if you're right, and he was dubious that I was right, he said, you're right. This is the greatest breakthrough in neuroscience in 50 years. So, how did you end up going from a traditional board-certified neurologist to being the guy you are and breaking all the taboos about what we think and what's true in medicine and telling a very different story about the brain?

In a word, I'd say dissatisfaction. So, here I am.

Like the Rolling Stones can't get no satisfaction.

I was gonna say, how did it happen? A lot of drugs. No, but I was very dissatisfied as a mainstream neurologist working in a practice with two other neurologists, doing what neurologists do, basically diagnose and adios, you know, making rounds at the hospital, seeing 40, 50 patients a day, and then going.

To the clinic and Writing scripts. Diagnosing adios means you diagnose the patient and then there's nothing you can do for him.

Yeah, and I felt- Neurologists just say goodbye. That's right, and I felt impotent by that. I mean, that wasn't why I wanted to become a physician. I wanted to turn things around. I'm by nature a fixer, no matter what it is, I like to fix things. And we don't do that as neurologists. To this day, you're really treating symptoms, you're not treating the underlying problem, much less preventing the underlying problem, which is a place that I think you and I will go to during this interview. But it's really, as I've said many times, focusing on the smoke but not the fire, what's really going on? And it turns out that the brain is no different in comparison to the heart, in comparison to immune related issues, the liver, and that is it is a reflection of things that aren't right primarily as it relates to the brain and the heart, et cetera, the pancreas and diabetes through the process of inflammation. Inflammation is as detrimental to the brain as it is to the rest of the body, our current popular lifestyle choices are fanning the flames of inflammation, which is actually redundant because inflammation comes from the word inflame, basically. Who knew? So that is become the focus of the work is to go upstream, not looking at a downstream treatment for ridding the brain of this toxic beta amyloid or helping the brain make more chemical acetylcholine. which doesn't work, but rather- which are.

The drugs that have been tried for Alzheimer's. Exactly.

Failed massively. We're gonna get into that too, I'm certain. But realizing that, yes, Alzheimer's is by and large a preventable disease. That's a disease affecting 5.4 million Americans right now, which is largely preventable. What is it like for families to go through that? I'm a neurologist, I've gone through that with many, many families, dealing with their dad, their mother, their husband, their wife. And my father died of the disease too. I mean, it's how do you put a value on the emotional content of that experience? You cannot, especially when you know that it is largely preventable. So these are the lemons from which we make the lemonade. We're going to move forward. We're going to light the candle. We do have to curse the darkness a little bit, and I'm certain that will come up today. But we've got to do our very best to let people know there's another side of the story that they have not heard. And the one side of the story that is being continually looked at is live your life however you choose, and then when you are suddenly suffering from a problem cognitively impaired, we've got a pill for you. I mean, that's been a narrative that was on the Alzheimer's awareness, the Alzheimer's Association website that I looked at yesterday that said, these are the drugs for Alzheimer's that will slow the disease.

And what does that mean? So you don't get in the nursing home three months faster, right? So it delays the admission.

Well, that's what it says. Therefore, therefore you should take these drugs. Well, it turns out that in the Journal of the American Medical Association online in November of 2018 was a meta-analysis study published by Dr. Richard Kennedy.

And that's a study of all the studies that have been done.

It is. And what he found was that not only are the currently two, the two largest classes of drugs that are prescribed for Alzheimer's, memantine and then what are called cholinesterase inhibitors, not only- Aricept and.

Namenda, which the drugs people- Exactly right.

Donepezil being the generic form. But not only do they not work, but they actually speed people's cognitive decline. And I'm going to take a pause with that. Think about it. The drugs that are being prescribed to the tune of close to a billion dollars a year here in America that families put their faith into that this might help mom or dad are actually worsening the decline in their cognitive function. It's like marketing a drug for blood pressure that's going to raise the blood pressure. Yeah.

So when we- the thing is doctors feel like they have to do something and there's nothing to do here.

And I say, great, here's what we should we should do. We should prevent that disease in the first place. And we know that we can do it despite the ideas that what we're talking about are termed pseudoscience.

So let's back up a little bit. You talked about inflammation being a huge issue in Alzheimer's, but it's also an issue in depression, in ADHD, in autism, in Parkinson's disease.

In cancer? In diabetes? In coronary artery disease.

It's pretty much every chronic illness.

Exactly.

Particularly the brain. And I don't think people realize that. question is, what is driving all this inflammation?

In a word, our diets. And we can start there and then work through the whole mechanistic pathway that ultimately leads to people losing their cognitive function. So our diets being higher in simple carbohydrates with reduction in healthy fat, reduction in dietary fiber, paves the way through multiple mechanisms for our blood sugars to rise, our insulin activity to reduce and ultimately that leads to inflammation.

And they call Alzheimer's now type 3 diabetes. That's right.

Diabetes of the brain. Exactly right. So it puts the ball back in the court of you, the consumer, not you Mark Hyman, the doctor, but you, the consumer, to do something and do it right now. And that is simply change your diet. Other things are really important. Restorative sleep, aerobic exercise, meditation. We could talk about a lot of things.

It's anti-inflammatory to meditate.

You bet. But if we can simply focus on the fact that the global diet is becoming westernized, that is increasing inflammation globally, and we're seeing incredible increased rates of things like Alzheimer's globally, those are important dots to connect and important dots to leverage because we can turn this thing around.

Yeah, it's both the diet and how the diet affects our microbiome.

Exactly right.

Which is influencing our brain all the time through creating inflammatory molecules that get to the brain. How does your poop get to your brain? That doesn't even make sense. Could you break that down for us?

Sure, break down the poop. And as you've written about, and you coined the term diobesity, the relationship between diabetes, higher blood sugar, obesity, creation of inflammatory chemicals, damaging the brain, heart, etc. We now know that what sets the, what we call the set point of inflammation in the body is a one cell layer thick that, as you've said in the past, separates the garbage dump, those are your words, right?

Sewer. I think I call it a sewer.

Sewer. From the rest of the body. Chemicals in the gut remain, by and large, dangerous, damaging chemicals, we call them antigens, need to stay there. When they transgress the gut lining, get through the gut lining, they stimulate immune cells to create the very mediators of inflammation, chemicals that we call cytokines, that then initiate these damaging activities for cells throughout the body. The downstream effect of inflammation is a turning on of the production of chemicals called free radicals, damaging chemicals that damage our protein, our fat, and even our DNA. and even our energy producers called mitochondria. So it all starts with diet. Diet nurtures our 100 trillion microbial friends that live in the gut and want me to be healthy. They want you to be healthy, but we have to feed them right.

You know, the thing about like a rainforest is, you know, it's got so many inputs of light and water and nutrients, whereas a monocrop cornfield. Exactly.

What you're getting at is, in a word, is diversity. Yeah. And just as we depend upon the diversity of in the Amazon forest, which is being destroyed.

