Change Your Brain Every Day - How to Teach Your Gut to Take Care of Your Brain PT. 3 - Dr. David Perlmutter

Episode Date: February 23, 2018

In the third and final episode of a series with “Grain Brain” author Dr. David Perlmutter, Dr. Daniel Amen and Tana Amen discuss the brain-gut connection. Learn how your microbiome plays a crucial role in inflammation. Dr. Perlmutter also shares ways you can increase the health of your gut to keep your brain healthy as well.

Welcome to the Brain Warriors Way podcast. I'm Dr. Daniel Amen. And I'm Tana Amen. Here we teach you how to win the fight for your brain to defeat anxiety, depression, memory loss, ADHD, and addictions. The Brain Warriors Way podcast is brought to you by Amen Clinics, where we've transformed lives for three decades using brain spec imaging to better target treatment and natural ways to heal the brain. For more information, visit amenclinics.com.

The Brain Warriors Way podcast is also brought to you by BrainMD, where we produce the highest quality nutraceutical products to support the health of your brain and body. For more information, visit brainmdhealth.com. Welcome to the Brain Warriors Way podcast. We are back with our friend, Dr. Perlmutter. And I love this episode because we're going to talk about what you can eat and what you should not eat to help your brain. So Brain Maker, the whole life program. And of course, for me, this is my forte.

This is my specialty. So I love this. So welcome back, Dr. Perlmutter. And we're also going to talk about the microbiome. Yes. And so how does a neurologist get interested in the gut? Bugs. Bugs in the gut. Yeah, what's a good guy like you doing in the gut? Bugs. Bugs in the gut. Yeah, what's a good guy like you doing in the gut? Well, several years ago, you know, in going to see patients day in and day out and not having, again, many tools in the toolbox,

we began to see a couple of dots come together. That is, number one, we began understanding that Alzheimer's is an inflammatory disorder, as is autism, Parkinson's, MS, depression. And at the same time, the literature began to be very clear in terms of the relationship of the gut bacteria to inflammation. So connecting those dots, I thought, well, maybe there are some answers here in terms of what we can do for the brain by looking at what goes on in the gut. And that is the genesis of the exploration and ultimately the manifestation that went behind the creation of the book Brain Maker, the relationship of the gut to the brain. Having said that, you know, I would indicate that to this day most of my neurology colleagues

don't really want to go to that place or recognize anything really below the foramen magnum as having any relevance in terms of the brain. But the literature now is expanding dramatically and in research institutions around the world, there is no book yet about the microbiome in the brain for professionals. I'm the editor of a book that has that as the title that'll be out in 2019.

Well, we've collected authors from around the world to write various chapters for both researchers and clinicians. So again, getting back to the connection, if inflammation is the cornerstone mechanism and the gut bacteria are involved in that through many ways that we can discuss, then the gut bacteria are important and that makes food important because their health and their ability to do all the great things that they are doing to keep you alive really depends upon what they eat and they eat what you eat I tell my

patients you know we've said for years that women when they're pregnant have to be careful because now you're eating for two everyone has to be careful because we're each eating for a hundred trillion. They eat what you eat. And when we make inappropriate choices, foods high in sugar, devoid of fiber, foods that contain additives and various things that can prove toxic, when they take medications, for example, antibiotics, proton pump inhibitors that are used to reduce stomach acid, commonly used non-steroid anti-inflammatories like ibuprofen.

These are factors that can damage the gut bacteria and can enhance inflammation, can enhance risk for obesity, can enhance risk for diabetes. So those are the types of broad strokes that go into the idea that our food choices and other lifestyle choices are very relevant, looked at through the lens of our gut bacterial friends. I love something that you said, and I applaud you for this, because as somebody who spent many years being very sick, you said that many of your friends don't want to look at anything below the brain. I'll just make that simple for our listeners below the brain as being relevant to the brain. And that's really frustrating to someone who ended up on nine medications because of that

philosophy. So everyone was sort of disconnected and not looking at how everything was affecting everything else. And as somebody who had thyroid cancer and multiple surgeries and treatments, you know, when your thyroid's messed up, it affects everything in your life. And as a result, other things began to go wrong and everyone just was throwing medications at me. And that's not really fair to the patient to think that way. So when your thyroid's messed up, you're depressed and that affects your brain. Well, you know, I use you all the time because that's why I married you. Besides you're beautiful and smart, you're just full of stories. Let's go back to how the microbiome actually becomes populated initially. Right.

