Heroic Interview: Brain Health 101 with David Perlmutter

You're listening to Brain Health 101, an optimal living interview with David Perlmutter and Brian Johnson.

Hi, this is Brian. Welcome back to the Optimize podcast. Today I am thrilled to be chatting with Dr. David Perlmutter. He is the author of a number of best selling books. We featured four of them and Grain Brain, Brain Maker, the Grain Brain Whole Life Plan, and Power up youp Brain. He is re releasing Grain Brain, which I'm very excited about. And he also has a new book coming out next year with his son who's also an MD called Brainwash to plant the seed on that that I cannot wait to see and share with you more. Today we're going to talk about brain health. I'm kind of thinking about this as kind of a Grain Brain, Brain Health 101 discussion. Dr. Perlmutter, thank you so much for taking the time. Thank you so much for the decades of hard work that you've put in to help us as both a leading neurologist and a leading nutritionist. Your work has just radically transformed my wife and I's my consciousness and my wife's consciousness around nutrition, how we raised our kids. We're deeply grateful and I appreciate you taking the time.

I will say, Brian, that that is a very empowering introduction. I mean, if I only helped out with Brian and his wife in this world, it's still, it's a lot and it's meaningful. So I do appreciate your support all along the way. And moving forward, I appreciate these opportunities to share, you know, my wisdom or my thoughts as I see them.

Well, again, thankfully you've helped a lot more than just me and my wife. And it's time for more and more people to become aware of your wisdom. So let's start at the top. Brain Health 101. Tell us what does a healthy brain look like, feel like, and then we'll talk about what gets in the way and what we can do to optimize.

It's a great place to start because you know what you're focusing on then are what are those lifestyle factors that really make for the best brain that you can have, the best brain you can hope for, not only in terms of radio right now in terms of its functionality, but what is the brain that you can create that will, moving forward, be resistant to disease, be resistant to degeneration, and remain functional throughout your physical functionality as well. And I think we have to understand that our brain has served us well for the past 2 million years and during almost that entire period of time the past 2 million years, the brain of the human has been increasing in size. In fact, virtually from 2 million years ago until just yesterday, the human brain actually tripled in size. What happened about 10 to 12 to 14,000 years ago is that stopped. The brain maxed out. And when I say yesterday, that's what I'm referring to. And since that time, the human brain has actually declined in its size by about 10%. And indeed, other health issues have become far more common in humans over the past 10 to, let's say, 14,000 years. Really asynchronous with the advent of agriculture. Those two things happened together. Does it mean that one thing caused the other? Well, in a strict scientific sense, I can't say that, but I sure think so. We understand that the foods we consume relate directly in and out of communication with our DNA on a daily basis. We call that epigenetics. How our food and other lifestyle issues are interacting with our genome. And suddenly, just in the blink of an eye, in 0.5% of our time on the planet, we turned the tables on our DNA. We started sending food signals to our genome that it has never seen before. And what that did, when we suddenly shifted away from a diet that was higher in fat and had higher levels of quality protein and much less carbohydrate, and certainly much less simple carbohydrate and sugar, we suddenly created a higher level of one mechanistic player called inflammation. It turns out that this inflammation that I refer to is really pivotal in terms of the degeneration of the human brain. We can understand that from a disease perspective when we get our arms around the notion that Alzheimer's and Parkinson's and autism are inflammatory disorders, as is depression, for that matter, and even other things like coronary artery disease, diabetes and cancer. These are issues that are really founded on upregulation or enhancement of, of this process of inflammation in the human body. So to get back to the focus of your question, what is best for the human brain to keep it in its best health and most functional disease resistant state, is a lifestyle that lowers inflammation, a lifestyle that incorporates dietary measures and other lifestyle factors, adequate amounts of sleep, exercise, and these days, meditation, forest bathing, getting out in nature, etc. All of the things that we have great science that would indicate that these are connected to lowering inflammation, the cornerstone of our most dreaded diseases, even well beyond the brain. And you know, when I say that, I think it's important to recognize that as you and I have this conversation right now, the World Health Organization is Telling us that the number one cause of death on planet Earth are chronic degenerative conditions. And when you see the term chronic degenerative conditions, the word that should come up behind me or behind you is the word inflammation. So these are inflammatory disorders that are without a doubt a consequence of our lifestyle choices that are really in great contradiction with what the human has been experiencing for 99.5% of our time on this planet.

And what would you say, just to drill right into that, what would you say is the number one lifestyle change that has most kind of damaged our brains and our overall well being?

