Change Your Brain Every Day - Your Brain's Silent War: Dr. David Perlmutter on the Immune Cells That Make or Break Your Mind

Episode Date: August 17, 2026

For decades, medicine has treated memory loss, brain fog, and neurodegenerative disease as inevitable — but what if the real battle is happening at the cellular level, inside your brain's own immune system? In this episode, six-time New York Times bestselling author and neurologist Dr. David Perlmutter joins Dr. Amen & Tana to unpack the findings from his groundbreaking new book, Brain Defenders. We explore microglia — the brain's immune cells that can act as either warriors of protection or agents of destruction, depending on how we live. Dr. Perlmutter breaks down the overlooked role of inflammation in conditions ranging from dementia to long COVID and lays out practical, evidence-based strategies to counter threats such as poor diet, environmental toxins, and lack of restorative sleep. If you've ever wondered whether cognitive decline is truly inevitable — or whether you have more control over your brain's future than you think — this conversation will change how you think about aging, disease, and prevention.   Purchase Brain Defenders: https://a.co/d/00qR4E3Y

In an ideal world, we wouldn't need to supplement the foods that we eat. We'd be eating wonderful, non-processed foods. But the threats from our environment are very real. The common supplements, like vitamin D, for example. Most people go to their doctors and the vitamin D level is 40. The doctor will say, well, your level's sort of in the normal range. It's just not good enough anymore. David Perlmutter is an American doctor, author.

Low carbohydrate, diet advocate, and promoter of functional medicine. Dr. Amen and David discuss how lifestyle choices can have an effect on your brain. If your immune system's not strong enough, infection will overwhelm you. But today, so many of my patients have lupus, MS, rheumatoid arthritis. Is it the same thing in the brain? This is War V. Every day, you are making your brain better or you are making it worse. Stay with us to learn how you can change your brain for the better every day. One of my favorite things is hearing how better brain health impacts entire families.

Marie told us she and her husband started taking Happy Saffron Plus and both noticed improvements in their mood, better mood, better relationships, better life. That's why I always say when your brain works right, you and the loves in your life work right too. Visit BrainMD.com and use code podcast 20 for 20% off. Better brain, better life. Welcome to change your brain every day. Today is going to be one of my favorite podcast because we have one of my friends and colleagues. I've known Dr. David Perlmutter for decades now.

He's a board certified neurologist, six-time New York Times bestselling all. author serves on the board of directors and as a fellow of the American Nutrition Association, serves as a member of the editorial board, of the Journal of Alzheimer's Disease, has published extensively. He's someone that I trust and often refer complex patients for his counsel. David, I'm just so happy to get to spend this time with you. Dan, any chance I get to hang out with you even for an hour is golden, so I appreciate this. So tell me what you're up to these days. So you're actually on a boat, which I know you spend a lot of time on a boat.

Tell me what you're most excited about. I'm most excited about the missing pieces of many people. puzzles in my life coming together in terms of trying to, professionally, trying to understand why it is that so many of the things that you and I have been messaging for so long are finally explained. I mean, for so long, we've known exercise is good for the brain. A diet that doesn't elevate our blood sugar that maintains insulin functionality is good. Getting enough sleep, restorative sleep is a good thing. Social connection. We knew all these things were good. We knew it from the epidemiology. We knew it from some of the interventional trials.

But I think for me, that missing piece of the puzzle that has now been found is why? What is going on that explains how all of these seemingly disparate inputs can ultimately do great things for the brain, and we know that they do? And it's through, to answer your question, it's through this new understanding that we have and that I have, that the upstream issue, the lever that is pulled, is the change in the brain's immune system, from being supportive to being destructive. And the empowering part of that narrative that you and I will unpack today is that it can be shifted back to being supportive again and really give us a greater chance at having a brain that is on board for us when we are getting on in our years.

As, to be fair, you and I are. And, you know, we've done all the work over the years, and that's why our brains are working the way that they are. And, you know, my mission as is your mission, is to really spread this gospel that we are the caretakers and the arbiters of our brain's destiny. It's not an issue of, you know, live your life however you choose, whatever is comfortable, and then hope for a magic bullet. I would embrace a new medication for Alzheimer's if it worked. We're not there yet. We have ways to go. but for now we've got to do everything we can to preserve and protect.

And that's what's been so exciting about this stage of my investigative career to really understand how everything that we've known for decades converges on what it does to the brain's immune system. I'm going to write that down. Preserve and protect because that's a military term. It is part of the presidential oath of office too. I'm speaking Saturday. at an event in Washington, D.C., and Pete Hengsup is speaking right after me, Secretary of War.

