You Winning Life Podcast Ep. 104- Get Brain Washed with Dr. Austin Perlmutter

All right, welcome back everybody. So today's guest is board-certified internal medicine physician, New York Times bestselling author with his focus on helping others to improve decision-making abilities and their quality of life. He's interested in methods of understanding and reducing burnout in the medical field. He's also the co-author of Brainwash. He writes for Psychology Today, on his blog called The Modern Brain. We're going to get into stuff regarding diet, nutrition, social media, being really connected, and figuring out how to be a healthier person in 2021. Dr. Austin Perlmutter, thank you so much for hanging out today.

Yeah, Jason, thanks for having me. I'm excited for this conversation.

So one of the things that, um, has been on top of our minds just in general is, um, what's going on with connection and using social media in today's world, right? It's now February, middle of February, end of February 2021, and we actually connected through the new app, or the newer app, Clubhouse. And, um, we were in a lot of the similar rooms of integrative medicine and functional medicine and, and that type of stuff. And I would love to just jump right into that process of, with everything going on, middle of a pandemic, so many people are over it, they're done with it, they want to return to normal. Um, social media on one side, such as Clubhouse, has become an incredible platform for people to connect. What's going on in your mind based on the research you've been doing, based on your personal practice, that we can take into consideration and that we should be applying?

Well, let's start with a theme that I think is going to come up a couple of times, which is I am not somebody who believes in things as black and white. I don't believe in absolutes. And so when it comes to the conversation around social media, there is a strong tendency for people to be on one side or the other. Mostly, if you're vocal about it, you're anti-social media person thinking that this is the end of the world. And obviously, just as you mentioned, there are some really wonderful assets, things like the app Clubhouse, which enables people to just come together and have conversations about things which are meaningful. And at least as far as I have seen, there isn't any outside influence as far as ads or attention capture that you might see on other platforms. So as a whole, I think it is important to think about social media as having pros and cons. But what I try to consider is what is the, the bigger picture influence that something like this is having on our collective physical and mental health. So there are a lot of social media platforms out there, but if you think about the span or the scale of a couple of them, so for example, Facebook, there are billions of Facebook users around the planet. And unlike other things, um, within the realm of social media, there is the ability to control the narrative. So what I guess kind of concerns me is that when so many people are paying attention to what comes out on a platform like Facebook Instagram, whatever, you kind of are controlling the narrative. You kind of are shaping reality for a lot of people. So then you have to ask, what is the quality of that reality? What is the quality of that narrative? And looking at themes across the last several decades as it relates to media as a whole, what you can see is that companies that are invested in media are going to be invested in keeping your eyeballs, keeping your ears, paying attention. How do you do that? How do you capture people's attention? You make the message sensationalized. You make the message negative. You make the message feel fear-inducing. These are very standard techniques to get our brains to focus. You know, there's something about something that is scary, fear-inducing, that causes us to pay more attention. And from an evolutionary perspective, this makes a lot of sense. You pay attention to the things that might take you out of the game, that might kill you. So you look at the, the scope of what is being put out, let's say even in the newspapers, and there's solid research suggesting that there's been what's called a steady march towards negativity, basically more and more negative information as time goes on. And then when you look at kind of the information out on social media, there is not only a tendency for it to be very polarized. So my political party is the greatest one, yours is the worst. But also there's a tendency for it to kind of induce a tribalism, an us versus them type of mentality, to induce fear there as well with everything is going wrong in the world. And what this does is kind of activates a part of our brain, a more primitive part of the brain called the limbic system, specifically an area called the amygdala. This isn't necessarily a bad thing. We need this part of the brain to be functioning, to be online, but when it's overactivated and for longer periods of time, it actually changes the patterns of our thinking so that we're thinking and behaving from a more impulsive, more fear-based perspective. And as I'm sure you know well, overactivation of this part of the brain and a decreased connectivity between this part of the brain and the part of the brain called the prefrontal cortex is associated with conditions like anxiety. So this was a very long answer to your question, but I wanted to set the stage for some of these things that are happening in the brain as a reflection of what's going on with social media, because the bigger thing that I'm trying to get people to understand is as it relates to the things that we care about, which I would argue in many cases are good physical, good mental health, you know, and everything else is kind of a surrogate for that. Those are outputs. Those are a reflection of the quality of our inputs. So if you think about this very basic machine, which is the human brain and body, if we're feeding it quality inputs, we're having a much higher likelihood of getting quality outputs. And when you consider that in America, the average adult is spending 11 hours each day in front of a screen, of which 4 hours is TV time, 2+ hours is social media, and then you have your computers, your tablets, whatever, that is a ton of input. And so you've got to be thinking, really thinking about what is the quality of that. We think about our food all the time. Is this a quality food or an unhealthy food? And how is that changing my body? We don't think about it as it relates to the inputs coming in from social media, from the news media that we're consuming. So You know, we can get into this in more detail, but what I tell people is that social media, media in general, it's a double-edged sword. You can gain from it, but if you don't go into it with a conscious idea of I can lose myself, you're probably coming out with a net deficit, and that will manifest in worse health.

So I see it so clearly. So my training as a marriage and family therapist is, uh, the systemic training, right? We see everything as you connected to what's going on around you in those relationship dynamics. So the name marriage and family therapist is a misnomer, right? It's real— we're systemic trained therapists. And my training as a neuro-emotional technique practitioner is spot on to what you were just saying about the limbic system and the amygdala and all the training, uh, of how we can help reset that and the physiology of stress and the nervous system response to that, which manifests in physical and emotional symptomology, is my wheelhouse. And our listeners have heard multiple people in the past get into different angles of that. I love the idea of, of talking about when you're looking at it from what you're putting into your body from a food perspective. Everybody days is so concerned. Am I on the right diet? Am I eating the right thing? Should I be keto? Should I be intermittent fasting? Am I gluten-free? Am I paleo? Right, all these things. But we don't take that same time, effort, and energy to what we're consuming when it comes to social media. And we know this, right? People who are listening, we know that it can't be good at some level to be constantly doing that. I remember the beginning of the pandemic, I had TikTok, uh, TikTok for like 3 weeks, and I'm like, this is absurd. The— what they're wiring your brain to be doing, where hours just disappeared at night when I was in bed and I had to get the app off my thing. And like, where the wiring changes in such a short time. And I think— do you think it comes connected to the repetition compulsion process, right? Because it's the swiping feature and it's the— right? Is there something that's going on neurologically that they're playing with, that they're doing that on purpose to get that to become an addictive substance?