It'd be a tough call. I would say probably the dietary change to a much higher carbohydrate diet with less adequate types of fats would be probably the most likely to be number one on the list. And here's why I say that, because I was tempted to say sedentarity, lack of movement, really the lack of activity that we find ourselves involved in. However, these changes are recorded in the past 10,000 years during a time when humans actually remain very, very active. The only variable being pretty much the dietary change. And of course, more recently, as we adopted wearing clothes, in other words, reducing our vitamin D production. But the big variable, I think, has been dietary. And we certainly know that that is incredibly in play in today's world, that what passes for food these days is a very bizarre kind of notion. I gave a lecture last night, and I opened the lecture by asking a question, what is food? Not a single hand went up. And finally somebody ventured her hand up and she said, well, it's what sustains us. Great. I mean, I can live with that definition. I then read, and again, this was last night, the 2018 Webster's Dictionary definition of food. And it was something along the lines of the protein, fat, and carbohydrates that any living animal needs to sustain itself. And that was it. And, well, it's better. But, you know, when we begin to understand what food is and what it means in the context of nutrition, we really understand that it's a very, very big and hopefully diverse discussion. Well away from protein, carbohydrates and fat. I mean, you know, that's been the focus of dietary plans for a long time. Well, we're going to limit your carbs and limit your fat and ultimately limit calories, which is, with all due respect, incredibly myopic. When we broaden our scope, we recognize that food is information, that food is actually in vivid communication with our gift from all of those who came before our genome. That Every morsel of food we consume is directly influencing genetic expression in terms of inflammation, to get back to that, but also in terms of cell metabolism, detoxification, creation of neurochemistry, to name but a few, immune regulation, et cetera. And it's very interesting that we can expand that conversation to recognize that it's not only our genome that is responding to the foods that we consume, but it's also the genome of the hundred trillion organisms that live upon us and within us, that their rna, in this case bacteria, are absolutely responding to triggers that are found within the foods that we consume. And I have to say that the mechanisms that are involved in that transfer of instruction from food to gene expression of the bacteria living within us, that mechanism was only delineated in the past few weeks. So researchers at Louisville University, specifically Jung Ting is the lead researcher, just published a report demonstrating how what are called exosomes, little tiny packets of RNA information from inside cells, from cell nuclei, get out when we digest plant foods, for example. That's what the research centered on. And make their way into the genetic material of bacteria living within us. Change the activity, the metabolic products, and even the location and functionality of the bacteria that live within us. That is breathtaking. That the food we eat is changing gene expression of the bacteria that live within us, that play a huge role in things like metabolism, our metabolism, our levels of inflammation, the balance of neurochemistry that deals with things like our mood, how we perceive the world around us. So what a powerful link was just discovered between the foods that we eat and how we see the world around us. So, you know, it's a few dots that have to be connected, but when you, you know, when you're falling asleep at night, you lean back and you think about these ideas. It's really an aha moment. It does fill you with awe.

So much there we can unpack. That is astonishing. I know you've been doing a lot of work on the microbiome, which you know is now called the second brain. Really Right. In terms of its, its relationship. And of course you talk about this in all of your books. Just to drill in on the practical side. Again, so we're close. Second of movement, sedentaryness. So we recognize that shining the spotlight back on the nutrition, the changes that occurred over the last 10, 12, whatever it is, thousand years, what can we do today that's going to have the biggest impact on optimizing everything you just described?

