Dhru Purohit Show - #225: The Real Cause of Alzheimer’s and Dementia and How to Prevent Them with Dr. David Perlmutter

Episode Date: July 1, 2021

The Real Cause of Alzheimer’s and Dementia and How to Prevent Them | This episode is brought to you by BLUblox. A declining mind is one of the scariest things I can imagine. Left unchecked, I’ve seen the devastating effects this process can have on individuals and their families. But we now know there is so much that can be done to prevent and even reverse Alzheimer’s and dementia and save people from a foggy future.    I know some of you may have had to reread that—yes, Alzheimer’s reversal is real. The latest research is showing some amazing results that give us a new perspective of hope, even (or especially) if you’re genetically predisposed.    Today on The Dhru Purohit Podcast, Dhru talks to Dr. David Perlmutter about the latest findings in the field of Alzheimer’s and dementia.    Dr. Perlmutter is a Board-Certified Neurologist and five-time New York Times bestselling author. He serves on the Board of Directors and is a Fellow of the American College of Nutrition. Dr. Perlmutter received his M.D. degree from the University of Miami School of Medicine where he was awarded the Leonard G. Rowntree Research Award. He serves as a member of the Editorial Board for the Journal of Alzheimer’s Disease and has published extensively in peer-reviewed scientific journals including Archives of Neurology, Neurosurgery, and The Journal of Applied Nutrition.   Dr. Perlmutter’s books have been published in 32 languages and include the #1 New York Times bestseller Grain Brain, The Surprising Truth About Wheat, Carbs and Sugar, with over 1 million copies in print. Other New York Times bestsellers include Brain Maker, The Grain Brain Cookbook, The Grain Brain Whole Life Plan, and Brain Wash, co-written with Dr. Austin Perlmutter. His latest book, Drop Acid, focuses on the pivotal role of uric acid in metabolic diseases, and will be published in February, 2022. In this episode, we dive into: -Dr. Dale Bredesen’s study showing that Alzheimer’s disease is reversible (9:13) -What contributes to Alzheimer’s disease (11:31) -Blood sugar dysregulation and fructose (18:43) -How our gut bacteria is responsible for regulating our metabolism (22:04) -What threatens our gut bacteria (41:17) -The importance of diversity in our gut (46:30) -Dr. Perlmutter’s diet (51:38) -How elevated uric acid levels lie at the root of many pervasive health conditions (56:45) -How to test for uric acid levels (1:08:59)  -Foods that are high in uric acid (1:11:38) For more on Dr. David Perlmutter, you can follow him on Instagram @DrDavidPerlmutter, on Facebook @DavidPerlmutterMD, on Twitter @DavidPerlmutter, on Youtube @DavidPerlmutterMD, and through his website https://www.drperlmutter.com/. Check out his podcast The Empowering Neurologist at https://www.drperlmutter.com/learn/empowering-neurologist/. Preorder his book, Drop Acid: The Surprising New Science of Uric Acid—The Key to Losing Weight, Controlling Blood Sugar, and Achieving Extraordinary Health at https://www.amazon.com/Drop-Acid-Surprising-Controlling-Extraordinary/dp/0316315397 Also mentioned in this episode: -Precision Medicine Approach to Alzheimer’s Disease: Successful Proof-of-Concept Trial - https://www.medrxiv.org/content/10.1101/2021.05.10.21256982v1 -The Science of Prevention Docuseries - https://scienceofprevention.com/ -The End of Alzheimer’s Program by Dr. Dale Bredesen - https://www.apollohealthco.com/book/the-end-of-alzheimers-program/ Sign up for Dhru’s Try This Newsletter - https://dhrupurohit.com/newsletter. This episode is brought to you by BLUblox. Right now BLUblox is offering my listeners 20% off, just go to blublox.com/dhru and use code DHRU at checkout. Learn more about your ad choices. Visit megaphone.fm/adchoices

We can scan brains 20 years ahead of time and determine already when there is compromised brain energetics. The choices we make in our 30s, 40s, and 50s are very relevant because they, again, portend cognitive decline in full-blown Alzheimer's disease. Hi, everyone, Drew Prode here. On today's interview, we have Dr. David Perlmutter, New York Times bestselling author and board-certified neurologist talking about how to prevent Alzheimer's Alzheimer's, dementia, and cognitive decline. If you care about your brain, this episode is for you. This episode of the podcast is brought to you by Blue Blocks.