And I'm going to say, I appreciate him. But there's another war, which is for the health of your brain and your body. Because everywhere you go, someone is trying to steal the health of your brain and body. So in your new book, you talk about the microglia. and that's part of the immune system in the brain. It makes up the whole of the brain's immune system. The brain has its own immune system. We call it the innate immune system of the brain,

and it's made up of these cells that you correctly identified as the microglial cells. Let's just make sure everybody hears that term, because we'll be kicking that one around today, microgleal cells, and they can be friend or foe. They can be on our side supporting and nurturing the brain, or they can turn their backs on us and digest away our neurons and our synapses and lead to breakdown of the blood brain barrier. And the important and empowering part of the story is that

they respond to our lifestyle choices as it relates to things like inflammation and metabolism. That's how we threaten our brains, but it's also our salvation. It's how we can bring things back online. So let's make it super simple for the people listen. When you say, It's the immune system for the brain. That means what? So if a sixth grader was listening. What I would say to that sixth grader is you've heard of the immune system, that we all want to have a robust immune system such that if we get an infection,

if we get a flu virus, that our immune system is going to kick in suddenly and take care of it, fight off the infection, and after a few days we'll be back into pain. And I think we've all kind of fallen into that mindset that that's what the immune system does, that pretty much the fireman is in the firehouse unless there's a fire and then the firemen are called out to take care of that problem. Well, that's a bit myopic, we now understand that the immune system in the body and in the brain, as if the brain's not part of the body, but the immune system in the brain is doing stuff all the time. It's doing repair. It's doing upkeep. It's keeping our synapses functional. It's helping us grow new brain cells themselves.

It's shoring up the blood-brain barrier. These are obviously very, very important to keep the brain functional and to help our brains resist disease. So it's not as if it's that sixth grade mentality of immunity that, you know, I've got a good immune system because, you know, I've taken various supplements, zinc and vitamin C, and now if I'm challenged, my immune system will protect me. It's a different way of looking at the human system.

immune system, isn't it? That this is what is nurturing a healthy and wonderful and functional brain. The important part of it is that those exact same cells, what we've just defined, those microglial cells that want to do everything they can to nurture your brain can shift to become what we call in brain defenders. We call it the evil twin. That very same cell can be what we call polarized and suddenly go around and digest away the synapses and destroy neurons. And as again mentioned, threaten the blood rain barrier. But importantly, one of the key influences that shifts the microglia cells away from being loving and supporting to being destructive is something called inflammation. Now, you and I have been talking about inflammation for a long time.

Me, I've been talking about it in context of neurodegenerative conditions like Alzheimer's and Parkinson's. and you've been talking about it in terms of things like depression and other mood disorders. But fundamentally, the issue with inflammation, the question, your first question, well, what are you thinking of these days? So how is inflammation threatening the brain? What does it do? What it does is it shifts our microgleal cells away from being supportive to being destructive. So this becomes a very important central mechanism for all of us to understand.

because this shift in the microglial cells, the brain's immune cells, away from being supportive, characterizes Parkinson's and Alzheimer's and PTSD and major depressive disorder and long COVID. So you can see it throws a very, very large net. So when we recognize that, you know, you could look upon that as that glass being half empty. But I say that glass is absolutely overflowing because this gives us opportunity now across so many disease processes to use this mechanism to our advantage and shift those microglial cells, those brain immune cells, back to doing good things. You know, while you're talking, I'm thinking about autoimmune disorders.

And, you know, if your immune system's not strong enough, infection will overwhelm you. But today, it just seems so many of my patients have lupus or epilepsy. or rheumatoid arthritis. And it's when the immune system sort of like loses its mind and you become the object of friendly fire. So is it the same thing in the brain where the microgris? It's not a classic autoimmune condition. I mean, in that, in those conditions that you mentioned, which are, you know,

by and large diseases of women, which Alzheimer's is as well, two-thirds of Alzheimer's patients are women, it is a very directed type of immune response against various tissues on the body, in the body, and depending upon which tissues receive the brunt of that immune response, we get the manifestations of the various disease processes that you mentioned. The ankylosing spondylides, the rheumatoid arthritis, systemic lupus herothemotosis. This is more of a kind of a global activation of an immune response in the brain. We can actually now do a particular type of brain scan called TSPO. TSPO is a marker of activated microglial cells.

And when you look at TSPO imaging, you realize that this microglial activation is something that transcends all the barriers as a relation to neurodegenerative conditions. it's not just Alzheimer's and Parkinson's, but also frontotemporal dementia, PSP, multisystematrophy, and as mentioned, even long COVID. And now that we're getting into this a little bit, we begin to understand that what characterizes that shift in this one cell from being the good twin to the evil twin, or the good witch of the west and the evil witch, I guess the good witch of the north, the wicked witch of the west, right? Glenda.