That's a great question. So let's start. The bullet points in the lightning Round here, I think that we have to focus on our diet and we can take a cue from the paleo movement if you like, but when you recognize that the human genome has not really undergone any dramatic changes in 70, 80,000 years, you really want to target our genome with the signals to which it responds most favorably. And certainly our diet is a very important signaling mechanism for our genome. So very specifically then, the diet should be one that has dramatically reduced level of simple carbohydrates and sugars as well. And it's a diet that has lots of good, nutritious, fiber rich foods, which are carbohydrate, I might add, but by definition not going to be the carbohydrates that influence us in terms of a calorie source. So when you're cutting the carbs, you don't want to cut the fiber carbs, you want to focus on net carbs, meaning total carbohydrates, take away fiber, take away sugar, alcohols, if that happens to be in some of the foods you're eating. But by and large it's total carbs minus fiber. We want to welcome fat back to the table and lots and lots of good fats, being emphasis on the word good, meaning not safflower oil, sunflower oil, canola oil, other oils, soy oil that are modified to remain on the grocery store shelves for years and years, which are pro inflammatory by virtue of their high omega 6 content. We want to eat the extra virgin olive oil, the fats and oils that are found in grass fed beef, if that's your choice, wild fish, nuts and seeds, eggs, who knew good fat? It was not long ago when you couldn't say the word good and the word fat in the same sentence, because that is a dichotomy that almost existed until today. So lots and lots of fat. You want to try to push yourself, not infrequently, into a state of ketosis, meaning that your body shifts away from burning carbs as a fuel source to a body that burns fat, both body fat and also the fat that is found in your diet. What we now recognize two important facts. Number one, that likely our Paleolithic ancestors spent a great deal of time in this state. We call ketosis, meaning burning fat, not carbs, number one. And number two, we fully understand why today this is a really healthful choice. When we're creating these ketones by burning fat by carb restriction and adding things perhaps to our diet, like MCT oil or coconut oil, we create chemicals called ketones, one of which is called beta Hydroxybutyrate, which beyond serving as an incredible fuel for your brain cells, is actually in and of itself a signaling molecule. It changes gene expression again to reduce inflammation. It enhances insulin sensitivity. In this world of ours, where In America perhaps 60 or 70% of adults are either pre diabetic or overtly diabetic, already shortening their lives, increasing their risk for Alzheimer's, coronary artery disease and cancer. So this is how we get away from that. We've got to welcome back to the table the diet of our ancestors, but realize that we can harvest new science, like the science that understands why the ketogenic diet is so powerful by doing things even beyond a paleo type diet, like adding in the coconut oil, or even more powerfully adding in the MCT oil to allow our bodies to capitalize on, on this science. Help us lose weight, help us sleep better, help us improve our moods, help us have better endurance, help our brains work much more efficiently, and ultimately help us do the things that bring us happiness and joy.

Beautifully said, and again, so much there. And as a personal experience, as I've deliberately shifted toward actually measuring my ketones and actually striving to see where my glucose levels are, where my ketones are, it's been astonishing to me on all the fronts you just described. From an energy perspective, an endurance perspective, as an athlete mood, all those things, it's just, it's astonishing to me the benefits I'm personally experiencing, and then our family as well. And I want to talk a little more about kids in a moment, but just a quick aside, exogenous ketones, what are your thoughts on that?

We're early in the world of exogenous ketones and I think that, you know, the real question is absorption to blood level, which we see is happening. What we do know is that blood level to brain level is linear. So when we raise beta hydroxybutyrate in the blood, however, we do it by caloric restriction, by intermittent fasting, by overt fasting, or by just taking a lot of MCT oil. For example, those levels of beta hydroxybutyrate directly translate to brain levels of beta hydroxybutyrate. But the addition of actual ketones, we're seeing more and more data indicating that there is very likely some pretty powerful activity associated, especially again mentioning beta hydroxybutyrate in terms of being something good and healthy for your body. You're targeting gene expression, you're targeting what are called G protein receptors that have modify how cells work, and you're actually directly enhancing brain metabolic activity while at the same time actually reducing the production of damaging free radicals. I don't see how you can argue with that as a deal. You know, that's a deal I want to be part of. So we're watching that development, and this is what's so exciting for people like yourself and myself, is that all the science is not done. It is dynamic. And so it means you got to keep focused on this stuff because every day or two a new study comes out and it's exciting. We can't wait to see what tomorrow will bring. And you know, I have to admit, in the past I've been criticized because my message changes with time. And that's the purpose of my life, is to change my message, as in lockstep with evolving science. So what you don't want is for people to lock in at a certain level and that's it. Nothing changes moving forward. You know, that sort of relinquishes our human gift of the ability to question and make progress. So I think we'll watch the science and see where it goes.

Yeah, that's inspiring. And just that idea too, of just leaving the fixed mindset to a real growth mindset, experimental mindset, where n equals 1, meets the emerging science and what works for us as individuals, which we're also learning so much about, right, that there's so much bio individuality here from our genetics, our microbiome, our stress levels, our exercise, that one size doesn't fit all right. There isn't one diet that's perfect for everyone for all time. That there's this interplay that's as dynamic as the science is. And to embrace that and to kind of move beyond the dogma has probably been my biggest liberation as a recovering vegan Jelica of low fat 10 years. There's this, you know, for me, just almost a joy to the process because there's a refusal to become dogmatic about anything ever again. Let's look at what works individually, let's look at what the science is saying. Know everyone's cherry picking, you know, the data they want to see because it's so broad, and then find what works for us and those general principles that make sense. And. And then the lab reports are going to tell you, is it working or is it not working? You know, the energy levels, the mood. It's fun to see that. And to bring it back to your point, maintaining that open mind, experimental mindset.