Because, you know, when you're initially conceived, you don't have a microbiome, right? I mean, there's an egg and a sperm. Ultimately, the microbiome becomes populated over time. And I remember in reading Brain Maker, you know, there's a difference between babies that were C-section and C-section, yeah. And babies who were breastfed and the health. And natural birth. And then early childhood traumas can actually change the microbiome. And when Tana was four, so she grew up in a fairly chaotic home. Yeah, my entire, like early from birth.

Her uncle was a drug dealer and a drug addict. And one of her first memories is witnessing her mother and her grandmother screaming, falling to the floor when they found out her uncle had been murdered in a drug deal. Shortly thereafter, she begins going to the doctor a lot for upper and lower GIs. And she's like, do you think any of that's related? No, I actually didn't think it was. You're the one who looked at me and you're like, you don't think that's related. So talk to us about how it develops and what keeps it healthy and what hurts. Sure. Well, let me just not let that anecdote go unnoticed. And because we talk about the gut-brain connection a lot, but I think what you're referring to here is the brain-gut connection and the idea that brain-related events like emotional trauma, for example, might manifest

in the gut. And it's true, it does. So that when we experience trauma, for example, might manifest in the gut. And it's true, it does. So that when we experience trauma, for example, ongoing trauma or repeated trauma, etc., or an event of acute trauma, we know that the various changes in chemistry within the body affect the microbiome. Cortisol, for example, has a powerful effect on changing the array of organisms that live in the gut, amplifies production of certain yeast species, for example, live in the hippocampus, the memory center, which are also involved in regulation of mood. So I just think, and for just a moment, the notion that brain events can ultimately lead to inflammation, the cornerstone of depression, is worth stating. So let me get back to the genesis then of the gut bacteria and other organisms that live in the gut. We realize now that, as you mentioned, a lot of importance has been placed on how a child is born, vaginally versus through cesarean section, but we now understand that there is colonization of the intestines

of the developing fetus as well, that the placenta is not sterile, that there are organisms living within the placenta, that there are organisms living within the brain, that we have to revise our concept about areas of the body that we had previously thought were sterile, anything but the truth. And it's very important to understand that those organisms actually influence our gene expression in these various areas and throughout our bodies. That's a heady concept that the bugs, the microbes living upon us and within us are influencing our own genome expression. So we inherit top down. Vertical inheritance is the DNA that came from those people who came before us. Our ancestors, their DNA was passed down to us. We say it was passed down to us, maybe passed up to us, but

in one way or another, it's vertical. But we also inherit information horizontally or transversely, meaning that, as you mentioned, at the time we are born, we get a lot of genetic information. We get information in the DNA of the various bacteria that live in the vaginal birth canal that mother transmits to us. This is information that informs this brand new baby about his environment, about her dietary availability, her caloric availability or scarcity. It gives that new child a snapshot of what his or her world is going to be like and preps that child for that world to come and as a matter of fact the amount of of dna that that child receives through this mechanism far exceeds the you know the the 23 genome that we receive from parental inheritance. So we receive a heck of a download at the time we

are born. I like to think of it in terms of you bought a new computer. That's what you got from mom and dad. They gave you a new computer. But at the time of birth, we load the apps. And the apps are up to date and give us really good information about now how we can perform, how we function using the template that mother and dad gave us. So, Dr. Amen, you are correct that this does have implication in terms of health of that child and the adult that that child becomes. That being born by cesarean section by virtue of the fact that you are deprived of that information download because you didn't go through the gates. You didn't get that package of information by being vaginally birthed. You get bacteria that's in the operating room and bacteria that's on the surgeon's gown. And at the same time,