It's an ecosystem in your gut.

You're right, it's an ecosystem in the gut and it's this relationship between our gut friends in our gut and also on our skin, in the brain who knew, in the placenta who knew, this relationship that we have to reconnect to. So in a very real sense, that's one aspect of what our son, Austin Perlmutter and I are talking about moving forward, and that is disconnection syndrome. All of the manifestations of disconnection, whether it's disconnecting from the messages of our gut microbiome, disconnecting from our DNA that is doing everything it can to keep us healthy, but that we are sending to it the wrong signals by virtue of the process of epigenetics. In other words, our food choices influence the expression of our DNA, who knew? The disconnection that we have from the good parts of our brain, we'll talk about that later, the parts of our brain that want us to be empathetic and compassionate and for the future. The disconnection that we have from each other as people because we're spending too much time down here looking at a screen as opposed to sharing the life of another individual. The disconnection that we have from our communities, from other countries, and disconnection that we have from the health and vitality of the planet. And that's where we take this, that the survival of our planet is really predicated on reconnecting at all of these levels.

In a sense, what you're talking about, David, is the role that your brain plays in allowing you to be connected or causing you to be disconnected. And that the way we care for our brains has a profound impact on our behavior, attitude, connection. That's a very radical idea that what you eat controls your ability to be present, to be focused, to be connected.

And here's what completes the circle. What you eat, leveraged by, or looked at through the lens of your microbes, does affect your behavior and your choices. And at the same time, those choices that you make affect the health and vitality of your gut microbes. So what you set up is what we call a vicious cycle, whereby eating the wrong foods changes the microbiome, it changes your brain, and makes you less able moving forward to make the right choices. So you make further bad choices, further damaging your gut bacteria, further changing your brain. And let me say that it's not just moment to moment changes in your brain that happens. You know that you make the wrong decisions, but ultimately as you continue to make these wrong decisions, you rewire your brain through a process called neuroplasticity. So you compromise your ability to tap into that part of your brain that lets you make good and appropriate decisions and you connect more aggressively to the part of your brain that is much more impulsive and much more fear-based and much more narcissistic.

So basically we move from a place of love and connection to a place of fear and reactivity.

That's right. And you mentioned Alberto BjoLdo, we wrote a book about this years ago called the Neuroscience of Enlightenment.

Power up your brain.

Power up your brain and it dealt what can we do first in terms of our lifestyle choices to enhance this process of neuroplasticity, to enhance the brain's ability to make stronger connections? Okay, once we've got that put to bed, in other words, higher levels of omega-3s, less inflammation, aerobic exercise being very important, then let's do the right things, let's make the best choices, and that will then set the stage for hardwiring the brain to those good parts.

It's pretty amazing how, you know, you in the pioneer in saying this, but the brain is plastic. It can actually change and reverse some of the insults that happen. So not only is it about prevention, but it's about treatment or slowing down of these conditions like Parkinson's and Alzheimer's. And I had mercury poisoning years ago, and early on I had a brain scan called a spec scan, which looks at the blood flow in the brain. And I had all these areas of my brain that had no blood flow, that were dysfunctional.

They looked like holes.

Not a good thing. They looked like holes, like Swiss cheese in my brain. And as I used functional medicine, as I repaired my brain, as I repaired my body to fix my brain, essentially, my gut and also the mercury affected my gut in terrible ways, I actually repeated the scan, you know, more than a decade later, and all those holes had filled in. my brain had recovered. It's not something that you learn as a typical neurologist, right?

Well, even, gosh, when I was 19, I was doing research on what's called micro neurosurgery. The operating room just got a microscope. And so neurosurgeons didn't have a roadmap to use the microscope because the anatomy of the brain had never been really teased apart microscopically. So our job was to create this roadmap for doing aneurysm surgery. So as part of what I did my research on, we were exploring how we can bring blood supply from outside the brain into the brain. So I became really kind of handy at tying small blood vessels together and I was invited to go teach in Madrid, Spain at what's called the Centro Ramón y Cajal and there, you know, this is an institution named after Ramón y Cajal, maybe the father of neurophysiology, and I walked into the lab and there was a statue of him with his statement saying that the brain is immutable, that it never changes, it never regenerates, that's it. And you know as well as I do that we were taught that in medical school, that the brain will never grow new brain cells.

That your brain cells in college, too bad.

Yeah, if you drank too much or whatever, but we know now that the brain A can regenerate itself and B can rewire or reroute pathways. How does a stroke patient recover? Well, he or she recovers because they bring online different alternative pathways. They reroute the signal ultimately, and that's how they can improve. So we take advantage of that process called neuroplasticity and turn it on by turning on the body's production of a chemical growth factor for the brain called BDNF. But at the same time, we have to capitalize then on the brain wanting to rewire itself by behaving in ways.

You remove the insults and you provide the right inputs.

Changing our behavior. The Dalai Lama said that if you want to be happy, practice compassion. And if you want others to be happy, practice compassion. So it really, you know, it's you can be happier if you can wire into the happy part of by doing things outwardly that demonstrate empathy, that demonstrate planning for the future.

Okay, so let's get into some of the details here because you've written a lot about, for example, grains, grain brain. This is a new edition of Grain Brain. Everybody needs to get a copy. It's completely revised and updated. It's pretty awesome. And I think this guy has really nailed it. Now, a lot of people, are not too happy with these ideas. You've been attacked on television, you've been attacked in the media, you've been attacked in medical journals, including indirect attacks against me and our colleague Dale Bredesen, who's really pioneered the idea that we could actually stop or reverse Alzheimer's, which you actually were talking about decades ago. What are the things that are challenging? You're talking about changing your diet. So let's talk about the food part because there's such controversy. Should we eat saturated fat? Should we not? Is sugar really that bad or not? Because the Sugar Association says sugar is.

Fine, so why wouldn't we believe them? So, I would say to your viewers, Google Perlmutter and CBS and watch a recent interview.

I saw this this morning.

Yeah, but just put CBS and Perlmutter, it'll come up. And as they show the book, Dr. Perlmutter has written a new book about carbohydrates in the brain. But before they cut to me, they said, But we reached out to the sugar industry and the sugar industry told us that we should eat sugar, decades of research, it's all good, have at it. What would you expect them to say? And why would you ask the sugar industry? And my response was, yeah, because it wasn't that long ago that the tobacco industry was telling us we should be smoking cigarettes. That's a good thing. But the reality is the question that I was supposed to answer, but I diverted because I wanted to really hit the sugar thing. was, Dr. Perlmutter, what you're saying is that all grains are bad. And I've never said that. Despite the name of the book, I believe that when we look at gluten-containing grains, we should avoid them. As you know, there's plenty of research in terms of what gluten, specifically a subpart of gluten, alpha gliadin, does in terms of threatening what we talked about earlier, and that is the gut lining.

So that in everybody or just people who are sensitive to it?