Et cetera, beyond what you and I are doing and talking about, it's the idea of listening to Another person's perspective, taking the time to stop talking and listening to another person's perspective. And, you know, that doesn't happen very much anymore. People say what they want to say and that's it. End of story, closed mind, and they move on. They're operating really from the amygdala. That's the way it is. And no consideration, no activation of the prefrontal cortex to really think about what people are talking about and what the implications might be. I did an interview with a chiropractor friend of mine named John Duillard, and he's a terrific guy. And he wrote a book really, kind of extolling the virtues of eating grains and even those that contain gluten, which is clearly counter to what I have been writing about and speaking about for many years. We had the most respectful and meaningful and educational for each other, a conversation on a podcast. And the response from the audience was just breathtaking. They couldn't believe that two people who held positions could listen to the other side. And, you know, maybe he changed my view a bit, maybe I changed his view a bit. Maybe yes, maybe no. We don't know. But, you know, who can dig their heels in and feel that they are right and everyone else is wrong? We will never make progress if that is how people behave.

Amen. Let's extrapolate that across our culture these days. Let's go. I want to bring that focus back to the family. My wife Alexandra was very clear. You need to ask Dr. Perlmutter about kids. Tell us about your thoughts on nutrition for kids. Ketosis over an extended period of time. Is this something we want to think about and engage in with kids? Ours are 6 years old. Our 21 month old is still breastfeeding and obviously eating the foods that we eat, et cetera. What are your thoughts on how parents should be approaching this with their children?

Well, I'd say that during your child's first six months of life, you don't have to worry about it because your child is already deeply into ketosis. So breast milk is one of the highest natural sources of medium chain triglycerides and as such, profoundly amps up the likelihood that an infant is into ketosis. Beyond that, the metabolism of the infant is such that they are able to actually store medium chain triglycerides, unlike those of adults. For example, we don't really have that opportunity to any significant degree. Our fat storage is what is called long chain fatty acids, which have a bit of a more difficult time in being manipulated biochemically to form ketone bodies. So the infant is really primed for ketosis. And why would that be? Well, we know that again, getting back to these ketones, beta hydroxybutyrate being the super fuel for the brain. This is a time when the brain is exploding, not just in terms of the number of neurons that it is growing, but also in their connection, what we call synaptoplastic activity or neuroplasticity, the joining of neurons to each other. In addition, something else is happening called synaptic pruning, where certain synapses are being removed just to make the brain more efficient. That continues well into our teens and even into our early 20s. So we begin life deeply into ketosis. We believe that as teenagers and young adults, we should be in ketosis. That's what the data shows. So I'm really trying to figure out, is there a spot during childhood when the child's brain should be powered by glucose and they should be eating lots of sugar, lots of carbs, and not so many fats? I'm gonna have a tough time with that. And maybe, you know, Brian, five years from now, you and I get together and I, and I say, well, now there's data that tells us what is best. My sense is that in and out of ketosis, even during, during childhood and adolescence, is, is the right recommendation. And I will see how that evolves with time. You know, humans throughout their lifespans have been in ketosis for again, as long as we've walked the planet, with the exception of just recently when we developed agriculture. So that would include children and that would include adolescents. So I would say that it may be a bit of a challenge these days to be able to implement a plan like that when kids go to school, when kids go away, et cetera. But it is clearly across the board, I believe the best thing you can do for health and specifically for the brain, super helpful.

And that's always been my take as well. You know, it wasn't just one segment of the population that was sustaining themselves this way. It was across the lifespan.

And. Exactly. Here's a little pearl for your wife, and that is that using MCT oil will still enhance the production of beta hydroxybutyrate, an important ketone, even if a child is not on a so called ketogenic diet. So, you know, people can be eating not such a great diet, you know, higher in carbs, but if they supplement with MCT oil, they're still getting the benefits of having beta hydroxybutyrate on board. And that might make raising a You know, a child, an adolescent easier in terms of making these dietary changes that you think ultimately as a parent are your obligation. Do the very best you can.

