Start Doing This To REDUCE INFLAMMATION & Prevent Disease! | David Perlmutter

The gut is playing a critical role in the health and functionality moment to moment of your brain. This is by and large a preventable disease that you don't have to get.

So David, we have so much to talk about. Your book Grain Brain was revolutionary in its scope and the implications for how we can change our brain and how what we eat and what we do in our lifestyle has an impact. In fact, how even our genes are not fixed, that we can modify our genes and our DNA that has changes in our health.

That's right.

So tell us more about how that works and how Grain Bane sort of explains it, but I want you to sort of synopsize it here for us to really understand why you wrote the book and why it's so important to understand this revolution of how we can change our gene structure.

Sure. Well, I wrote the book because I was extremely frustrated being a neurologist in having very little to offer patients. And it really became clear that our lifestyle choices play a huge role in the fate of the brain, that we, by making lifestyle choices, changed the destiny of our brain. We understood that there was a heart smart approach and that the foods that we ate, the exercise we ate might have an effect on the rest of the body, but the brain was out of that conversation and my aim was to change that. because the data was there and my task was to gather that data, present it, package it up, and hope that the world would embrace it and the world did embrace it in 30 languages. So that happened and it really is now, I think, a really well-established understanding that we have a significant role to play in controlling our genetic destiny, the brain is somewhat at the mercy of our genes, but the empowering part of the story is we can change that by our food choices, by how we live our lives in terms of stress, really leveraging the amount of exercise we get, and even something as seemingly simple as how we sleep is hugely impactful in terms of rewriting the book with reference to your brain.

Yeah, it's great. So we often thought, Alzheimer's is just drawing a bad card. Your parents got Alzheimer's, you had bad genes, and there are genes that predispose to Alzheimer's. We know that APOE4, which is a gene that is involved in lipid metabolism, has a big impact and can increase your risk up to 75% if you have a double 4 gene. But what you're saying is that doesn't necessarily predestine you to getting Alzheimer's.

A very good word. It is a predisposition, not a determinant. Meaning that while some people have a higher risk for Alzheimer's by virtue of their genetics, that isn't written in stone. There are plenty of people who carry the APOE4 allele who do just fine cognitively, and there are plenty of people who don't carry it and end up with full-blown Alzheimer's. So I think that we're just beginning to understand that we again have such a huge role to play. You know, if you live to be age 85, your risk is 50-50. And if you are a type 2 diabetic, which is pretty much a choice, your risk may as much as quadruple.

Yeah, 400%.

And that's a lifestyle choice. So I think genetics are important. I probably am at significantly increased risk for that disease by virtue of the fact that my own father died of Alzheimer's. So we really have to get the word out that we may be able to cut our risk in half by gaining aerobic exercise on a daily basis, that not becoming a type 2 diabetic may also cut our risk in half. And I think it's critical that these words get out because no one is talking about it. When you watch television in the evening, the news, all you see are advertisements for Alzheimer's drugs that do not work. So I think the message is to embrace the notion of preventive medicine as it relates to the brain. And that's the message everyone has to get.

Yeah, I mean, it seems like we've done so much research, billions and billions of dollars of research on Alzheimer's, over 400 published studies on reversal trials on drugs, and 99.6% of them don't work. And the ones that work, delay the progression of Alzheimer's such that you'll spend three months more at home before you go to the nursing home. And so what you're suggesting is that this is not inevitable, that there's actually a possibility of stopping or preventing the.

Cynic in me, and I'll admit it, is that this is the dirty little secret that shouldn't get out. Because what has to happen is a miracle drug needs to be developed, So that it can be monetized. That's how the system works. And the idea that our lifestyle choices, which don't cost anything, can prevent the very disease that's costing us, in this country, $230 billion a year, that message can't get out. And, you know, Dr. Dale Bredesen, I'm sure he's gonna be one of your interviewees. We were talking and I said, you know, it's the quest for the magic bullet. He said, it isn't a magic bullet, it's magic buckshot.

There are multiple factors that have- Shotgun approach.

Exactly, but there are multiple things that come together, lifestyle, including exercise, diet, yes genetics is important, medications, nutritional supplements, all of these things have to be brought to bear to keep your brain healthy. And by all means, I'm here to say, this is by and large a preventable disease that you don't have to get. And again, coming from a person who, I'm a neurologist, sure, but I'm also a primary relative of a person who developed and died from that disease.

Yeah, so it reminded me of a story from Dale Bredesen who told me that he got funding for $2 million to do research on Alzheimer's by using multiple approaches, diet, exercise, sleep, nutritional supplements, things that help support health. and he was told by the Institutional Review Board that reviews the safety and efficacy of studies that it wasn't okay to use all these interventions because how would you know what worked and was it safe to actually eat better, exercise, sleep, deal with stress reduction and take a bunch of supplements? And I'm like, this is ridiculous.

It's the type of medicine that you and I have been practicing for years and years and when our Alzheimer's patients stabilize or actually improve and they want to know, well, which part of the program do you think is doing it? And I tell them, I don't care. It doesn't matter to me. We're only interested in the result. And unfortunately, that's not how science in the Western world works. We want to know what is that variable, what is that factor, because then It can be monetized.