Yeah, so yes, I do. But just to go back one moment here, back to this kind of difference between food, physical input and the inputs coming in through our senses. If you sit down and you eat a meal of junk food and you feel crummy afterwards, you can make that connection, which was, "I ate this giant cheeseburger, this thing of fries, this milkshake. Now I feel crummy." Either psychologically or physically, you can make that connection. But when we consume media, whether that's social media, watching the news, whatever, we may not make that connection, which is, you know, "I watched 2 hours of TV before bed, then I didn't get a good night's sleep. The next day I woke up and I was feeling terrible and I lacked I lashed out at my spouse. We don't necessarily say, oh, that is a result of all of that stressful news media I consumed last night. What people have to appreciate is that whether it's a physical or a sensory input, it still funnels into the same neurotransmitters. It still funnels into the same hormones. All of this stuff goes in and affects the brain in similar ways. So it isn't like you can just say, I'm going to eat a really healthy diet, but I'm going to binge watch Netflix and watch 2 hours of the news each day and scroll on my phone. And I'm going to be fine, and my brain is going to be fine. It doesn't work that way. So I think this is a huge miss for people. Now, as it relates to the question you had asked about why is it so addictive, you know, there's still kind of a debate as to whether things beyond the conventional drugs are actually addictive. So there's a debate in the world of food science, there's a debate in the world of technology. There are terms like internet addiction, gaming addiction, but they haven't necessarily been integrated into the diagnostic criteria, at least in the United States. But But setting that aside for a moment, I think what is clear is that we have trouble stopping ourselves from compulsively checking our phone, from checking our emails, checking our likes, seeing if people commented on our profile, seeing when our latest delivery from Amazon is going to show up. And there are neurologic reasons why that is the case. I think that the best way to explain it revolves around the dopamine system. I think there are a lot of kind of distortions as far as what dopamine is. It isn't necessarily the pleasure chemical, but what dopamine does is it causes us to be motivated to do certain things and not other things. That's really one of the key areas that dopamine is involved. It's what's called incentive salience. How much do we want to do something versus something else? And what behaviorists have shown with initially animal research and more recently with kind of human behavior is that there are certain things that activate our dopamine system in such a way that causes us to compulsively or continuously feel the need to continue doing that action, even if it isn't all that great for us. And so the original kind of analogy or the research is in gambling, and it's something called a variable ratio reward schedule, which is a complicated way of describing this. But the idea is that when our brains are intermittently rewarded, they love it. The dopamine system lights up. It just can't get enough of this. So if I was to give you, you know, a button to press and every time you press the button, you got $5, your brain would be interested in it, but after a while it wouldn't be as interested in it, wouldn't be as excited. But if you press the button and sometimes you got $5, sometimes you got $10, sometimes you got $0, the brain can't get enough of that. It's, it's so interested in continuing to do this thing. So it's kind of like the slot machine effect, right? And what you'll see is that across the board, as it relates to our social media, it's the same thing. As it relates to our email, it's the same thing. It's, you open your phone, sometimes there are a few emails, Sometimes there are some likes, as I said, sometimes there are some comments, and the brain can't get enough of it. So it's, it's kind of hijacking an aspect of our innate physiology. And, you know, you can argue whether it's good or bad. If you're using this for a good thing, right, if you're using this variable ratio schedule to get somebody to do something healthy— this is the idea of gamifying things like dietary plans— then wonderful. But it all kind of collapses down to the quality of our engagement with with media. And I would argue, as you already alluded to, that most of the time when we're engaging with our devices, it's mindless time. So even if you want to say there's no overall downside as far as it's compromising your brain circuitry, the bottom line is you're not doing the stuff that has been consistently for thousands of years associated with better health. You're not engaging in those in-person relationships. You're not getting outside into nature. You're not exercising. You're not being mindful and eating your food. Instead, you're eating while you're on your phone. Instead, you're watching TV instead of exercising. Instead, you're staying inside to play a video game instead of going out into nature. And again, I'm not saying that those things are bad. What I am saying is that the opportunity cost is significant. So for people saying, "I just want to be a happy, healthy person," you're not getting there. If anything, you're just kind of pulling off the road on your journey towards getting to be a healthy, happy person when you're engaging in an hour of kind of just scrolling mindlessly on social media. And then, you know, I do think that there is enough research to suggest that in some people there are negative effects as a result of using these devices, social media and the like, especially when we're passive in it. I think that is the concern. When we're just kind of sitting there mindlessly scrolling, that is actually associated with worse mental health. Uh, and I think there are a variety of reasons for that. But what I really want for people to appreciate is that when you are mindlessly engaging with these digital devices, you are missing out on the stuff that has been for thousands of years associated with better physical and mental health.

It makes so much sense. And I know that there's been division amongst creators versus consumers in the social media world. And by us doing this, we're creating media, we're creating content. But then you have the flip side of the coin of, you know, putting it out there. Are enough people going to listen? Is there going to be the likes on our social media posts? Even though we know that we're doing it from more of a, uh, a good reason, right? We're doing it for healthier reasons of why we're doing this, why you've written books and why you're doing speaking and why I'm doing my podcast. And more of my stuff outside of my day-to-day therapy and coaching practice. But we still do want that recognition of doing that good job, right? So, so I wonder, for even those who are coming more from an altruistic perspective of doing— of creating content, that we still do have to take into consideration that of course we still want the positive likes, still we want the reviews, we still want all those things. But our— I think our starting point might be a little bit different if you're looking at it from a healthier place, right? Because we're— it's— we're doing it as a good for all. But do you— have you seen anybody that you've worked with or collaborated with that where they started off with this, I'm doing this as a good for all, but they still had the negative effects at the end of the day of what you're talking about?