Yeah. And just to get just a personal story for our listeners, we're obviously, you know, strive to do our best nutritionally, et cetera. I think there's some hesitation about entering this state, which I want to talk about too, which I think is probably the biggest barrier is it's so ubiquitous our culture with the refined carbohydrates, the sugars, the flours, the grains that it must be okay I think is the default thinking pattern with standard of care. Wouldn't all that dialogue that goes with conforming to very unhealthy society. But I will say that as we actually experimented with this and deliberately restricted for us it was never a high carbohydrate but he ate a significant amount of fruit and even eliminating fruit for us. And he's amazing. Our six year old is just a, he's just a wonderful boy. Yet when we did this it was amazing to see he's even better. There's this level of now goosebumps. They say that this level of presence and fun and playfulness and stability and we test ourselves with a little, you know, we use keto mojo as our thing for the ketones and the glucose. And we never said he needed to do it but you know, he felt left out so he wanted to do it. Ketones off the charts. His glucose is extraordinarily where it needs to be, you know, just. And his mood is correlated. And so it's just been this beautiful experiment for us as we've looked at it and then also looked at the data. It was very helpful for us to actually correlate the mood with the data in our context. There was the ketone and the glucose measures and to see the two go hand in hand with the what we would have been more conservatively concerned about a very strong restriction on carbohydrates all the way down to he hasn't had fruit in, I don't know, X weeks at this stage as part of this experiment running now. And it's never been better. So it's just been fun for us. But even us as willing as we are to play at the edge, we still have a challenging time to not conform to societal standards. So I want to address that a little bit. Just the pressure that we feel to conform on a broader level and the idea that it can't be that bad for you if everyone's doing it and you know, doctors aren't telling us to be thinking about this, etc.

Well, let me comment. If everyone's doing it and in general, health is declining, that would indicate that what everyone is doing isn't necessarily the most salubrious course of action. Number one, when you say that out.

Loud, it's so obvious, but yet knowing that it's still so difficult to change our behaviors. Right. So sorry to interrupt you, but go ahead.