And I just think that's ridiculous. It is. And then we're changing that at Cleveland Clinic now. We're actually doing these multimodal interventions and then looking at outcomes. That's right. And then we can reverse engineer. Maybe it's not important to sleep, but I think it'll be important to sleep or maybe you don't have to exercise, but I think it will be. And then we can sort of put together, maybe you don't need all these supplements. Maybe you just need this one. That's fair, but we need to actually be able to sort of create health.

By putting all the ingredients for health in.

If broccoli is good for you, you wouldn't just eat broccoli and eat that all year and be healthy, right?

It's funny you say broccoli. Let's just say there is a plant food that's good for you that has associated with some great results in whatever parameter, reduction of headaches, weight loss, blood sugar stabilization. What is happening in Western culture is they want to extract the so-called active ingredient. And you might fail because it may not be the active ingredient. but it may be that all these wonderful things conspire to bring about a result. And it's a totally different paradigm. Turns out that it works wonderfully as it relates to the brain. Who knew?

Right, it's true. You mentioned that diabetes caused a four-fold increase, like a 400% increase in your risk of getting Alzheimer's. That's dramatic. And they're calling Alzheimer's now type three diabetes. So how does this whole sugar-carb thing related to this because this is part of what your book was about.

Sure, and you know I have to admit that when Grain Brain was written, I wrote it during 2012, it was published in 2013, the answer I would have given you, and I did give countless times, was that elevated blood sugar changes our proteins, glycates our proteins, that turns on inflammation and it turns on the production of damaging free radicals. And it works because when you see measurements of these glycated proteins like A1C, you see it correlates very nicely to dementia risk and even shrinkage of the brain's memory center called the hippocampus. But we now understand that there is this interplay between diabetes and changes in the gut bacteria. That there's a fingerprint within the gut bacteria that identifies diabetes, and we can talk about what people are doing with that in just a moment. But it's those same changes in the gut bacteria that seem to be associated with diabetes that are also associated with inflammation in the body and permeability or leakiness of the gut, both of which are known to be turned on as it relates to the Alzheimer's brain. So now we've shifted our emphasis from just this glycation of protein, the protein binding to sugar, to the gut. I mean, here you are talking to neurologists, we're talking about the gut, which is a book I wrote after Grain Brain that dealt with this beautiful relationship that has been studied and known about for thousands of years that we are just discovering that the gut is playing a critical role in the health and functionality moment to moment of your brain.

It's true. I wrote UltraMind Solution almost 10 years ago and it was a result of nothing I read in a journal, but the extraordinary results I was seeing by accident by treating people's gut their brain would get better.

That's right.

And I was like, what's going on here?

That shouldn't happen.

No.

And it does happen.

It does.

We work on the gut and the brain gets better, and the skin gets better, and the joint pain goes away. These are all issues that are based upon inflammation. And guess what? Alzheimer's is a prototypic inflammatory disorder. Same sort of inflammation, same markers, same mediators, as they're involved in heart disease, as diabetes, as even cancer.

There's almost like a few common pathways.

That's right.

And depending on the person, it can hit different organs, whether it's autoimmune disease or dementia or heart disease or diabetes or cancer. I mean, at Cleveland Clinic, there are scientists now discovering that the microbiome plays.

A role in the development of cancer. Oh, that's right. And, you know, we call these the broad strokes. And, you know, there is this real push for us to be super specialized these days. and to develop protocols that are so specifically targeted for the individual, we call this personalized medicine. I think that's great. But at the same time, we know that taking a step back and looking at the broad strokes about what really are the general dietary recommendations were-- Few years ago.

And we didn't understand how it was connected to all these diseases, including brain disorders, not just Alzheimer's, but depression, autism, ADD, Parkinson's. I mean, these conditions are, we thought were in the brain, but you're talking about the microbiome as this new organ that we have to actually investigate, learn about, treat. And so tell us more about this sort of discovery you made about how this all works in your book, Brain Maker, that led you to sort of kind of revolutionize your thinking.

Well, again, it was because of, I think, lack of tools in the toolbox. Neurologists are working at the premise of diagnose and adios, meaning that, Boy, we'll come up with a great name for a disease, and that sounds great, aren't we smart? But then there's nothing to do. We're left empty-handed, and I wasn't going to spend the rest of my career doing that and having people walk out of the office without something to do. so I endeavored to discover what were these relationships. I mean, if we granted inflammation is an underlying mechanism of Parkinson's, MS, autism, Alzheimer's, they are inflammatory disorders, okay, then where is this inflammation coming from? Not a bad question to ask. And it turns out that when you look at the- It's sort of self-evident, right?

But it's not something we do in medicine.

It's coming from the gut. Okay, that means this neurologist is gonna start paying attention to gastroenterology. Oh no, you can't go there. That's the turf of the gastroenterologist. And I went to my gastroenterologist friends and began discussing this. There was no interest. And it became very evident to me one day when I worked on a patient with migraine headaches by changing her diet and putting her on, get this, a gluten-free diet and her migraine headaches went away. This is something she had for 25 years, was taking narcotics for her pain. She went back to the gastroenterologist who said, I've scoped you. You don't have celiac disease. Why on earth would you go gluten free? Go back on gluten, you need it. She refused. Had she done so, we know her headaches would have recurred. But that said, there is such pushback on anything nutritional, as you well know, recently there was an innuendo based upon a study that came out saying that if you go gluten-free, you're going to be at higher risk for heart disease. And that is not the conclusion that the authors actually reached. Harvard researchers, the conclusion was if you go gluten-free, which means likely cut back on dietary fiber, that's not a good thing. I am totally in for that.

