Interview - Brain Maker with David Perlmutter, MD

You're listening to Optimize with Bryan Johnson. More wisdom in less time.

Hi, this is Brian. Welcome back to Optimal Living 101, the interview series. I'm really excited to be with Dr. David Perlmutter today, one of my favorite new teachers. I just got introduced to Dr. Perlmutter's work. In the last few months, I've read Power up youp Brain, the Neuroscience of Enlightenment, one of the best subtitles ever, Grain Brain, which is a phenomenal book as well, and then Dr. Perlmutter's most recent book, Brain Maker. Each of them covers a different aspect of the good doctor's expertise. My understanding is you are the only board certified neurologist, only doctor who's both a board certified neurologist and a member of the American College of Nutrition. Is that right?

As best I know, that's correct, yes. What a strange combination, a neuroscientist being involved in an organization that deals with nutrition. Where in the world would that come from?

Well, this is the combination of those two of being one of the world's leading experts in both the brain and neurology and in nutrition. And obviously that's what I'm so excited about to chat about today. So you've been a deep inspiration to me and my wife and appreciate you and your wisdom and I appreciate you taking the time to be here today.

Well, I'm delighted. And just for the viewers, they need to know that I reached out to you because I saw your YouTube video and I was so impressed with your work that I wanted to connect with you and things happened quickly and I'm really grateful for that.

Fantastic. Well, life is good and excited about all we'll explore today. Let's start at a really, really high level. Just how does what we eat affect our brain? A lot of people don't see the connection there. How do they go together?

It's a great question because, you know, we kind of live in a reductionist mentality where the brain is over there and the gut is over there and, you know, we're just a compilation of various parts. Well, the brain is really dependent, first of all upon nutrition. It requires high levels of high quality fat. Various vitamins affect brain function moment to moment and have a huge role to play in how the brain ages either gracefully or succumbs to a degenerative condition. But more importantly, I think as we move forward now, we are realizing that there's a lot going on with our food choices, more than just their nutrient content. We realize that within us live 100 trillion organisms, we call these commensal organisms, meaning that we are sharing the table with them. Co, meaning with mensa, means eat. And basically think about the fact that these bacteria living within your intestine are eating what you decide to eat. And that puts a different spin on your food choices moving forward. Recognizing that food choices that are inappropriate will lead to changes in those bacteria, lead to differences in the balance, differences in the array and the complexion and the diversity. Whereas choosing to eat in a way that nurtures your gut bacteria will be a powerful inspiration for the rest of your body to be healthy. And realizing that the gut bacteria are basically the arbiters of your health, moment to moment, and your future risk for disease, including brain disease. You know, Brian, 99% of the DNA in your body isn't what you got from mom and dad. Although we all focus on the 23,000 genes that we inherited from our parents. 99% of the DNA in your body is bacterial, and it lives in the bacteria that call your intestine home. So that just from a genetic perspective, there is so much going on with respect to the bacteria, not to mention the fact that those gut bacteria living within us are actually changing in either a good way or a bad way, the expression of our own DNA. So I think the message here in moving forward is we've got to eat in such a way that we nurture our microbiome, that collection of bacteria living.

Within us, which is the heart and the essence of your newest book, brain, how that microbiome affects everything in our lives. I think it was Mark Hyman who said your book could have been called health maker, not brain maker. Right, Just the importance of the microbiome.

It's hard to imagine now that we are at this place that there is a heart smart diet that would somehow be different from a low risk for diabetes diet or a cancer risk reduction diet, or a brain smart diet. No, there is a right diet for the human body. If the diet increases inflammation, it's going to be bad for the brain, for the heart, for diabetes risk, cancer risk, et cetera. So basically we look upon a diet being optimized when it's a diet that reduces this process called inflammation. Inflammation is the cornerstone of coronary artery disease, type 2 diabetes, Alzheimer's, Parkinson's, Ms. and even cancer. So we've got to do everything we can to reduce inflammation. That means eat lower levels of carbohydrate, eat nutrient dense foods, lots of good fiber, welcome healthful fat back to the table as well. And also realize that this process of inflammation from stem to stern, top to bottom, begins in the gut and is mediated by the good or bad types of bacteria that live within us. So, you know, you mentioned those past three books of my books that I've written, and it's really exciting and certainly validating for me that the messages of these books have all said the same thing, though. In Power up youp Brain and in Even Grain Brain, we knew that a lower carbohydrate, higher fat diet, higher fiber was the right diet, but we didn't have all the pieces in terms of why. Now we have the why, and it is supported by things like the Human Microbiome Project, the results of that study, that group of studies, and all the literature that's coming out now that's saying, wow, it turns out that these gut bacteria are determining health issues from top to bottom. So it's a very empowering time for me as a brain specialist to finally be taken to a new playing field. We've been given a brand new stadium here on which to play our game. And as such, we've got a whole new arena of tools that we can bring to bear powerfully with respect to keeping the brain healthy and even intervening when the brain starts to fail in a very, very powerful way by looking at what's going on in the gut. And I will say it again, who knew? Who knew this is where I would be at this stage in my career, looking at gut bacteria, of all crazy things, as the most powerful leverage point for brain health.

It's amazing to read the case studies of your own work with your patients in healing everything from ADHD to autism to all the other progressive brain issues. Let's go back to the low carb. So I'd love to hear, why is a low carb diet the optimal one? What's the science behind that? What's the thought process behind that? Just so we can just love to hear you capture that.