Yeah, you know, we are really at the mercy of the herd mentality and the sense that we need to conform. And I have to say that social media has made that dramatically worse and has really basically hijacked our brains to make us believe that we have to be thinner, taller, shorter, whatever it may be, richer, more popular, have more likes, more friends, you name it. And always offers up a quick click fix for the. For the response, buy this, eat this, and you'll be then whatever the goal may be, artificial goals that are set up really so we can be manipulated. But I want to tell you about one interesting scientific study that kind of validates this notion of ketosis. And it's a study of all of humanity, and it's been going on for 2 million years. And it kind of shows that our ancestors were on the right track. They lived for 2 million years and got us to this point, point. Suddenly our health is declining, and it's declining very, very rapidly. I mentioned earlier that, you know, the human brain is now shrinking, having increased in size over time, that bone density is decreasing, that overall our health is decreasing. People would say, well, you know, our Paleolithic ancestors, they only had a life expectancy of whatever it was, you know, 30 years old. Is that true? Yeah, it's true. Because they would die of trauma or in childbirth, et cetera. Those early births get factored into the average. But, you know, there's fossil evidence of our Paleolithic ancestors living into their 90s, living into 100, and people don't really want to talk about that. You look at their den, you look at the teeth of these fossilized humans from thousands and thousands of years ago. They've got beautiful teeth, and you don't even these days see that. So. And again, as mentioned, the density of the bones. So you're up against the herd mentality. And you know, what we talk about five years ago, when I first published, Grain brain was very much against the grain. What can I say? I mean, was I. It's a terrible pun, but I've used it before. But the fact is, it really raised a lot of eyebrows and I'm so very taken that, you know, we just put our putting out the new revision five years later that the science just basically validated what we talked about, that it was not the fat and it has never been the fat. It's been the sugar and the high level of simple carbohydrates. And yes, as a matter of fact, gluten is not good for human health. That's all we said. We said eat higher levels of good fat. So we've been validated by the predimed study that added a liter of olive oil to the diets of humans each week on top of the Mediterranean diet, and showed a further 40% risk reduction, for example, in risk for dementia. We've seen the Lancet study that demonstrated a huge study that involved 18 countries that showed that those individuals who had highest level of carbohydrates during the course of the study had about a 28% increased risk of death, whereas those who favored fat, their risk of dying was reduced by about 23%. And we rallied against the notion that, you know, you should live your life come what may, and then when you're suddenly finding that you can't remember things, there's a pill for you, Brian. We talked about it five years ago. We've again talked about it in the new release, Grain Brain. There is no pill, there is no effective treatment for that dreaded Alzheimer's disease whatsoever. And oddly enough, just three days ago, a study was published by the American Medical association looking at the two major classes of so called Alzheimer's drug, what are called cholinesterase inhibitors and a drug called memantine. And they found that in comparison to people not taking the medications, those who took the medications and declined cognitively more rapidly. So it's not just that the drugs don't work, they actually speed the progression of the very disease that they were designed to treat. And that flies directly in the face of the notion of above all, do no harm. It's been predicted that Aricept, for example, one of the cholinesterase inhibitor drugs, the subject of this study that came out a couple of days ago, predicts that their sales are going to decline so that by the year 2022, they're only going to have half a billion dollars worth of sales globally. That's, you know, that's going to happen relatively soon. And it's only half a billion dollars in sales for a drug that has no proven efficacy that's actually making Alzheimer's patients worse. So, you know, does it raise the hair on the back of your neck when we talk about this stuff. It sure does. It really serves to validate the mission of being in a place of doing the very best you can to get this information out. Because, you know, truly the number of people I reach, the number of people you reach is finite. And in comparison to the incredible reach of pharmaceutical advertising to doctors to make these decisions, you know, it's paltry. And I sure wish that more people could learn about what the true science is telling us. But I have to say, I don't think 5 years ago the Journal of the American Medical association would have published a study like that. But this is in the face of, or through the lens of the notion, well studied and described notion, that Alzheimer's is significantly preventable. Think about that. We know that lifestyle factors like you and I have talked about today are profoundly important in determining who does or who doesn't get Alzheimer's. Sure, there are some genetic risk factors, but they pale in comparison to the lifestyle factors, higher blood sugar, sedentarity, not doing any movement, poor quality sleep, for example, that are dramatically associated with increasing your risk for this incurable disease. That's the message that really needs to be talked about. I had the opportunity 11 months ago to speak to the World bank and International Monetary Fund about this exact topic that was simulcasted to 50 sites around the world. And of course, I had to talk about the monetary implications of the epidemic of Alzheimer's disease now costing our planet $1 trillion annually, rivaling the market value of Apple Corporation. And I said, you know, we don't have a treatment. Millions and millions of dollars are being spent in pharmaceutical research to find the magic treatment for this disease. Although parenthetically, Pfizer, a couple of months ago, actually in February of 2018, cancelled all of their research for Alzheimer's, realizing it just wasn't going to pay off. But again, here are the lifestyle changes that can reduce a person's risk for the disease before it happens. Like John Kennedy said, the time to fix the roof is when the sun is shining. Doesn't that make more sense than trying to develop a magic pill to cure a disease after it has already manifest? Hey, if there was an Alzheimer's pill, I would be writing prescriptions for it. And I would have given my father that magic pill when he had Alzheimer's that took his life. You bet I would have used it. But I mean, here's a study that came out, as I mentioned, just a couple days ago, saying that this drug being taken right now by millions of Americans is not Helping mom or dad or husband or wife, and it's actually speeding their cognitive decline. That's kind of important information.

So again, to now go to the other end of the lifespan. So we have a broad range of individuals who'll be listening to this, some of them parents of young children, but those are going to be kids of parents who are entering their later stage of life. You talk about there is no magic pill. What came to my mind when you said that was. But there are little poison pills and we just need to make the connection between those little, you know, bites we're taking of the highly refined carbohydrates, the sugar, the flour, the grains. Can you give us a quick 101 on it's grain brain? Right, so what's grain doing? What are these highly refined carbohydrates doing? You mentioned inflammation, but like what's actually happening so that we canwe can hear that and then take action.