What characterizes the shift of these cells turning their backs on us is a shift in their metabolism. In other words, their ability to make energy, their mitochondria making energy with the shift to being the evil twin is downregulated. It's less effective and they shift over to another energy producing process called glycolysis. But what is so important is that the metabolism of these cells, of these cells, cells mirrors body metabolism. That is really empowering. In other words, we can control the metabolism of these immune cells and keep them supportive and keep them away from being destructive if we target our own body's metabolism, i.e. keep our blood pressure where it needs to be, keep our blood sugars where they need to be, keep insulin functioning. And when you understand that the microglia in terms of

being friend or foe are so sensitive to our body's metabolism and the shift in the microglia is what characterizes Alzheimer's, then you understand this relationship then between the progressive worsening of metabolism in American adults and the ever-increasing rates of Alzheimer's disease. Rates of Alzheimer's and the increase mirrors what is going on with metabolic health in America, really globally. It's obviously a global problem. So it gets down to so much of what you've been talking about for so long, and that is we've got to do everything we possibly can to get our metabolism back to being in shape and get, and that will shift our microglia back to being supportive. I hate to say it's that simple because it's certainly complicated. But recognizing that metabolic issues

are key to shifting those microgle cells, the brains immune cells, away from being supportive. Now, we mentioned inflammation a few minutes ago. That inflammation that targets our microglia cells and has them turn their backs on us, that inflammation can come from anywhere. And one of the prime sources of that inflammation that these microgluele cells are sensitive to is the gut. this explains an awful lot. You know, many years ago, I wrote a book called Brain Maker that talked about something back then that was, I think, disparaged,

and it was this gut-brain connection. Now, of course, everybody's talking about the gut-brain connection. But now that we understand the brain's immune system, these microcgle cells, and how sensitive they are to inflammation that comes from anywhere in the body, we get a much more overwhelmingly positive understanding of the relationship between the gut and the brain. Because when the gut becomes permeable,

because of changes in the microbiome, the gut bacteria and its metabolic products, when that permeability happens, it amps up inflammation throughout the body that includes the brain and does what, it shifts the microglyle cells away from being supportive. So now we understand what researchers have been talking about

for so many years that changes in the microbiome, in the gut bacteria presage the development of Parkinson's and Alzheimer's. A study was published just last week indicating that measuring and following the microbiome can be predictive of when the clinical manifestations of Parkinson's will appear. In other words, the first thing you could identify are the changes in the microbiome long before there's a tremor, long before there's a rigidity or stooped posture, all the hallmarks of when people say, well, that's when Parkinson's began.

No, it isn't. It begins decades before, as does Alzheimer's. We realize now that the shifts in our metabolism that happened when we are in our 40s and our 50s are the seeds that are sown well before the clinical manifestations, the memory loss, the reduction in ability to utilize executive function, for example, When those things begin, this disease has been going on for decades. So our mission, and again, back to your original question, what floats the boat these days?

No pun intended, what can I say, is really to understand that we can be very preventive about Alzheimer's disease and realize the time to act is not when people are becoming forgetful. It's when they're developing these metabolic issues in their 40s and 50s. Yeah. Now, in 2005, I wrote a book with Rod Shankill called Preventing Alzheimer's, and people just lost their minds about it. But there's an article in Lancet a year ago that said 50% of Alzheimer's disease is preventable. And in fact, it might be more. My goodness, I have so many questions. But while we're on the microbiome, I'm working on New York. I was a little antide before, though.

That was fascinating. Go ahead. I'm working on a new book called The Neuroscience of the Lord's Prayer. And it's almost done, and I've had so much fun with it. But give us this day, our daily bread. So I did a whole thing on bread now, Wonder Bread, versus Bread, 2,000 years ago. But what's the impact of the Western diet, which is loaded with Breed? bread on the microbiome, on the gut barrier, on the blood brain barrier.

Well, let me first comment on give us this day our daily bread. And I think the bread is give, it's just an expression of gratitude that you have food to eat. So the Lord's Prayer starts off with a statement of gratitude that there's, something that I can eat. And I think, you know, that is so fundamentally important that we express gratitude throughout the course of our days and lives. So, but that said, a fascinating study appeared last year in the Journal of Prevention of Alzheimer's. I mean, can you imagine a journal of prevention of Alzheimer's? 10 years ago, 20 years ago, people would have been scratching

their heads like you and I, right? We've been talking about this for so long. And yet, This is a study that followed 20,111 people for two years and they basically did two things. They looked at the foods they ate, the people kept a food diary, and they looked at who developed Alzheimer's disease. And lo and behold, actually, this study followed, it was 1,1325 people. And what did they find? it found that consumption of ultra-processed foods, I know that's where you were going, was associated one serving per day associated with a 13% increased risk of the development of Alzheimer's disease, one handful of chips.