I guess this is probably going to take us to the end of our time.

I'll just give it to you from now on.

There are countless reasons. First of all, from the perspective of the epigenetics of this information, meaning how our foods influence our gene expression, you have to understand that the human genome has evolved to respond to certain foods over a couple of million years. Humans have never had carbohydrate access. There weren't wheat fields and apple orchards, much less cans of cola. And who knows what sources of carbohydrates we could talk about for hours. That said, we know that our dietary choices Change our genetic expression through what we call these epigenetic mechanisms. When we have higher levels of carbohydrates, we raise blood sugar. That's actually very straightforward. And when blood sugar is elevated, it does some things that are very detrimental. First of all, elevated blood sugar changes the array, the complexion, the diversity of the gut bacteria, and favors the types of gut bacteria that lead to inflammation and the types of gut bacteria that lead to destabilization or breakdown of the lining of the gut, causing what is called a leaky gut. When the gut is leaky because of a high sugar, high carbohydrate diet, changing the bacteria, then certain chemicals within the intestine which belong in the intestine, make their way out and they stimulate the immune system, leading to things like inflammation and even autoimmunity. And these are the cornerstones of everything bad you don't want to get even. Mild elevations of blood sugar are related to risk for brain failure. In the New England Journal of Medicine, August 2013, a very powerful study was published that demonstrated. It looked at a group of middle aged to elderly individuals without dementia and found that those individuals, even with subtle elevations of blood sugar at like 105, which is well below the range of diabetes, they followed these individuals for six points years as an average, and found that even mild elevations of blood sugar, like I mentioned, represent a profound risk for developing dementia. The brain doesn't like elevations of blood sugar, even at ranges where your doctor will say, oh, don't worry about it, you're not diabetic yet. But when you persist in consuming a higher carbohydrate diet, you ultimately pave the way for becoming a type 2 diabetic. And that's the situation now affecting about 25 million Americans. You know, it's virtually epidemic and it's virtually a disease caused by modifiable choices, primarily diet and exercise. That is a disease brought on by eating a higher carb, lower fat diet. When you become a type 2 diabetic, you've put yourself now in a category where your risk for Alzheimer's has gone up fourfold. Now, a month ago I would have told you your risk was doubled. But now a new study came out in the journal Archives of Neurology indicating that in fact, the risk is increased fourfold by becoming a type 2 diabetic, which is basically a choice based upon eating a high carb diet, like your original question. And recognize that Alzheimer's is a disease for which there is no cure and there is no treatment. And that really puts a powerful spin on the notion of limiting your carbohydrates because once that happens, once you've been given that diagnosis, there is nothing in the physician's compendium of drugs that will help you at all. Despite the commercials that you might see on the evening news, none of the medications is effective to any significant degree. My mission is to state that we should now welcome the ideas of preventive medicine to the arena of brain health. And Brian, it goes right to the heart of your question. Why should we eat a lower carb, higher fat diet? Because we struggle with our patients who've been diagnosed with Alzheimer's. We do our very best, but we want to be preventive. We want to close the barn door. A recent study appearing in the journal Alzheimer's Disease from researchers at the prestigious Mayo Clinic found that those individuals whose diet is higher in fat and lower in carb have an 80% risk reduction of becoming demented in comparison to those who have a higher carbohydrate, lower fat diet whose risk is increased by about 44%. That is dramatic information for me as a neurologist. It is got. It's got to be dramatic information for your viewers as well. Suddenly, the Mayo Clinic is telling us that our lifestyle choices matter a whole heck of a lot and that when we implement these changes in our diet, we are paving the way for reduced risk for disease again for which there is no treatment. Now, the United States Dietary Advisory Committee two months ago came out with a statement saying that dietary fat isn't anything we should no longer be avoiding, that the biggest risk in the American diet is our level of carbohydrate. So when a governmental advisory committee now jumps on our fringe side group saying that carbs are the issue, we've got to take notice. The committee also said that fat really isn't the issue and dovetails really very nicely with a recent study appearing in April of 2014 in the annals of Internal Medicine that demonstrated in looking at over 500,000 individuals that those consuming the highest level of the dreaded saturated fat had no increased risk for heart disease in comparison to those who ate the American Heart association recommended lower dietary saturated fat diet. So we've come full circle and recognized that in less than 110 of 1% of our time on this planet, we started eating a low fat diet for reasons that are beyond silly, if I may. And we suffered health consequences because of it. Spiraling rates of coronary artery disease, Alzheimer's disease, cancer, and other issues that so characterize what happens in Western cultures Because we went away from the diet that humans have eaten for a couple of million years, higher in good fat and lower in carbohydrate. So I offer that up as the short answer to your question.

Yeah, and I understand we can talk about that for hours, as you said, if not weeks and weeks, why? So then why, with this evidence that's coming in, why does a low carb approach get such, from different circles, a negative kind of pushback? What's your thought process there?