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dot com slash d hr you with the code drew dhru dhru i hope you'll check them out so that you can get better quality sleep to give love and attention to all the things you care about in the day now let's get back to this week's episode welcome to the drew perot podcast each week we explore the inner workings of the brain and the body with one of the brightest minds in wellness medicine and mindset this week's guest is dr david perlmutter dr perlmutter is a boylmutter is a boyl board-certified neurologist and five-time New York Times best-selling author. Welcome to the Drew Perrault podcast. Each week, we explore the inner workings of the brain and the body with one of the brightest

minds in wellness, medicine, and mindset. This week's guest is Dr. David Perlmutter. Dr. Perlmutter is a board-certified neurologist and five-time New York Times best-selling author. He serves on the board of directors and is a fellow of the American College of Nutrition. Dr. Perlmutter's books have been published in 32 languages and include the number one New York Times bestseller grain brain, the surprising truth about wheat, carbs, and sugar. On today's podcast, we dive deep into the topic of Alzheimer's, dementia, cognitive decline, and how our lifestyle, especially our diet, can either take us towards those diseases and conditions or away from

them. Stay tuned for a fascinating conversation. Dr. David Perelmutter, welcome back to the podcast. It's a pleasure to have you here. Well, Drew Pruitt, it sure is great to see you again, even though it's virtual. Next time we'll be in the Holy Land, right? We'll see each other in real time. It's so true. I want to jump right in and talk about Alzheimer's because you wrote a really interesting Instagram post. I think it was a few weeks ago, and you were saying Alzheimer's reversal is real. It's not just a theory. And you were hinting at a new study, a small one, but something exciting that came across your desk that you wanted to highlight and make your audience aware of. So why were you excited about the study and what do they cover inside of there?

Well, I'm hoping you'll share that study with a link. This is work that I've been aware of actually for quite some time. I know you know Dr. Dale Bredesen. And he really, recently published a book called The End of Alzheimer's The Plan. You know, the first book was The End of Alzheimer's, and this one is the plan. And I wrote the forward to that book, and in that forward, I think it really did capture my excitement about the work that he's doing, even beyond how he's broken the mold beyond Alzheimer's. And let me explain. You know, we live in a world where we try to really pigeonhole our diseases to think that

they are caused by one thing and therefore we can fix them with a remedy. And there's such an effort underway to find an Alzheimer's drug that works. Just last month, Eli Lilly announced the results of a trial in which their monoclonal antibody Donenamab was found to reduce the rate of decline of Alzheimer's patients by an astounding 32%. When they made that announcement, the stock value went up, I think, $20 billion, $1, Eli Lilly. But what does that mean? It means it slowed the decline by a third. It means people are still declining and going to get worse, and we know where it ends up generally. So it really wasn't stabilizing Alzheimer's, or can you imagine actually improving their situation? Because

they're looking at one thing. This is a monoclonal antibody that is targeting this so-called beta-amloid protein that's absolutely the cause of Alzheimer's. Well, we know that study after study has really made it very clear that beta amyloid is almost an innocent bystander. It is the brain's response to various challenges, like infections, for example. So it's sort of like blaming the firemen who arrive on the scene for the fire. It isn't that way at all. And study after study where beta amyloid is targeted, have actually been shown to make patients decline more readily. So what Dr. Breterson is leveraging beyond his results, I'll talk to you about them in just a moment, he's really leveraging the notion of multiple inputs, really kind of the cornerstone of what

is called functional medicine, where we don't look at what the disease is that a person has, but rather, who is the person who has the disease? What is the unique, personalized approach that we can take to understand how that person got that way? Alzheimer's is not just a bio-energyetic issue of glucose, lack of glucose utilization in the brain. It's not just that there's beta-emoid, not just that there's a decline in acetylcholine, not just that there's temporal parietal atrophy. There are a lot of things that, you know, roads that leave. to roam here, or as I've been said in the past, many, many places to jump on the bus.