It's difficult to say. I think we know that probably most people have some degree of increased gut permeability or leakiness of the gut when they consume gluten or specifically gliadin. That said, the non-gluten containing grains, grains meaning seeds of grass, things like rice and corn can be consumed in a quantity that doesn't present a lot of carbohydrate. if you're watching your daily consumption of carbohydrate and you want to have a little bit of wild rice, have at it. Or some non-GMO corn, good luck trying to find that. But I think that if you're counting your carbs as you should be, looking at net carbs, that I don't think that's necessarily the worst idea. Having said that, again, because you know.

There'S just a bit, just to back up on the carb thing, now there's been some recent studies published by Walter Willett and others at Harvard, looking at thousands and thousands of people showing that people who eat very low carbohydrate diets don't do well. They die early or people eating very, very high carbohydrate. But somewhere in the middle, about 50%, which to you and I seems like a lot of carbohydrates, do better.

Can you kind of address that? Because it's- well, I think people should eat tons of carbohydrates. You should be eating carbohydrates. I just did a blog with somebody and it was said, why we need more carbs. David Perlmutter, MD and people, I think the hashtag was why that's fantastic. WTF, right? So, yeah, we need lots of carbs because we need lots of fiber in our diets, by definition.

Broccoli is a carb.

You bet, it's a carbohydrate. So, that's right. And there's something magic when you take, you make a bagel or a croissant. I mean, it's no longer a carbohydrate or simple carbohydrate, it's a croissant or whatever it is.

Yeah.

But you're right. So broccoli, kale, I mean, these are good sources of dietary fiber, which is by definition a carbohydrate, though it's non-digestible. And polyphenols and antioxidants. You bet.

And fuel for the microbiome, fuel for your gut bacteria. So, yeah, I actually in my book, Ultra Metabolism, I wrote carbohydrates are the.

Single most important food for health and longevity. And what I was referring to was vegetables. But then people take it out of context. They say, yeah, he's not paleo. He's not keto. so I think that, you know, the biggest faults then with the, well, with that type of research is you've got to qualify. The other area that needs great qualification is, you know, I'm often challenged by people saying, well, you know, the, the China study said that you eat meat, you're gonna die. And, and Dr. Dean Ornish says we need a very, very low fat diet. And people ask me, what do you think about that? And I would say, you know, I agree with both of them. Why do I agree with both of them? Well, I think by and large the type of meat that people eat that goes into these studies where they come up with the relationships to colon cancer, for example, you bet those are very, very threatening forms of meat.

I personally- But it's actually not even meat. It's actually processed meat, which is basically-.

It's processed meat and- Chalani. You know, there is a sense of alchemy that somehow you can feed a cow or other animal that you're going to eat, garbage and it'll magically turn into gold.

Literally garbage.

Yeah.

They find skittles and you bet that are spire.

So I think there is a place on the table if you choose to eat meat for grass-fed, organically raised forms of animal product. And similarly, do I think that Dr. Ornish has some merit in his discussion of a low-fat diet? Yes, because the type of fat that is eaten in Western cultures is awful. It's highly processed Omega-6 oils, soybean oil, canola oil, soybean, sunflower, that dramatically increase the production of inflammatory chemicals in the body and get back to where you and I started our conversation today. And what's really interesting to think about, you know, we've wondered the mechanism for that over the years. We've said, well, and this is a little technical for your viewers, but they'll love it, the Omega-6s produce chemicals called prostaglandins and leukotrienes that can be pro-inflammatory. We kind of glammed onto that for many years.

They're like the hormones of your immune system. They create inflammation. Right.

But now we know with all the interest in what's called the endocannabinoid system, which is what everyone's interested in now because of the availability of CBD and the use of medical marijuana, that the omega-6s help to increase the production of two important cannabinoid chemicals that are produced within the body. We call them endocannabinoids because they're produced in the body, 2-AG and another one called anandamide, which bind to a receptor called the CB1 receptor that absolutely explodes the production of these inflammatory molecules. And interestingly, omega-3s- I'll set that down.

When you said it was eating vegetable oil activates these receptors that creates inflammation.

Yeah. And this is yet another way to understand the beauty of the Omega-3s, because similarly the Omega-3s create cannabinoid-like chemicals in the body that block that activity. And that's another important pathway by which the Omega-3s are so good for us. So when people like Dr. Ornish say we should be on a low-fat diet, pretty much based upon the type of fat that people consume in America, I'd say he's right. But you can get even more bang for the buck if you not only cut those oils out and fats out, but add to the equation the omega-3s. So we improve this ratio of omega-6s to omega-3s, which is so high now in America, down to a level of three to one or two to one, whereas typically in most people's diets, it's about 20 to one in favor of the omega-6s.

These are new. I mean, we didn't have these oils a thousand years ago, a hundred years ago. You're right. We increased our intake of soybean oil, which is now 10% of our calories, 1000-fold since 1900.

And canola oil that health advocates still talk about, which was developed at the turn of the century as an industrial oil to lubricate machinery.

Yeah. Rapeseed oil, they call it. Yeah, that's a good thing. And now it's highly GMO contaminated. Yeah, it's an issue. so you mentioned Omega-3s and the other issue people are concerned about is saturated fat. And particularly in the context of Alzheimer's, the APOE4 gene, which is a gene that may increase your risk of Alzheimer's. Well, it does depending on how many copies you have and so forth. Is this something we should be worried about? I mean, Bulletproof Coffee and everybody- yeah.

Let'S- Let's cover Time Magazine, it says eat butter. What's the deal here? Butter is back. And let's take that apart a little bit, unpack that. just for your viewers to be really clear that there are some genes that help increase a person's risk for Alzheimer's. And one of them is the so-called APOE4 allele. And you can learn about it by having an at-home genetic test that anybody can do. And 20% of Americans will carry the APOE4 allele.

One copy.

One copy. And some carry two copies, which is clearly associated with as much as a 12-fold increased risk for developing Alzheimer's disease. The APOE genes are involved in the production of apolipoproteins, and that's a big term, but it has to do with proteins in the body that carry fat, deliver fat to where those fats might be needed. There is some indication that the benefits of saturated fat for the brain, we'll talk about that in just a moment, and even the benefits of a ketogenic diet, and we'll talk about that as well, I guess I'm putting a lot of things on the plate here.

Okay, we got it.

Okay.

We might be a little long here.

We might have to add another memory card. But those things are less beneficial in the APO E4 carriers, meaning that they're not going to gain as much benefit directly from ketogenic diet or a diet that's higher in saturated fat.

Is there harm?

Doesn't look like there's harm. And that said, I think that there are benefits that everybody gains that I believe if there is some sense of harm would offset those potential issues which are very minimal to begin with. And that is what the benefits are from consuming saturated fat is the types that we recommend, MC2 oil, coconut oil, the saturated fat that's found in eggs, for example. The benefits are that we enhance our body's ability to produce these important chemicals that are called ketones. There's this huge interest these days all over the internet and certainly in various venues for lectures, et cetera, in what is called the ketogenic diet.