I unfortunately think that is the case for just about everybody who is a quote influencer. As much as you go in with the hope of being able to help other people, you're going to— unless you outsource it, that's kind of an interesting caveat to this— but you're going to, you know, start to pay attention to those metrics. And I've never met anyone who's just able to say, you know, I'm only tracking my Instagram followers because I want to better show up and be able to help people. That's what you say, but it does still activate those circuits in the brain. And certainly people are at different levels as far as their sensitivity to that, but it's, it's still the same stuff. And I think that's why it's so important for people, even who are in it for the right reasons, to set boundaries on how they interact with their technology, because, you know, the technology isn't going to discriminate. You could go in with the best intentions, but it's still going to light up the same circuits in your brain. You're still going to start paying attention to, you know, how many likes you got on this post versus that post. You say it's from an analytic perspective, but it's, it's still can become, I think, a deficit or a detriment to your mental health. Similarly, you come into these things with the idea that you want to educate other people, let's say, but you realize that the way to reach people is to convey information in a certain way. That if I was to be here in this podcast with you and just say basic stuff like, you want to eat less processed food, you want to try to turn off your phone for a couple hours of the day, people will hear that, but they won't connect with it. In order to connect with people, you have to have an emotional charge to your information. Even when you look at studies, right? If you publish a study and it says something really interesting, it's only when that gets converted into a news media message that has some emotional charge that people start paying attention to it. And that's why I think it's— people in general need to pay attention to kind of these rules of influence and these rules of basically appreciating how the brain makes sense of information. Because if you're not aware of it, you're going to have your attention and your decision-making kind of subverted by whoever is the strongest influence around you, you know, whatever the strongest gravitational the original pull is, but once you start to appreciate how easy it is to have our thinking manipulated by others, you develop a bit of a defense system. So all of a sudden, you realize, "I have all of this stuff in my cart on Amazon. I don't need any of this." You have a plan, which is, "I know that the brain is impulsive as it relates to these things. I know that when I am stressed, I tend to buy things I don't need. Now I have a strategy where in order to ensure I'm not making impulsive choices, I leave stuff in my cart for a 24-hour period before I allow myself to make that purchase." So it's first of all understanding the weaknesses, and then it's having strategies so that you don't act impulsively.

I remember it was— had to be around '99 or 2000. I was living in New York at the time, and I was teaching in an after-school religious school Hebrew school program at a synagogue. And our teachers had to rotate around and man the staff counter between— they came up there from school before they started the Hebrew school class. And the day that I was doing it, one of the days I was doing it, I was with the assistant from the the, uh, the office assistant, and the kids are like grabbing at it. And I'm like, gosh, like, you know, they can't— like this instant gratification. And her response was, instant gratification isn't fast enough anymore. So, and this was like, right, we're talking like 2000, right? '99, 2000, 2001, where this was— Instant Messenger was like, right, that was the thing around that time. And Harry Potter. So we're like, just to like, you know, to date myself at, you know, as far as what's going on, there was no, you know, it was MySpace, there was no Facebook really, there was no instant, you know, and so there was none of what we're talking about now. And if that was context of instant gratification isn't fast enough in 1999, where are we exponentially in 2021?

There's a lot of conversation about how our world has devolved into one of instant gratification, how our attention spans have shrunk. You know, I think there's kind of a bifurcation there where some things have gotten longer. For example, podcasts— people listen to an hour-long conversation, that's an attention span, right? But also they want their videos in 30-second clips, or as you said, TikTok-style clips. So So I do think that overall there's been a shift in the way that we spend our attention as it relates to instant gratification. Again, getting back to like how humans make decisions and what made sense. We all have a bias towards short-term thinking, towards impulsive thinking, towards instant gratification. And, you know, it's kind of the bird in the hand. If you can have something right now, why not do that? Because we don't know what will happen in the future.

Right.

So I do think that we are over-relying on instant gratification and that has its problems. But the main reason it's a problem is because all of the things that we are getting as far as instant gratification are taking away from our health. So if you're going to engage in instant gratification for food, you're getting fast food. That's terrible for you. If you're engaging in instant gratification in your relationships by trying to get likes and stuff on social media, not as good as the real thing as far as actually having meaningful conversations with people.

Or even the hookup culture that's become, right, the Netflix and chill culture is the same Yeah, yeah.

I, you know, I don't know that I have enough expertise in that, but having met my current girlfriend on a dating app, I can say that there's definitely benefits to that as well. But, but I do think there's that piece of it, which is when you can always have something slightly better, it's very hard to be satisfied with what you have in the moment. And, you know, here we are watching TV, scrolling on our phones on Instagram at the same time. Like, if it's never enough, if you can always have something that's a little bit more interesting. And I think it does take away from the quality of our interactions. But my main concern, as I mentioned, is that yes, we're making more kind of instant gratification-based decisions. Maybe that isn't the end of the world, except for when we make these choices, we are being funneled into these ways of basically destroying our health. So instant gratification comes at the cost of long-term health and happiness because the choices that are set up to be so impulsive and instant are preferentially those that are bad for us.

So if we walk through the three brain theory, right, we were talking about neurology a little bit ago and you're talking about the limbic system in the basic understanding, and I'll break it down for the listeners who who haven't heard it yet in a previous episode, right? We have the, the triune brain theory, which is you have your neocortex, which is your rational brain, your dominant thinking, you're choosing to make things purposeful. Then you have your mammalian brain, which is timeless, right? That's something when you think about that awesome grunge song from the '90s, right? The Foo Fighters comes on, you're back in that concert, um, and your, your emotions are connected to that part of the brain. And then you have your reptilian brain, which is your survival brain, your fight, flight, feeding, reproducing, right? So, so as we're going through that process that you talked about, can you kind of walk us through, you know, how that instant gratification is playing out at each of those levels from any of the research that you've—

Sure.

Yeah.