And I think that if you're going to ever have a shot at reversing Alzheimer's, you have to understand which of the multitude of factors, and Dr. Bredesen, it's identified more than 36, not just beta amyloid accumulation or type 3 diabetes or underlying herpes infection. Many things have been proposed. But to try to identify in that, person who's sitting in your office with declining cognitive function, what's going on with him or her? And then when you figure that part out, then you develop a program that looks at those issues and does it's best to correct those issues. Maybe it's lack of supportive hormones. Maybe it's lack of adequate insulin function. You know, so many different things. Cultivate a program that

is specific for that patient. Again, we call that personalized medicine and realize that that can offer up more likelihood of improving that person's situation. So what Dr. Bradison just published in the study that your viewers can now review is that in a group of individuals who were indeed suffering from mild cognitive impairment or even diagnosed with Alzheimer's disease, that when he created this program and people stayed on a personalized program for the nine-month period of time, that 80% of them didn't just stabilize their condition. They improved. He describes patients going back to work, regaining control over their finances. I mean, it's astounding. And beyond, if that weren't enough, and it is, believe me, it is in my lifetime to see that happen. But if that weren't enough,

the idea that he proposes that we should engage this notion of really gaining as much information as we can about an individual and his or her uniqueness prior to initiating therapy. I think we can use that approach in all walks of medicine. And to be sure, that challenges the mainstream motion of trying to make people fit into the treatment. I often say that a person comes to your office and says, I've been walking five miles a day and look at my feet. They're all blistered and torn up.

And the doctor says, well, let me write you a prescription for a pair of shoes. And the person gets the prescription filled and they don't fit. It's a size nine and the man wears a size 11. He comes back and he's complaining. And the doctor says, well, you know, in a study of 10,000 people, size nine was the average shoe size would, you're going to have to just figure it out. You know, it's very clear that we have to understand the needs of the patients as it relates, in this case, to Alzheimer's disease.

There are nutritional issues. There are, you know, a host of lifestyle issues that we've been talking about for years. You and I have had this conversation for a long time that are so incredibly relevant. but yet, you know, the fallback is, well, I'll do what I want, live my life, however, and they'll develop a drug one of these days that'll pull me out of the woods. That isn't reality. You know, you mentioned these multitude of different pillars that could be contributing. It's not one thing.

So the solution is not going to be one thing. Let's talk about those items that contribute to it. You know, you mentioned Dale Bredesen. We've had them on the podcast before. We've gone into his books a little bit. but a high level from what you've seen and kind of leveraging on some of his work, Diet gets so much attention and we'll come back to Diet in a minute because that's one of the main components that you're super known for with your books that you've put out there because

it's something that we can control. Give us the next big bucket that you often see for people that often doesn't get as much attention as diet does when it comes to cognitive decline, dementia, and Alzheimer's. I'd say that first, as a counter to the notion of, you know, what are the big legs that support this decline would be genetics. Genetics is not that relevant, you know, in fact, playing only about 5% role that, you know, people say, well, I carry the APOE4 allele, therefore I'm at greater risk. But understand that that's so-called Alzheimer's gene plays upon other variables that we can absolutely control. So, you know, the point I want to make for your viewers is really quite simple, and that is if mom or dad had Alzheimer's, or if you know that you, by virtue of your 23 and me or other genetic profile, carry one or two of what are called the APOE4 alleles, which are indeed associated with increased risk for Alzheimer's, all well and good and interesting.