mother has been blasted with antibiotics as well. So if she chooses to breastfeed, that that child will further be compromised in terms of his or her microbiome by virtue of the fact that the skin bacteria on mother's breast will change and the breast milk will change as well by virtue of the fact that mom got that antibiotic. So this may well explain why C-section children have a much higher risk of autism, ADHD, type 1 diabetes, celiac disease, adult obesity, and even some mood issues moving forward, certainly allergies and asthma as well. I want to make one very important point, and that is that C-sections are important. They are valuable, they save lives. So I'm not mommy bashing here. But I am saying to any of your viewers who, moving forward, are going to

have a baby, that there's more to the discussion, should we or should we not have a C-section, than simply how big will the scar be. That the choice for C-section has to be looked at in terms of its potential downsides in terms of that child not developing an appropriate microbiome that is most salubrious, most involved in giving health. And if you choose for whatever reason, or you have to have a C-section, than finding other ways to populate the gut. Right. Like I gave Chloe probiotics early in life because I had to have a C-section. I didn't have an emergency C-section. So some of us have to do that. Yes. And there is reason that, God bless the fact that we have emergency C-sections. So your baby's here and you're here to have our discussion

today. Wouldn't happen. Right. Exactly. So I don't feel guilty for that. But do OBGYN doctors sort of get this? Mine did. No. I mean, I'm not going to say categorically no, because I think, you know, certainly, but I think by and large, this isn't part of the discussion. Mine actually did. Mine actually was told me that you should absolutely try to have a vaginal birth. There's reasons that child is supposed to go through the birth canal. So she was pretty savvy. I don't know if all of them are that

way. But since you had the C-section, did she say we need to figure out how in a healthy way to populate this baby's microbiome? No. Well, let me tell you, no one has the answer for that in specific, but Dr. Maria Dominguez Bello at NYU has pioneered the research and the idea that you know you're going to have a C-section, what do we do? Well just prior to C-section, a surgical sponge, a moist surgical sponge is placed in the birth's canal top. Oh. Harvest this information in the form of the bacteria. That's so interesting.

Then it's put in a warm, moist environment. You have your baby, and then the baby is totally inoculated over his or her face, into the mouth, into the nose, with mother's vaginal birth canal bacteria. That's so interesting. Her more recent research published in the journal Nature has demonstrated that there is recoverability of mother's organisms that are DNA sequenced in that child's poop as much as six months after birth. So I think we're just beginning to understand that, but I think that ideology, I think,

is going to be explored much more aggressively because I think it makes a lot of sense. That's so cool. And I'm curious, and maybe it's too long for this podcast, and I would love to have you back if it is, but what about traumatic births? So a child is born vaginally, but they're born breech, or they have had to use forceps. Are they still better off being born vaginally and receiving that download, or is the download interrupted? I think it'd be very difficult to weigh those one against the other, because one doesn't know

how you characterize trauma. I mean, as your husband would indicate in terms of athletes, you know, that there is everything from none to catastrophic. Right. How long was the child hypoxic? Were forceps used? What were the decelerations of the heart looking like, et cetera?

So I think these are not necessarily comparable. I think that within reason, women should have a vaginal birth whenever possible. The notion that 33% of the births performed in America today are C-section births is a little difficult to embrace when the World Health Organization has indicated that about 10 to 15% of births in America might be so distressed that they would require a C-section. So what that means is that C-sections are being performed for other reasons. I don't know, we can speculate what those reasons are, but we'll leave it at that. The point is though that this event of birth is hugely important in terms of the information download

that happens at that time. Well, I'm also a child psychiatrist, so we have tens of thousands of children's brains. And, you know, I often say the day you are born is one of the most dangerous days of your life. So we see birth trauma, forceps deliveries, breech babies, and we can see damage years later. So it's critical to make the most thoughtful, careful decision that you can. But let's talk about, you have kids or you're an adult, what is the right diet