For those who consume 10 or more servings a day, which is not uncommon, when you consider that 60% of calories that Americans consume right now are from ultra-processed foods. So for those individuals, the risk for developing Alzheimer's increased by 2.7 fold. So again, this is a study that went on. Actually, it was 12.7 years they followed these people. So 12.7 years during that study, think about that, almost a 300% increased risk of developing Alzheimer's disease if you choose to eat the foods that you just mentioned. Foods that are associated with increased permeability of the gut line.

that absolutely threaten metabolism via being metabolized very quickly broken down into simple carbohydrates that increase blood sugar, that threaten insulin functionality, that increase inflammation, all of the things, right? So it is no surprise then that this incredible shift in the quality and let's say the quantity of bread and other ultra-processed foods is having its. manifestations in the brain and, you know, absolutely throughout the body, cardiovascular disease, cancer as well. So the immune system doesn't like to be threatened by these changes in our metabolism. And as a matter of fact, we now have a new term that has entered the lexicon. It's called

immunometabolism. And it is this relationship between our metabolism and the functionality of our immune system. Is it overactive? Is it underactive? Is it balanced? All related to our metabolism. Our metabolism is related to our lifestyle choices. So that allows us then to relate our lifestyle choices to the balance of our immune systems. And you said a while ago that you're seeing so much autoimmunity in your clinical practice. And it's not just that Dr. Dan Eamon is seeing it in his office. That's what the statistics are telling us that there's a continuing uptick in rates of autoimmunity in developed countries and to some degree around the world as well. We used to call it the standard American diet. Then it became the Western diet.

It's a global diet now. I mean, these foods are eaten globally and we're seeing the consequence. One of the most important lessons I've learned after helping thousands of people is that when you support your brain, you often feel the difference in your life. I love hearing stories like this one. Happy Saffron Plus has given me the peace I've been looking for. I can't say enough about it. It has truly been a godsend. Stories like that remind me why I'm so passionate about helping people care for their brains.

Visit BrainMD.com and use code podcast 20 for 20% off. Better Brain. Better life. So how do you activate the evil twin? So we've talked about some way. So processed foods activate the evil twin. I suspect chronic stress and negativity would activate the evil twin. What else?

I always enjoy my conversations with you. We get to it. It's great. Everything you mentioned very important. And, you know, you mentioned lack of socialization and chronic stress. That's been a big part of your outgoing messaging for so long. We should talk about the fact that chronic stress raises inflammation, leads to increased gut permeability through the action of cortisol,

and that targets our brain's immune cells, and shifts them to being the evil twin. So, you know, for your viewers, this is a new understanding of what your messaging has been for so long about, you know, how ultimately damaging chronic stress is because it shifts the brain's immune system, and that is a setup then for major depression, Alzheimer's Parkinson's and all the neurodegenerative conditions. The other big players, we've talked about the ultra-processed foods, it's huge. But I would add to the list, very important, something we call sedentarity, in other words, being sedentary, not moving around, not being active, not saying, well, I'm going to find the time

to exercise. No, we don't say that. We say I'm going to make the time for exercise each and every day because exercise is a very handy way of keeping your microglueal cells on your side, being brain defenders. Next thing as important is restorative sleep. The quality and quantity of sleep is incredibly fundamental. You're spending a third of your life in this activity, more than you spend eating and more than you spend exercising, one would hope. And everything people are talking about as it relates to sleep is fundamentally important because even one night of non-restortive sleep because it was too short or it was not restorative for whatever reason you didn't get into deep sleep, you accumulated various toxic debris in your brain will shift your microglial cells. Not all of them,

of course, but begins that process. And here's the point I want to make, and it's really, segues beautifully into your work. When the microglia shift from being M2 supportive to being M1 destructive, what do they do? What do these evil twins do? Why are they so darn evil? Because they increase the production in the brain of inflammatory chemicals. They start spitting out the very inflammatory cytokines that damage the brain and shift other supportive. microglial cells to the dark side. It spreads through the brain like a cancer and becomes a feed-forward process. Now, how does this relate to things you've been talking about for so long? Let's talk about chronic, traumatic encephalopathy. We know quite well that the football players