Most people don't eat gluten and dietary fiber, it's white flour. Right.

But the point is that the fundamentals are that the brain is not able to deal with inflammation very well, that inflammation happens when we disrupt the gut bacteria by a diet that's inappropriate, by taking medications that are disfavorable.

What are the medications that screw up your gut microbiome?

Well, I mean, the obvious ones are antibiotics. We've now seen research that indicates that antibiotics affect a type of bacterium called the mitochondria. Now that's gonna sound like a bit of a stretch, but a new study came out looking at beta-lactam and aminoglycoside type antibiotics.

These are types of antibiotics.

And shows that these are actually mitochondrial toxins. Now I just took a leap. For your viewers, the understanding is that our mitochondria were once free living bacteria. So that's just a little tidbit, but when you disrupt the gut bacteria by taking antibiotics, Understand that is a lifelong change in your microbiome that is never the same again. Antibiotic exposure is strongly related to diabetes risk as much as a 50% increased risk from one course of antibiotic. A very large Danish study demonstrated that. The non-steroid anti-inflammatory medications are notorious for disrupting the gut bacteria and that likely explains why C. Diff or Clostridium difficile is higher in people who generally take these non-steroid anti-inflammatories. I think the biggest issue is going to turn out to be oddly enough, these acid blocking drugs called proton pump inhibitors.

Which you can buy over the counter.

Are generally bought over the counter. One study out of Stanford indicated about a 16% increased risk of heart attack in people taking these PPIs. And if you have that heart attack, your risk of dying from it is increased, is doubled, basically. And that happens because of changes in the pH of the gut. Why would you be surprised that these drugs would change the acidity of the gut? Because that's what they're designed to do. When you change the acid level, acid-based balance of the gut, it changes the environment in which the bacteria live. certain species will thrive, certain species will be suppressed, and you have this loss of diversity of gut bacteria that leads to leakiness of the gut and the brain, and it sets the stage for disaster. I mean, one of the side effects.

Of PPIs or acid blocking drugs is irritable bowel syndrome.

Who knew?

And it causes diarrhea and C. diff.

Well, interestingly, JAMA Neurology, the Journal of the American Medical Association Specialty Journal Neurology, last year demonstrated that chronic users of these proton pump inhibitors have more than a 40% increased risk of developing dementia. To the extent that the authors concluded that avoiding PPIs might be a way part of the program for prevention of Alzheimer's disease. So, all of these things that relate to increased risk for dementia, we are now looking at through the lens of how these affect the microbiome, how they affect the gut bacteria, how does that affect gut permeability, how does that reduce the production of a certain short-chain fatty acid called butyrate, which plays such a critical role in how our brain is energized, in the maintenance of the blood-brain barrier, in the change of expression of our DNA through what's called histone deacetylase inhibition, through even the cellular functions of metabolism that are regulated through these complex channels that begin with what are called G-protein receptors. So this is what butyrate does.

Butyrate is a product of healthy bacteria.

Exactly right.

So when you have good bacteria in your gut, it produces this compound called.

Butyrate, which your brain loves, your gut loves, your immune system loves. And you nurture your gut bacteria by giving them what's called prebiotic fiber, eating those foods. the Mexican yam, the dandelion greens, the asparagus, foods like garlic, onions, leeks that enhance the function of these bacteria. They're so happy they're gonna say, I'm gonna help Dr. Hyman be healthier tomorrow.

I want more asparagus, please.

Because I am gonna make more butyrate. The richest source of butyrate that you can eat is butter, which is in fact where the word butyrate comes from.

Yeah, well, you know, your butter is back. Butter is back. Yeah, I just reviewed an article that was a review of 6 million patient years over hundreds and hundreds of thousands of patients over many, many, many years finding no association with butter and heart disease and potentially reverse association with diabetes. I mean, you eat more butter, you get less diabetes.

Old habits die hard. I was on a nutritional panel and I think you may have been on it. in New York a year or two ago. And there was another individual who just, it was all about how butter will kill you, it'll make your children born naked or some terrible thing.

That it will.

And low fat and is the way to go. And hey, I'm all for listening to other people's opinions, but let's look like you say, at what is the research telling us? The research is telling us that sugar, for example, isn't necessarily a good thing. Well, you need sugar to help the medicine go down, but sugar will destroy your brain and it does so through its effects on the gut bacteria.

Yeah, the gut bacteria, I just want to sort of pause for a minute because most people I don't think understand the impact that it actually has on our health. And I was recently thinking about it, we've got 10 times the number of bacteria in us than our own cells. And we've got probably 100 times as much bacterial DNA as our own DNA. and what our DNA does is produce proteins, information molecules that govern the function of our body. And so when you think about it, your genes maybe make a couple of hundred thousand chemicals or proteins. Your bacterial genes are making literally millions of proteins that are getting absorbed, that are interacting with your biology. So your microbiome metabolome, in a sense, the metabolites that are produced by the microbiome, are probably more influential in your health than your own cells.

No question.