Yeah. So, so this triune model of the brain, I would say at this point is more of a model and not necessarily consistent with the latest neuroscience, but it is helpful as a way of understanding that there are these different areas of the brain and they have overall different functions. As it relates to instant gratification versus long-term reflective thinking, pretty consistently scientists have identified a region of the brain that seems necessary for reflective, well-thought-out consideration for decisions, and then another part of the brain that's more involved with the impulsivity. And, you know, what's really interesting is you need these things in balance. And there's this idea of this somatic marker hypothesis, right? It's basically the concept that when we make decisions, That is an incorporation of emotional and visceral data that comes up through the vagus nerve, through the rest of the body, into the limbic system. And then that goes into the prefrontal cortex and it's integrated into the way we make choices. So it's the concept of like having that gut feeling that is incorporated into the weighing the pros and cons of a choice. And what's fascinating is, you know, they look at people who have had damage to different parts of the brain. And when people have damage to the limbic system, to the amygdala, They can't necessarily incorporate that gut feeling piece into their decision-making. It turns out that rational thinking isn't all that possible for most things. You know, you get to the grocery store and you're looking at buying a bottle of salad dressing. There are 80 salad dressings. If you were going to sit there and make the pros and cons list, you would never leave the grocery store. So you need a little bit of that feeling, which is, I like the color of that bottle.

Mm-hmm.

Right. That isn't necessarily something you factor into your conscious pros and cons, but you get a feeling from it. So it makes it easier to make the decision.. So you need that information, that visceral emotional information coming up from kind of the lower areas of the brain and from even deeper in the body. Like I said, the vagus nerve that gets funneled into the prefrontal cortex. But on the other hand, you really need the prefrontal cortex to give you the opportunity to have this moment of reflection between the information and the action. And people tend to get pretty specific about this. You know, we tend to mention the prefrontal cortex as, as being in charge here, but basically all of the neuroscience papers will implicate specific regions of the prefrontal cortex, specifically a part called the dorsolateral, so dorsal and lateral prefrontal cortex that exerts this kind of top-down control over our decision-making. And researchers have actually shown that if you take healthy people and you take magnetic stimulation over this part of the brain, it decreases the rate of impulsive thinking, of impulsive decision-making. So this is kind of how they figure out that this is a key aspect of our ability to suppress impulsive choices. What we want, the, the model that we talk about in Brain Wash, isn't so much that you want all of one and none of the other, all of the prefrontal cortex, none of the amygdala. Instead, it's that you want to have good communication between these two parts of the brain. It's something researchers study through something called functional connectivity, which is the idea that in real time, there appears to be connection between these parts of the brain. That connection is what enables us to kind incorporate the emotional data, but also the higher-level thoughtful data in the way that we make choices so that we're not stuck making these impulsive, irrational, emotionally charged choices, but that we're also not stuck weighing the pros and cons of every single thing that we do. And what's interesting is that there are a couple of factors that people have shown, for example, not getting enough sleep, for example, having high levels of stress, that appear to break the connection between the prefrontal cortex and the amygdala. On the other hand, there are things that we can do like mindfulness and meditation or getting enough sleep that appear to increase the strength of that connection. So what I'm trying to say here is we think of lifestyle modification, we talk to patients about lifestyle modification as a way of doing things like losing weight, improving blood pressure, right? But what we're actually doing at the level of the brain is changing the circuitry, changing the way that we make decisions, changing our mental health status, this. So there isn't, you know, this mind and then— or a self and then the body, right? Which Descartes would be very upset. But what I'm saying is that there's— it's all interconnected, right? It's all the same neurotransmitters, hormones. They have different roles in different parts of the body, but we can affect that through the things that we do. So we can first of all understand our problems as a result of our brain function, and then we can make changes to our diet, to our exercise, to our mindfulness practices, to the content we take in through social that fundamentally rewire our brains for better mental health, for better decision-making, for a better kind of you, you know, this, this self, this unchanging self that is independent. It's not really a thing. We are always changing. Who we are is always changing. Once we get on board with that, we're so much better able to change that for the better. And, uh, I think it opens the door to so much curiosity and also to empathy because you're no longer blaming somebody's identity for what they do. Instead you're saying, huh, what might be going on in their brain and body? And if they're interested, if they're coming to you and they want help, it's not like the only thing that you have in your toolkit is to say, well, let's work on, you know, some psychological concepts of who you are as a human. Instead, let's say maybe we'll work on your blood sugar, right? Because we know long-term elevated blood sugar changes decision-making. So I know I said a lot, but this is such a key concept is you get rid of this idea of an unchanging self yourself, and then you get into the idea of the fact that you're always changing, right? You embrace flux, you embrace change, and then you try to make that change shift towards a more positive, beneficial, healthy state.

Everything you said is pretty much the comprehensive approach that I take as a therapist, where through my neuro-emotional technique world, we're trained to look at it, uh, the way that Dr. Walker, the founder of it, came up with the home run formula. And you have to touch all four bases and connect with all four bases in order to have a person be at their biggest successful potential. So we look at it as first base are all the emotions and what I can do either as a talk therapist and using this NET modality. Second base would be toxins. What has the body been exposed to that the body's still carrying toxicity-wise that needs to be taken out, right? Pesticides and, uh, anything else that they've been exposed to, environmental stuff like that. Third base would be nutritional deficiencies. So we're talking about, right, anything that could be going on. If you're talking about like leaky gut, is it blood sugar handling, hydrochloric acid for, right, for digestion issues. Other supplementations: vitamin B, vitamin C, vitamin D. Right now we know there's tons of research going on with COVID and vitamin D. Um, and then home plate would be structural. And you and I both know this, is that a structural physical symptom can come from the downstream of your emotions, of toxins, and nutritional deficiency, right? So our— my job as a therapist is to assess, is that actual chronic pain coming from one of those other areas? Now I'm not putting my hands physically and doing any manipulation or physical therapy, but I've seen constantly in my practice over the years since doing this modality that I've helped relieve and get rid of chronic pain due to solving an emotion, a toxin, and a nutritional deficiency. And that cascade really does— one can affect all those other things, right? You can have a chronic pain from the emotions, you can have a toxicity issue that's affecting your biochemistry, which is again is an emotional thing. Like you said, blood sugar— the first thing I'm always checking with my clients is what's their blood sugar handling when it comes to emotional stuff. And, and I know that in the world of integrative and functional medicine, um, the therapists really do need to probably bone up their expertise on this because we have no training on nutrition. We don't really have training. No one talks about the research on sleep. No one talks about the research on organic food or processed food. Or, you know, which I wanted to pivot the conversation into, inflammation, which I know is something that you're, you're a heavy hitter on. So let's, let's talk a little bit about like, hey, what is inflammation? Um, I know like we can talk about C-reactive protein and all that other stuff, but like when it just comes to nutrition and diet— and then I know what you were talking about before about consuming media, the inflammation that it can cause just from like what's around us that way. So what's your, what's your definition of inflammation? Um, and what are some of the things that the listeners can do to identify whether that is what's going on for them and also to change their lifestyle around Right.