Well, people are down on what they're not up on. And by that I mean study after study is appearing in our most well respected journals, as I've quoted, indicating that in fact it is the carbohydrates in our diet that is so detrimental to health. But the pushback I think comes from governmental bodies who have an interest like the U.S. department of Agriculture, who makes dietary recommendations, but whose mission statement really is to help our farmers sell their wheat and corn and other high carbohydrate foods. That's, you know, that's the reality of the situation. Wanting very much for us to start our day with whole grain goodness and use lots of high fructose corn syrup derived from corn because it's good for the economy, because farmers can sell their products. I'm not trying to castigate farmers for growing food. Where would we be if they didn't? But I am saying that grain based diets and grain based foods represent a significant threat to our health. And when we are told to eat a low fat diet, the message that is conveyed is therefore, eat more carbs. If you cut your fat calories, you make them up by eating carbohydrate calories. And that means eating the breads, the cookies, the pastries, the cereals, et cetera that are still recommended on the American Diabetes association websites as being appropriate for us, knowing full well that these are powerful sources of carbohydrate that can very well lead to the very disease that they're talking about. So old habits die hard. Even amongst my physician colleagues, most, most are still saying to people, hey, you've got to cut your dietary fat if you want to lose weight. Nothing could be further from the truth, as you well know. And if you want to do well by your heart, you've got to stop eating saturated fat. Well, as I mentioned, that's not what the science tells us. The Annals of Internal Medicine is one of the most well respected peer reviewed medical journals on the planet. This was the largest meta analysis study of saturated fat ever performed. And yet still people are saying you've got to cut your saturated fat. Look, 50% of the fat in human breast milk is saturated fat. Who made a mistake there? God made a mistake. Nature made a mistake. I don't think so. I would rather look at that information and ask that question than to ask your neighborhood doctor what he or she thinks we should be eating based upon what they have read 10 years ago.

I love it. So we'll go to.

I'm sounding a little bit cynical right now. I'm normally not this way, but I think you love it. So there you go.

Yeah, this is good.

I think it's important to kind of have that conversation. So on the theme of breast milk, my wife lobbed a question she wanted to have me ask. We have a two and a half year old, a little over two and a half. She's been breastfeeding throughout and just wrapping that up. And is this low carb approach appropriate for pregnant women, for children?

Absolutely. It got us this far. We made it 2 million years based upon that approach. We had no carbs and we made it. So what the baby needs is fat. Fat, fat, fat. That's what your wife needs because that's brain food. Think of all the fat in breast milk. And so. Exactly right. The last thing your wife should be eating is a high carb diet, increasing her risk for weight gain. And hopefully she wasn't on a high carb diet during her pregnancy, because if she were on a high carb diet, it would have changed the bacteria array. The flora in the birth canal which the baby passes through to gain his or her first microbiome, first bacteria. That's this microbial baptism that babies born through the vaginal birth canal experience as opposed to being born by cesarean section. So low carb. It's worked for 2 million years. That's a heck of a track record.

I love it. Yeah. And so I was vegan for the better part of 10 years, followed a low fat, high carb approach. Obviously, as you said, there's the only way to go about it. And our story is that worked until it didn't work. So that was better than eating some of the other stuff. We were clean, nutrient dense. But I'd get a migraine headache once a month. I was constantly hungry. The moment I removed grains from my diet. My little belly, the joke we had when she was pregnant was my belly was nearly as big as hers. And I, you know that that effect. So it's been interesting to observe that whole process and there's so many different threads that we can pull on that I Want to start with the. So when I was on the low fat, higher carb approach with the tendency to have a migraine, kind of the vulnerability, and I was actually nervous about that at different times and I made sure I had to do this and this and this, otherwise it'd be a vulnerability. Why is that? What was going on in my biochemistry? One word, microbiome.

What's that one word? Inflammation. So I was reading a neurology journal just last night which was giving the latest standards for treating migraine headaches. And it listed the top 10 pills to take. And it's just breathtaking. Migraine headache is not a deficiency of any one of those drugs. You have to ask the question, why am I getting the headaches in the first place? Not how do I treat it once it's already happened. Let's focus on the fire, not the smoke. That's what the drugs do. And if with your migraine headaches you had gone to a neurologist, most neurologists, with all due respect, they'd say, you know, Brian, I'm going to write you a script for this or that and next time you think you're getting a headache, take this or maybe we'll put you on a medicine that will help prevent them. That doesn't work for me. My statement to you would be, hey, Brian, maybe the grains might be an issue for you. And what happened? You went off your grains and you haven't told me this, but I would suspect your migraines improve with time.

I'm pretty bulletproof of this. I mean, it's a non issue.

You know how many years I've been seeing that in my practice and I've been talking to other physicians about it and there are lots and lots of physicians who are open to that. I mean, sometimes I'll lecture to a group of 2000 doctors and I'll present my cases. You know, we treated this, I'll show the picture. My patients love to have their pictures in medical conferences. This is a gentleman who actually we published some of these, who had migraine headaches for 35 years in an investment banker, was on narcotics every day or every other day because of his incapacitating headaches. And he had a gluten sensitivity. He was, went gluten free. His headaches basically went away. We published his story in a peer reviewed journal. Some people will pay attention to that, most won't. Most will say, I'm going to live my life come what may and when I have a headache, I'm going to take a pill But I would say those are not the people who are watching you and me have this conversation right now. So that's okay. But that said, it's just a very different approach. And to me, you know, here, you stopped grains. Well, how could you stop whole grain goodness and stop eating bread? My goodness bread is in the Bible. Give us this day our daily bread. How could you knock bread? That's the criticism I got when grain brain came out. It's in the Bible, for crying out. How? Crying out loud. How could you knock it? Well, I don't want to be theologic here, but the Bible was written. When was it written? I don't know, 2,000 years ago, probably a little bit less. Right. But that said, is that when we started eating bread? No, I think we started eating bread 10,000 years ago when humans developed agriculture and began growing grains. But still, that is less than 1/2 of 1% of the time that we've been on the planet. We didn't have gluten. We didn't have bread and carbs for all this time. Suddenly, we introduced this new foreign protein into our bodies. And as Harvard researchers have demonstrated, gluten leads to leakiness of the gut, a concept that you and I talked about a little while ago, and that is the cornerstone of inflammation. So everything is about reducing inflammation. And diet is the biggest key.

