Secrets of Brain Health- Drop Acid and Grains

Unlock the secrets to a sharper mind and a healthier life as we navigate the profound insights of Dr. David Perlmutter, a leading neurologist and acclaimed author. Our journey with him reveals the pivotal brain-gut connection that dictates our mental clarity and longevity. Discover why your gut health and diet are not just about waistlines but about safeguarding your brain from the perils of modern living. Through Dr. Perlmutter's expertise, we learn how the everyday choices on our plates have far-reaching implications for our cognitive health, drawing connections to his latest work, "Drop Acid," and offering transformative advice you won't want to miss.

As Dr. Perlmutter shares, our palates and stress levels are hijacking our brains more than we realize, impacting our behavior and overall well-being. Learn about the ancestral diet that shielded our predecessors from chronic inflammation and how today's dietary missteps can lead to a compromised decision-making process. Our conversation sheds light on the brain regions involved and how reversing inflammatory cycles can have societal benefits, fostering compassion and unity. These powerful discussions serve as a beacon for those seeking to break the cycle of food addiction and align their lifestyle with evolutionary wisdom for optimal health.

Finally, we delve into the risky terrain of gluten and grains, guided by the principles of "Grain Brain." Dr. Perlmutter takes us through the potential harm posed by these dietary staples, including their link to neurodegenerative diseases. We explore personal stories of transformation that illustrate the emotional and physical liberation that can come from dietary changes. This episode is not just an education—it's a call to action. We invite you to join the conversation, share your feedback, and become an active participant in a collective quest for a healthier, more vibrant future.

Please support this podcast by checking out our sponsor (20% off with this link):
https://prolonlife.com/Lufkin

ReverseAgingRevolution Summit June 20-22, 2024 https://robertlufkinmdcom.ontralink.com/t?orid=49&opid=2

Live video broadcast every Tuesday at 11:45 am pst on X, Facebook, LinkedIn, Twitch, and Youtube to a loyal audience of over 300,000 followers.

Also available as an audio podcast on Apple Podcasts, Spotify, Google Podcasts, Stitcher, Pandora, iHeartRadio, and and everywhere quality podcasts can be found.

*** CONNECT WITH ROB ON SOCIAL MEDIA ***

Web: https://robertlufkinmd.com/
X: https://x.com/robertlufkinmd
Youtube: https://www.youtube.com/robertLufkinmd
Instagram: https://www.instagram.com/robertlufkinmd/
LinkedIn: https://www.linkedin.com/in/robertlufkinmd/
Facebook: https://www.facebook.com/robertlufkinmd
Threads: https://www.threads.net/@robertlufkinmd
Twitch: ...

Transcript

Speaker 1: 0:02

Welcome back to the Health on BW Secret show, and I'm your host, dr Robert Luckin. In this episode, we embark on an enlightening adventure with Dr David Polmutter as we unravel the critical connections between our lifestyle choices, brain functions and the global shifts in nutrition. Dr Polmutter is a celebrated neurologist and best-selling author who brings his wealth of knowledge to the table, discussing the subtle yet profound ways our gut health and waste circumference can dictate our mental clarity and even our longevity. Discover why the TAPE measure can be your best health advisor and how simple, informed choices can transform your relationship with food. If you're seeking empowerment over your health, our conversations will illuminate the path to proactive well-being, guided by Dr Polmutter's expertise and his latest thought-provoking book entitled Drop Acid.

Speaker 1: 1:00

From dissecting the impact of seed oils to understanding the pivotal role of uric acid, we lay bare the facts and myths of our modern diet, armed with practical solutions and resources provided by Dr Polmutter, this episode is your catalyst for change, equipping you with the knowledge to make healthier, more informed choices for a vibrant future. This episode is brought to you by L Nutra, maker of the prolonged fasting-mimicking diet. If you'd like to try it, use the link in the show notes for 20% off. You can support this podcast by checking out their website and taking a look at all their other innovative products. And now please enjoy this week's episode.

Speaker 2: 1:49

And I'm very pleased today to, in this session, to have Dr David Polmutter here as our guest. Dr Polmutter is a board-certified neurologist and he's a six-time best-selling author and I'm very pleased to have him here because he has helped to really bring the conversation to the table for the public about our diet and how it affects our health and, in particular, how it affects our brain. So, dr Polmutter, so nice to have you here, welcome.

Speaker 3: 2:25

Well, I'm very, very delighted to be here with you today and to especially spend time with you today, dr Sidharth. This is a lot of fun, going to be a lot of fun.

Speaker 2: 2:34

I want to mention one thing we have in common we received your MD degree at the University of Miami and I received my PhD at the University of Miami in physiological psychology. So we share that in common as well.

Speaker 3: 2:51

Well, I was actually just last week over at the campus again and you would not believe what's gone on there in a very positive way. So it was nothing like it was for me in medical school. Our son went to medical school there as well and it, even since his day, has transformed. So you come from good roots.

Speaker 2: 3:09

Right, and we have interviewed your son and it was wonderful to talk with him. He's just really brilliant and I love the level of compassion that he demonstrates in our conversation, so that was also really great.

Speaker 3: 3:25

Well, that makes me feel really really good, as you can imagine.

Speaker 2: 3:29

Yeah, can you tell our audience how you first got interested in this area that you've written so well on?