Yeah, the number one diet books on Amazon.

You bet, and with good reason. And it's a brand new phenomenon for humans. It's only the type of diet we've been on for a couple million years. Physically on and off of it. Right, but we've been in and out of ketosis for a long, long time. So it's got a heck of a track record. and we can talk about that, but basically it's a diet that counters inflammation, that enhances energy production, that activates this BDNF gene pathway to create more of that growth hormone to grow new brain cells, that helps reduce the production of free radicals, that helps get rid of damaged energy producers called mitochondria, that helps us with our ability to rid our bodies of cells for example, that are damaged. So in multiple arenas, being on a ketogenic diet is really a good thing. So I think that the ability of the coconut oil and the MCT oil to make that happen really is very, very powerful.

And there's data that's showing that those actually help improve outcomes in Alzheimer's patients.

There's actually a data that indicates interventional that simply using MCT oil improves cognitive function in established Alzheimer's patients. And what did I just say? There's data that shows that a nutritional intervention is effective in turning dementia around. There's also data from Iran that demonstrates that probiotic intervention demonstrates improvement on the Mini-Mental Status Test, which is a standardized test doctors use in the office to determine how well a person's brain is functioning.

It's impressive. I just reviewed a book by the new head of the Lou Ruvo Center at Cleveland Clinic, which is the Alzheimer's Research Program there. And I was shocked to read he talked about using ketogenic diets in patients with Alzheimer's as a way of treating the problem, which is pretty radical. You've got the head of a major academic medical saying they're saying, yes, we can use food as medicine. We're seeing this trend.

Food is medicine. Who knew?

And yet there's this there's incredible backlash about this. We're going to get into that in a minute. There was an article in the Journal of the American Medical Association called the Rise of Pseudomedicine for Dementia and Brain Health. And you and I would be considered in the pseudomedicine quack category. I think for me, it's a personal.

Badge of honor that I'm on quack watch. Me too.

Along with most of our best friends. But the saturated fat thing, I just.

Want to come back to. The founder of Quack Watch commented on this article in Jamo. You need to see that.

I'm sure, I'm sure. I feel like I'm doing a good job when I get more people attacking me from certain categories of like Monsanto and the farming history. But the saturated fat thing is fascinating because I want to be able to hear that saturated fat is not necessarily bad, that it is something that can be helpful in many conditions. but that's with one big caution, is to avoid what I call sweet fat. And the reason that saturated fat, I believe causes, and I want to hear your opinion on this, causes problems in the research which can correlate saturated fat with disease like heart disease and other problems is that when those studies were done, they're done in the context of people eating saturated fat in a high starch sugar diet. I call that sweet fat. Think of donuts, french fries, ice cream. cookies, these are high fat, high sugar combos that are deadly. So the caution is if you're going to eat saturated fat, you can't eat a diet high in starch and sugar. Yes, high in carbohydrates, plant foods. I always say 75% of your diet should be plant foods in terms of starch, not in terms of starch, in terms of vegetables. In fact, most of your diet should be plant foods by volume, but they have very little calories and most of your calories should be fat. but it's not much volume. Can you comment on that?

Yeah, sure. And I would say, let's even take this unpracticed further. And it doesn't even have to be in relationship to eating carbohydrates, simple carbohydrates, because the data comes from these studies that look at calculating the amount of saturated fat in somebody's diet based upon the foods that they eat. And they calculate, well, this person eats a bunch of beef, they eat a bunch of bacon, et cetera, they get a lot of saturated fat. As we talked about earlier, those are the wrong kinds of foods for many, many reasons. So this is a calculated determination of saturated fat. It's not a biochemical demonstration that saturated fat does something in the body. It's people who ate a diet higher in saturated fat, which delivers lots of because these are the modi, these are foods from animals that have been fed, as we said earlier, garbage. That's where those saturated fats, how they're delivered to the human body. So it's not a clean type of study. It doesn't relate to telling a person to take a tablespoon of organic coconut oil. No relationship whatsoever. Look, 50% of the fat in human breast milk is saturated fat.

Saturated fat, wait a minute. So basically breast milk is almost as much saturated fat as pure butter.

You bet. And why is it there? Because it helps for brain development, helps for immune system development.

It helps prime the- It was 25%.

50%. It's of the fat. It helps prime.

55% of the calories in breast milk is from saturated fat. We're told to get less than 5% by the American Heart Association. So according to the American Heart Association.

We should ban breastfeeding. I think it needs a label. They need to go around and say, stamped breasts all around the world saying, this is not hard- out fat. Avoid this. I mean, you know, it wasn't long ago when we were told not to eat avocados are nuts. Yes. Because they had high levels of the dreaded fat. That was about the worst, and we know where that came from now. We know how medical literature in the late 1960s was tainted by industry, by Sugar, who wanted, who influenced what was published in the New England Journal of Medicine. as recently revealed in the Journal of the American Medical Association and ended up on the front page of the New York Times. And doctors bought into that. We bought into what our journals were telling us and it was patently wrong. Now you bring up a journal article from the Journal of the American Medical Association that is castigating our approaches to dealing with brain health, calling it pseudoscience. We began our Pseudomedicine. We began our conversation today with a discussion of the publication in the same journal, I'll have you know, in November of this year, wherein it was revealed that the so-called Alzheimer's drugs that this article is a proponent of don't work but actually make people worse. Which is the pseudomedicine.

Exactly. Well, I think part of the problem is that our type of medicine has not had the funding to study these interventions. Nobody's funding dietary interventions because they're expensive, they take a long time. Nobody's looking at these complex systems approaches to treating dementia, which you and I have done for decades. It's not just treating one thing. Like our friend Dale talks about, about medicine, maybe there's 36 different problems or 54 or 12. And if you don't deal with all of them, you're not going to get better. and our colleague and mentor, Sid Baker, says, if you're standing on a TAC, it takes a lot of aspirin to make it feel better. And if you're standing on two, taking one TAC doesn't make you 50% better, right? So, if you have mercury poisoning and gluten sensitivity and you just deal with the gluten, the mercury still might be a problem and you don't get better. And, I think that's a really important lesson. I think this article is very disturbing to me because it didn't really analyze the data behind it. And, there's so much data behind the kinds of things we're doing, whether it's optimizing our diet or exercise or restoring sleep or meditation or using nutritional support, which is the B vitamins and methylation or getting rid of mercury or fixing the microbiome or balancing hormones. These are the things that we use in constellation to help optimize brain function. And what we know is that these things work. I mean, the only study that's ever been shown at a scale to reverse or slow cognitive decline is called the FINGER study, which was basically using multiple interventions, diet, exercise, stress reduction, addressing risk factors for the heart, for example, insulin resistance.