have stopped playing football, that Muhammad Ali came out of the ring, and yet his Parkinson's worsened, and yet the football player CTE continues to worsen over time. Something lit the fuse and process continues even when the inciting event is over. We've wondered why that happens, and here's how it happens, that these activated microgleal cells spread those inflammatory cytokines to their neighbors and recruit them to being damaging microglueal cells as well. So what is being explored now at the highest level of scientific research is really very aggressive ways of reverses. that shift. Transplanting healthy microglueal cells into the human brain, it's already happened. Transplanting mitochondria, allowing the microglia cells to revert to better metabolism and therefore

shift back to being M2 supportive brain defenders. We can do it equally as well by changing metabolism, getting people who really needed on a very aggressive program to shift their metabolism. That means getting on, for example, a ketogenic diet, allowing those mitochondria to do work and produce ATP. When the mitochondria become functional again, then they shift these microglueal cells back to being on our side. So there's so much going on. There's so much going on. And don't you love it? I don't know if I told you, but I did the big NFL study when the NFL was sort of lying. I know you did. And I was a consultant on the movie Concussion. And the law, is that CTE is chronic, progressive, and untreatable.

And I just think that's a load of crap because what we see, and last year, diagnostic imaging brain said you can diagnose CTE with spec and Pat and now the tau markers before people are dead. And I'm so excited about it. But what we saw is 80% of our. players get better when we put them on a group of supplements plus a brain health program. So we have to change the narrative away from this is chronic, progressive, and untreatable to you need to look early and you need to be on a brain health program early.

So on our podcast, we did Tim Tebow. So he was an NFL player. I mean, you know, historic college quarterback. Yeah. And he has two of the E4 genes. And he got knocked out. So he has damage, which we showed on the podcast, was left frontal lobe.

And I'm like, and he's like run around the world saving children, which is so awesome. like, we need to get this under control. So talk about the E4 gene. And if you have one copy or two and how perhaps it's not a death sentence, but it should be a wake-up call. Everybody needs a wake-up call. And for that 25% of the American population that carries at least one of the APO-E-4 alleles,

it's a louder wake-up call. and certainly if you carry two of the alleles, then that wake-up call needs to be screaming. But it's a different way of looking at it. I mean, you know, traditionally and mainstream neurology is going to say, basically get your things in order. And I, like you, am, I'm appalled by that response because there is countless research citations now

that indicate that that's just the wrong approach and it's devastating to people. that, you know, an interesting study came out in the Journal of the American Medical Association last year was called the Pointer Study. And the Pointer Study looked at 20,000 people and followed them for a couple of years. And these were individuals who are at least 65 years of age, many of whom, if not most, had some metabolic issue ongoing, like type 2 diabetes or at least insulin resistance. and these individuals over a two-year period should have cognitively declined if nothing was done. And what the point of study did was really interesting. They divided the group in half, 20,000 people divide it in half.

One half got a program of diet and lifestyle and stress management, exercise, all the things, and had during the two-year period 36 interventions or meetings with people either in real time, face-to-face, or virtually, how are you doing? How's the diet? What are you eating? What's your exercise program? They checked in with these people an awful lot. The other group had either two or three a year.

So they really basically got the information and said, you know, do your best, see how it goes. And here's what they found in the study. Again, these people should have declined. And many, there were APOE4, carrying one allele and carrying both alleles in the study. and what they found was quite fascinating. Again, the entire group should have declined.

The group that had the 36 intervention, they didn't stabilize. They actually improved in multiple metrics of their cognitive function. But the part that people are not really looking at that I think is really important is the other group that got the information but didn't get the handholding. What did they do? They improved. Can you imagine just giving them the information? They improved almost as robustly as. the group that had the aggressive supervision.

So the point that I want to make here is that, and that's just one example, there are countless studies indicating lifestyle intervention in people carrying the APOE4 allele work. And it's not a sentence that it is not written in stone. It is a predisposition. I won't argue that point. The risk for Alzheimer's, if you do nothing, is increased fivefold if you carry one allele. if you're heterozygous, if you're homozygous and carry two alleles, the risk may be as much as 12-fold. Think about that.

But that is a predisposition. It's not destiny. And you quoted something earlier. It was the Lancet study. The Lancet Commission issued a report in 2024, and they looked at 14 lifestyle-modifiable factors. And they said, if people pay attention to these factors, wear a helmet. if you're exposed to air pollution, you'll be careful wear a mask, using an indoor air purifier, etc. 14 lifestyle modifiable factors, as you well said, Dr. Eamon, risk was reduced by 50%.