Speaker 3: 3:39

Well, let me. I'm not sure of the area that we're talking about, but I think I know, and I think I know the answer to the question, and that is, you know, as a practicing neurologist, I began to wonder well, why are these patients coming into my office in the first place? What you know, what's the underlying reason that they're having neurological issues? Because I found myself becoming frustrated with the fact that we were only treating symptoms, we were treating the smoke and ignoring the fire. And I began to recognize that there was, even though we had various diverse types of disease by names that we were treating, whether it's Parkinson's, alzheimer's, huntington's, you name it that there were some commonalities, and among those commonalities was a mechanism called inflammation. And interestingly, as I just said, while we were focusing on the smoke and not the fire, the word inflammation comes from the Latin inflammatory, which means to burn, to light a fire. And we've now come to recognize that this unbridled inflammatory activity seems to be underlying so many of the chronic neurological degenerative conditions that we, as neurologists, encounter. And you know, I think, that the role of inflammation, I think, has taken a lot more prominent posture in society these days vis-a-vis COVID, because people are familiar with the so-called cytokine storm, whereby there's a sudden explosion of inflammatory mediators, which we call cytokines, and that characterizes the sudden explosion of inflammation in the human body, which, as we know, has profoundly detrimental effects. With the same time, we need to embrace the notion that even a chronic elevation, to a much smaller degree of these inflammatory chemicals called cytokines can be problematic as well. Let's call it the cytokine drizzle, whereby just a bit of a tweak up of the level of these chemicals, inflammation over time, can still wreak havoc in the body and certainly in the brain.

Speaker 3: 5:53

So what I'm saying is that we need to embrace this notion that inflammation is playing a central role in the progression of the degeneration not just of the brain, but of multiple body parts, including the heart and, importantly, including the immune system itself, which means that the very system that's creating the inflammation in the first place is susceptible to damage from the very process inflammation that it creates.

Speaker 3: 6:24

So, to go back to the original question, as I began to get my arms around this, I began to ask well, if that's what's going on, well, why is it happening? And once we gain an understanding in terms of why this inflammation is happening, what can we do about it. How can we be preemptive or preventative as it relates to inflammation's role in causing the brain to degenerate? Because wind the tape back we don't have any effective treatments for Alzheimer's, for example. So if we can get to the root of the causality of the problem, maybe then we can develop strategies to be preventive, as it relates to a devastating condition affecting some 6 million Americans today. That number expected to double by the year 2030. So that's really what brought me into the fold as it relates to really embracing inflammation's role.

Speaker 2: 7:26

And can you tie this into your own perspective on aging and longevity?

Speaker 3: 7:35

Well, that's a million dollar question, isn't it? Everybody wants to know what is the key for aging and therefore helping to extend both our health span and our lifespan, and I think that inflammation is a central player. I don't think it is the player. I think it's intertwined with a lot of players, be they down regulation over time of mitochondrial functionality, those energy organelles within virtually every cell in our bodies. Is it the accumulation of damage to our DNA? Is it the excessive action of free radicals, for example? Are these?

Speaker 3: 8:15

Is aging and the compromise of all longevity a consequence of metabolic changes, insulin resistance, for example, hypertension, changes in the blood lipids, increased waist circumference, increased body mass index?

Speaker 3: 8:32

And I think, to be fair, we recognize that these factors are all contributory and also serve as markers to predict shortened life span, shortened health span. We have certain biomarkers, like telomeres and markers of free radical media distress, markers of insulin resistance, for example, and there's importantly, of mitochondrial functionality, that are all very valid in terms of predicting shortened lifespan. We know that other, more sophisticated markers, like looking at changes in DNA vis-a-vis the Horvath clock, can also be very instructive in terms of predicting where a person might stand on his or her not chronological age. But what is their biological age? How far along are they on the continuum of being born and then ultimately failing and dying? So inflammation plays an important role. Inflammation in and of itself is important, but inflammation has metabolic implications. Inflammation affects various metabolic parameters, like our blood sugar, like the function of insulin, like the function of our mitochondria. So all of these very important factors interplay significantly and ultimately conspire to read out as to will our lifespan be lengthened above what is considered normal, or will it be foreshortened?

Speaker 2: 10:09

Yeah, it's like a puzzle with all of these pieces, but they're all interlocking because they all affect each other, so it's a great field of play to work in to find out how all of these pieces tie together.

Speaker 3: 10:31

And really what you just said absolutely is confronted by modern medicine, the underlying doctrine of modern medicine, which is to find the cause and therefore create the cure, meaning singularity.

Speaker 3: 10:48

And we recognize that's just not how it works, that there are multiple inroads, for example, to Alzheimer's disease, and as such we can't leverage one pill, one approach to take care of a problem like Alzheimer's, diabetes, coronary artery disease, so many of our chronic degenerative conditions.

Speaker 3: 11:06

We have to embrace the notion that the body is highly integrated, that things that are going on in the gut, for example, in the liver, in the kidneys, in the thyroid, in the immune system, all are interplaying in such a way as to affect outcome in terms of the health of any body part, and that affects the health of the entire organism.

Speaker 3: 11:27

You know this very much stands in contrast to the reductionist view that the brain stands alone from the gut, from the heart, from immunity, and modern medicine really refutes that aggressively, that the brain, for example, is highly influenced by the functionality of the immune system. Who knew that the gut, things going on in the gut, matter a heck of a lot in terms of the brain's function right now and the brain's resistance to disease in the long run as well, and you know that's a tough pill to swallow for mainstream medicine certainly mainstream neurologists that what's causing neurological problems may often be found elsewhere in the body, like the gut, and therefore nutrition becomes important. And you know other aspects of our lifestyle choices that affect the gut are very important.