and what are the right supplements to take to try to optimize your microbiome. And for everybody, I just recommend you read Brain Maker. It's just fascinating. It's easy. And you will never, again, look at food the same way or your poop. You will never look at your poop the same way. Hopefully that doesn't happen too often that implies they're looking at their poop what is it it's like 60

percent of it is dead bacteria so and you know what everybody looks at their poop you said i mean i'm a nurse i had to look at everybody that's a good thing because things have changed yeah i had to chart the everybody's poop. And I think that's a good thing because then you're able to see if things have changed. Yeah, I had to chart the size, the color, the shape, you know, everything for everybody. So, you know, I'm a nurse. Absolutely. And I think that's a reasonable thing to do. And I want to answer that question in two ways.

First, from the notion that we, I believe, understand what are called the broad strokes. And second, that we live in a time when we're embracing the notion of personalized medicine. In other words, beyond what the broad strokes are, what are the variations based upon an individual that are important as well? First, let's look at the broad strokes. By far and away, what is critically important for the health of the microbiota living within us is that they receive adequate amounts of prebiotic fiber. Everybody knows fiber is important, but there's a unique type of fiber called prebiotic fiber. Prebiotic nurtures the probiotic. This is the type of fiber that our

good bacteria can use to reproduce themselves, but more importantly importantly to do their processes of metabolism to make the chemicals that they make that are really important for us so vitamin vitamin K b12 to make short chain fatty acids to heal the gut lining so prebiotic rich foods are things like hit Kamala which is Mexican yam dandelandelion greens, garlic, onions, leeks, chicory root, and really pretty much a lot of fruits and vegetables. We've known that that's a good diet for a long time. And here's yet another reason that your plate should be colorful and mostly filled with fruits and vegetables, mostly vegetables, if you're considering the sugar content. and I think that's very important.

I think that it's very important that we welcome fat back to the table. We've gone through about a four-decade period of time of fat phobia, which was unlike any diet humans have ever consumed as long as we've been walking this planet. It was brought on us by interests who didn't have our health in mind simply to get us on higher levels of shelf-stable carbohydrates and lower levels of fat with the mistaken notion that fat was damaging to our bodies and that if we ate a lot of it and all of our children were going to be born naked or some crazy thing would happen. But that said, to be clear, good fat.

We're talking about unmodified, healthful fat, the extra virgin olive oil, the avocados, avocado oil, nuts and seeds, wild fish, grass-fed beef, et cetera, good sources of good fat, that doesn't mean all fats are good. Certain fats are, in fact, damaging to health. Those shelf-stable vegetable oils, safflower oil, sunflower oil, corn oil, etc., most of which is genetically modified, and that carries yet another level of baggage. So fat is important, fiber is important, and minimizing those foods that are going to spike our blood sugar. So simple carbohydrates need to be avoided. It doesn't matter if it's maple sugar from the most sacred maple tree in northern Canada or honey that comes from bees that live on an

ashram and meditate three times a day. It doesn't matter. Your body sees that and says, sugar. I love that. And it's getting a kick out of this. Well, because I get that all the time from people. But it's wholesome. It's pure. It's clean. And it's natural. Yeah, arsenic is natural. Right. Yeah, right. So plutonium, there you go. But that said, so that's the basics. Then I think we move to a place of what we want to avoid. And let's talk about the broad strokes there as well. If we're castigating, and I think rightfully, sugar in our media, in our books we write, et cetera, then it tends to give a message that then sugar-free is the way to go.

Well, yeah, sugar-free is the way to go, but that doesn't open the door to artificial sweeteners. And that's unfortunately where the media is taking us. If you watch TV, there's this zero and something that's sugar-free. And what we now understand is that there are dramatic changes that happen to the gut bacteria when they are exposed to things like aspartame. Aspartame is directly toxic to the gut bacteria, and it's why we see, paradoxically, that those individuals who are drinking one or more cans of a diet drink every day have a dramatic as much as two-fold increased risk for diabetes and obesity in comparison to those who are drinking sugar-sweetened beverages. I'm not saying drink the sugar-sweetened beverage, but it's very, very misguided. If you think you're drinking diet XYZ