Yeah, it's amazing. And in your book Brainmaker, you talk about the other things that could have happened in our history, right from birth to throughout, that might have affected our leaky gut tendencies and just our overall microbiome. And it was amazing for me to check the box. I was born naturally, but immediately went to formula. You talk about the importance of breast milk, and then I had ear infection, infections all the time, tubes put in my ears, antibiotics constantly, allergy shots three times a week for years, or three of them a week for years.

You are the perfect candidate. You are an individual whose microbiome, whose gut bacteria was profoundly affected by early life experience. The good news is what Brainmaker talks about is okay. I mean, we've all had our stuff. I mean, who hasn't? There's probably not a single viewer who hasn't been on an antibiotic at least once. And I knock antibiotics because they're overused. But on the other hand, they're life saving and very important. But the point is, these antibiotics are broad spectrum and they take out the bad bugs, but they take out the good bugs upon which our health depends. The empowering part of this book of Brain Maker is you can rebuild Your microbiome. And I do my very best to provide the readers with the tools how to make that happen? What is the water I should be drinking? What should my diet be like to nurture the microbiome? Why should I start to eat fermented foods like kimchi and kombucha, cultured yogurt? Why should I be focusing on prebiotic fiber foods like jicama, Mexican yam, Jerusalem artichoke, asparagus, garlic, dandelion greens, my favorite, and foods that will then provide the type of fiber that will then nurture the bacteria living within me? Why do I want to do that? Because my life depends upon it. Because I was exposed to antibiotics as a child, or I was born by C section, or I wasn't breastfed, or I'm overweight, or I'm depressed or have an autoimmune disease, or I have gluten sensitivity. All of these are indicators or risk factors for having a damaged microbiome. But here is the empowering part of the story, and that is that you can absolutely press the reset button on your microbiome and gain a second chance and pave the way for wonderful health. Reducing your weight, improving your mood for the rest of your life by culturing a better bacterial array in your gut. I say it with a bit of a surprise in my voice because it's hard to imagine for me still that as a neurologist at this point in my career, that's the discussion, Brian, that you and I are having. But it is the most powerful influence that I can have on any patient and anybody I come into contact with now in terms of getting them to feel better.

Can you tell us about that study? I think it was out of ucla. Sorry if I interrupted you.

Oh, no, go ahead.

I think it was out of UCLA where they brought the individuals into the lab and did the FMRI work and then had them eat fermented. I think it was yogurt. And can you walk us through that? That just blew me away.

So the study was published by Dr. Emerin Meyer in the journal Gastroenterology. He took 36 women, divided them into three groups. One group, as you mentioned, was given a fermented, or rather a probiotic enriched yogurt. The next group got a yogurt that did not have bacteria, did not have probiotics in it. And the third was given a placebo that wasn't even yogurt. And what they did was, after four weeks eating these foods, it's obviously not the only foods that they ate, but they Performed, as you mentioned, a functional MRI scan. And that is a unique type of MRI scan that actually looks at the parts of the brain that light up during various types of activity. While these women were in getting their MRI scans done, they were shown faces, pictures of faces that were a bit threatening. And what they demonstrated was that the women who had eaten the yogurt with the probiotics had a different mental brain response when they were challenged by these photographs. Less threatened, less activation in areas of the brain that deal with anxiety, for example. Now, the implications of that study are profound. Meaning that changing the gut bacteria through consuming food that was fermented changed the way these individuals perceived the world around them. How you experience your life is mediated by the bacteria in your gut. So I spoke to Dr. Meyer about that study at Harvard. When he presented, I said, you know, this is breathtaking. And he was so humble. And he said, well, you know, yeah, it's interesting stuff for sure, but we have more work to do, as you would expect a quality individual to respond. And at that point, a couple weeks later, I invited him to be a participant. We're having a international symposium on the microbiome later this year down in Hollywood, Florida, and he's going to update us as to his research and really thrilled to have him present more of his research. But wow, what are the implications that we now understand there are changes in the gut bacteria that correlate with depression and anxiety, ADHD and autism. And when we recognize that these dramatic changes in the gut bacteria correlate with autism, we suddenly take a step back and say, well, gee, if these gut bacteria are so in such a state of disarray in autism, what if we could change the gut bacteria aggressively? Maybe that might do something for that disease for which we have no treatment. And even taking a further step back, what I'm saying is recognizing that autism may not be primarily a brain disorder. It may have its origin in the gut, as so much peer reviewed research is now telling us. So what we did was we looked at autism from that perspective and began aggressively treating our autistic patients. Not by giving them chemicals for their brain and mind altering medications, but by changing their gut bacteria and doing it aggressively, both with oral probiotics and also by using enemas of probiotics. And even more aggressively, by discussing with families the use of what is called fecal microbial transplant. Actually taking fecal material from a healthy individual and implanting it into the colon of an autistic patient and seeing what happens. Well, the results are dramatic and As a matter of fact, on our website, drperlmutter.com, we present video of a child who could barely speak, couldn't interact socially, who received six FMTs or fecal transplants. Mother carried this out at home. From the neighbor's child who donated her stool. I'm not suggesting that your viewers jump in and do this. I'm not suggesting this is a treatment for autism. But the results were profound. I mean, profound is an understatement. People should go. Drpomutter.com, look at the video. I'm going to actually see that child with his mother in another week or so. They're coming down to Florida to see me. But it's breathtaking. We now have been told that the University of Arizona has completed recruiting a whole bunch of autistic children to do exactly that, to rebuild their gut bacteria to help their autism. In fact, one of the pioneer researchers is a guy named Dr. Derek McPherson. Fabe. I'm going to interview him next week on a forum similar to this. Who has really demonstrated these profound changes in the gut bacteria. Finally, when we stop looking in the brain, there are breakthroughs in such a devastating condition as autism. Now, if autism were a genetic issue, we wouldn't suddenly see such a profound uptick in the number of cases, but recognize in the past seven or eight years, rather the past 15 years, that the incidence of autism has gone up seven to eight fold. That doesn't speak to a genetic issue. It speaks to an environmental issue. In other words, factors over which we may have control when we see that the risk of autism is doubled in children born by C section, where they don't get the microbiome by passing through the birth canal. As you and I spoke of earlier, we have to take notice of those peer reviewed studies and say maybe there's something going on with these bacteria that is then secondarily affecting the brain. So what a time to be learning all this information. But more importantly, what a time to recognize that there is so much that is actionable in terms of dietary choices and lifestyle choices that can rebuild the gut bacteria.