And therein lies the criticism. Yes, but therein lies the criticism because the notion of leveraging multiple inputs into a system and looking for an outcome is absolutely at odds with the current model of how science as it relates to medicine is carried out. You mentioned Dr. Bredeson, there's a new book coming out where he actually reviews case studies of reversing Alzheimer's disease. And I had the opportunity to write the foreword for that book, and I talked about how this is unprecedented that he is not looking at what we call monotherapy to find the golden single drug that can be monetized. And yet he's looking at using multiple, but getting a great result. so why would we argue with that? But, you know, it is an inconvenient truth for people who want to believe otherwise that we need to create single approaches with monotherapy and that can be the home run, billion dollar product that makes the investors very happy.

Well, it's exciting to be excited to hear that I'm working with some of the top scientists at Cleveland Clinic talking about how do we study these systems approaches? How do we break the paradigm? How do we actually design a trial where we can test this theory instead of calling it pseudo medicine, calling it the future of medicine, which is really what it is.

So I have to say that as I get older, I'm less offended by these. And I really find it to be almost complimentary. It's sort of like complimentary medicine, because to be the outlier and to be disruptive, I think is really a good thing these days, because the status quo is not where we want it to be. And we need to challenge the status quo and it's why people call us out. It's why you appear on the various videos and so do I and some people put a thumbs down and comment, well, you know, I read the China Study and it said we should all, we shouldn't, you know, it's great. People want to believe because it's an inconvenient truth to tell somebody, you need to stop drinking diet drinks. You need to stop eating as much sugar as you're eating because it's going to compromise your health Most people don't want to hear that message. They'd rather, as I mentioned earlier, hope for the magic bullet. As it relates to Alzheimer's, it's interesting that in February of 2018, one of the world's largest pharmaceutical companies, Pfizer, gave up. Gave up, yeah. A lot of companies. We're not gonna chase down the magic bullet for Alzheimer's anymore because it doesn't.

Have a good enough ROI. We're turning out hundreds of studies, billions of dollars spent, going down this rabbit hole that is the wrong strategy for identifying the risks, the causes, and the treatments for cognitive decline or Alzheimer's. It's pretty stunning and everybody's failing and now people are starting to pay attention to what we're doing.

I have a slide that I'll show you at a conference you and I will be attending in a couple of days. And it's really quite interesting because it shows, it measures a group of people in terms of insulin resistance, whether they have insulin resistance, which is the consequence of diet, or not, over time, who collects the most beta amyloid, this sticky protein in the brain that is associated with Alzheimer's risk, who collects more beta amyloid? And it's dramatic how much more amyloid is in the brains of people who are insulin resistant. The reason I mentioned it in the context of our discussion right now is because the amyloid in the brain has really been the focus of the pharmaceutical industry trying to create an Alzheimer's drug, amyloid does or doesn't play a role, whatever, but-- Sort of like sticky toffee that comes out. Right, but developing drugs to get rid of amyloid or to keep it from forming in the first place has been the focus of billions of dollars of research. Because if you could get rid of that protein, that might cure Alzheimer's. It doesn't. But the point is that we can determine on the front end how to lower our risk for developing amyloid in the brain in the first place.

It's a reaction to something. It's a, it's, it is. It is.

It's driving inflammation. That's right. It's an overreaction. It's an overreaction to infection, for example, to herpes simplex virus, to chlamydia, to various organisms that do in fact colonize the brain. The microbiome of the brain. There is a microbiome of the brain. In fact, in a book we have coming out, there's a title, I mean, a chapter dedicated to that from Dr. Tansey's group at Harvard. Yes. So it is really quite incredible to realize another slide, series of slides looks at the degree of brain shrinkage if you carry the Alzheimer's gene in comparison to the degree of brain shrinkage in one year plotted against your hemoglobin A1C or your average blood sugar. And it turns out that the rate of shrinkage of your brain is greater with a higher A1C than it is carrying the Alzheimer's gene. And you can't change- that's pretty frightening. You can't change the Alzheimer's gene.

If you got it, you've got it.

You can change the expression of the gene. You can, but you can sure as heck lower your A1C by simply making some dietary changes. Yeah, low sugar start. You bet. More carbohydrates in the form of fiber. And more good fiber. Nurturing your gut bacteria, reducing inflammation. But again, that is the inconvenient truth people don't want to embrace. The ball is very much on your side of the net. It's not up to me on the other side of the net, the doctor to fix this. It's up to you to hit that ball appropriately with some topspin so that I can't return it. Give it a good shot. And here's how to do it.

How?

Lower your consumption of simple carbohydrates. Eat more healthful fat. Eat more dietary fiber. Exercise. Make sure that your sleep is restorative. really important, very much underrated. We spend a third of our lives sleeping or trying to sleep, and we recognize that so much is going on during that activity, which we used to think is simply passive, but that we understand that this is hugely involved in reducing inflammation, in enhancing the brain's ability to take the garbage out through the activity of the lymphatic system, to triage.

Our daily- the lymph system of the brain David talked about the brain system. Exactly. Which has to work at night.

It works at night. It's got the night shift.

Garbage out of your brain.

So that you're ready to go the next day. And to triage our day-to-day experiences and put them where they will be meaningful for us to rely upon in terms of leveraging new information to make decisions. So underrated.

I want to come back to something we were talking about before because I think we kind of glossed over it, which is this study on the low carbohydrate versus high carbohydrate diets and what that showed and what it didn't show and challenging the very notion of grain brain, which is that we should be eating a low starch sugar diet. When I looked at that study, and I actually am giving a talk at.

This conference called the Failure of Nutrition.

Science and- Tomorrow, you are. Tomorrow, yeah.

At 10:15.

At 10:15, which will not be when this podcast is airing. No, this is evergreen. But the, the extraordinary thing is when you start to dig a little bit, the headlines were, Low carbohydrates kill people. They're not safe. And everybody reads the headline and go, okay, it's science. It's published in a major journal. It's top Harvard scientists. It must be true. But when you actually look at the data, first if it's a population study, which doesn't prove anything, it just shows a correlation, yes or no.

You know, I wake up every morning and the sun comes up 100% of the time.

That means that if Mark doesn't wake up, the sun's not going to come up. That's right. They're correlated 100%, but there's no correlation cause and effect.

I noticed that whenever people's windshield wipers are going, it's raining. Obviously the windshield wipers make it rain.

Absolutely, absolutely. But what was fascinating about the studies when you look a little bit deeper, first it wasn't really low carbohydrate. The low carbohydrate group was 38% carb, which is not low carbohydrate. And second, when they did the study, it was thousands of people, tens of thousands of people over 25 years, gave them two questionnaires separated by six years. What did you eat last week? And people actually don't tell the truth. It's well documented. In fact, in this study, the average caloric intake was 1,500 calories. Now, the average person is about 2,000-2,200 calories. Where are the other 700 calories? Could have been all sheet cake and we don't know what they were eating. So, the study may be suggestive of certain things. but it's really not proving anything. And people get all caught up in the headlines and don't really look critically at the studies. And that's part of the problem.