No question that having that genetic predisposition and others, pre-Sinolin 1, for example, increase your risk. but by all means the die isn't cast. It means that our choices, we have control over things that are really influential. And I think the biggest issue would be, and they're all important, don't get me wrong, but I think the biggest issue, at least in our modern world, has to do with our metabolism and elevation of our blood sugar, and therefore compromise of our ability to have insulin in the body do its job. think, you know, to take a step back, back to high school biology, well, what's the importance

of insulin? Insulin is important for getting glucose or sugar into the cell and therefore lowering or regulating blood sugar levels. Well, all well and good, but I think that we have a tendency to be really myopic when we assign our understanding of insulin or other things in the body, other metrics to a specific area to the exclusion of other functionality. And, you know, for example, we say, well, testosterone is the male hormone. You know, women need testosterone. Very important. Progesterone was named because it's progestation. It's the, you know, a female hormone that goes up during gestation. Why would my body have progesterone receptors? I think it's important to expand in this case on what insulin does in the human body and specifically,

vis-a-vis our conversation now, how does insulin relate to the brain? Well, insulin does play a role in allowing brain energetics. We'll come back to that in a moment, but it's the way that blood sugar gets into the brain glucose to ultimately lead to the powering of the brain cells, the neurons specifically, and that's really important. When our bodies become insulin resistant, we'll talk about how we get there, I guess I'm paving the way for a lot of conversation, then that functionality, brain energetics, is compromised. That's a bad thing. We can scan brains 20 years ahead of time and determine already when there is compromised brain energetics that is the harbinger for future cognitive decline and ultimately Alzheimer's disease. And that means, tangentially,

that, you know, the choices we make in our 30s, 40s, and 50s are very relevant because they, again, portend cognitive decline in full-blown Alzheimer's disease. Other things, however, that insulin does, I think are very important. For example, we know that insulin is degraded in the brain by something called, oddly enough, insulin degrading enzyme. Well, it turns out that when we're unable to stimulate adequately this insulin degrading enzyme, because insulin functionality is compromised, that that same enzyme is involved in the degradation of this protein we referred to earlier called beta amyloid. So that's now a connection between insulin and beta amyloid.

We know that insulin is important for, again, regulating blood sugar. And why is that important? Because when our blood sugar is elevated, we change our proteins via something called this process of glycosylation, where proteins bind. to sugar, and that's an issue because not only does it change what the proteins look like in terms of their three-dimensionality, but it also, because of those changes, alerts the immune system that, hey, here's a protein I've never seen before, and what happens? The immune system gets activated and inflammation gets turned on, and inflammation is really a central player

in what degrades the brain in Alzheimer's. So the point I'm making then is, regulation balancing our blood sugar, keeping our blood sugar under control, is, while everything is important, I think that might well be perhaps the most important issue, you know, in terms of what throws the widest net, in terms of for your viewers, what they need to pay attention to, that this blood sugar regulation is in the front row and that we need to do everything we can, getting back to diet, and I know you wanted to move past that, but I chose not to, because it's so important, something we all make choices about every single day, unless we're fasting, of course.

And everything we can, with reference to diet, to keep blood sugar levels under control, basically lower than they might otherwise be these days, I think is very relevant. You know, utilizing things like continuous glucose monitoring, checking our blood for ketones, being really aware of fructose in the diet, so many things that influence blood sugar,

our sleep patterns, our exercise patterns, sleep as we measure with our wearable devices. All of these things play into balancing blood sugar levels, and the brain is exquisitely sensitive to its provision of its fuel, which is basically glucose. And when that's compromised, when that is threatened, that really does set the stage for future to climb. I'm glad that you doubled down on the diet. I did want to cover diet. I was going to cover diet. I was going to a few other things, but I'm glad you actually forced it in the direction that you wanted to go in because it's just another reminder that just like we say, you can't exercise your way out of a bad diet. If you're serious about brain health, you cannot approach the topic without thinking about

blood sugar regulation. And I think that's an important message for our listeners, and it's a hopeful one because that's actually something that's largely in most people's control and will continue to be in their control as they start to use wearables like CGMs. And I know you're affiliated and I'm affiliated with a company that's doing some great stuff in that space. We'll chat about them a little later on. So I'm glad you doubled down because I think that is just an important thing for everybody to remember is that we're looking for sometimes the right supplement in the traditional world of medicine. It might be actually what medicines are there that you've covered earlier. But it really has to come back to core blood sugar regulation. While we're on that