Yeah, no question. I want to get into some details on that and talk about saturated fat as a fuel for fat in general, as a fuel for the brain. But I want to underscore this whole idea. I think the first shift that needs to occur for us to invest the energy in the nutrition is to realize, as you said, perhaps autism, these other issues are not a brain issue, it's an actual gut issue. Can you just tell us a Little bit about the second brain and serotonin and how much is going on in our gut that affects our brain that we thought was just exclusively in our brain.

It's so exciting and it's so, from, from an interventional perspective, it's so empowering to have these tools. So you know, again, from the autistic perspective perspective, we've, we've now stopped looking in the brain and realizing that this gut brain connection is very, very powerful, that the gut and the bacteria within it influence all, all manner of brain activity. There are direct connections between the brain and the gut mediated by nerves, primarily what is called the vagus nerve. But also recognize that the gut is highly innervated in and of itself. But I think where the money is is in the way that the gut influences the brain at multiple levels. In a normal functional level, the gut does produce, as you mentioned, the neurotransmitters. 90 plus percent of the happy chemical serotonin is manufactured in the gut. Dopamine is manufactured in the gut. Nutrients that are so critical for brain health. The vitamins from the B group, for example, vitamin K, are manufactured or extracted in the gut, making their way then to the brain. Short chain fatty acids, acetate, butyrate, propionate are manufactured by the very gut bacteria that we're talking about when they are digesting this prebiotic fiber that I mentioned earlier, that was the prebiotic foods, the jicama, the asparagus, etc. So again, nurturing those bacteria gives us these raw chemicals that the brain is so desperate for. Now, from a perspective of malfunction or disease, the big player in terms of brain malfunction is, as mentioned earlier, inflammation. And inflammation happens when the gut becomes permeable. Now we can measure that, and we do measure that by measuring a simple chemical in the blood called lps. And it stands for lipopolysaccharide. I don't want to get too technical here, but simply stated, this is a blood test you can get in your doctor's office. LPS that measures two things, the leakiness of the gut and the degree then of inflammation that is turned on. Alzheimer's is an inflammatory disorder, meaning it comes from leakiness of the gut. When you measure the LPS level in Alzheimer's patients, it's in the book I have it in Brainmaker. Actually it's very, very high. LPS levels are elevated in autism, they're elevated in major depression, which is a gut related inflammatory, inflammatory disorder. And LPS is dramatically elevated in ALS or Lou Gehrig's disease. Now, I, like many others, poured a bucket of ice water over my head to generate research dollars for als, a devastating condition. But I'm here to say that now that we see this study that shows high levels of LPS in Lou Gehrig's disease, we've got to stop looking at the brain. Maybe not stop let other people look at the brain, but where I'm going with that is research that will look at the gut as offering us up the potential to have an impact on a disease that currently has no treatment whatsoever. Again, as the question was, what is it that allows us to look at the gut? And here is all the data. Each of those markers, LPS being elevated in each of those issues. I have that literature in brainmaker with graphs that we've made that show it in a very graphic way that's very intense, making you begin to think that, gosh, we've been looking in the wrong place. You know, a Slick Willie was asked once, the bank robber, why do you rob banks? And he said, well, that's because that's where the money is. So you would think that for brain disorders you should be looking in the brain. Well, it's not where the money is, it's in the gut.

Yeah, absolutely phenomenal. So again, just continuing to underscore that if anyone has any of these issues, depression, autism, anxiety, whatever, obviously not autism if they're watching this, but children with and concerned about Alzheimer's, etc.

Yeah, well, you know what? There are individuals on the autistic spectrum I think, who might well gain a lot from. From watching this. Who I was thinking of, the kids to some degree may gain more than others.

So it's so counterintuitive. And I think this goes with the two things that I find most counterintuitive here. Wow. It's the gut that's driving the show to underscore again, 90% of our serotonin is created in our gut. That is one of those things that I have to continue to wrap my brain around.