I had a similar experience recently when a study came out and the headlines were a gluten-free diet increases risk of heart attack. All you gluten-free people, you're all gonna die of a heart attack. And again, Harvard researchers and I had to respond to this and the answer is read the study. And what the study showed was that people who adopt a gluten-free diet by and large, have much less dietary fiber. They don't know what's gluten and what isn't gluten, so they're eating less dietary fiber.

They're eating gluten-free cake and cookies.

Exactly, and what the authors commented on in their conclusion was that they fully recognized that there was less fiber consumption in the gluten-free group. It had nothing to do with, but the way they spun the article was that gluten was a toxin.

Yeah.

I mean, going gluten-free was somehow toxic.

Toxic, right.

And you wonder, how could avoiding something make it a toxin in the first place?

It's very confusing.

But the headlines gets fun, you know, case in point, what you have here, the pseudo medicine, my goodness.

Yeah, so it's pretty exciting where we're at in terms of the brain, and I think that you've clearly been out ahead of this for decades. In terms of the newer ideas around fasting and intermittent fasting and fasting mimicking diets, there's a lot of noise about this. And ketogenic diets are part of that spectrum, which is like a fasting state. When we don't eat, we get ketogenic. And when we eat a high-fat, low-starch diet, we get ketogenic. So, what is the utility of these? What do you think about these things? Is this really where we should be going? And what are the differences?

First, I'll say that the beauty of this coming into the forefront, which it really is right now, at least we think so because we're seeing it day in and day out, is that these are approaches that emulate our ancestors. Meaning that our ancestors had times of caloric scarcity and that would do things to their physiology that would allow them to survive. and that's a very important fundamental premise because it plays into the gene activation part of that story, plays into why researchers like Dr. Walter Longo, I know you're going to interview him, why they're getting really incredible results across a huge spectrum of our modern day maladies, be it cancer, heart disease and even dementia.

They're treating the root causes of all of them.

Yes, well, you're, and your harvesting pathways that lead to good gene expression. You're tinkering with the expression of the life code in a positive way and offloading some of the negative expression of DNA that would have otherwise happened based upon how people were otherwise eating. So there are, first of all, there's a term intermittent fasting, which I think is clearly a bit nebulous. Does that fasting for a couple days every month? Or does it mean just deciding not to have breakfast till noon? Time-restricted eating. Yeah, well, it's actually, that's a little bit different. We'll get to that in just a moment. But, you know, when we have our last meal in the evening, there's a period of time that we don't eat generally, unless we're getting up in the middle of the night and hit the refrigerator. But that time- People do. And Klein-Levin syndrome is one. Don't ask me asked me. But people go to sleep, they wake up in the morning, and then that first meal is called the break fast. You break your fast. And if you can protract the time till you do that, then your body will indeed produce more and more of these chemicals we talked about earlier that are good for us called ketones. So protracting that, I find until maybe noon, one or two o'clock, I think is a good thing.

I knew you were coming today, so I didn't eat breakfast.

Well, I did, because I don't think it may well be the, I thought it was gonna be the only meal I was gonna have today, but turns out that that's not the case. But typically, if you must know, what I do at home is I don't eat until about one o'clock or sometimes two o'clock, or sometimes not at all, or sometimes just the evening meal. And people wonder, well, how do you function? I function really well, as a matter of fact. I mean, I may add to that a little bit of MCT oil, just to get my ketones a little bit higher. So the fasting mimicking diet that you will obviously learn more about when you interview the person credited with inventing that, Dr. Walter Longo, is a technique to gain the activation of the genes, the positive aspects of this approach, while at the same time making it more tolerable and available to the masses.

So it's like eating 800 to 1100 calories a day, which puts your body into a semi-starvation state that activates all these anti-aging comparative mechanisms.

And let me just say that the other thing that fasting does that I think is underrated but nonetheless really important is that it enhances a sense of gratitude, which I think is hugely important. When you realize suddenly that you've taken food for granted in our society, we all do that. because it's plentiful. But when you're not eating and for a day or two and you suddenly realize that, wow, we live in a time when I can eat when I want to. It raises your sense of gratitude and that through what we talked about earlier, the rewiring of the brain, the more gratitude that you experience in your life, the more it wires your brain into the gratitude center.

Yeah, powerful. So, Part of the theory of the fasting mimicking diet, if I want to get into that for a little bit, because it is confusing even for me, someone who's been studying this forever, different opinions. He's no saturated fat, he's very low protein, no animal protein. And the theory is that saturated fat is inflammatory and promotes aging, and he's found this in mouse model.

In mouse model, yes.

Which may be certain kind of mice and does it apply to humans and what do we mean? And then he also talks about the role of protein activating a particular pathway. It's called mTOR, which is a protein that actually can cause the protein actually causes activation of this pathway that seems to lead to accelerated aging. So he's saying no animal protein and that we should eat a low protein diet and that the fasting/mimicking diet is extremely low protein. How do you reconcile that with the rest is sort of the science of what we know around protein and aging. In fact, he even suggested as we get older we need more protein.

I'd say first of all that we have to always keep an open mind that my position on animal protein has changed over the years and will likely continue to change. I eat less and less of it. I eat more of a plant-based diet for many reasons, not just with respect to my health. But beyond that, There are two sides to the mTOR story, as you well know. Rhonda Patrick, I think, has done a terrific job in talking about the upsides of mTOR in terms of building muscle mass.

What activates when you exercise, what we know is a great thing.

Exactly. So I would say that we have to keep an open mind and these are still some unanswered questions that we are going to leave on the table. We're not going to be dogmatic and say it's this way and a story, but rather we we will need to study it further. The broad strokes are more dietary fiber, less simple carbohydrates, and changing the quality of the fat that we eat. I think nothing's indelible, but I think those are important bullet points that if we could just get that message across, that's really very, very fundamental. The other lifestyle issues that we talked about earlier, I think are important as well. you know, we have to really respect a researcher like Dr. Longo. And then a caution would be to recognize that we cannot always extrapolate from the mouse model to humans directly, though we do it a lot. I do it a lot. But, you know, for example, the glymphatic system was demonstrated. We talked about it earlier, the clearing of the brain during sleep. If they were able to get the rodents to sleep on their left side, Does that mean people should sleep on their left side? I don't think so.

I sleep on my left side. No, I sleep on my right side usually.

But maybe there's some knowledge there. But again, so we will follow the work of a terrific researcher like Dr. Longo and watch what he comes up with. I mean, with a person as dedicated as he is, he deserves a lot of attention.