topic, you're not just talking about sugar and high levels of sugar in the diet or in added sugar in the foods that are there. Even for people that consider themselves quite healthy, there's other forms of things that are regularly part of our lifestyle today, even in the world of modern wellness food, that are consistently throwing off our ability to regulate our blood sugar. What were some of the surprising things that you found over the years in putting your books together that act the same as sugar inside the body. Well, that act the same as sugar in the body. Let me just take that back a little bit. And one of the surprising things that I found that really

plays such a central role in blood glucose regulation is a different sugar called fructose. You know, the amount of fructose we are consuming now is, I think, breathtaking, seeing that Table sugar is 50% glucose and 50% fructose. That's what sucrose or table sugar is. But now we're seeing our foods peppered, wrong term, sweetened with what it's called high fructose corn syrup, which might be 52% fructose, but in reality, maybe as high as 90% fructose. Now, the messaging on fructose over the years was, hey, that's a better choice than eating glucose because fructose, unlike glucose, does not elicit this. insulin response that we just spoke about. And while that may be true in the short term, we know that ultimately through its unique metabolism, that fructose is extremely threatening

to the way that insulin works in the body and ultimately leads to elevation of our blood sugar, elevation of our blood pressure, dysregulation of our lipids, increased risk of obesity, increased risk of other metabolic issues. So, you know, we, been told that fructose is a safer sugar. Even the American Diabetes Association did until quite recently recommended fructose as an alternative to glucose or a highly refined carbohydrates in general. So I think we now understand, we'll get to this later, that through its production of something called uric acid, that fructose is a powerful threat for our metabolism, therefore elevation of blood sugar and then this increased risk of insulin resistance that we talked to

talked about just a moment ago. But, you know, I think that we could take this conversation to a lot of places. We can take it to the gut bacteria because we know that the signals sent out by our gut bacteria have a huge role to play in regulating our metabolism. There is well-described changes that can occur in the gut bacteria that paved the way for insulin resistance. And in fact, we know that that is a direct response to the various foods that we eat. But I think, interestingly, we can look at how these changes in our gut bacteria brought on by, for example, consumption of fructose and therefore leading to higher levels of insulin and blood sugar, may have been in our hunter-gather days quite adaptive.

because think about it, when did we eat fructose? When did we have fruit sugar? We had it when the fruit was ripe. And before modern agriculture, fruit is ripe in the late summer, early fall, signaling to us that winter is coming, winter, a time of caloric scarcity. So fructose changes our gut bacteria such that it prepares us for winter because our gut bacteria get the fructose signal and say, hey, winter is coming. We need to change metabolism. here and starts storing fat and reduce the burning of fat so that we keep it around. We actually have to make more glucose, a process called gluconeogenesis. So it's the response that we get from fructose, not only in terms of our gut bacteria,

but also in terms of what has created the downstream metabolism of fructose, which is uric acid. Uric acid is the danger signal saying, winter's coming, not going to be a lot of food. you'd better make fat, you better store fat because you're going to need it if you're going to survive. And we have higher levels of uric acid because of an unique series of mutations that occurred in our primate ancestors 14 to 18 million years ago, whereby we have much higher levels of uric acid. So those ancestors in our primate lineage who had those mutations survived. And now you and I and every other human walk in the planet has an increased production of this uric

acid such that we make fat, we store fat, our blood pressure is at risk for being higher. We develop non-alcoholic fatty liver disease and we develop a dyslipidemia, higher levels of LDL and cholesterol because these were actually protective of us in the day. So what I'm describing then is what is called an evolutionary environmental mismatch, where in our past, these mutations, these changes to our metabolism allowed our survival, but now, because of the different environment being pounded by fructose, day in and day out, lack of restorative sleep, lack of enough exercise, you know, we'll talk about these things, and challenges our genome. And it's really, I think, the fundamental of the so-called paleo movement

that we really need to respect our paleolithic genome and give it the signals that we can control that it wants in order to keep us healthy and allow us to survive, allow us to procreate, and allow us to be disease-resistant. It's such an important point because so many times when people, whether they're in the wellness world or they're just, you know, somebody who's just trying