Which is, and so that begs the question which I'm gonna ask you, which is how do you make sure you cultivate the healthy inner garden? What are the things people can do and take away that help them actually fix that? So taking away the drugs that are gut-busting drugs. Good point.

And then, that's a great place to start. What are the things, first of all, that are bad for your gut bacteria? And then we can talk about, okay.

Now what do we do that's good?

And you mentioned sugar. Yeah, well just to recap, really important, medications, everybody's got to review their medications, especially antibiotics, the non-steroidal anti-inflammatories, and the proton pump inhibiting acid. Even the birth control pill, I hate to say. Even birth control pill, how we are born by cesarean section versus vaginal birth. There are a lot of immune related issues like type 1 diabetes, celiac disease, autism, ADHD, even adult obesity. issues that are dramatically increased in terms of risk in kids who were born by C-section. Why? Because they didn't get the seeds, they didn't get the anointment of bacteria that they would have gotten by passing through mother's birth canal by virtue of having been born by C-section. Chlorinated water, lack of sleep, stress. We're now seeing data that correlates higher levels of diversity of gut bacteria correlated with max VO2, meaning the more exercise. Respiratory fitness you have, it correlates with higher levels of diversity of gut bacteria. That is not to say that getting in shape will increase your gut diversity. I think it does, but extrapolating from that article doesn't allow me to say that, but you allow me to say that.

I'm saying it.

To rebuild though, the microbiome, I think we've got to be really super diligent about the the diet has to be very high in fiber. So missing from the standard American diet, Western culture. I think that the issue about fat is really important. We've got to welcome good fat back to the diet that we've been castigating, not we, others have been castigating for such a long time. Fat is fundamentally important.

Let me stop you there because there's evidence that high fat diets can negatively affect the gut microbiome. And when I looked at the data, it was, what kind of fat? And omega-3 fat seemed to optimize gut flora, whereas omega-6 fats and inflammatory fats like soybean oil may actually negatively alter gut flora.

That's right. And when you emailed me about fat and the microbiome last year, the article that I sent back to you, as I recollect, was the article you had sent me talking about the possible detrimental effects of fat on the microbiome. And I said, Mark, look at it though. The study actually was high fat and high sugar. Sugar diet. And that's a take-home message. If you're pounding sugar, everybody wants to eat more fat now because we've heard that it's good for you. But if you're eating sugar, all bets are off. You're just paving the way for disaster.

I call it sweet fat.

Whatever you want to call it. Bagel and butter. Yeah, but if you're going to bring fat back to the table, and you should, A, it's got to be good fat, healthful fat, we'll talk about that in a moment. but B, you've got to simultaneously cut the sugar, got to go. And what are people now doing? They're getting the low sugar message and they're drinking and eating artificially sweetened foods. Well, that is about the worst thing you could do. For your gut microbiome.

For your gut microbiome.

We didn't understand why artificially sweetened beverages were so associated with diabetes, for example, more so than drinking sugar sweetened beverages. People who drink artificially sweetened, no calorie, no sugar, and yet they're more than doubling their risk for diabetes. How in the world could that be? It was counterintuitive. And we came up with all kinds of ideas, but now Israeli researchers have shown us it is straightforward because of changes in the gut bacteria. Last month, a study came out showing a dramatic increased risk, over 44% increased risk of getting Alzheimer's disease becoming demented in people drinking artificially flavored and sweetened, sweetened rather, a pop or soda. And again, what could be the mechanism? And the authors hit it on the head. It's because of changes in the gut bacteria, which then code for increasing inflammation, the cornerstone of every brain disease that you don't wanna get.

So speaking of the brain, You know, we're talking about, in a sense, a bacterial brain that lives in your gut. But there's also kind of a second nervous system called the second brain in the gut. So talk about how that influences your health and Alzheimer's and brain function and what people can do about it, what causes it.

So, you know, the notion is that there is a gut-brain or brain-gut, as I prefer to call it, obviously, connection.

It's the most important organ in the body.

I'm not gonna go there. But that said, It doesn't really make sense anymore to differentiate between the gut and the brain because they really are functionally very, very similar. And they're connected. You know, there are large channels like the vagus nerve, which is a very, it's a superhighway connecting the gut to the brain. And interestingly, it looks as if the vagus nerve is transporting all kinds of things these days beyond just electrical impulses. that are having a role to play in brain health or disease. For example, a recent study demonstrated that in people who had what's called a vagotomy years ago, where the vagus nerve was cut, which is what they used to do for ulcer treatment, vagotomy and pyloroplasty, that their risk of Parkinson's is dramatically reduced. It turns out that what the research now is revealing is that misfolded proteins that have their genesis in the gut were being transported through the vagus nerve to the brain and may relate to the risk for Parkinson's. That's pretty exciting. But more importantly, I think that the relationship of the gut to the brain is both physical, but it's also chemical. We talk about serotonin and dopamine and so-called neurotransmitters. Failing to recognize that the lion's share of these chemicals are not made in the brain, they're made in the gut. And they are made at levels that lead to mood stabilization, when the gut is healthy. Dr. Emran Mayer at UCLA wrote a wonderful book about this relationship between the gut, the gut health and mood regulation, for example. So intriguingly, we now look upon, for example, depression and inflammatory disorder as possibly having its genesis in the gut. How do we know that? Because markers of gut leakiness or permeability are dramatically elevated in correlation with depression as they are in Alzheimer's disease, autism, and even Lou Gehrig's disease. So again, we mentioned earlier that we've got to pull away from being so cerebrocentric and look at the body as a whole and particularly the gut for reasons that you well described. The number of organisms, their bacterial, rather their metabolic products, and not the least of which their genetic component in terms of being hugely relevant in terms of health and longevity.