Yeah, it's extraordinary to look at the work because the question is always compared to what, right? Things can be looked at in isolation and seem to be good or bad, but when you actually look at comparing things to other things, what do you find? I mean, you can find, for example, that a plant-based diet is much better in creating better outcomes than a diet that's a typical American diet. Even a low-fat vegan diet is far better than a typical processed American diet, right? that is not a surprise. But what about comparing a vegan diet that's low fat to a, for example, a Paleo diet that's very high in starch from carbohydrates that are good like the vegetables, right? And higher in fat and a little more animal protein and see what happens comparing the biology of these things. How do they affect the aging process? It's very fascinating. One of the things that I found challenging with Dr. Longo and I'm going to chat with him about this is that he says, yes, even a low carbohydrate diet will lose weight, you'll change all the biomarkers of diabetes and then some resistance, but that doesn't matter because it promotes aging and activates all the aging mechanisms.

Great conversation to have. A thought that comes to mind that maybe you'll bring this up with him and that is, in a sense, his fasting mimicking diet program is a resembles Dr. Bredeson's approach in that he's incorporating this program into cancer therapy where people are receiving chemotherapy, for example. Much as Dr. Thomas Seyfried wrote the Metabolic Basis of Cancer, talked about using a ketogenic diet in correlation, I mean, along with chemo. Conjunction with chemotherapy, radiation therapy, and surgery, but doing your best to avoid steroids if possible. So not that the fasting-mimicking diet is the end all, nor is a ketogenic diet, but Dr. Seyfried describes the end all, but could be looked upon as adjuncts to amplify the effectiveness in a more comprehensive way of more standardized approaches, much as Dr. Bredesen talks about leveraging multiple inputs.

It's interesting, you know, the doctor, I mean, there's a lot of people using it for for many problems, right? We see studies, for example, from the group Virta Health looking at ketogenic diets reversing diabetes in 60% of patients and getting them off medications or down on the medications in 98% of patients, reversing all the biomarkers of aging. We see this. And we also see guys like Siddharth Mukherjee looking at ketogenic diets and cancer. And animal models, they've been able to reverse stage four pancreatic cancer, stage four melanomas. and now they're looking at doing this in human trials. So we're going to be getting more and more information. Tell us, since you published Grain Brain five years ago, almost six years ago, what has changed in the science? What do we know? And why did you revise the book? Because it was such a great book. I read it. So did a million other people, apparently. What is different and what can you tell us about the emerging science?

The playing field is really different now. So, you know, I was criticized when the first edition came out by an unnamed individual at an unnamed Ivy League medical school.

One who will not be named.

One who will not be named, but it's in New Haven, Connecticut. We'll leave it at that. And that this was nonsense, that my ideas about carbohydrates, et cetera, really made no sense at all. And believe me, he wasn't the only one, as you you would have expected to criticize what we were talking about.

Same folks that don't like me.

Yeah. And what has really happened over the past five years has been this incredible degree of validation. There was no keto, paleo, any of that stuff. That's really new stuff.

Yeah.

And it's really focused on the notion of getting rid of these simple carbohydrates. There was no real recognition about gluten except for what Dr. William Davis had talked about in Wheat Belly, which really, I think, opened the door to the whole gluten discussion. And just the notion, because I went for the brain, what would you expect? Just the notion that our lifestyle choices can rewrite your brain's destiny was really the central theme of the book. And reduce your risk for untreatable diseases was really very discomforting for people who wanted to believe in the monotherapy give me a pill mentality. So that's changed quite a bit. There's been incredible studies that have supported the notion now about insulin resistance, the importance of insulin beyond just its role in providing glucose to the brain in terms of being a trophic hormone for the brain, allowing brain cells to be healthy beyond just powering them up. And insulin. Insulin. good?

A lot of insulin.

Well, we need insulin in the brain. We compromise the ability of insulin to get into the brain when we become insulin resistant by having a high sugar diet. That the blood-brain barrier that keeps things in or out of the brain, its ability to absorb insulin and therefore bring sugar into the brain is compromised when we become insulin resistant. Who knew? And yet, as you mentioned, Virta Health, Dr. Sarah Hall Hartberg done incredible work showing that we can absolutely reverse that. You've demonstrated it time and time again. The other interesting part of the story is now, which we didn't have back then, we see brain scans that show the brain's inability to use blood sugar as a harbinger of Alzheimer's 20 and 30 years later.

So let it if your brain can't properly handle sugar, you can tell 30 years in advance whether you're at risk for Alzheimer's.

That's right. And we see that in children whose mothers had Alzheimer's, APOE4 carriers, and importantly, we see it in people with insulin resistance and in young women who have PCOS. That they already, though they're young, have these deficits in the way that their brains are able to utilize sugar. We don't yet have the data in terms of their future risk for Alzheimer's disease, but I think because about 80% of these women are overweight and have insulin resistance that they're a setup for Alzheimer's risk. What is really quite exciting is the work of a doctor, Steven Cunnane, who I was on a panel with just a week ago in Los Angeles, who has done these side-by-side brain imaging studies showing what we've known about that the brain can't utilize sugar as a harbinger of Alzheimer's. And even in Alzheimer's, the brain can't utilize glucose as a fuel. But if you now use a new up-to-date type of study that shows the brain's ability to use fat, specifically ketones as a fuel, these brain cells are fine. They're ready to go. They just need a different fuel source.

Well, such a different paradigm than I learned in school, right? That the brain uses 25% of our glucose, that glucose is the main fuel for the brain, and yet you're saying there's this parallel pathway for energy for the brain that isn't sugar, it's fat, and it actually runs cleaner, makes the brain work better, can reverse chronic fatigue.

If you're a hunter-gatherer and you three or four days into trying to track down the wildebeest or whatever it is you think is going to be your source of calories and you're not, it's not working out for you, the first thing you've got to power is your brain. You've got to be clever enough to get food or you'll die. So we evolved this incredible alternative pathway that allows the brain to burn body fat and use it as a very powerful, what Dr. Veech has called a super fuel. So that's the type of validation that Graham Bran has received and the type research that has been done over the past five years that connects some dots for me that we're missing because we didn't have that research. But, you know, we had thought in looking at these brain scans that show that there are areas of the brain that are not utilizing glucose in the Alzheimer's patient, that that was an indication that those areas were where there were neurons that were dead, not working anymore. And that's flawed.

Yeah.

Because when you supply ketones, Those neurons come back online and say, oh gosh, I've been away for so long.

Have you been using clinically?

Oh, absolutely. I mean, that's the fundamental for why we now see interventional trials using MCT oil for increasing ketones, why Dr. Bredesen and his protocol uses a diet that increases ketones.

I've seen this true. It's striking. I had a patient who had diagnosed with early Alzheimer's. We addressed a whole bunch of issues that she had, including mercury, gut issues, inflammation, nutritional deficiencies, hormonal issues like thyroid. She did great for years. She would typically have been in a nursing home.

Yeah. And.

She had a big stress, which was her husband died and she declined. So I said, why don't we try a ketogenic diet? Let's just be a little more aggressive. And her son said it was like a miracle. It was literally, she was not coherent really. Memory was really bad, couldn't navigate her life. and boom, it was like she came back online when she went on a ketogenic diet and was aware of her surroundings, her memory was dramatically improved, she was able to function in her life and be active and do things. I mean, these are anecdotes which are highly disturbing. I hear you.