I love the word counterintuitive because intuition isn't. Isn't intrinsic intuition is something that we develop intuitively. A high fat food is bad. Well, it's not intuitively high fat food is bad because we've been told that for years, intuitively we should stop eating eggs because they have high cholesterol. And that's not intuition. That is because that's what people said. Eggs. If you eat eggs, your children will be born naked or horrible things will happen. I think intuition is when you Eat olive oil that it feels good in your mouth. That's intuitive. That is. Hey, this is feel good food.

So counter conditioning would be more appropriate.

Well said.

I like that.

Well, it's funny to see our son, you know, because we were. My wife was vegan. Throughout the beginning of the pregnancy, we switched. We named our son Emerson. And you know, all life is an experiment. The more the better. We realize, well, let's. Certain things are working, certain things weren't working. But to see him, the way he consumed beef when he was young and whatever started to eat these foods, it was just remarkable. We looked at that, one of his favorite foods, just.

That's not, you know, that is more intuition. That's not this condition. You know, I remember when our son was about maybe 12 and he developed rip roaring hives. And at that point we were pretty, well, we were certainly strongly vegetarian. Protein was soy. I mean, it was the whole nine yards, as we all did back in the day. And gosh, remember we were on vacation and he was allergic to water. He couldn't even shower because he would break out in hives. It was breathtaking. And we spoke to a friend of ours who is a Chinese acupuncturist and he took our son's pulse and he said, you son is lying, he needs to eat meat. And you know, so we went out and we bought him a steak and his hives went away in a blink. And we gave his body what it needed. And I think that pulse diagnosis in Chinese and Ayurvedic medicine, there's a lot of intuition there that is deep seated knowledge that we've got to pay attention to, not what we're told in advertisements in medical journals. That's not intuition, that's marketing. So we're being again, a little cynical, but it's time. It's absolutely time.

Can you tell us about saturated fat? Again, I keep on saying saturated fat, but fat in general, much of which is saturated in the different types that we can consume. But how is that super fuel for our brain? I certainly have experienced that. I'd love to hear you describe that.

Well, it is. And what we understand is that when the brain is burning fat in a state of what we call ketosis, it's a far more efficient, efficient fuel. It produces less damaging chemicals that are called free radicals. It produces more energy molecules called ATP. So really the brain does very, very well when burning fat. And really a low state of ketosis may very well be the natural state for humans. And it's brought on by eating Fat and low carbs. It's also brought on by fasting, which is a very good thing for the the body. We start to mobilize fat and we begin to shift our physiology so that it's more able to burn body fat. A far more efficient storage method of calories than is glycogen or the storage method for carbohydrates. So we really must welcome fat back to the table. But I want to just be super clear that when we see studies that a high fat diet can do this or that or, or the China Study has told us that those cultures eating lots of fat have a higher risk for cancer, colon cancer, and you name it, I tend to agree with that science. I tend to agree with the China Study on many levels. And that may be surprising. The reason I agree with it is because they're not characterizing the type of fat that were included in the statistics in the studies. And by and large in western cultures and throughout, throughout the world today. The type of fat that people are consuming is awful. I wouldn't go near it because it'll kill you. So what are these fats that people are eating? These highly modified processed vegetable based, derived from crops that have been sprayed with glyphosate that are genetically modified, you name it. Every bad thing you can say is what is in the typical fat that people eat. And even that goes into the standard meat that people will eat. So the statistics say that meat eaters have a higher risk for that. We have to take a step back and say, well, what meat eaters are you talking about? What was the meat that these people were eating? And it's not fair because by and large the meat that people are eating is awful stuff. I mean, you wouldn't go to the grocery store and buy the beef or the chicken or the eggs or the milk and eat that and think that that represents a reasonable option. Why? Because the meat comes from cattle that have been fed corn or soy that may well have been given antibiotics to change their microbiome that didn't have the opportunity to eat what they would have eaten, which is grass. And therefore this is meat that is life threatening. It's high in omega 6 pro inflammatory fat. Well, it's fat, but it's bad fat and it's low in omega 3 anti inflammatory fat and may very well be tainted by hormones and antibiotics as well. So to make these global statements that meat eating is bad because here are the studies that looked at those who ate meat versus those who are vegetarian and the books are written about that the China study is certainly one of them I think is very, very unfair to the consumer. I often say that those metrics are much like saying, well we're going to do a study comparing people who drink alcohol versus those who don't and the alcohol drinkers. We're not going to break it down between those who do shots of tequila or scotch in comparison to those who drink a glass of organic Merlot each day. There's no difference. It's alcohol, it's all the same. Well, I think we're all quite aware that that is unfair, that alcohol comes in many shapes and forms, as does fat, as does meat. So when I say a higher fat diet, I'm not talking about people eating hamburger from cattle that have been raised in horrendous conditions that threaten the human body in terrible ways. I'm talking about welcoming healthy fats back to the table. Organic olive oil, extra virgin, having some coconut oil, nuts and seeds, fat that is derived from grass fed beef, organically raised dairy product and eggs, etc. Hard to come by to some degree, perhaps more expensive. What's the cost of it in the long run? I think it has huge value, but I think the more that we encourage people to buy those foods, the more pressure there will be on the distributors and farmers to make them more available.

Yeah, that's amazing. I mean my, again, personal experience with the vegetable oils. It's amazing. If I have even the smallest amount of vegetable oils, I can feel that there's actually an irritation that will exist in my nose. I can actually feel the little sore almost that just triggers with vegetable oils. It's a fascinating thing to see.

Well, you're just, you're just flipping the inflammatory switch.

It's amazing.