I'll tell you something very interesting about it. So my point is risk reduction by 50%. And that includes the APOE 4s. Think about that. But what was really interesting about the Lancet Commission report, of the 14 things that they talked about that were really impactful, they didn't mention diet. I'm not making this up. They did not mention diet.

So. That's insane. I, along with Dr. Robert Lustig, wrote a letter to the editors of the Lancet after the report came out and said, hey, all willing good, great study. Somehow or another, diet didn't get mentioned. And here are 14 references about the mind diet, Mediterranean diet, you know, et cetera. So maybe you could issue an arrest. Ratham or, you know, some sort of correction.

And we got a letter back saying, no, not going to do that. But thanks for pointing it out. And please keep reading the journal. But you know what? You stay in the batters box. As you well know, you stay in the batters box. But, you know, we've got a huge problem here in America with 7.6 million Alzheimer's patients costing us, interestingly, I saw a social media post of, you know,

view, I think I saw it yesterday, with the director of Medicare and Medicaid, Dr. Mehmetaz. And I had this discussion with him as well, costing us $360 million to care for these individuals. And that is the monetary cost, not obviously the emotional cost, which I believe should be something that we talk about as well. We don't talk about, you know, what goes on to loved ones and family members. It's devastating in there. You know, hell am I. A crazy statistic is 15% of caregivers also have Alzheimer's.

And that's not a good. You know, I have another question. Why women? Why do women have a higher risk? Is it that they live longer? Is it that they were robbed of estrogen and progesterone? Why do you think? In a word, microglia.

Let me explain. And you just hit upon it. Turns out that in the perimenopausal time, when estrogen and particularly estradial, E2, plummets, suddenly the synapses in the brain, the connections of one cell to another cell via the dendrite, are attacked and labeled by something called complement protein, C3A complement protein. labels, attaches itself to the synapse, when it does so, it sends a signal to the microgluella cells that says, eat me. The microglial cells become activated and digest away the synapses. And this is a direct consequence of the sudden plummet in the supportive

estrogenial. Dr. Lisa Musconi has an interventional trial actually ongoing right now to really flesh this out and really give us great information as to timing. When should then a woman begin this estrogen replacement therapy or hormone replacement therapy if we're going to add in also paying attention to natural progesterone and, yes, even testosterone in a woman? But estrogen dial turns out to be the key player here. And the timing is really fundamental. And I think that just premenopausal is the ideal time. Women should be following their hormone levels, not just because I'm starting to have hot flashes.

maybe I need to take some Premarin, but really throughout their lifetimes with judicious, correction, with hormone replacement therapy, throughout their adult lifetimes, my opinion. And, you know, so the issue is, would I be, if asked, supportive of the idea of hormone replacement therapy as a way of helping reduce Alzheimer's risk in women, making up two-thirds of Alzheimer's patients? And I answered categorically in the new book Brain Defenders. I said, you bet. I don't think I said you bet.

I said yes. But now I'll say to you, you bet, favorite expression of mine. Because, you know, for too long we've sort of castigated this notion of hormone replacement therapy, really because of a flawed series of papers that came out, you know, relating HRT with really artificial hormone replacements to breast cancer risk. And it was completely wrong and was a huge, I think, disservice to women around the world, for that matter. What about toxins? You know, they say we're consuming a credit card's worth of plastic a week in this country.

But environmental toxins, I know for me, I fight my mercury level and basically stopped eating fish. and I'm sort of always detoxing. I don't drink. I don't do drugs, although that would be a question for you. What does marijuana do to this? What is alcohol due to this? But what's the impact on toxins and the microglia?

There's the evil twin. The evil pin loves the toxic environment. Whether it is glyphosate weed killer on our food, or Paraquot now being used aggressively in the United States on our foods, or the PM2.5 particles that are now so present in the very air that we breathe, being worsened by climate change as it relates to wildfire. Wildfire smoke isn't when you bust out the marshmallows. It's not the forest burning that is the threat.

It's the other stuff, the buildings and the insulation and all the terrible pollutants that get into the smoke that we breathe. that's so devastating, but the particulate matter itself, this PM2.5s, even from burning wood, a burning incense in your home, is threatening. It's profoundly pro-inflammatory throughout the body, and vis-a-vis our earlier discussion, anything that amplifies inflammation will amplify the shift away from being brain defenders, M2, microglia, to being brain destroying M1 evil twin. So it's a different world that we live in. And to bet that we have evolved with a set of detoxification enzymes for the number of toxins to which we are exposed every single day, that's not reality.