They're ends of one. I mean, look, Dr. Mary Newport wrote about her husband, an N of one. She put him on a ketogenic diet, has a new book coming out. And I recall one elderly Italian woman who couldn't, her family didn't want her driving, writing checks anymore. They're very worried about her. And they brought her to see me and she came to the office with her three sons who were very big and they were very, they wanted mom to be fixed. And I, you know, the pressure was on. I didn't want to mess this one up. So, you know, put her on ketogenic diet. She returned to driving a car and and was able to manage her finances, and I'm glad I got that one right. Yeah.

They're doing this across the spectrum, and.

I'm not the only one. You bet. And I would say there's great value to the ends of one.

Yeah. Well, there's a whole new research program at the National Institutes of Health called N of One Research, which uses individuals as their own control and measures what happens within their biology as a way of validating the science. So we're getting away from this reductionist model of drug designed studies essentially looking at one drug for one disease with a single outcome. That's great for drug companies but it doesn't help the average person and doesn't actually test the science of what we know to be true which is really connected.

And you know the validation and giving us the ability to use medications is really based on at most 3 to 5% of people, once it's out in the market, using a drug. So 95% of people have never been exposed to a drug that then they do get, as then they become an N of 1, they become a trial. And I think there's a big push these days for what is called personalized medicine, where we learn as much as we can about an individual, his or her genome, microbiome, et cetera, lifestyle choices, and then try to cultivate specific protocols that are best suited to that individual. and I think that's great, but I think that we can extrapolate as we learn about specific gene modifications or gene expression, we call these polymorphisms, gene variances, let's say, of individuals that teach us lessons that we can then use for the population at large, too. We see when a certain pathway is not working appropriately in an individual, manifests, we can generalize that in terms of understanding that pathway to a larger audience, as opposed to looking at a large audience and trying to make that data work for you as an individual. Yeah.

So, David, you've been a real leader in helping us understand these things and helping us make this complex science understandable, readable, and actionable so people can change their lives. Because this isn't just a theoretical book. Grain Brain is a practical book that if you implement will literally change your brain and change your life. And you have been working on some very cool stuff recently. You've been working on this Alzheimer's documentary which is a 12-part online documentary that's coming out when?

It'll be out in the about summer of 2019.

19. Great. So, this is fantastic and everybody should keep an eye out for that. They should check out his work at at drperlmutter.com and you'll learn all about the new Grain Brain Edition as well as the documentary, right?

Correct.

And you also should pay attention to this new book called Brainwash, which is authoring with his son, Austin. And it's an exciting diversion for me, for you, because you're talking about the science of human relationships, of connection, of meaning, of purpose, of the disconnection between our brains and who we really are by feeding them the wrong stuff. It's really a fascinating diversion for you, but it's also really relevant today because people are not functioning well. I mean, I just read a paper in the, I think it was New England Journal of Medicine, about ADHD and kids who are using more screen time have more developmental issues, have less ability to function, have more cognitive issues as they grow older. So this is a huge problem in our society and we're not really addressing it. And this book, Brainwash, I think is going to be enlightening in that.

Well, I would say I wouldn't call it diversion and maybe we'll call it a progression in the next chapter.

Well, it's not a deep academic biochemistry science book.

It absolutely is.

It is, but it's through the lens of human behavior.

Yeah. Well, I think that what goes on around us really motivated this book to be written. And it is an exploration of, and there are 400 peer-reviewed references, so it is a scientific exploration of what is the effect of our modern lifestyle, of our time spent on looking at screens, of our lack of adequate restorative sleep, of the westernization of the global diet, what is the effect on the hardwiring of the brain. And what is happening is we're seeing that we are becoming more wired into the fear center, the center of impulsivity, of lack of compassion, as opposed to being wired into our gift, which is this prefrontal cortex, that allows us to make decisions by thinking about, well, what are the future consequences of that decision? The part of the brain that allows us to be empathetic, that allows us to be compassionate individuals. and we've realized now as we are preparing the manuscript that to a significant degree what we are talking about is basically existential as it relates to humanity. Because these changes in the wiring of the human brain away from the areas that let us be forward thinking and compassionate to the areas of sudden impulsivity and caring about each each other and caring about the planet. This is happening globally and it's in lockstep with the westernization of global nutrition trends and in lockstep with the amount of screen time and the influence of screen time on the wiring of your brain.

This is a radical idea, David, that you can extrapolate to what's happening in the world today with the rise of autocratic societies and and the polarization of countries in terms of either fascist or more socialist ideas. You see that happen in our country with this extreme polarization. And even Congress is just an epitome of what is happening to the rest of us. And I remember being in a lecture years ago where they showed the voting patterns in the Senate and Congress in the 50s and 60s and 70s compared to the voting pattern now. And there was tremendous this crossover collaboration, and now they're completely separate. It's all the Democrats vote Democrat, all the Republicans vote Republican. There's no crossover, there's extreme polarization, and it's happening everywhere around the world. And I wonder if what you're saying is that our diet and our addiction.

To screens is driving these behaviors of polarization and disconnection. It's exactly what I'm saying, and it is a feed-forward cycle. because the more our diets are the way that they are and the more screen time we spend, the more we distance ourselves from the areas of our brain that can help us break out, that can help us make better decisions, make better resolve and stick to that resolve. So it becomes a feed forward cycle. And, you know, this is the broad scope that we've just really embraced, Austin and I, in terms of our work.

It's a pretty important important thing because people don't connect what's happening in our culture and politics in the United States and globally to what we're eating.

That's right.

That's a major paradigm shift.

You know, you and I have been talking about all the things that are connected to diet, well, insulin resistance, inflammation, coronary heart disease, you name it. And that's a big story in of itself. But when you ask yourselves, what are the major threats to our survival, certainly those diseases are the number one cause of death on planet Earth, but just how we are behaving. Take a step back, that is a broad view that is extremely compelling and challenging to write a book about. I will tell you.

-Nutrition, that is a great topic and that's really what we've been both writing about for a long time.

-Well, you've mentioned earlier today in our time together, the relationship between our gut microbes. I think you mentioned the context of your wife. The relationship of gut microbes to how we perceive the world, to our mood, and then we just have to connect the dot between our food and the health of our gut microbes. Now the circle is complete.

It's pretty amazing. So, David, thank you so much for joining us today on the Doctor's Pharmacy, a place for conversations that matter. If you want to learn more about Dr. Pramoda's work, Go to drpermutter.com, that's D-R-P-E-R-L-M-U-T-T-E-R.com, he's one of the most thoughtful, compassionate, kind, smartest docs I've met. He's been my mentor and my friend for decades. And I'm not just saying he's cool because he's my friend, but he really is cool.

That's a great compliment.

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