And you know, you look around you wonder why are people so unhealthy? It is because of the foods that they're eating and how those foods ultimately target their microbiome. And you know, you see these people who are struggling to lose weight, you just go look, you know, go to the airport and walk around. All you see are overweight and obese people and signs that say terminal at the airport. And you know, it's a scary proposition. So that said, what's going on with these people when they diet? You know, they'll go very low carb and even low fat and cut their calories down to whatever, you know, 1500 calorie diet a day and they can't lose weight. The reason is, might well be because of the changes that have been made in their microbiome. That they've created a situation, as I've talked about in Brainmaker, where they have higher levels of the major group called firmicutes. When you have higher levels of that group of bacteria called firmicutes, those bacteria will extract more calories from whatever food you eat and keep you fat. And one of the surefire ways that you can change your gut bacteria and favor a situation to make you fat is to drink no calorie beverages. Artificially sweetened beverages have a dramatic effect on changing the gut bacteria and paving the way for obesity. Now, you talk about counterintuitive. How do you think people who are drinking a liter or 2 of 0 calorie, 0 sugar diet this and diet that every day and they're gaining weight? Well, it turns out two things. One study demonstrated more than doubling risk for type 2 diabetes and people who suck down high levels of diet drinks each day. And number two, the study that showed why that happened was recently published in Israel and showed that it happened because of changes in the gut bacteria. So stop the diet drinks, start drinking a little bit of kombucha if you must, maybe water it down, but bring these fermented foods to the table, start eating kimchi at every meal, take a high quality probiotic, and suddenly the weight will start to come off of you. And at the same time, your mood is going to improve.

When I read the research that you cited from the UCLA study, I literally immediately went to the grocery store enough on the kimchi and all the different sauerkrauts and whatnot.

People needing fermented foods for over 7,000 years, some people, and, you know, basically this sounds a little bit crass, but in the process of rotting, you know, food rotting, it ferments. It's the action of bacteria starting to break down the sugars in the food. So we've been actively fermenting foods like wine for maybe 7,000 years, but we've been eating foods that have been loaded with bacteria from time immemorial. So it's always been what we've eaten. The idea of sterilizing our food and our lifestyles and antibiotics, all of this is not doing the microbiome any good. One interesting study, I put it in the book, actually looked at, measured in over 100 countries, one measurement of diversity of bacteria in the gut, how many different species of bacteria and even other organisms living in the gut, like parasites, in various countries and the incidence of Alzheimer's. And what it found was really quite remarkable in those countries where there was very low diversity of the gut bacteria. Because of antibiotics and sanitation and our obsession with hygiene, the rates of Alzheimer's were astronomical in comparison to countries where there was a rich array of bacteria and even other organisms living in the gut, like parasites that we all dread. But the gut was healthy and inflammation was low, and risk for developing Alzheimer's in those countries is lower. So we've got to take a step back and say, hey, maybe we're not doing ourselves such a great service by taking an antibiotic every time we have a sniffle. By thinking, well, I really don't want to deliver vaginally. I think I'll just opt for the C section, as do one third of births occur in America today. One out of three births is via C section. What I want women and husbands to understand, or whatever the situation is where a birth happens, is that the discussion about a C section needs to go well beyond how long will my scar be? Discussion should be including such factors as doubling risk for autism, tripling risk for ADHD, increasing risk that my child will have type 1 autoimmune diabetes by 70%, and even having a child whose risk for obesity as an adult is increased by 50%. That is what our literature is telling us and what we see happening when children are born by cesarean section. So I just want parents to be aware of that. The word doctor doesn't mean healer, it means teacher. That's Dr. Perlmutter's message and that is to be the teacher and then make your decision. I want you to be made more aware of this information and then you're an informed consent.

Let's go in there real quick because those of us families, you know, who have had children via C section, what can they do practically to kind of, you know, start rebuilding that microbiome? What would be a.

Well, one of the things I think is really powerful in the book and that is that let's be clear, C sections are reasonable at times. They're life saving. They're important. I don't want to be mommy bashing here because people have to have C sections sometimes. But that said, as we described, I know don't talked about research from New York University, NYU, one researcher has developed a technique whereby a sponge, a 4x4, is placed in the birth canal prior to birth and then extracted and kept moist and warm during. While the C section is performed, the baby is born. And then that 4x4, that sponge is placed over the baby's face, into its mouth, into its nose to inoculate the microbiome to create those original bacteria. That need to be vested in the gut. And thereafter, as we're talking about what you can do, by all means breastfeed. Because it's not just the contents of breast milk in terms of the fat content and the immunoglobulins that it contains. It's also the notion that that child is going to have his or her lips on skin, on mother skin and extended extract bacteria in that experience as well. Not to mention the bonding that happens, the eye contact with mom as she's looking down. There's so many things that happen in a good way when we follow what we've been doing for millions of years. But that said, be super judicious about giving kids antibiotics. By and large, a kid with a cold doesn't need an antibiotic. By and large, a kid with a sore throat does not need to be given an antibiotic. Obviously, this is a discussion to have with the treating physician. There are instances in which a bad strep infection, for example, needs to be treated. But it's quite clear in the Journal of the American Medical association and in the Lancet that articles are appearing that we are dramatically overusing antibiotics. Antibiotics represent the number one one prescription for children age 10 years or younger. Four out of five Americans will take an antibiotic every single year. That is, it's breathtaking. So hey, if you're in the business of making these pills, that's business as usual. But when our best organizations, medical organizations, are telling us back off, you don't need to be doing that. When the World Health Organization characterizes one of the top medical issues moving forward in the 21st century as being antibiotic resistant organisms, that is something we should take notice of. We are creating organisms for which we have no treatment because we are abusing antibiotics. But to be more on point with your question than what you can do those things I mentioned, because they are things we can think about right now. You have a young child thinking about antibiotics. You may have more children. What is the method of birth? But how do we repopulate the gut? Again, fermented foods, as mentioned in the book the prebiotic foods to nurture the gut bacteria, eating foods that have lower levels of sugar, avoiding diet drinks and artificially flavored gum and so many things. Even medications that contain aspartame and beyond that, recognize that common medications will challenge the microbiome as well, including the various acid blocking drugs that people think they need to take every time they eat a sausage because it disagrees with them. As the commercial would show you, so many of the Drugs that people are taking day in and day out are associated with changes in the microbiome. Even certain antipsychotic medications are now demonstrated to dramatically alter the microbiome. So I think we're in a place now where there's a robust amount of information for the consumer that is actionable in terms of lifestyle choices to nurture better gut bacteria and therefore realize disease resistance and better health even today. But I just think it's a question of education. Even the non steroid anti inflammatory drugs that everybody takes when they have a headache or a stiff muscle, sore muscle, those change the gut bacteria as well.