Speaker 2: 12:22

Yeah, yeah. So I appreciate when you've talked about sugar and diet. I've appreciated how you've related this to their impact on brain and behavior. Could you start diving into your perspective on sugar? And, by the way, I was, I enjoyed one of your talks that I, one of your interviews that you did, where one of the people interviewing you started out her conversation by telling you that she had a jelly donut for breakfast and that was the handoff to you to talk about the impact of stress. But you didn't have a friendly audience, so to speak, and that's really true for a lot of people.

Speaker 3: 13:12

Well, it's true, and that certainly was not the first time I was confronted by adversaries. And what you're referring to was a national morning show on one of the networks, and the interviewer, who at least began the interview then I was accosted by the other four people sitting at the table indicated that you know, dr Promo, you just revised one of your books and one of your main themes is that eating sugar, a lot of sugar, is bad for your health. But I had this croissant for breakfast, or jelly donut, whatever it may have been. And then she continued to say and before I had a chance to respond, we reached out to the sugar industry and they told us that consuming sugar in modest amounts is perfectly fine for your health. And my response, as you'll recall, was in fact, you're right.

Speaker 3: 14:08

There was a time when the tobacco industry told us that smoking cigarettes was a good idea for our health. So, you know, people tend to be down on what they're not up on. And you know what? If people don't challenge you, it means you are status quo, and status quo doesn't move the ball down the field.

Speaker 3: 14:27

We have to challenge dogma, we have to challenge commonly accepted ideas that maybe not beliefs, but at least ideas, because you know it's very clear that certain ideas have been perpetrated upon us, for example, the notion that dietary fat was a bad thing.

Speaker 3: 14:44

That was perpetrated upon us actively by industry, wanting us to consume higher and higher amounts of sugar, and their effort, to you know, massaging this method or message to get us to eat more sugar was profoundly effective. That we were told that eat all the sugar and carbs you want. It's the fat that's killing you, and really nothing is further from the truth and really nothing is further from the diet that humans have eaten until just the past few minutes. We've always had a diet that's had much higher levels of fat, which paved the way for our survival, and we didn't eat refined carbohydrates because, quite simply, there weren't any. We didn't find cartons of soda or even juice fruit juice hanging from trees during our hunter-gatherer days, and therefore we weren't bombarding our bodies with these high levels of refined carbohydrates that set the stage for insulin resistance that is really quite threatening throughout the body.

Speaker 2: 15:47

Can you go into how it impacts brain and behavior and perhaps the mechanism by which it does that, because a lot of these mimic the impact of chronic stress, by the way also, it's true?

Speaker 3: 16:02

Well, I think let me rephrase the question, then, and that would be is there some relationship or similarity between the detrimental effects of chronic stress and some dietary indiscretions that we may engage? To be fair, eating a diet that's high in refined foods, ultra-processed foods, devoid of nutrients, especially devoid of fiber, similarly similar to rather chronic stress. Both challenge the health of the gut and, specifically, the organisms that live there, and that's important, because both elevation of stress over time and its creation increase of a chemical called cortisol, as well as eating bad food, ultimately lead to changes in the gut. That leads to the gut becoming permeable or, in more common parlance, leaky, and why that's an issue is it gets right back to the beginning of our conversation. That sets the stage for inflammation when the lining of the gut is threatened because the gut bacteria have been challenged and can't do their job to shore up the gut lining, then the gut becoming permeable allows various types of chemicals to make their way and other components, even bacterial components, make their way across this now permeable membrane, if you will, and leads to an uptick in inflammation. So what we've just connected which really is, I think, right on message for our time together today is a relationship between chronic stress by virtue of the increase in cortisol, as well as changes, inappropriate changes to our diets, in ultimately leading to inflammation. That is so threatening to the human brain. And, if I may, I'm going to take this conversation a little bit further. Why is that such an issue? We'll get back in a moment to the direct effects of inflammation in the human brain. We've already talked about the uptick in inflammation being threatening to the health and functionality of the brain cells, but I'm going to take it to a different place because it just came to mind. I think it's really very important. One important threat to the brain of chronic inflammation is it actually leads to changes in our ability to make good decisions.

Speaker 3: 18:35

I need to take a couple of steps back. I want to just state that, for simplicity, there are two main decision making parts of the brain and impulsive. I want it right now. I don't care about other people, I don't care about my future self area of the brain called the amygdala that doesn't look at looking at various factors, looking at considering the future, etc. It's I want to do it now. I'm going to make that decision Now.

Speaker 3: 19:06

Another area of the brain the adult in the room, if you will, is called the prefrontal cortex. It lives behind your forehead and that's an area of the brain that says whoa. We're going to look at data, we're going to consider other opportunities or choices. We're going to ask ourselves what is the long-term effect of this choice that you are going to make on you and on others around you, etc.

Speaker 3: 19:30

Now, fortunately, this prefrontal cortex is generally in the driver's seat and can control that other area, the amygdala, the impulsivity area, the child in the room.