because it's going to help you lose weight, it does exactly the opposite. It puts your microbiome, your gut bacteria, in a state of wanting to harvest every possible calorie from your food that they can. Your body thinks it's starving, and as such, accumulates calories, and you get fat. Yeah. I actually read one study that said that sucralose actually could decrease your good gut bacteria by 50%. Is that accurate? Quite dramatic. It's quite dramatic. And it's why we see these correlations with things like diabetes, other inflammatory disorders, and obesity. It's why we see researchers in Amsterdam, for example,

one fellow that I recently saw present at Harvard, talk about doing fecal transplants and reversing type 2 diabetes. Wow. Wow. So that's certainly an extreme approach. I would say that in our society, the other important issue that needs to be vetted, and that is the effect upon the gut bacteria of the commonly used medications, like over-the-counter acid-blocking drugs. Severe effect on the microbiome which might explain why chronic users of these so-called proton pump inhibitors may have as much as a 40 percent increased risk

for alzheimer's disease and that was published in the journal of the american medical association we got to scream this information out to the world because it's really important. People think if they don't tolerate the sausage sandwich, as the commercial would lead you to believe, that if they just suppress their stomach acid and they can then eat the sausage sandwich, everything is good. Well, when you change the pH of the gut, starting at the stomach, you're going to change the pH of the intestine, where the bacteria live. You will select out some populations to overgrow, and you will suppress populations of other potentially good bacteria. It explains why, for example,

taking these acid blocking drugs is associated with overgrowth of something called Clostridia difficile, which causes what's called C. diff, and kills 40,000 Americans a year from diarrhea that cannot be controlled. This is information that's very important. We know that taking antibiotics is strongly associated, like artificial sweeteners, with

increased risk for diabetes. And I think that's information people need to get. The non-steroid anti-inflammatory drugs impart significant changes on the microbiome as well. You don't see that talked about on the evening news when people are told, hey, you have an upset stomach, take this acid-blocking drug, or your joint hurts, take some ibuprofen. But yet, we need to practice under the doctrine of above all, do no harm as physicians. But unfortunately, that doesn't seem to extend to the manufacturers of these drugs. Yeah. So what about people who have Lyme? So more and more common, more and more commonly diagnosed, who end up on long-term antibiotics.

It's a huge issue. And I think that Dr. Richard Horowitz, how do you like the way I'm ready for this one, in his wonderful book called Why Can't I Get Better? And more importantly, what to do about it, rather solving the Mystery of Lyme and Chronic Disease. So I've read that. It's a wonderful book. Pretty thick, too. Yeah. Looks at that, and looks at the idea of supplementing with probiotics.

And I think beyond that, in this day and age, we should absolutely be looking at the idea of fecal microbial transplant in individuals who, by necessity, have to take antibiotics, even for a fairly short period of time. Now, I'm not saying everybody who takes an antibiotic because of an event of pneumonia needs a fecal transplant. But as you, and the reason you asked the question is, you know, these individuals with chronic Lyme disease are on months and months, or if not years, of antibiotics and are really imparting a dramatic change upon their microbiome.

You know, maybe it's the nurse in me or maybe it's coming from somebody who's been sick. And you mentioned that, you know, the fecal transplant sounds like an extreme way to handle something like type 2 diabetes or some of these issues. And yet, maybe it's because it sounds gross to people. Let's just be honest. But to me, it doesn't sound that extreme. When you talk about losing your eyesight, your legs, your heart function and dying,

and your overall quality of life, it doesn't sound that extreme. If the answer is that your gut is affected because of something that happened to you. I think they're also in animal studies, aren't they using it as an anti-aging intervention as well from young mice to older mice and show an improvement. But in the few minutes we have left, what are probiotic foods and supplements that you recommend? I know this is an area of interest for you. Well, there are a lot of foods that are fermented, and they're just teeming with great organisms.

One of them, which is my favorite, is kimchi. Me too. Gosh, there is a lot of research appearing that looks at kimchi in terms of how healthful it is. You're going to have to get used to it. Kimchi is really a staple. Oh, you must like kimchi. I do. She does.