Yes, it's pretty stunning when you think about the way we sort of missed the boat and sort of blamed all sorts of other factors like bad parenting or emotional trauma or stress or mental illness on the brain as opposed to the gut. And, you know, I'm not a researcher, although now we're doing research at Cleveland Clinic for most of my career, I've been a practicing physician. And I just noticed this phenomena. I wasn't even trying to treat the brain and it would get better from all sorts of conditions by simply fixing the gut.

Well, as we've often learned as of late, these issues are oftentimes two-way streets. When you mentioned early life trauma, for example, there are now signature gut bacterial changes that are seen in association with people who had trauma during their early lives. And that these changes in the gut bacteria correlate with measurable changes in brain areas. Certain areas of the brain are less functional in correlation with those changes in the gut bacteria that correlate with early life trauma.

That's amazing. So what you're saying basically is your thoughts and your feelings and experiences talk to the bacteria in your gut and change them in ways that are harmful.

And then the gut also communicate back and alter our feelings, alter our gut, alter how we perceive the world. Dr. Emord Meyer mentioned his work earlier, he took a group of 21 women and divided them into three. Or actually, I think 22 of them cut them in half. Didn't cut the women in half. Cut the group in half.

The magic trick.

Part of the group got a yogurt that had no probiotics. The other group got a yogurt that was enriched with probiotics. And after a period, I think it was a couple of months, he measured brain activity and found that those Individuals who were consuming higher levels of probiotics had changes in their brain functionality. Now that's breathtaking because that tells us that gut bacteria can change the function of our brains. That gut bacteria can change the expression of our 22,000 genes that we got from mom and dad and from all of our forebears. That tends to make our gut bacteria, you know, assume a much higher, I think, place in terms of respect and in terms of where we are today and certainly where we need to go in the future when we are confronted by things like Alzheimer's and cancer and autoimmune conditions for which we have really very little to offer except for in the case of autoimmune issues, the so-called biologics, which work at the very end of the cascade of immune problems where we now understand that the problems actually begin further up the line and by paying attention to the gut and manipulating the microbiome with specific probiotics and even groups of probiotics, we finally get to the beginning or the origin of these issues.

So David, you in your practice and in your book have identified ways to optimize the gut floor as a way of treating the brain. So could you take us through the strategy and the practical application of how do you tend your inner garden and what are the steps you take? to transform your gut.

Sure. And I think that, again, having mentioned what we did mention in terms of what makes a good microbiome go bad, those steps are again favoring prebiotic foods like I mentioned, the jicama, the garlic, onions, leeks, the dandelion greens, asparagus. Those are foods that are really important because they nurture the gut bacteria. They help the gut bacteria reduce inflammation, produce more butyrate. these prebiotic fibers have actually been shown to increase what's called BDNF and therefore play a role in growing new brain cells through this intermediate of the gut bacteria.

And they're like fertilizer for the gut bacteria.

They're fertilizers for the gut bacteria to do what they want to do and that is keep you healthy. But beyond that, there is a place for probiotics, that's for sure. There are some very good probiotics on the market. We look for products that have a large number of different strains that have been studied 10, 12, 14 different strains, 15, many billions of bacteria, but you really want to look for products that have a guaranteed shelf life. I think that's really very important. Beyond that, some of the things where we push the envelope a little bit in the clinical practice is giving probiotics not just orally but giving them through enemas, I know that sounds strange. We've had terrific results with it, and you know we have. Putting probiotics in an enema bag and administering them, and even beyond that, going as far in some cases as doing what is called a fecal transplantation. Now, this is not something that everybody who's learning this information needs to take home, but there is a time and a place to consider revamping and reestablishing healthy gut bacteria by taking fecal material from a healthy individual and transplanting it into somebody whose gut bacteria has been really disrupted. We know that more than 500 hospitals in America today are doing fecal transplantation, as crazy as that sounds, in the treatment of a life-threatening diarrhea illness called Clostridium difficile, which now still kills 30,000 Americans each year. Most hospitals don't do it and yet it is by far and away the most effective treatment known to man.

I mean half of regular treatment fails and then you know 98% of fecal transplants work immediately.

That's right. I mean the standard of care for treating C. Diff is of all things antibiotics.

That's right.

Which likely produced the C. Diff in the first place and it's about 26% effective in terms of putting a person in a position where they will not have a relapse. And as you well mentioned, 96 to 98% cure rate with fecal transplant. Is it icky? Is it bizarre? Yeah, I get that. Of course it is. But I get through that when I see an autistic child speaking for the first time in his life. And I see University of Arizona doing a trial of fecal transplant in 20 autistic children. When I see a researcher in Amsterdam, Dr. Max Nieuwdorp, reversing diabetes by doing fecal transplantation, is it bizarre? Sure it is based upon our up-bringing about poop, but we could put that aside and recognize this is a powerful modality based upon recalibrating what's going on in the gut and hoping for improvements throughout the body including in the brain.