Amazing to go into detail. Again, so much in the book, so much research with the practical application. Super inspiring. Again, highly recommended for everyone who's listening and I'm curious. I want to wrap this up appreciate again all your time.

Want to know.

Kind of just what are you eating? So what does a typical day look like for you? And I want to end it with kind of your number one tip. You mentioned some ideas in your book, but I'm just curious what that looks like.

Well, more and more, as fate would have it, I'm eating actually less and less. I am oftentimes not having breakfast. I don't know where it is written. Where is this Rosetta stone that's telling us three meals a day? I mean, when you think about it, if you were a hunter gatherer, what are you going to stop chasing the gazelle because it's lunchtime? I mean, you know, where is it written? So generally in the morning I'll have a couple of eggs with kale or spinach or a lot of dandelion greens. So I make a lot of omelets with dandelion greens and then I use a lot of olive oil on top of that and generally have on the side have half an avocado. I have a coffee each morning. I love the heck out of that. At lunchtime, if I have lunch, it's generally a salad that is enriched with jicama. I would love for your viewers to become familiar with jicama. Mexican yam health food stores carry it. You use it like cabbage or beets. You slice it up and put it in a salad and dinner is going to be some kind of protein like fish, mostly fish. Wild salmon is something I'm big on. I catch a lot of fish myself. I catch a lot of mahi and grouper and snapper. I actually do a lot of spear fishing. So that's where that comes from. And I will have meat maybe once or Twice a week in the form of a grass fed beef steak or whatever I can fine. But the plate is generally about two thirds overflowing with colorful vegetables. And so these are fiber rich, nutrient dense vegetables. And I drink a lot of water. I probably don't drink enough wine. I might have a glass of red wine once or twice a week. I should have more, I guess, but I don't. But these are only. This is as you think about the food, when you're eating food, you should be thinking that you're eating for not just you, but for your gut bacteria as well. We call them again, commensals, because they're eating what you eat. So I'm doing my best to nurture good bacteria. Now, you didn't ask, but I think I should offer this up as well. I take some nutritional supplements. I take about 10,000 units each day of vitamin D. I take resveratrol, fish oil, vitamin E, vitamin K, a multivitamin with minerals and a probiotic. So I'm very big into the DHA that is found in fish oil. I use a lot of olive oil at every meal. For sure there is olive oil. But beyond that, I think it's also worth mentioning that usually about once every week or two, I don't eat all day. I just don't. And oftentimes it's a time when I'm intellectually involved in something. I'm writing either, whatever, you know, writing something intense either from an academic perspective or a book. And I just find that when you're in that mild state of ketosis that it works better upstairs. You know, there's actually a pharmaceutical, what we call a medical food that doctors can write a prescription for as an intervention to help Alzheimer's patients. And it's basically a way of raising a type of ketone fat because now the science is so profound that it validates having higher levels of fat in your brain. So I think fasting is really good because it makes you more ketotic. Good for your brain, but from an epigenetic perspective, meaning how does it affect your genes? We know that when you fast, you turn on genes like the sirtuin genes that help you increase your body's antioxidant production, reduce inflammation and help with detoxification as well. So not just what you eat, but looking at times of not eating.

Yep. In all your books you also talk about sleep and exercise and these things. But just to step all the way back to the general optimal living, we obviously talked a lot about nutrition and how that impacts us what's your number one tip for people looking to optimize their lives?

The number one tip? Tough call. I'd say get rid of the sugar. Number two, Aerobic exercise. You said number one, but I can't.

That's good. Keep it going.

Yeah, but I say get rid of the sugar. You've got it. Aerobic exercise because that turns on brain supportive life support of genes. Number three, you've got to get good fat back into your diet. Number four would be to absolutely focus on eating fermented food, getting those bacteria back into your life.

Wonderful. Well, I so appreciate you and all your the passion with which you do it. So thanks for your influence in my life and in countless people's lives and.

Well, I sure appreciate it and what a great venue. I mean, I love the fact that you're so dialed in and interested in making a difference. That's super cool.

Appreciate that. All right, talk soon.

Okay, bye. Brian.

Hi, this is Brian.

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Me.

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