to live their best life, this is not an area they study, they may not be listening to this podcast, anybody who's dealing with extra fat on their body and has struggled with it for a while, feels that their body is working against them. They feel that there's something wrong with them. They feel like even some cases, I've heard people go to an extreme

and feel like their body is almost punishing them. And what you're really highlighting here is that your body is doing exactly what it was designed to do. It's just we're giving it the wrong signals. It's constantly preparing for winter based on the way that we're eating, living, and going about our modern lives. It reminds me of a story that I was hiking up in Glacier National Park up in Montana,

near and by the border of Canada. And I was with the guide. And she was like, you know, there's this really cool edible berry that I want to show you. And it was about end of September getting ready for snow season, October up there, especially at higher elevation. She said, let's go through this path over here. We went to that path. and the berry bushes were there, but all the berries were gone.

She's like, oh, the bears actually came in and must have eaten all the berries. They're getting ready for hibernation, so they're eating as much fruit as possible because they're going to go hibernate over the winter, and so they need to store all that fat. And so in that same way, we're going around in our diet between the grains that we're eating, the fructose that's in our diet, the severe blood sugar dysregulation, the overproduction of insulin, we are telling our body, winter is coming and we better get. ready. You know, one of the things that, I'm sure you've seen this too, with a lot of people that follow your book, blood sugar, if we look back actually and zoom out at sort of dietary

trends in America, starting first with sort of Alice Waters, you know, the sort of farm to table movement, the rise of sort of vegetarianism in the 60s with sort of the hippie culture and that sort of thing like that. And then coming into now, nowadays, clean eating and then more hyper-focused areas, personalized nutrition, blood sugar regulation and managing your blood sugar is a new concept for a lot of people because we're used to thinking in terms of, you know, good and bad, right? So if somebody's vegetarian, they think, okay, meat, you know, and I'm not, and I know you're not, but just looking from their lens, okay, meat is bad and then this is good, or this is good and this is bad if somebody eats a particular way like gluten-free or whatever

it might be. But blood sugar regulation and paying attention to that, it almost is like, look, any diet can work for you and every diet could also work against you. There's actually a ton of products that are on the market that are called keto that when people are using things like levels, continuous glucose monitor, they're seeing that actually this thing is raising my blood sugar more than anything else that I'm eating right now because it's this processed snack that's there. So I'm very excited and I'd love to get your thoughts on a personal level. You know, as you've been monitoring your own blood sugar and making it make sense for you and your life and your level of activity, have you been surprised at what things might move the needle in the right or the wrong direction when it comes to your own blood sugar management?

Yes. And I think it, you know, more broadly, it is great information. we can all learn personalized medicine for ourselves based upon the input from wearables these days and learn things like I didn't realize cashews were such an issue. And they were for me, for whatever reason, eating cashews bumped up my blood sugar. I also recognized that my blood sugar was not as ideal with not a really good night's sleep. So a lot of correlation between the metrics of my sleep, again, as determined by a wearable and what I would see on my CGM or continuous glucose monitor.

And I think, you know, that's sort of the beauty of what levels is doing is allowing us to to see it in real time and then to make those correlations. But, you know, I think that what is most important is not to define the best diet for everybody. And that's been the trend. Everyone should be vegan. Everyone should be keto. everyone should be paleo. And I think what is more valuable is to define the goals.

What are we trying to achieve with our diets? Certainly, as you well mentioned, that control over blood sugar, keeping blood sugar in check is a certainly valuable goal. If you want to take it further than keeping uric acid in check, keeping other inflammatory markers in check, all well and good, having a diet that caters to the gut bacteria, a diet that's rich in polyphenols, antioxidants, all well and good. But I think these days we have the ability to personally obtain the metrics that can then reveal the value or the threat imposed by the dietary choices that we make. That's the science part. There's a social part to our dietary choices as well, and we leave that up to the individual. But all roads lead to Rome, I mean, we can adopt any of the popular diets and modify them to reach our goals. Like you say, what might have raised my blood sugar,