I hate it. I trained in Hawaii where there's a large Korean population. And so we used to go to a Korean restaurant every Friday as a group of psychiatrists, and I just could never get used to it. But I love sauerkraut. Well, there you go. And, you know, to take a step back, why are virtually all general large cultures in the world, cultures, interesting word, involved in this fermentation of one sort or another and it's because it's a way of preserving food when food is fermented it lasts a heck of a lot longer you know in the days prior to refrigeration that was always a challenge so it's you know what went into

creating things like yogurt and kimchi and kombucha and cheese, and certainly wine and beer as well. These are fermented foods. So, but the data looking at things like kimchi is really very, very exciting. So foods that are fermented, as some of that I've mentioned, kefir is certainly very popular these days, and a lot of people are drinking kombucha.

I say, you know, the easiest thing to do is to make this stuff at home. I can do it. It's not that hard. Beyond that, of course, there are commercially available health food store kinds of probiotics. And I think as we move forward, we're sort of seeing that there are good products and products that are not so good. And then, you know, briefly, I'd say that you want to look for a product that has a long shelf life, long stability, meaning that if this product says it has 50 billion organisms, it shouldn't be a product that says 50 billion organisms at the time of manufacture. That's all well and good.

But if, you know, three weeks after it was shipped and two weeks after you get it home, it has only half that amount, it's not going to do you that much good. You want to look for a product that's going to give you a couple of years of guaranteeing that level of organism. You want to find a lot of diversity in the species.

So we typically look for 12, 14 or so different organisms that are clinically validated to be positive in terms of your health. So those are the issues that we want to look for in terms of buying a probiotic. We want to see one that's obviously non-GMO as well. And at the same time, we want to nurture those bacteria. We talked about prebiotic fiber. That's the fiber that you eat in terms of these vegetables that then gives these bacteria what they need. The good news is that if you don't like kimchi, you can buy a probiotic pill. If you're not eating enough prebiotic fiber, you go to the health food store and say, I want some prebiotic fiber, and they will direct you,

and then you'll find a bag of fiber that you can mix into your morning drink, and that is pure prebiotic fiber. The best product out there, which is, again, what you want to look for, I think, is made from acacia gum. Acacia is this tree in Africa, you know, the tall canopy tree where the giraffe gets the shade and the sun and the heat. And that tree secretes a resin that is called acacia gum. And it is sustainably harvested. It is organic and it's pulverized, made into a powder. And it's the best, in my opinion, prebiotic fiber that

there is and very well tolerated. So you can go to the health food store and say that's what you want. Those are very important considerations. And I think in moving forward that we're going to see a lot more emphasis, hopefully even in terms of ingredients labeling moving forward, in terms of prebiotic fiber. Very, very underrated, but hugely important. So helpful. You know, it has just been a joy to be with you again.

And we'll have you back on again. Everybody should know that Dr. Perlmutter has his own podcast that I listen to or watch regularly. How can people learn more about your books and your educational events and materials? Sure. My website is, oddly enough, drperlmutter.com. drperlmutter.com. drperlmutter.com. Our website, as you know, is very enriched with not just my blogs, but in my blogs, I talk about a scientific study. We hyperlink right to it. So we have a robust library of full, not just the abstract, PDFs of all the studies that I quote. And I'd

like your listeners to sign up for our weekly newsletter. I put it out every week and they can watch our podcast comes out every Sunday. Of course, it's virtual. You can watch it whenever you want. And I enjoy doing that. I get to interview brilliant people like yourselves. And I'm sure you've enjoyed your podcast. I mean, it's such a great experience. And you get all these books that people send you to read. It's great. Yeah. Great. Well, thank you so much, my friend. Thank you so much. Thank you guys. Love you guys. We love you too. Thank you for listening to the Brain Warriors Way podcast. Go to iTunes and leave a review and you'll automatically be entered into a drawing to get a free signed copy of The Brain Warrior's Way and The Brain Warrior's Way cookbook we give away every month.