Speaker 3: 19:42

We call this top-down control, whereby the adult we hope is in the driver's seat, making better lifestyle choices, reducing our consumption of foods that are threatening to our health, getting out and exercising, going to bed on time, interacting with other people, having social relationships, doing all the right things. We require and need this top-down control whereby the adult in the room is in charge. That relationship whereby the adult in the room is helping make the better decisions, is damaged and even destroyed by inflammation. Think about that when you are engaged in any lifestyle habit, choice that increases inflammation in your body, it means that, moving forward, you're going to make worse choices. You're going to make worse choices as it relates to your food choices, staying up too late, binge watching, whatever the show may be, sitting on the couch, not exercising, not interacting with other people, and that's going to make the situation worse. So, yes, inflammation threatening to the brain and the heart, the immune system, insulin functionality, etc.

Speaker 2: 20:57

But, importantly, inflammation threatens our ability to make good decisions, and I think that's really very, very important, because when we start making poor decisions, then we amplify inflammation, we create a vicious circle that makes us really, you know, go down this rabbit hole and makes it very difficult to climb out yeah, and again I continue to see the parallels with stress, because when a person is stressed, when there's danger, their brain also tends to shift down to the lower centers, the more survival levels, or, if they're dealing with emotional issues, the more emotional centers as you mentioned, the amygdala danger and lose connection with the prefrontal cortex and again make poor decisions, reactive decisions, as as you identified. I also heard, related to this, what you're saying right now, that you've connected this to some of the polarization that's going on in our society lack of compassion. Can you say a word or two about that?

Speaker 3: 22:12

sure, and I think that, calling it like it is, we're seeing much more polarization of our society, much more divisiveness, much less of an appreciation of the needs of others.

Speaker 3: 22:28

And, if you wind the tape back a little bit, I made a relationship, I drew a relationship earlier between the health of the gut bacteria and, or lack of health, the gut bacteria and ultimately increase in inflammation and then inflammation threatening to lock us into a more fear-based, amygdala visualization of the world around us. So if we get to this place of poor bacterial health in the gut because we're eating crappy food, and if the the idea of the Western diet, which was the standard American diet highly processed, devoid of good levels of nutrients now becoming the global diet threatening the gut, increasing inflammation, we've now connected important dots that recognize that the change in global nutrition, by virtue of how that's changing the microbiomes of people around the world, such that leakiness of the gut and therefore increased inflammation is happening and inflammation threatens to lock us into a more amygdala-based worldview, we create an, an understanding of how the global change in diet is leading to this polarization, this sense of it's all about me and you know. The rest of the world be damned it's a.

Speaker 2: 23:55

It's a great connection that you're making here and it's a very important connection because of how universal it has its impact. Can we bring in the conversation about grain and how you see how grain plays a role in this and what your suggestions are around this subject?

Speaker 3: 24:19

I will discuss that. I first want to say that you know I wrote a book years ago called grain brain and the thesis of the book was basically that grains can't present a threat to our health, at least through two mechanisms. First, some grains contain a protein called gluten, and specifically a subpart of gluten called alpha-glydein that has been demonstrated to do exactly what I mentioned before, and that is threaten the gut lining and make it more permeable and hence increase inflammation. Now that is layered on top of a notion that we've seen that already in a disease called celiac disease, whereby there's a direct immunological challenge that leads to this permeability and can have wide-ranging effects in the body. But we explored the further expansion of this notion of gluten in terms of health threat with the understanding that a large segment of the global population doesn't necessarily have to have celiac disease but can have what is called non-celiac gluten sensitivity, meaning that they can experience increased gut permeability as a consequence of exposure to this protein found in wheat, barley and rye, without necessarily having celiac disease. Now, when we wrote the book, that of course raised a lot of eyebrows, which was a great thing, as you indicated before set the stage for me to be challenged on television, in the press, etc. Which is, I think, a very good thing. That's how we make progress. But I think the point I want to make is that's been now validated in our most well-regarded, peer-reviewed medical journals, like the Journal of the American Medical Association the notion that you don't have to have celiac to have sensitivity to gluten, which can cause inflammation in your body.

Speaker 3: 26:17

The second message of grain brain was that refined carbohydrates and refined grains, whether they contain gluten or not, can represent a significant health, a threat to our health and specifically our metabolic health, by ultimately leading to increased insulin resistance and raising our blood sugar. Why is that a brain? Hence the name grain brain relationship Because we know that even subtle elevations of blood sugar pose a threat to the brain and ultimately may serve as a mechanism whereby we've increased our risk for an incurable disease called Alzheimer's. Those are the central tenets of grain brain. Now, that's not to say that grain brain categorically stated that all grains are bad. There's nothing wrong with some non-GMO corn and things like quinoa, which is by definition not specifically a grain, but often lumped into that category and even wild rice. We want to be certainly cognizant, or mindful of our portion size so we don't bump our carbs, but the message was that refined carbohydrates, processed grains and certainly grains containing the protein gluten were things we should be thinking about.

Speaker 2: 27:43

One of the questions that I have, and I think a lot of people have, is whether, if some of the things we're talking about have some negative consequences, is there a lower level of these where the body is perfectly capable of resolving whatever products we're talking about, if the body can handle a certain minimal amount, or is any amount not good?

Speaker 3: 28:15

I think clearly, getting back to what I just stated, the body can definitely handle small amounts of non-gluten containing grains, absolutely. Again. Some non-GMO corn rice, other types of grains that are non-gluten containing, perfectly fine. The part that becomes an issue and may be threatening is when they're highly processed, Puffed rice or some cereal, whereby, as soon as you consume this highly processed food though it's based on a non-gluten containing grain, can spike your blood sugar quite dramatically, and that's what you clearly want to avoid. It's why we're gaining such insight into how these foods affect us, when we now wear things like continuous glucose monitors and we can determine within 30 minutes what was the effect of consuming that type of rice. Did it spike the blood sugar or did it not? I think the second part of your question might be can people get away with eating gluten containing foods? The answer is yes. I think this is a situation, unlike the celiac patient, where you might be able to tolerate some and do okay with some.