That's huge. It's huge. So, you mentioned sugar and you mentioned sugar in the brain. We talked about Alzheimer's type 3 diabetes. And, you know, it's such a manifest problem in this country with the average person having 22 teaspoons of sugar where the American Heart Association says eat six. And for some it's much more, including children. we eat 152 pounds of sugar and 146 pounds of flour. That's a pound of sugar and flour a day for every man, woman, and child in America. So how is this impacting the brain and what should we do about it? And also, I want you to touch on the title of your book, which is Grain Brain, and are grains included in this or is it just sugar? And should we be eating any grains?

Well, there are a lot of questions there. First of all, there are some grains that I think are not necessarily threating and I think that if you can find a non-GMO corn or you want to eat some quinoa, which by definition is not necessarily grain, but everybody talks about it as if it were, the issues with grain are twofold. It's their carb content and the fact that they contain gluten in my opinion. There are other issues as well. We know that wheat is, although it is not genetically modified in America, is still sprayed with an herbicide called glyphosate, which is powerfully threatening to the gut bacteria as the work of Dr. Stephan Senneff has made very clear to us.

Roundup.

Roundup, you got it. And we understand that this, we're going tangentially here, but that's a powerful threat to the microbiome. It has insinuated itself into so many foods. It is the largest global herbicide in terms of its use, 1.35 million metric tons being sprayed on our food and animals food around the globe threatening the soil microbiome, threatening the microbiome in you and me, and it needs to stop. The World Health Organization has characterized glyphosate, the active ingredient in Roundup, as a probable human carcinogen that was published in the well-respected journal the Lancet. And as it gets to sugar, you're right. And I want to just take a step back a little bit on sugar because as we've learned from one of our mentors, Dr. Jeffrey Bland, food is information. And it means that the foods we eat are changing the expression of our DNA. That's a heady notion. But the food we eat changes moment to moment the expression of our DNA. Our DNA has been honed to make us the best we can be. over a couple of million years to make us the most able to respond to changing environments, smartest, or some might argue these days how smart we really are. The point is though we have this wonderful relationship with our genome, with our DNA. When I say we get our 22,000, 23,000 genes from our parents, yeah, but who did they get it from? It's been passed down generation to generation. Food is information. Suddenly, 200 years ago, we developed the technology to overwhelm this information paradigm with sugar. So we're now sending signals to our DNA the likes of which it has never seen and our genome is freaking out. It doesn't know what to do with the signal that's coming into the body. There are many things we can talk about diabetes, glycogen protein, leakiness of the bowel, inflammation with reference to sugar. But I think it's good to every once in a while take a step back to look at the genetics of what this has done to us. We know that diets higher in sugar enhance that very process that we've got to do everything to avoid and that is inflammation. So you're right, the statistics on what we're doing in terms of sugar consumption are overwhelming and what so many people don't recognize is that they're consuming sugar, though they don't spoon it out into their food, but yet, you know, the glass of orange juice, the 12 ounce glass of orange juice is nine teaspoons right there that you didn't even add in. And that's before the croissant or whatever wonderfully, you know, language something arrives that it's okay because it's a croissant, it's from France, it's got to be good for me. Or the bagel, you name it. more sugar, more carbs. And the problem is that we're in this mindset that fat was what we should have eaten, but we stopped the fat in favor of the sugar and it has amplified diabetes, cancer, heart disease, you name it. The good news is that through books like the ones you've written, that fat has been really validated as an integral part of our diet and it's the sugar, it's been the sugar, Like Gary Taubes and Robert Lustig have talked about and Mark Hyman. It's the sugar.

It's the sugar stupid, right?

You know, old habits die hard. We have a sweet tooth. It's a survival mechanism. We love our sugar. There's no one who's gonna watch this who doesn't like sugar. I would eat sugar if it wouldn't be harmful. So what did we do? We said, well sugar's bad, I'll take the diet drink. And now we look at the data I talked about. on the diet sodas and we're digging the hole even deeper.

So the flip side of this, of the sugar being a driver of a lot of the health issues, including Alzheimer's, including depression, including ADD, autism, all through the ways that we describe. The flip side of that is fat has been exonerated. And you wrote a lot about that in your book and even saturated fat, which still is demonized. And I think that You talk in your book about ketogenic diets as a strategy for brain health. And we see this being used in Alzheimer's and epilepsy and brain cancer.

That's right. Right?

So tell us about that flip and also the extreme version of them, which is eating like 80% fat.

Right. Well, first I'll say that when Grain Brain was written, did I ever take the heat for that, for saying we should be eating less carbs and more fat? fat. I mean, that was back in the ancient times of 2013. And, you know, the Amazon comments, oh, this is a diet that's going to kill you. And I'm not dead yet. Monty Python, not quite dead yet. And so I took my lumps and continued to do so, which is good because, you know, if you're not an outlier, no one's going to say bad things about you. So that's a good thing. Yeah.

The pioneers have arrows in their back. Yes.