Yeah. So inflammation gets a whole lot of play in conversations. Inflammation gets blamed for everything, right? It's— I'm pretty sure inflammation is responsible for the lost socks that went into the dryer. And everyone has a definition of what it means. The scientific definition is pretty concrete as far as acute chronic inflammation, and it has to do with certain processes that occur at a cellular level with activation of parts of the immune system. Where I would start is to understand that inflammation is a state of the immune system, right? So it's not— people tend to separate these things. There's inflammation and there's immunity. Not really. Inflammation is an activation state of the immune system, and inflammation isn't a static thing where it's you have it or you don't. It's always going to be changing because it's a reflection of certain cells, certain cytokines, which are these kind of messengers in the immune system. So, what I think is more helpful is to understand where inflammation is problematic for our health. And this is specifically related, for the most part, to chronic inflammation, to a low-level smoldering inflammatory activation of the immune system. This is the one that is linked to heart disease, to diabetes, and also to worse cognition. So, inflammation, you mentioned CRP, markers like that predict people getting dementia, Alzheimer's dementia, decades later. So there is this correlation between an altered or dysregulated state of immune function now and worse cognition, worse physical and mental health in the future. What I think people should start to understand more of is again, this divide between the self, the mind, and the body is not a real thing from my perspective. And that inflammation, while it may have the effect of causing you to have a swollen, painful joint if it's in the knee, in the brain can have very different effects. You know, you're not going to feel swelling. You're not going to feel pain necessarily in your brain. I mean, you might have a migraine, but in the brain, what we know is again, long-term associated with worse mental health, short-term associated with— sorry, worse cognitive health, but short-term associated with worse mental health. Inflammatory markers, an activated state of inflammation, predicts depression, and it's actually a pretty significant correlation. But most recently, researchers have shown that when you cause inflammation in a person's body, you can do this in a couple of ways, that it lowers the quality of a person's decision-making in that it makes them more impulsive. What we're saying here is that this concept, inflammation, that we might associate with poor gut health, with heart health, with long-term cognitive health is actually something that is influencing our thinking, our mental health on a moment-to-moment, day-to-day basis. And so, working backwards from this, I think it's critical that we ask ourselves, what are the things in our lives that are unnecessarily causing inflammation? Because it turns out you actually need a little bit of inflammation, and this is one of the reasons that exercise is so good for us. But when we get it in kind of consistent doses, either through our foods or through our news consumption, through our social media consumption, because stress is actually one of the key pathways that activates chronic inflammation. So if you're chronically stressed, it leads to chronic inflammation, then you're going to see a lot of these negative effects on your brain function. So I think it gets back to the question of your inputs. Are your inputs quality? I think that for most people, they don't appreciate that when they're watching hours of the news and feeling anxiety, feeling stress, that's actually a pathway towards inflammation. And worse thinking. I think more people understand the role of food and inflammation and certainly we can go into detail as far as what I recommend as a general anti-inflammatory diet. There are different perspectives on what that looks like, but really a lot of that comes down to supporting gut health, supporting a healthy gut barrier because a lot of inflammation is actually a result of bacterial components and other stuff getting through the gut lining and activating the immune system. But yeah, I think that, you know, there's nuance to it. There's nuance to everything. Inflammation isn't bad, but when it's sustained at high— well, I should say sustained at really low levels in the background for years at a time, that seems to be one of the underlying drivers of the majority of our chronic health conditions.

What do you think some of the tests that people should take if they're going to their doctor, they're hearing this episode and they're reflecting like, wow, this is really what's going on for me. And again, I see this all the time. All the time. And in fact, one of the conditions that I'm now making with anybody that's coming in with any chronic type of issue— and my practice is kind of the worried well, it's the average person who's going through some stuff, and maybe some anxiety, maybe some depression, some major life changes that are going on, but I don't work with severe mental health issues. I don't deal with high conflict issues, stuff like that. But anxiety, depression, those, those general things that we as humans go through. And I'm now making it like, when, when's your last— when was your lab, and I'm finding over and over again that the labs are being done incomplete, that they're not checking certain things. They're not checking thyroid, they're not checking vitamin D, they're not checking some of the other things I would check for some inflammation on a— what they would call the comprehensive metabolic panel. So what are some of the things that when they're— when a person after this episode goes back to their primary and needs to advocate for themselves, which is a whole nother conversation, because, um, my sister this morning just told me, like, when she asked for a vitamin D test, like, the doctor rolled her eyes 'Adder, you live in Miami,' like, you know, that's like the common thing. And I'm finding massive clients with vitamin D deficiencies up the wazoo. What are some of the absolute must tests when they're doing a lab to help indicate what direction they should be going in to take the next steps, whether they're gonna work with a functional medicine or a nutritionist or whoever, a specialist?