Speaker 3: 29:32

The mission of the book was to call it out. We wanted to explore the work of researchers around the world who were really doing the deep dive into this notion of non-celiac glucose sensitivity. Researchers like Dr Marius Hadjavassalu in England who had begun realizing that a lot of neurological problems in my area of interest were rooted in the fact that some people had these experiences when they consume gluten, even though they did not have celiac disease Movement disorders, certainly, headaches, depression, fatigue, etc. That he observed were related to their response to gluten containing food. In our clinic, after reviewing researchers like Dr Hadjavassalu and others, we began putting people on a gluten-free diet who did not have celiac disease, who knew we're getting really, really.

Speaker 3: 30:36

Sometimes you don't have to get a lot of great results, but in some people, certainly not every headache patient was there because they had gluten sensitivity. But I can tell you for some headache patients to finally find an answer and stop taking narcotics that they'd been on for decades for their headaches and realizing it was just related to gluten. How did we know that? Because their headaches would go away on a gluten-free diet and then we would challenge them with gluten containing foods and, lo and behold, their headaches would return. It made believers out of them and they were happy to come off of their narcotic medications. So that's what prompted writing that book so many years ago 2013 now, and certainly not every medical problem is related to gluten sensitivity, that's for sure, but some are and we wanted to call that out.

Speaker 2: 31:32

Yeah, well, that's a great way of testing your hypothesis if you put them back on and then they resume having the symptoms again. So it's a beautiful demonstration and I'm wondering we're talking about physical symptoms, but what's your experience in changing people's diets in terms of anxiety and depression? Other emotional related issues?

Speaker 3: 32:00

Well, dietary interventions for mood disorders, I think, is a new area, it's an exciting area and it's got a lot of underpinning in terms of latest science. I mean, when you have people like Dr Uman Nadeu at Harvard that are really getting the word out that diet matters a whole heck of a lot, it becomes yet another tool in the toolbox to really approach the actual underlying problem, as opposed to treating the symptoms. Let's be clear the medications used, for example, to treat depression are treating the symptoms. They're not treating depression. Although they're called antidepressants, they work on the symptoms of an underlying problem, which is the manifestation being depression. It's quite clear that modern research and medical literature draws a strong connection between depression and a mechanism called inflammation. We're new. We're right back to inflammation. Depression is an inflammatory disorder.

Speaker 3: 33:09

There are characteristic changes that are demonstrable in the gut bacteria that are seen in conjunction or in association with depression. What does that tell us? It doesn't tell us that there's necessarily a fingerprint that we can ascertain in terms of evaluating the various species of bacteria in the gut that would correlate specifically every time with depression. But when we look at various broad pictures of the gut bacteria and, importantly, their metabolites, we begin to see relationships to depression. The gut bacteria, as I mentioned earlier, are really fundamental for maintaining the gut lining. Changes in the gut lining that allow certain chemicals to get into the bloodstream, like one called LPS, are seen to associate with depression. Ear levels of blood LPS, which indicates the leakiness of the gut, correlate with depression, and even the antibodies against LPS are seen to correlate with depression, again indicating that there's a relationship between leakiness of the gut and risk for depression and risk for Alzheimer's and risk for autism and risk for autoimmune conditions, risk for celiacless, risk for type 1 diabetes, et cetera.

Speaker 3: 34:32

So it's really important to look at this, because what is that saying to you right now as a clinician? It's saying something's wrong in the gut, and here I have a patient suffering from depression who's been put on antidepressant for the past 20 years. Maybe there's a way here we can finally approach the underlying problem and not just treat symptoms. To be fair, there's nothing wrong with treating symptoms, but I think most in the field would agree that the effectiveness of the antidepressant medications that are offered to patients with depression are not extreme, to be kind. Therefore, we really ought to be paying attention to what the heck's going on here. Why is this patient depressed?

Speaker 3: 35:18

The evidence points to the fact that there's a strong relationship with depression to the process called inflammation or the mechanism and therefore, what is causing inflammation. Could inflammation be caused by something called gluten sensitivity? You bet? Can inflammation be caused by changes in the gut bacteria? That's been made very clear. Therefore, let's do something out of the box and let's work on re-establishing gut health, perhaps as an inroad to help this patient with his or her depression, now that we recognize that it may well be related to inflammation. Let's work on a diet that takes out these highly processed foods, that brings back in dietary fiber to nurture the gut bacteria, that uses things like probiotics and prebiotics and even postbiotics we'll hopefully define that later on to re-establish gut health and stop challenging threatening the gut health with certain medications, with chlorinated water, with these ultra processed foods, with chronic stress, with lack of restorative sleep, with lack of exercise. These are all lifestyle choices that have a huge impact on restoring gut health, that have been demonstrated to be effective in reducing inflammation and helping people with depression.

Speaker 2: 36:44

David, how do you determine gut health?

Speaker 3: 36:48

Well, there are a lot of ways. I think one of the simplest tools that I use is actually it's a very sophisticated tool it's called a tape measure. It's a very, very sophisticated tool. When you take a tape measure and you put it around someone's waist, it is a surrogate marker as to how healthy is that person's gut, not in terms of the size of the gut, but rather what's going on inside the gut, in terms of the health and functionality of the gut bacteria.