And just the basics of do we choose to power our bodies with fat versus carbohydrates was looked at in the Journal of Alzheimer's Disease. The study was published by researchers at the Mayo Clinic and they demonstrated that those individuals who favored a higher fat source for calories for their bodies had about a 44% reduction in risk for dementia as opposed to about an 86% increased risk for dementia if you chose to go the carb route, eating more healthy carbs and healthy grains as you say it, that's been debunked. Taking it to the extreme, when you really restrict your carbs and sugars and really add in not just dietary fat but other unique types of fat like coconut oil or even more effectively what is called MCT, medium chain triglyceride oil, you ultimately shift your metabolism to a point where your cells begin saying, you know what, I'm not gonna be burning sugar all the time because it's not around. We are flex fuel organisms. We can burn other things. We can shift, we can adapt to burning fat, not just dietary fat, but fat that we harvest from our own bellies or wherever we're storing fat. Through the liver, these free fatty acids then are metabolized into what are called ketone bodies. And these ketone bodies are an incredibly efficient Power Fuel, a powerful fuel.

They're a Power Fuel.

Power Fuel. I gotta get to.com before you do. URL: powerfuel.com. But that said, it's a terrific way to power your brain. And, you know, pharmaceuticals have known this for a long time to the extent that they actually developed a powdered product years ago that they were marketing, a still market, as a way to power the brain and get results in terms of memory. So it turns out that powering your brain with fat is a better way of augmenting brain function, preserving the brain, preventing brain decline. It's been used therapeutically since the late 1920s to treat epilepsy. In 2005 in the journal Neurology was a powerful article showing incredible improvement in Parkinson's patients by going on what we're describing a ketogenic, a diet that makes ketones, a ketogenic diet. More powerful than any medication in terms of reducing the rating scale that's used to rate how bad Parkinson's patients are doing.

It's amazing.

Just dietary. And yet, all that neurologists do generally is treat the symptoms of Parkinson's. I think there's merit to using those drugs. I write the prescriptions. But you've got to treat the fire, not just the smoke. We do that in Parkinson's by giving things like coenzyme Q10, by giving things like NAC and putting patients on a ketogenic diet. Why? Because it makes sense. But beyond that, it's what the science tells us we should be doing.

Yet it's almost absent from medical care, right? Doctors treat patients with Alzheimer's and Parkinson's never mention diet. Never talk about it.

It's true, and I'm not going to curse the darkness, but my mission is to light the flame, and that is to, for any people who want this information, that's what this is all about. That's why we do these presentations. So for those people who want to learn that there's more out there, I'm here to say there is a lot more out there, and there are a few people who are going through the literature published in the most well-respected peer-reviewed journals. What did I just quote? The Journal of Alzheimer's Disease. What did the New England Journal of Medicine tell us in September of 2013? They made a very simple statement. Here's the study. It took several thousand individuals. They said, hello, how are you? We're going to do two tests on you today. We're going to measure your blood sugar, and we're going to measure how well your brain is working. They followed these people for about seven years. They came back and they only did one test. How is your brain working? They did an examination of brain function. They didn't even measure the blood sugar at that examination. What they found was a dramatic correlation between their original blood sugar and whether or not they became demented. And what they found was really quite startling, and that is that even having a blood sugar of 105.

Which is normal.

Which is so-called normal was dramatically associated with risk for dementia. So you just put the word normal and these are quotes for those who don't know in quotes because we need to challenge that and that is not go with what is the normal value but what is optimal. A blood sugar of 100 is not optimal and yet go to the doctor, you'll get a pat on the back or who knows where but they'll say it's fine, you're in the normal range. For people like you and people like me who are out there helping to get better information out. We want optimal range. We want the best information. Blood sugar 85 to 90, for example. That's what you want. You want your A1C not at six because you're still not diabetic. You want your A1C at 5.3, 5.4. That's ideal. That's what's associated with brain preservation. And these are things that are based upon sugar versus fat.

Now, so we talked about saturated fat and I want to sort of help get that debunked. And I also want to talk about statins, 'cause you write a lot about statins, which are ubiquitous and prescriptions. I met a 39-year-old woman who was given a statin who exercised all the time, had normal triglycerides and HDL, who really was healthy and took care of herself, a normal weight, not diabetic, and their doctor was giving her a statin. So how does this affect the brain? And should we be worried about saturated fats?

Well, these I think are two different topics. Let's first start with saturated fats. And the brain loves saturated fats and the body loves saturated fats. We've been eating saturated fats for as long as we've been walking the planet. So, you know, when you realize that 50% of the fat in breast milk is saturated fat, who did you say got that wrong? Mother Nature or God? I'm not willing to take that position and accuse either of those two positions. So we need saturated fat. Why is it so good for us? Because by virtue of the fact that saturated fat is saturated, it means, by definition, it cannot be oxidized. That's the beauty of saturated fat. Why we incorporate saturated fat into our cell membranes and our brain cell membranes, our neurons, is because they can't then be oxidized. Or damaged. Or damaged by these crazy chemicals called free radicals, which we actually need. but which everybody seems to be mounting a war against. So, I think that it gets back to something that we talked about earlier. In the context of eating a diet that's got a lot of sugar in it, then we begin to wonder about having high levels of saturated fat and total fat in the diet. Now, as it relates to cholesterol, ice cream, fried... All those good things. Yeah, a fried ice cream would be about as bad as you could It's not just fat, but it's got trans fats too. But the notion of cholesterol being our enemy is, you know, something- well, that's the whole thesis of saturated fat is.