Yeah, well, you know, before I get to that, I would just advocate for people that you don't need labs to make these changes. Labs can help you to motivate you, they can give you directionality, and they're especially relevant in conditions of extremes. So if you're very hyperthyroid or hypothyroid, then getting your thyroid levels is going to be very helpful because you'll be able to intervene on one side or the other and start getting back towards a regulatory state. If you have frank diabetes and you're peeing out a ton of liquid every day and you're dehydrated and you're losing weight, it's really helpful to know what's going on with your pancreas. But what's challenging, I think, is to try to come up with a universal set of labs labs that can capture all of that stuff. And so that's why I say, you know, for the average person, my advocacy is to look at basic lifestyle interventions because I think for the average person, they're getting excessive levels of stress and through that, you know, neuroinflammation and damage to their brain by watching too much news, by engaging with too much social media. For the average person, they're getting a ton of inflammation and unhealthy kind of inputs through their food. They're not exercising enough. They're not getting enough sleep, basically everybody could benefit from those interventions. And so you find some of these changes on the labs, that's great, and it's great if you have somebody that can work through that. You know, maybe you have a specific issue with your cortisol regulation, maybe there's something specific going on with your immune markers as it relates to inflammation. But, you know, again, I think that the first step for most people, unless something is really problematic and you need urgent care, is to start looking after some of these basic lifestyle variables It's interesting because I'm kind of in this spot where I've spent several years trying to look at the very most recent research as it relates to interventions to improve brain function. And those range, you know, there's research being done on senolytics, which are molecules that can help to remove kind of damaged cells. And so there are a bunch of these new chemicals that they're using mostly in, you know, animal research. They're not necessarily available for humans yet. And they're cool, right? And they might work to improve brain function, but they're not, they're not necessarily something most people can use. For the most part, when I look at even all these most recent updated studies, they're still talking about the same interventions that people have been using for thousands of years to improve their health, for thousands of years to lower inflammation, like turmeric, for example, curcumin, the ingredient in that which we know has an anti-inflammatory effect. Yeah, there's research that suggests that it has an anti-inflammatory effect for people with joint inflammation, but we kind of know that it's been beneficial for thousands of years. And it's so just like, do you need the proof for that, or can most people benefit from maybe considering eating some foods like that or drinking things like green tea? So I don't want to dance around your question here. I think it is important in many cases to get a baseline understanding, but I think that that should be customized to a person's areas of increased symptomatology. So if they have GI issues, then maybe getting a GI panel would be the first place to The other thing that I would tell people is there's a lot you can learn from even the basic labs. So if you get a hemoglobin A1c, which is a marker of— it's a diabetes screening test, it's also a test that people use to track their diabetes— and that is elevated, and elevation is really, you know, for a person who's non-diabetic, if you're in the 6s, that's kind of an elevation. That is a surrogate marker for inflammation. It tells you that there is inflammation going on in the body. So you don't necessarily need to get this whole panel of inflammatory markers to make sure that you do or do not have inflammation. It can be helpful in certain cases, cases. But my advocacy again is to look at the basic lifestyle modification factors that are beneficial to most people and then work within that to find those that are most helpful to you and to see how you experience your clarity of mind, your physical health. And certainly if you have access to a provider and have specific symptoms, that's helpful too. I've seen many times different providers will get kind of fixated on a certain lab set, a certain lab panel, a genetic panel, and it's like that's going to cost hundreds of dollars, potentially thousands of dollars And at the end of the day, if your recommendations are the same, which is work on your sleep, exercise, eat a more healthy diet, then I think that can both be a waste of money and also a distraction.

Is there an evolution in the foods at this point based on your research and your practice that you're telling people to increase and to avoid?

Yeah, there is. So again, it's trying to look at the things that people have done for a long time, seeing if there's a basis to that, but also the more recent research. And when it comes to dietary recommendations, there are many different camps. There's a big schism right now around plant-based and carnivore. There's the keto, the paleo, all these different variants. And I think you're always going to find data to support a diet. There have been so many studies done. But when I'm looking at recommendations, I'm trying to take into account what are the large-scale, long-term population-based studies in addition to when available, which there often not RCTs or randomized controlled trials pitting certain diets head to head. And my take on this is that for the average person, the most important thing that they can do is move away from the standard American diet, which is high in ultra-processed foods, and move towards a diet which is higher in whole real foods. You know, for some people that may be more animal products, for some people that may be more plant-based. I don't think that's the important thing for the majority of people. It's just getting off of this train, which is leading you to poor physical health, poor metabolic health. So it's eating more ingredients that are single ingredients that you can identify and eating less ingredients or less foods that have 18 ingredients with complicated chemical names. That's step one. I do think for certain people, certain diets are better, right? There is a huge benefit to individualize this. So for people with metabolic dysfunction, a diet like the keto or low-carb diet that lowers, uh, levels of high insulin or improves insulin sensitivity that can promote weight loss and the like, that's what I would think is best for those people. For other people, you know, for people let's say with thyroid issues, going on a really low carbohydrate or fasting type diet may not be the best option. So I think the starting point for the majority of people is what I described, but I do think that in specific cases, you know, some of these diets may be very helpful with the understanding that it's a big difference between changing your lifestyle to start eating a certain type of pattern of diet like the Mediterranean diet versus doing an intervention with something like keto for for a couple of weeks to try to improve insulin sensitivity.

And where does the gluten debate sit right now? Because I know that's part of a family history.

Family history.

Yeah.

So it's funny, I've actually kind of shied away from trying to talk about gluten just because it is something that my dad has spent so much time on. I am of the mind that obviously if people have gross gluten insensitivity as in a person with celiac disease, obviously that's not a good call and that there probably are other people with gluten sensitivities that don't necessarily qualify as celiac. I don't eat a lot of gluten, but it's more because, you know, the foods that I eat tend not to contain gluten than it is me actively avoiding it. Um, so again, I won't necessarily comment on that research because I've been— you're actually the first person that's asked me about gluten, which is kind of shocking. But, um, I think it goes into the list of variables that for a person may be worth considering, uh, if you're considering something like a elimination type diet, it's something to look at. If you have a lot of GI symptoms, I think it is something to look at. If you're looking at ways to overall improve inflammatory markers, there's research suggesting that gluten can disrupt the intestinal barrier even in people who are otherwise healthy, so it might be helpful there. But it isn't one of my top variables that I go to as far as ways of optimizing cognitive function.

Because I know the reason for me, from my perspective of asking that question, is for years I didn't realize that it was actually a sensitivity. I got the celiac test, all that stuff, and it never showed up on any of the, you know, endoscopy and biopsies. But I know that when I have a combination of wheat, yeast, and sugar, I have a lot of physical responses to it, right? So I know for some people, right, everybody's talking about, well, is it the wheat? And is it the glyphosate? Is it the, right, the pesticide that they use? Is it the actual gluten, or is it a combination of yeast and that? Is it the sugars? Is it fermenting in your body, right? Is all those different things. And I know people like going from the gluten conversation, which, right, there's all these cross-reactants. And I know that people have mood effects connected to it. And I know that some people are saying like kombucha and some fermented foods, right? There's that debate of like, this is really good for the gut health, and the gut health is about, right, the dopamine and the serotonin that's created in your gut connected to your brain. And then there's people were saying, no, no, no, stay away from fermented foods, stay away from kombucha, stay away from all those type of things.