Speaker 3: 37:20

Now, beyond that, other surrogate markers that would lead you to believe that the gut bacteria are not where they need to be doing.

Speaker 3: 37:28

What they need to do would be things like fasting blood sugar, fasting insulin level, looking at a continuous glucose monitor, markers of inflammation that are measurable in the gut, like C-reactive protein, and more esoteric ones like tumor necrosis factor, alpha interleukin 1, beta, il-6, et cetera. These all tell you that there's increased inflammation in the body and therefore likely there are changes in the gut. Now, these days, you can actually measure both the metabolites of the gut bacteria as well as the RNA signatures of these bacteria themselves, and characterize the gut bacteria. Do you need to do that? I don't think so. I think we can assume right off the bat, even without testing, who is at risk for having what we call dysbiosis, or disturbances of the health and functionality of the gut bacteria, and who therefore might benefit from interventions focused on restoring gut health that can then benefit the brain benefit how a person's metabolism works, their response to insulin, for example and that, downstream, has an effect on the brain as well.

Speaker 2: 38:45

Yeah, I appreciate your focus and looking for the root causes rather than just treating the symptoms, and in my work we can look at a whole array of physical symptoms and trace it back to what I refer to as autonomic dysregulation, and that if you help a person restore their ability to self-regulate, a lot of those symptoms go away. So there's a similar kind of looking for the root causes. You're recommending, or you're suggesting, changes in diet. That's very difficult for a lot of people and you're also suggesting that the bad diet makes it even more difficult to make these decisions because of how it impacts the brain itself. What's your opinion about food addictions and how this fits into what we're talking about, and how do you address that with your clients, with your patients?

Speaker 3: 39:50

Let me answer that question in part two of this response. I just want to answer in part one, just by really indicating that there is a place for symptomatic medications in modern medicine. That's important. There is a time and a place for medication for head pain, headache, for using medication for anxiety and depression, et cetera, and again, I don't want to give the impression that those are off the table. It's why we want to have an integrative approach, an integrated approach, and that is one that looks as opposed to alternative medicine. An alternative approach seems to really want to focus on N or more alternatives to standard of care. There's great value in standard of care. I'm not derogating it, that's for sure, but I don't think it's fair for that to be the exclusive purview of the health care practitioner. Having said that, getting back to other parts of the question, I would say that we need to recognize that addictions to foods, for example, really are an indication of making poor decisions and succumbing to desire. I want it, I'm going to eat it now. Damn it and that's it. I want that food.

Speaker 3: 41:22

And let's take a step back and recognize that some of the foods, many of the foods that people seem addicted to, are foods that are sweet and have a lot of sugar and you can't stop eating, whatever the cookies are. And the reason that happened, or one consideration, is that sweet hacks into a programming deep within our brains for survival and that is the desire for sweet. Our brains are hardwired, they came preloaded with the sense that sweet is survival. Why so? Because in our hunter-gathered days we would eat sweet. Because sweet triggers mechanisms in our bodies to increase our hunger, to increase our production storage of fat as a survival mechanism and to make us a little bit more insulin resistant, such that our blood sugars will go up and power our brains. So there isn't a person walking our earth right now who doesn't have a sweet tooth. I often ask when I lecture to large groups, say I want you to raise your hand if you don't have a sweet tooth. And pretty much nobody would ever raise their hand because we're all hardwired to like sweet.

Speaker 3: 42:36

Sweet taps into the amygdala and says eat this and eat it now. So when we can't resist, it's because our amygdala is screaming I want it, I want it now and I'm going to stamp my feet until I get it. It's a child in the room making that decision. What we're desperate for, as it relates to our food choices and even as it relates to food addiction, is to bring the adults in the room and make it OK. Make it OK to make a better decision.

Speaker 3: 43:05

So I think what you were getting at is the notion that when we're in a bad place as it relates to inflammation, we're pretty well locked in to that amygdala and we're going to continue to make poor food choices. How do we overcome that? Well, what I will tell people is that, first visit, we're not going to change your diet at all. You know darn well that sitting down with a box of Oreos isn't in your health interest. That's not the decision that you should make, and probably you know darn well that's true, but you can't help yourself. I get it. That gets to the heart of making poor choices and being virtually addicted to eating sweets.

Speaker 3: 43:47

What I tell them, however, is we're going to try to re-establish this connection between the child in the room and the adult in the room and bring the adult back into the house to help with decision making. I'm not going to worry about the food choices you make for this week or the next two weeks, but here's what I want you to do. I want you to get up once or twice a day and walk to the mailbox. Now this would be a person who's basically sat on the couch and done nothing and says I can't exercise, I have no endurance. I'm not saying I want you to go ahead and jog for three miles a day until I see you next. I know darn well that's not going to happen. Probably they couldn't do it, nor would they do it, but there's got to be something that can be done to increase exercise. That's the first step.

Speaker 3: 44:33

Oh and, by the way, as long as we're doing a couple of things before I see you again in a couple of weeks, I'd like you to not have any screen time after dinner.