So we do our best to amplify our ability to detoxify. I talk in the book about something called sulfurophane that you get from chewing broccoli sprouts. There are a couple of companies that make preformed sulforaphane. But, you know, this is one of the other benefits of, for example, sauna exposure to allow us to help detoxify. So it's about amplifying our detoxification pathways and also dramatically reducing our exposure. These issues that you bring up are ubiquitous, especially for people who live in cities, who especially live near busy highways. living the proximity one lives to a very busy highway relates to Alzheimer's risk by virtue of those PM2.5 particles that are generated from the tireware, putting that into the

air that we breathe. So I'm glad you brought it up. I mean, people are paying more and more attention to the purity of the water that they drink, but what about the air that you breathe every single minute? Well, now I'm freaked out because when I grew up, I was three-havoured. from the 101 freeway in Los Angeles. We could hear the traffic. I mean, over time, you just sort of lock it out. Yeah, I mean, I remember on our bicycles chasing after the, they were fogging the streets for mosquitoes.

And we thought that, and of course, everybody said, oh, obviously it's safe because if it was safe, they wouldn't be doing it. And we had those, I don't remember what plane it was. I guess it was a, I don't remember, but flying really low. I mean, you know, they were like 800 feet over the house spraying for mosquitoes. And, you know, these days they've changed what they spray. Where I live, they still spray, but they use something called BTI, bacteria, therogenesis,

that is basically toxic only to the larvae of the mosquitoes. It's a parasite, and it doesn't apparently have any effect on humans. But, you know, we had, all of us had exposures in our childhood, okay, that's in the past, we can't rewrite that, but there's a lot going on even today in terms of what's sprayed on our food. You know, the glyphosate usage to kill weeds, we were told that healthy normal plants, if they were genetically modified, they would be fine, the weeds would die, and great, everything's wonderful. Well, we now see that the plants are, even the weeds, are evolving to become roundup resistant. So now we're using paraquot on our foods, which has been banned or dramatically reduced in 70 countries around the world. But unfortunately not here in America. We're using more and more because the farmers will tell us we have to do this because we've got to kill those nasty weeds.

And paraquot is a mitochondrial toxin. back to our conversation. When we threaten the mitochondria, we shift our microglial cells. It's why there's a strong relationship then between paraquot exposure, sprayed on our foods, and risk for Parkinson's. It doesn't make sense that we put mitochondrial poisons on the foods that we eat and then scratch our heads when we're wondering why there's ever-increasing rates of Parkinson's. That's the one that's really increasing much more rapidly percentage-wise than Alzheimer's or other neurodegenergic conditions. We're seeing it everywhere. And keep an eye on that.

So much of your work has been involved with Parkinson's IV glutathione. I remember watching. Yeah, that was 25 years ago. Long time ago. So let's talk, before we have to stop, let's talk about supplements. Or, yeah, supplements. but I'm sort of thinking, all right, I want to protect my brain. I want to defend it against the war that it's in.

How do I go through my day and defend my brain so the evil twin shifts back to one that loves me? Well, I think that your microglot themselves already love you because somehow they know all the good work that you're doing. But interestingly, it is a war. In fact, the first title of this new book was Brain Wars. But the publisher said, and I was going to go through all the threats, all the way the world around us sort of is conspiring to threaten our brains and the war that's happening within the brain based on the shift of the microglueal cells. But so much of what we can be exposed to, even the threats that we perceive around us, the real threats, and the real threats, and the perceived threats that are exacerbated

by what we see on social media, by doom scrolling, what we're seeing on the evening news or the news throughout the day, that everything seems to be threatening. And when we imbibe that level of threat by virtue of taking in that information, it is a powerful activator of our stress response. Again, something you've been talking about

for an awful long time. The stress response with activation of cortisol is threatening to our microglia. They see that, and they shift to the evil twin. Loud noises. The polluted air that we may be exposed to. The other environmental threats, we talk about it in the book.

So it's really upon us to recognize those. I call it out so people can think about these things and what they're exposed to, the foods that we eat. What time did you have breakfast today? Well, I didn't eat right away. I ate at noon. Good plan. Time restricted eating.

That nurtures your mitochondria, the energy producers in your microglial cells. and that helps keep them in their M2 supportive configuration. So it's about what we eat, it's about when we eat, and yes, you mentioned supplements. In an ideal world, we wouldn't need to supplement the foods that we eat. We'd be eating wonderful, non-processed foods that are timed with the season. But, you know, the threats from our environment are very real. So I think that the idea of supplementing is very important.