Yeah.

Um, you know, as it ties back into neurotransmitter creation in your gut. And that was, I guess, my angle of what your thoughts were, right? When, when people talk about that gut-brain connection, kind of circling it back, um, for me, I know personally it's been like I've been gluten-free for a while, and I know that I can have within a 5-minute reaction or a 2- to 3-day reaction from it that for years it took— no one figured it out and it was by my own process of elimination.

So you know that's relevant for you, right? That is concrete data in an N-of-1 study that it's probably something that you should avoid. So, you know, I think those are the types of things when people are interested, when people are motivated to do those elimination diets and find out what is or isn't good for their body, it's ideal. A lot of people just want the solution, which is take this pill, do this thing, and everything will get better. And then and it doesn't work for them, it's right back to the drawing board. And it isn't kind of like a systematic process, kind of like what you're describing. So I think for motivated people who have an interest in and a background in some health stuff, these are the types of things that are so great because they give us a better understanding of what's happening in our bodies. But I just hesitate to make the universal recommendations to people as a first line of therapy before we've tried lifestyle modification.

For sure. So taking that back into the lifestyle modification, there's the mindset component, right? And this is, I would say, uh, what they're already thinking about their capabilities of being able to, uh, to achieve this. And there's the, the field of epigenetics, right, of being able to, uh, modify and change your, I guess, your genetic predisposition in a way. And a lot of people, and I hear this comment, and I'm sure you have as well, but my family history is this, or my body type has always been that. How would How do you help people approach that from that perspective of empowering them to let go of that story so they can have the productive changes, like you said, this lifestyle modification?

Right. So there are a couple of key things to think about here. First is, do our genes play a role in our health? Yes, absolutely, 100%. But it's not necessarily the code of our genes that matters so much as it's the way it's expressed. And so the way that I've heard this explained before is when it comes to to things like certain genetic predispositions to diseases, your genes load the gun, but you have to pull the trigger, which means it's your choices that influence the way that your genes are expressed. And as it relates to this concept of epigenetics, that's basically this idea in action, which is epigenetics, the idea that there are changes to the way your genes are read that influence your health significantly. It, it is an alteration in kind of the whole conceptualization of what genes do, because you could have genes that predispose you to a disease that don't get activated. You could have genes that predispose you to health that you could target through specific lifestyle modifications to increase the expression of certain proteins that have an anti-inflammatory effect. So in many ways, this is kind of like the idea of neuroplasticity, right? Which is that your brain is always rewiring itself. Itself, depending on the inputs that come in. Similarly, your genes are always being expressed in a different way depending on the inputs that you put in. It really does put the power into your hands as far as quality of your decisions influencing your kind of fate, your health fate. Um, and you mentioned mindset with that too. You know, there's fascinating research about how optimism can improve health outcomes compared to pessimism. And we know that these are things that, influence every aspect of our physiology, from our genetic expression to our telomeres. So there are a lot of paths into this, but I think the take-home idea here is that basically everything within our bodies is in flux, and many of those things can be modified by the decisions that we make. Not all of it, right? So there are certain genetic diseases that, despite our best efforts, are going to, um, come out and cause problems. But as it relates to a lot of these genes that predispose us to chronic disease conditions, things like perhaps type 2 diabetes or heart disease or even Alzheimer's, there's a lot that we can do to change the way that those are expressed.

So coming— because you finished medical school how many years ago at this point?

It's been a little while, probably about 8 years ago. Okay.

And I'm wondering just from people who are maybe even—

No, wait, medical school, probably about 5 years ago.

5 years ago. Okay. Plus residency, all that stuff. So for those who— I mean, I know that the medical field is, right, is, is, is evolving. On my, on my mom's side, I have a ton of medical doctors. And as I discussed this stuff with them, right, that it was such a different mindset and different training. And research is evolving, programs are evolving. For someone who is considering going into the medical field and also has a passion about this type of research and knowledge and wisdom, is there ways that they can kind of discern by looking at programs? To see will they get what you're leaning into, what your studies of research is, what your passions are. If they find that that's connective, where— what they should look out for, what they should note in order to make a decision about where they would want to go, or what type of residencies and specialties to look into. Or, you know, is it something that they should do? I have a friend of mine who was doing med school and was taking a functional medicine training on the side because he wasn't getting that program right.