Good. So what you're asking me to do, Brian, is connect a couple of dots that we've raised in our conversation so far. And the first dot is inflammation being the cornerstone of neurodegenerative conditions like Alzheimer's. And now let's link that to the over utilization of carbohydrates in the modern American western world diet now globally. You're trying to connect those dots and mechanistically it's actually very straightforward. We know that the higher levels of sugars we eat, oddly enough, the higher will be our blood sugar. Who knew? Eat more sugar. It raises your blood sugar, increases your risk of diabetes, increases your risk of all these conditions we've talked about. But how does it relate to inflammation? And there are many, many things involved. First, higher levels of blood sugar increase a process called glycation, where sugar binds to proteins and changes the shape of proteins in our bodies. When the proteins have changed their shape, they activate immune pathways that deal with this and start to increase the production of these inflammatory chemicals. So glycated proteins dramatically increase the production of inflammatory chemicals called cytokines, number one. Number two, we depend upon the action of a hormone called insulin to create a healthy and maintain a healthy brain. The more sugar in the diet, and consequently the higher the blood sugar, the less able we are to respond to insulin. We become what is called insulin resistant. So these two players are in operation and are the link then between our dietary change, raising our blood sugar, the process of inflammation and and ultimately a process called apoptosis, meaning the death of brain cells. So let's break it down a little bit for your listeners in terms of how they could get a sense as to how this may be going on in their bodies. First of all, we are now able to measure the rate of glycation in the human body by doing a simple blood test that many of your listeners have heard about. If you watch television, you see advertisements for diabetes drugs that lower what your A1C. Everyone's heard about A1C. Well, I don't need to check that because I'm not diabetic. It's not the right answer. The right answer is get your A1C checked because that is a measurement of what we talked about, the glycation, the binding of sugar to protein. In the case of A1C, the protein happens to be hemoglobin. Hemoglobin A1C. The higher the A1C, the higher is the rate of inflammation in your body. But I'm going to take it a lot further than that. In a study that we reported in the first version of Grain Brain and we reiterated this time around, there's a direct correlation between the level of A1C in your blood and the rate at which your brain shrinks on an annual basis. And this is happening in so called normal levels of A1C, not the high A1Cs that you see on television. I want my A1C less than 7. This happens at the A1C level of 5.8, 6.0. These are hemoglobin A1C far below the level of so called diabetes, meaning that lower is better to a certain degree. There is also a study that was recently published in the journal Diabetologia Diabetologia that compares cognitive function right now with your A1C, meaning that on multiple markers of cognitive function like memory, the higher your A1C, the worse you're going to perform right now, not in the future, but right now. A study appearing in the journal New England Journal of Medicine in September of 2013 showed that blood sugar was the most powerful predictor of risk for dementia. So it gets back to what we're talking about. Earlier. You talked about blood sugar. You talked about measuring your ketones. You get your ketones higher and your blood sugar lower by eating a more ketogenic diet, a diet that excludes those refined carbohydrates and sugar in all of its forms. I don't care if it's organic non GMO honey that's made from bees that prey three times a day or maple syrup that comes from trees that are in a, you know, garden that's been there for 100 years. Or agave nectar, which is probably the most dangerous sweetener on the planet. And yet you find it in health food stores because it's got somehow attached to the word nectar. And it sounds so wonderful. We've got to get away from the fact that naming something makes it better. A croissant. Doesn't that sound great? What's a croissant? No, it's just simple carbohydrate with a little bit of a highly modified carbohydrate like a bagel, like pizza dough. It doesn't suddenly transform into something just because we've named it something else. We gotta start to recognize our foods for what they really are. That's why, you know, you write books, you do podcasts like you do, to really just let people be more informed and then they're able to make better decisions for themselves.

Brilliant. Well, we can talk all weekend and I am excited to chat more about how we can share more of your wisdom with our community and beyond. What have we not talked about today that you'd like to make sure we cover?

Oh, you really do you want to open that up? Maybe next time we'll do a deeper dive into the microbiome. We'll look at the effects on brain health chemically by exercise. We will explore the role of sleep in brain health in reducing risk for Alzheimer's or increasing it, depending on the quality of that sleep, how the glymphatic system works. We'll talk about some emerging therapies from a pharmaceutical perspective that may actually prove effective. We'll talk about some direct communication from the gut to the brain. We'll talk about how the microbiome is involved in regulating the mood of humans. We'll talk about how meditation and prayer play a role, how nature bathing is important, and about how we can really ultimately distance ourselves from other negative aspects of our digital lifestyle that may really be impacting our decision making ability in terms of making the right decisions. So I think we've got more to talk about in the future. I do want to tell your viewers I'm sure this will be okay. That that article that I just talked about with respect to Alzheimer's medications not working. I'm going to send you that article or link to it. So I really would like to get that out again published by the American Medical association, so have that appear magically on the podcast. I think that'd be a really important thing.

That's fantastic. We'll definitely highlight that and people can find you. What's the best place for them to find you.

DrPerlMutter.com DrPerlMutter.com we have a very robust website, fully searchable. All of the studies that I quote are available in their PDF, full PDF form on the website. You can search by topic, you can search by name. We send out a weekly newsletter, which is just a blog I might do, or maybe a video. So that's a good place to follow me. I do Facebook as well. David Probater, M.D. i do a lot of live Facebooks. I did one last night from a local source restaurant while we were eating dinner. I thought it was great. This woman was so dedicated to why that was important. So I do, I guess Instagram as well and all the other things that are important. Truthfully, I have a team that helps out a lot with those things.