Speaker 3: 44:42

Now, I know that sounds draconian, but if you want to read a book or something, I just don't want you on a screen, I don't want you exposed to blue light. That way there's a chance that we might establish better sleep and therefore have a powerful leg up as it relates to reducing inflammation and significantly improving that connection between the adult and the child in the room. Then, to get to your question, we layer on those dietary recommendations slowly and lovingly and carefully, knowing that that person, likely after a couple of weeks, is much better equipped to begin to implement. So you made a very, very good point, and that is people are not going to make these changes. They're not equipped to make those changes. That amygdala is screaming and the exercise helps. But I want one more point I want to make, and that is there's probably nothing worse that would activate that amygdala than not getting a good night's sleep. In terms of quality and quantity of sleep, research has demonstrated that the amygdala may be as much as 60% increase in its activity just from one night of non-restorative sleep.

Speaker 2: 46:03

Wow, yeah, it certainly validates the importance of a good night's sleep. One of the things I do with people when they talk about how they are so reactive and then they don't have control, and I encourage them to take a time out, ground themselves, breathe, so that they can reconnect with the prefrontal cortex. So different ways of helping them do what they're typically not doing.

Speaker 3: 46:36

And I bet everybody can relate, yours truly as well. I remember when we'd be up all night in the emergency room or in the operating room, whatever it may be, and come six or six o'clock in the morning we're getting ready for rounds and where we wouldn't go to the cafeteria, we would go to the pediatrics floor and take all of the baby food out of the refrigerator, especially. I think it was banana. One of the flavors, it was pure sugar. I mean, that's what's in baby food and we just suck those things down for that sugar. A bad idea, bad choices. I knew it very well. But you can control yourself when you're up all night like that.

Speaker 2: 47:21

You mentioned something about an evolutionary mismatch. Can you describe what you're referring to there?

Speaker 3: 47:31

Yes, and as we look at our DNA, our gift from all who have come before us, the refinement of our DNA generation to generation, has allowed our survival, has allowed us to be healthy, disease resistant and reproduce. That's what DNA does in every species on the planet, and that survival depends on a given set of circumstances. And truly the circumstances under which we live are unlike any that humans have been confronted by in our history on this planet. In the last few seconds of our time on this planet, suddenly we are confronted by an environment which influences our gene expression that is nothing like we've been exposed to ever in our evolutionary past. The amount of stress, the lack of sleep, lights on at night and certainly the types of foods that we are consuming these are all environmental cues for our DNA to express the genes that are coding for our survival or to express genes that are maladaptive, that are going to lead us down the pathway of illness and compromise our longevity. So it's a mismatch. What's behind the underpinning of the so-called paleo movement? That we should eat at least more, as did our paleolithic ancestors, meaning eating foods that are certainly less processed, less refined foods, that are fermented, for example, our ancestors wouldn't reject fruits on the ground that were already starting to rot.

Speaker 3: 49:19

When a fruit is on the ground rotting, it's fermenting. The sugars are being fermented by the various bacteria. We would eat that and probably have no problem with it. It sounds distasteful today, but we still eat fermented foods today. We know that sourcrout, for example, is a fermented foods, kimchi a fermented food. Lots of foods that are fermented are actually good for us, help restore even the bugs that live within our gut, the germs, if you will. They're germs in one sense of the word, but they're there to help us in exchange for us feeding them and giving them a place to live. So that's the mismatch between nature and nurture, between genes and environment, if you will. That, I think, is front and center in terms of the maladies of health that characterize the day that we live in.

Speaker 2: 50:15

And would you suggest we attempt to mimic diets that predate agricultural developments?

Speaker 3: 50:23

Yes, absolutely. I think that when you look historically at what's happened to human health, as measured by our dentition, as measured by our bone density, and even what we're able to glean from looking at fossil records, but also by looking at those populations, hunter-gatherer populations that are around today, that we see significant changes that are introduced when our modern lifestyle is adopted, primarily our diets. So, yes, I think, getting back to certainly eating the types of fruits and vegetables that one might encounter, which means not processed we mentioned earlier Eating an apple is a great thing. An apple contains fiber, it contains vitamin C, contains actually a small amount of fructose and sugar in comparison to a 12-ounce glass of apple juice that contains 36 grams of sugar and almost no fiber and yet is promoted as being a health food.

Speaker 3: 51:31

I was in the hospital last week visiting and saw what this individual was being served Hospital food with the apple juice and the refined carbs on the plate. This is a time when we need good foods the most. To answer the question, yes, the foods of our hunter-gatherer forebears, who primarily gathered they did some hunting but they primarily gathered I think is clearly going back to the work of Dr Lauren Cordain really were foods that tended to be good for us, primarily because of their macronutrients, but also the micronutrients and how they would help nurture the gut bacteria.

Speaker 2: 52:18

Well, it certainly would be great if hospitals modeled good eating behaviors.

Speaker 3: 52:25

Well, yeah, that's true. We. You may see that changing in the future. We're actually involved in a project that may show the world how individuals can be hospitalized and also, at the same time, eat good food. Who knew that? That was important? You know, when you go to veterinary school, you get a year of nutritional study included in your degree. When you go to medical school, that doesn't happen. I had, I went to, we went to, you know, I went, as you mentioned, Miami and we did not receive one hour of nutrition instruction in four years of medical school, because nutrition doesn't seem to matter to humans health. It matters to your dog, but it doesn't matter to you and I, you and me.

Speaker 2: 53:20

This has been a great conversation. I really appreciate all of the wealth of wisdom that you're you're sharing with our audience. I have a couple of last questions. Seed oil is is related to inflammation. What's your position on having seed oil in your diet or not?