I actually did that too. Um, it's such a good question. And I think what it reflects is the idea of what are we trying to do with our vocation? What can you do that is both interesting to you but also helpful to others? And so I'm not an expert in all the different fields of medicine, all the different degrees of medicine. I only know allopathic medicine. And I have friends, of course, who have other degrees, a lot of naturopath friends up here in Oregon. I think You know, in life, you can't always be looking at all the possible decisions and changing your trajectory on a day-to-day basis. You pick something that seems like it's more or less in alignment with where you want to get to, and then you stick to it for a while. And allopathic medical training is, is interesting in that if you decide to do it, at least for me, there's not a whole lot of reserve. It's not like, you know, you're doing some work, but you're also questioning what you're doing with your life and thinking about this, that, or the other alternative jobs because it takes so much of your time. You're going to be really stressed. You're going to be in the hospital. You're going to be studying for tests. And for most people, you're going to be going into a substantial amount of debt to accomplish this end. So you get out of your training, your basic medical school training, and then you get to apply for residency, whether that's psychiatry or internal medicine, what I did, or, you know, neurology. These are all options. You have to think about, I think, where you want to go as far as what's interesting to you and the message you want to be putting forth. And unfortunately, you also have to think about how people will see you and what your degree might do as far as getting people to listen to you. Uh, that's just the state of things right now. So if you get an MD, people will take you more seriously than if you get other degrees. And I don't agree with it. It's just kind of the way it is. So, um, I've been very lucky in that I've been able to morph what I do now into what is more consistent with what I care about. But, um, I think what's challenging is that many people get out of their medical training and they find themselves in a lot of debt and they find themselves needing to do a job they don't really like in order to pay off their debt. Next thing they know, they've purchased things that were expensive, like a house with a giant mortgage, a new car, and they're doing their job longer because it's essential for them to be able to pay this stuff back. And then, you know, it may not necessarily relate to what they want to be doing in their lives, to higher quality of life. So that, that's kind of a more career guidance, which is basically to talk to people who actually have the outcome that you're looking at and make sure that it is what you thought it was. But if a person has a fundamental desire to improve human health, there are so many ways that they can do that. I would just say find the stuff that is interesting to you and then find the Venn diagrams between subjects that haven't been explored in enough detail. And then whether it's a podcast or what you do in your clinic or a book that you you become the content expert on that Venn diagram. So if it's stress and the immune system and gut health, you find that little slot and you become that person and make sure it's something that is interesting to you. But I think that's the way that we have the possibility of really moving the ball down the field as it relates to things like functional or integrative medicine because you are integrating multiple areas of research and certainly there's benefit to talking about the basics about sleep, about diet, but it is fascinating to me that when you get to the nuance of let's say, how do you influence brain metabolism through diet and how does the immune system play a role in that? There's just not that much information. And so when you sit there and really focus in on it and try to learn it well, you can deliver so much value to other people by synthesizing it and by conveying it in a manner that allows people to make those changes. So my big kind of takeaway from this is find your Venn diagram. Find your Venn diagram as it relates to your family, as it relates to your vocation success, as it relates to, you know, the amount of nature that you need, find where that is for you, because then you're not trying to compare yourself to other people who don't have relevant data. And then also, as it relates to the message you're putting out that is helpful to others, find your Venn diagram, which will make you a, quote, expert in that, but will also allow you to deliver value to people you talk to.

I love it. I love it. I see it as the— what are you uniquely positioned to solve based on what you're curious in, what you're passionate about?. And it could even be something from your own story that you had to do by based on your sheer will to get through it. And that's kind of my journey as a therapist was that way, right? My parents were divorced. And of course, right? My, I ran away from the family business that my siblings have went into. But I had to travel down the rabbit hole of integrative medicine in order for me to feel better about things that traditional therapy wasn't helping. And that's when I did stumble on out of University of Miami, they have a great complementary medicine and I'm not sure if it was open when you were there at, uh, with Dr. Knoffel, right? Jenna Knoffel at iCamp. So I took trainings with her, and that got me into neuro-emotional technique when I was having panic attacks. And within 3 sessions, my panic attacks went away. And then that was the rabbit hole that got me into functional medicine and applied kinesiology and all that other wonderful stuff. And it just opened the doors of like, oh my God, they never taught this to me. But it's not their responsibility to teach it to me because that's not part of the traditional mainstream process. It's my job to become an expert in what I wanted to become an expert in.

And I think one other thing I'd add to that, which is it's one thing to just have access to, you know, scientific information. Some people will be very inspired by that, that'll be motivating enough. But it's another thing when you have kind of the doors opened as to your understanding of what reality is and what it isn't. Hey, uh, I had a call with a girl who was applying to medical school recently, and she was asking me for advice on, you know, what is the stuff that I should be reading, what are medical books that have been helpful. And I said the book I recommend that you read that I think would be most influential and most helpful is The Untethered Soul by Michael Singer. And there were a number of reasons why I said that, but, um, you know, there are those moments where you see things in a different way and that changes everything about your path forward. And there is a tendency in the world of medicine to put all your eggs in this basket of, quote, science. And while science is fantastic, it isn't necessarily motivating enough for people in their personal lives to continue to do what is necessary to be a good provider. And so once you can incorporate just a little bit of this existential, metaphysical, whatever you want to describe it, piece to what you're doing and appreciate that answers are not so concrete as we want them to be, and that science is still just trying to explain the things that are far beyond our comprehension, then it, for me at least, it's much more inspiring to stay in the game game and to look and say, people don't have all of these information answers, and I can contribute to this by just looking at it in a slightly different way. I think that can be a significant driver, and I think these are the types of explorations that are sometimes lacking in people who commit to a life of, um, kind of conventional science.

I see it as the magic of healing, the magic of science, the magic of whatever art we choose to practice, whether it's in the clinical field or a business field, but it's still— there has to be some magic left in it. And that's your gut intuition. That's the soul level of that. And I'm staring at the book. It's literally 7 feet away from me on my bookshelf that you just mentioned. And speaking of books, I want to just one more, you know, just let's plug, you know, Brain Wash. And it just came out, correct?

Well, actually a year ago, January.

Okay. So pre-pandemic, since I defined since I closed my office, literally the beginning of March last last year. This whole year has been a—

I'm pretty sure we're still in March of 2020. Yeah. Yeah.

So definitely like, so everybody out there, right, listening, you should check out the book, The Brainwash. Um, I know that, uh, Austin has been very active on Clubhouse. So if you're a Clubhouse person, if you're an iPhone— all you Android people have been knocking iPhones for the last number of years. Sorry. You know, I just got to talk some crap about you because right now iPhones are the only people who are getting access to, to Clubhouse right now, but you can check out Austin and Austin Perlmutter on, on Instagram and any other places. Uh, and I know you have your blog on Psychology Today.

Yeah, I have a podcast that I've been doing a couple episodes of. It's called Get the Stuck Out, and you can find it on Apple Podcasts and Spotify.

Awesome. All right, so guys, if you're listening to this, you want to make some really simple practical changes that are going to be game-changing for your life, check out his book Brainwashed. Check out his blogs, come jump on a Clubhouse conversation. And, um, like always, if you found this episode useful, or if you know someone else that this episode will be useful for, please do us a favor, just send it out to them. And as always, also, if you have the time, take 2 minutes, go on iTunes, leave us a positive written review with a star, and also check out Austin's podcast as well. And thank you so much again. I know this is one of my favorite topics to be talking about, of the mind-body connection and that it's not mind and body, it's all integrative, and how we can take simple practical steps in our life to just be healthier and happier. So thank you, thanks so much.

Absolutely.