We talk about it in the book. We talked about a couple of supplements that particularly target the microglial cells like Rosemiric acid, dihydromycin, both of those are kind of unique. They're not, you know, the common supplements people take. But I think that the common supplements, like vitamin D, for example, very important. There are vitamin D receptors on the microglia. When they are stimulated, it keeps the microglia on our side. That's pretty straightforward.

Pop a 5,000 IU capsule of vitamin D each day and have your health care provider, of course, follow your levels. Very important. So everybody should know their vitamin D level. That's right. And I get it somewhere between 50 and 100. That's right. And I, so that I target around 80. And, you know, if most people go to their doctors and the vitamin D level is 40, the doctor will say, well, your level is sort of in the normal

range, I don't go for in the normal range. Anyone who's listening to Dr. Amos' podcast wants to be in the optimal range, right? We want the best for you, not just normal. Normal is, it's just not good enough anymore. You know, what's normal? Normal is these days. These percent of people, 85 and older will have Alzheimer's. That's normal.

And that's not normal. And depression isn't normal. And Parkinson's is not normal. You know, they used to say Alzheimer's is Alzheimer's disease. and we call it Alzheimer's its old time. No, we should expect when we turn 80 and 85 at 92, you and I are going to have another podcast together. We expect that that's what we should be doing.

Our bodies, we do our best to keep them in shape. And, you know, again, it's so difficult to watch this happen. I interviewed Bruce Willis' wife. I know that you're familiar with her not long ago. We talk about it. I guess. She was on my podcast as well. What it's like. And what do people do when the world gives you those lemons, you know, that hardship. We see what she's done with it, you know, her outreach to help others.

Because there's another side of the story that people need to know. We do not have today, as you and I have this conversation, an Alzheimer's drug that works as an example. We know that several months ago, a cochrane analysis came out looking at 17 different studies on the so-called beta amyloid Alzheimer's drugs comprised 20,342 individuals followed for 18 months in each of the studies, each of the 17 studies. They looked at risk and benefit. The risk was high. 20 to 25 percent of these individuals developed brain hemorrhaging and or brain swelling, and the effectiveness was basically done. Their term in the Cochrane analysis was the effectiveness is trivial in terms of slowing the decline. Recall what I told you earlier, that lifestyle intervention

in the pointer study actually was associated with stabilization or improvement. And a study done at Harvard by people you know, Dr. Rudolph Tangi and Dr. Dean Ornish, actually a small study, 51 individuals followed for 20 weeks. Lifestyle intervention. In Alzheimer's patients, 20 weeks showed it stabilization or improvement. I mean... Every day you're making your brain better. You're making it worse by the choices that you make.

And even if you have Alzheimer's, you can accelerate it. And, you know, so many people go to care facilities, and they give them menus that have spaghetti and burgers and chocolate cake on the menu. I'm like, oh, great, let's just accelerate it because we don't really like them that much. Anyways, we can go on and on. Yeah, but what do you call these centers? They're called memory care centers, right? And I think that that's not really the emphasis here.

We shouldn't, the emphasis should be memory care when you're 40 years old or 50 years old. That's when memory care should begin. So it's not when you end up in an institution because you're, you know, demented. Well, Markhan, on the decade of brain health, we'll see if we get that through. But I would so want you to be involved. I always accept, always. Thank you. You bet.

How can people find your book? How can they find what you're up to? The book is called Brain Defenders. It's sold at bookstores and online. The best place to go is the website, Brain Defenders.com. And that's part of my website. If you go there, you'll see all the things people get, all the gifts, et cetera, when they buy the book.

And that's where you can learn what I'm doing as well, what I'm up to. But, you know, I appreciate being with you again, as always. It's really great to just to feel the camaraderie because we have a shared mission. And it's so good to know there are other people out there that are, you know, singing in the choir. Well, now some of the people singing in the choir are actually at HHS. And at CMS, I'm so excited because we're having. having a real conversation rather than before, which was protecting the institution of sick care. It's so timely.

Well, yeah. So I'm extremely hopeful. Thank you, my friend. So great. Thank you. So good to see you. I never get tired of hearing stories of hope. Gregory shared that after taking Happy Saffron Plus for several weeks,

He felt more hopeful, less overwhelmed, and experienced no negative side effects. Hope changes everything. When people feel better, they think better, make better decisions, and create better lives. That's why stories like Gregory's means so much to me. Visit BrainMD.com and use code podcast 20 for 20% off. You are watching, listening. Think your brain every day. Leave a comment, question, review, get Dr. Perlmutter's new book, Brain Defender.

You can also follow him online. He's got a wonderful podcast. I think I've been on five or six months. You are a repeat offender, that's for sure. I'm a repeat offender. Thank you so much.