We're happy you have that team so you can focus on your own. I do.

I admit it freely. But nothing goes out that I don't overview and most of what goes out is stuff that I obviously write and contribute. So I would say that Grain Brain has been revised as we talked about coming out soon. It's a book that is in 34 languages around the world, which I think is. I'm really excited about because it's just to know that this important message is. Is following what's happened to diet. You know, diet kind of begins in America and then it's this Westernization around the world. People want to follow what goes on here. Well, they can, but we're going to follow as well by giving out this information globally that, you know, this idea of what we're eating being appropriate should be challenged. I will say, however, that it's very heartening to travel the world and realize that not everybody is necessarily embracing what we consider to be food. So, you know, a lot of places are still pretty darn connected directly to their food that it isn't a trend of sourcing locally and growing organically. That's just how it's always been in the old world, in Europe, and to some degree, of course, and how in many areas it remains. So, you know, if you want to feel good about things, you take a look and see what's going on globally in some areas with respect to food. So there's really, really hope because I think what we're seeing is the science is telling us that those types of diets, you might call it the Mediterranean diet, that's the type of diet that people used to eat around the Mediterranean basin, seems to have some positive health relationships. So I think that there's really hope to spread a message that food matters. And we'll continue to do this and hopefully if I get invited back on your show to cover a few of those topics next year or three years, who knows? We'll see where we've come.

Yeah, that's exciting. I look forward to that again, Grain Brain. Check it out. Amazon, wherever you get your books. The revised edition. It's exciting to see the research catch up over the last five years and where it's going to be over the next two, three, five years, and then each of us being the change. I mean, this is our work. Optimize is from the Latin optimus, which means the best. So our challenge is be the best version of you. And the outcome of that is another ancient word. Hero literally means protector. So a big part of our work is be a hero, you know, have the strength for two to make a difference in the world. Every. Every dollar we spend is a vote for one thing or another. And you and I talked a little bit about the fact that 90% of our food supply or something comes from 10 different companies. Well, they're kind of. They're going to respond to what the market is demanding. And if each of us takes this challenge on to be the change we want to see so we can change the world together, that's how it's going to happen on that micro level extended to the macro. And we just need to get serious about this and again, be the exemplars that are helping break the conformity, which we talked about a little bit. And it just fires me up, you know, as we talked about in the prelude before we came on the recording here, of just doing the work, it's time, you know, now is the time to do it. I so appreciate you. I'm so grateful for you, and I'm honored to be able to support your work and look forward to doing more in the years and decades ahead. So thank you again.

Well, I appreciate that. And, you know, I remember the first time I met. I've never physically, personally met you, but I remember the first time I met you. Virtually, you were talking about one of my books with the board behind you, the whiteboard, and doing all those animations, I thought that was really very, very cool. That was a long time ago. But I will say, you know, talking about what you and I have talked about earlier, before we went on the podcast, that you mentioned that these top 10 companies are responsible for 90% of the food around the world and that they are following what, you know, the market trends I would say that I was very, very pleasantly surprised at my core, having visited the number one purveyor of food on planet Earth just a couple of weeks ago, Nestle. And yes, they're of course, interested in what the market is interested in, but they are also turning the direction of that ship to a place of doing what's right and realizing what's important for the health of the planet and hoping that the market will then follow them as they make these changes in their direction. And it is very, very exciting to just conceptualize in terms of what the future may hold in terms of an organization like that that has such a huge impact on the planet. So, you know, there's a lot of stuff going on around us that isn't pleasant. But I really want to focus on where those candles are, because there's a lot of darkness for sure, but there are some candles, and it looks as if more and more candles are being lit every day. And I want to, you know, I want to go to sleep at night feeling really positive. And I also want you to know that I really appreciate your work. And you just heartfully get these messages out that help so many people who you will never meet. And though I bet sometimes you meet them on the street and they thank you for the work that you're doing. You know, every time that happens, I'm sure you feel great, but realize that for every person you run into, there are thousands who you never meet. But, you know, you go to sleep at night thinking about that, so, you know, good for you.

Thank you. And the fun has just begun. I'm just fired up at all we can do together. So beautiful reflections. The world is changing. Now it's the question of how do we accelerate that rate of change and play our role in making a difference. And yeah, look forward to chatting again soon. Until then, drperlmutter.com check it out, grain brain. And then again, we've got all those notes and look forward to sharing a bunch more. Thank you.

Thank you, my friend. We hope you enjoyed this episode of Optimize with Brian Johnson. To find out more, go to Optimize Me.