That it raises your cholesterol. So it's bad because cholesterol is bad.

Cholesterol is bad. And there is something, believe it or not, that somebody has called bad cholesterol, LDL, and it's breathtaking. I don't know if it was Don Draper, but somebody on Madison Avenue came up with the idea, we're going to call LDL, bad cholesterol. It's not bad and it's not cholesterol. It's neither of those two things. And yet everybody wants their LDL as low as possibly they can get it and their cholesterol as low as they can get it as well. And you know, when you realize, for example, that those elderly individuals who have the lowest cholesterol have the highest risk for dementia, you should take a step back and say, gee, therefore does it make sense that we should declare war on cholesterol? No, we need cholesterol. Why? It's a critical part of cell membranes. It is a brain antioxidant. It is the chemical from which your body makes testosterone, estrogen, progesterone, cortisol, and even vitamin D. So we wonder why it is that people who have the lowest level of cholesterol have such issues. There are plenty of factors that we can read about on a lipid profile that do relate to cardiovascular risk. One of them is a damaged form of this LDL that we call oxidized LDL. And what does it mean?

They say rancid LDL.

Rancid or yeah, rancid LDL. What does it mean? It means it became oxidized, became damaged by free radicals. Now more and more laboratories are demonstrating that because we can reduce the oxidation of our LDL by Believe it or not, reducing our sugar. How does it work? Oxidized LDL correlates with the level of glycated LDL, the level of this protein that has been bound to sugar. The less our level of our blood sugar, the less that process happens. Reduce the glycation of LDL, it reduces the oxidation of LDL. That's why that's important. If you don't know your oxidized LDL, you can infer whether it's high or low by looking at your A1C. that's a blood test that far too many Americans are very familiar with because 28 to 30 million of Americans are now diabetic and estimates are that as many as 100 million of us may be what is called pre-diabetic. And it's not a surprise, you know, when you look at the numbers, you look at people in general, that that's happening. Diabetes is happening because of our diets being higher in sugar, But it's also happening, and this is really important because of changes in the microbiome, as is obesity. There are plenty of people who aren't taking in very many calories and are now on low carb, low sugar and eating a little bit of fat and still can't lose weight. And they will not lose weight until they first reprogram their microbiomes, their gut bacteria, that right now think their body is starving. and hold on to every calorie as if they are starving. That scenario sets the stage for diabetes, it sets the stage for Alzheimer's disease as well. Diabetic, you quadruple your risk of Alzheimer's.

So what about statins? Because you're just saying that cholesterol is important, that it's not the enemy we thought, that it's damaged cholesterol, it's an issue and that's worsened with sugar in your diet and other factors. Millions and millions of Americans are getting statins. People who don't have heart disease, who have low risk factors, normal blood pressure, normal blood sugar, who exercise, who don't smoke, if their LDL is high, they're getting statins. So what is the risk of those drugs and what is the future of this?

You know, it's what greases the skids, these simple ideas. that cholesterol is bad and will kill you, that a diet high in fat is bad and will kill you. They take traction and they are tenacious and it takes a long time and a lot of work for forward-thinking progressive healthcare practitioners to reverse those wrongs. You know, by and large, people who have elevated cholesterol without other risk factors, in my opinion, do not need statins and yet They're prescribed left, right, and center, as you well characterized. Are there people with multiple risk factors with familial genetically elevated cholesterol who should bring their cholesterols down to a more reasonable level? I think there's an argument in favor of that. Dr. Sure. Dr. But not overdoing it. It's not the lower the better. But at the same time that cholesterol is being lowered with a statin drug, ask yourself what are the downsides of statins and is there anything we can do to offset those downsides? And yes, we understand that taking a statin drug has a detrimental effect on coenzyme Q10 level, a nutritional supplement that people can buy in the health food store. The idea of taking a statin drug without adding CoQ10 will not be considered malpractice, but in the world of integrative medicine, if we ever could influence that, it would be. We need CoQ10 on board, I think all the time, but certainly in the presence of a statin medication. So I think many, if not most, patients on statin drugs shouldn't be taking them. They are dramatically overused in patients with stroke who have no heart disease because of the correlations of stroke, and maybe the patient does have some heart disease hiding in the background. The data is very sketchy on reduction of next stroke by taking a statin medication. There are researchers trying to squeeze the use of statins into an Alzheimer's treatment protocol, which makes absolutely no sense whatsoever.

Amazing. So, you know, for people watching, they're listening to all this and they're both probably enraged and enthused about what they can do and what's been happening them. You know, what would be the things you'd want to say to them to help them become empowered about their brain? What are the take-homes?

I love the word empowered. That is having the knowledge to make change. And let me just say that we live in a world where we are told to live our lives come what may and when the shoe drops and we are given a diagnosis, we hope there's a magic pill. There is no effective treatment for Alzheimer's. and yet Dr. Hyman, it is as you well know, a preventable disease. That's the message. It's a dietary issue. Exercise is fundamentally important for growing new brain cells and staving off Alzheimer's.

If you loved that last video, you should check out the next one for sure on getting to the root cause of all disease. When we hyper-hygenized ourselves our food's purified and when we're not playing in farms and dirts, when we're exposed to all the horrible diet we have in America, all these factors drive this.