Speaker 3: 53:42

It's a very good question and we're hearing quite a bit of chatter these days that seem seems to relate, you know, the introduction of seed oils into human, into the human diet, beginning in the late 1800s and then much more aggressively in the early 1900s, relating that to changes in our metabolic health. I'm aware of that. You know there's the discussion that seed oils are high in Omega obviously Omega six is linoleic acid, etc. And therefore pose a threat by virtue of increasing the very process that we spoke about. There's discussion that somehow consumption of seed oil is threatening to the composition of cardiolipin, an important protein as it relates to mitochondrial function. But when you unpack the actual relationship of seed oil mechanistically to things like cardiovascular disease, I think there is some suggestion that it relates, but it's not to my satisfaction, a really, you know, nailed shut.

Speaker 3: 54:51

I think that you know a lot of discussion looks at the Omega six to Omega three ratio, indicating that, you know, our ratio had been traditionally something like two to one, although in modern times is as high as 20 to one, and therefore that's our undoing.

Speaker 3: 55:07

As it relates to the role of these dietary fats in cell membranes, in, especially in immunoregulation, I would say that by and large. It makes sense to reduce our consumption of processed seed oils, for sure, but I'm not, you know, I'm not in favor of including things like olive oil, for example, or avocado oil in that discussion. So I think you know this is still a level, an area of science that is on being unpacked, and we're going to watch it quite closely. I would say that you know, we humans have eaten saturated fat for an awful long time. I am pretty well convinced, by looking at the data, that there's very minimal evidence to suggest that consumption of dietary fat is necessarily a health risk for cardiovascular disease, in contrast to what we've been led to believe over many, many years. So I think we have to keep watching this. You know I am very much in favor of good Omega three supplementation as an offset, and but again, we're going to watch as this story evolves over time.

Speaker 2: 56:23

Right, and then a last question. I want to make sure we give you the opportunity to say a little bit about your latest book, drop Acid, about uric acid.

Speaker 3: 56:33

If you can just say a few words about drop acid, is not a book telling everybody they should be taking LSD every day, that's for sure. It was a cute title, I thought, and everybody who asked me about that title it's always with a wink and a nod, but. But having said that, the acid we're referring to is something called uric acid, and uric acid is something traditionally that we learned about in the context of kidney stones and gout. But it turns out that uric acid is a very powerful mechanistic chemical as it relates to metabolic health, such that higher levels of uric acid increase blood sugar, increase insulin resistance, are associated increased body fat, are actually a threat to mitochondrial function. So we want to keep our uric acid levels in check.

Speaker 3: 57:24

Uric acid traditionally has been thought of as being the downstream product of the breakdown products of DNA and RNA in our food, food, foods that are high in what are called purines. We now know that the biggest in road to producing uric acid in the human diet is the sugar fructose, and it was a survival mechanism. It's through the consumption of fructose that our ancestors, by making higher levels of uric acid, were able to survive by making more body fat, by becoming more insulin resistant, by turning on gluconeogenesis, making more blood sugar to power their brains to avoid starvation and predation. Nowadays, though, we're turning on, you know, the production of body fat to get ready for the winter that really never comes. So it's this relationship with elevated uric acid with metabolic mayhem, if you will and the relationship of causing uric acid elevation from our consumption of fructose sugar that I really wanted to message in this book. And then, once I made those relationships, the second part of the book is dedicated to okay, I get it now. How do I fix the problem? Beautiful?

Speaker 2: 58:40

beautiful. Well, again, thank you so much and I really appreciate all the work you're doing to bring good, evidence based information to our population and and contributing hopefully to reversing what's been a trend over the last many years. So thank you so much. How can my pleasure reach you if you have any, any offer you want to present to our audience that they can reach out to you.

Speaker 3: 59:14

Well, the best place to find me is Dr Perlmuttercom, Dr. My last name, Perlmuttercom. You know we do a lot of social media. Instagram, I think, lately has become really, really popular. We post on Instagram every day. There are entrees on Instagram to my blog and I think my Instagram is David Perlmutter. I should know that, but I don't know. Maybe it's David Perlmutter MD, but I suspect people can find it, I'm sure, and my podcast is called the Empowering Neurologist and I've had the opportunity on that podcast to interview just incredible people who are dedicated to helping move that ball down the field. So that'd be a great place to learn more information.

Speaker 2: 59:58

Great, thank you. Thank you again and continue to do your great work, and I'm going to go get that drop acid book now that I know what it's about.

Speaker 3: 1:00:08

There you go.

Speaker 2: 1:00:08

Thank you for having me, you're welcome.

Speaker 1: 1:00:12

If you're enjoying this program, please hit that subscribe button or, even better, leave a review. Your support makes it possible for us to create the quality programming that we're continually striving for. Also, let us know if there is a certain topic that you would like to see covered or a particular guest that you would like to hear from.

Speaker 4: 1:00:34

Can I start?

Speaker 4: 1:00:35

It's already recording, oh sorry, this is for general information and educational purposes only, and it's not intended to constitute or substitute for medical advice or counseling, the practice of medicine or the provision of health care, diagnosis or treatment, or the creation of a physician, patient or clinical relationship. The use of this information is at their own users' risk. If you find this to be on the value of, please hit that like button to subscribe to support the work that we do on this channel, and we take your suggestions and advice very seriously, so please let us know what you'd like to see on this channel. Thanks for watching and we hope to see you next time. You should say that.

Speaker 1: 1:01:26

That's good. It's for you to say that's very good. Do you like it? Do you want to do it one more time, or is that good? I think that was good.

Speaker 4: 1:01:34

Yes, you need to say the recording.