might not raise your blood sugar. But we can determine that when we're careful. We start doing a little bit of science and understand that we're all different. We all have certainly different genomes. We all live in different places. It's varying times of the year. Seasonality varies across the planet. And perhaps most importantly, aside from our genome, our microbiomes are very different and play are my array and diversity and numbers of organisms living in the gut are really influential in terms of how we interpret the foods that we eat and how it plays out in terms of measurable metrics like blood sugar for example so i think gaining that information through the technology that we have as individuals apart from what we can get in the doctor's office i think is exceedingly

valuable. And it gets back to, you know, an earlier part of our conversation where we were developing, we went somewhere else, but we were developing a dichotomy between just the notion of sort of living your life however that you want and then hoping for an Alzheimer's drug versus really beginning to embrace the notion that our choices have huge impact in terms of our brain's destiny. And that, you know, that's a wedge being good. Ron in our society right now being, you know, really tending to really reveal it how polarized we are that the mainstream would have us believe that, you know, there's another drug down the pike coming soon enough that'll save us all and getting excited about a drug that

slows the progression by 32 percent. That's all well and good. But I am not really interested in a drug that'll slow Alzheimer's progression by 32%. I'm interested in lifestyle approaches that can reverse that problem, for example, and put people back on their feet. And that is, again, in the realm of personalized medicine, what does that individual need? It's much more important to know the person who has the problem rather than understand the problem the person has. You were mentioning the gut bacteria earlier.

I have another question for you on a personal level, because people are always interested And obviously your experience is your own experience. It's not necessarily going to be everybody's experience. But it highlights, again, this theme of personalization. So just as you mentioned, you know, for you, cashews, that was something that you were highlighting. Again, just for you that you've monitored. No, I love them. Yeah, though you love them.

And I'm sure you have them occasionally. And it might just mean less quantity, right? And being aware, is there something on a gut health level that you find doesn't work for you? Like sometimes people see that, you know, even. though certain types of dairies might actually could be beneficial, right, like super high quality dairies or goat's milk or sheep's milk. You know, I personally know for me, yeah, I personally know for me that, you know, dairy, no matter how high the quality, I have to be very careful about the dose because I still am very

reactionary, probably because I was on a lot of antibiotics when I was younger and, you know, decimated a little bit of my gut bacteria. When it comes to your gut health, you know, and we're also eating for our gut, are there foods that you just know that don't sit with you as well, if there are any? I would say that that's more of a cognitive prefrontal choice rather than more of an emotional or a visceral kind of a response. I don't have any real intolerances that I can experience or I have experienced and therefore know that that particular food isn't good for me. You know, my choices come from more of an understanding in terms of the value of a particular food or the threat of a particular food or lifestyle choice or medication, you name it, in terms of the gut bacteria.

Give you an example. Last week, I had surgery on my shoulder and I was given a prescription for an antibiotic to keep the wound from being infected and made sense to me. You know, my career start off in general surgery, then neurosurgery, and that was standard operating practice. So I know what a threat that you just mentioned it, you know, how your early life experience was. I know what a threat that is, you know, antibiotics, though they can save lives and are very important part of our armamentarium, nonetheless, they are weapons of mass microbial destruction in the gut.

And I like to not to take it. And so far so good, I'm four days into it. My wound looks just fine. So I think I'm going to be okay. Do you know, would there have been an upside to taking an antibiotic in terms of reducing risk of infection? Yeah, I would think. But knowing the downside, knowing the risk, knowing the relationship between antibiotic exposure, for example, and the development of type 2 diabetes, well described. In women, antibiotic exposure is associated with an increased risk of breast cancer. We could certainly talk about antibiotics and non-surritoral anti-inflammatories and acid-blocking

medications and a host of others that are directly threatening the gut bacteria. So I think that these are choices that I make less on how it feels to me as opposed to what I understand about the science and then taking that information and getting it out in any possible forum like chatting with you today. That allows me to get information out that, you know, that would be helpful for people in terms of catering to the health and diversity of their gut bacteria. It's really, really important. Matter of fact, interestingly, a study was published this morning that was sent to me by Dr. Stephen Gundry. You may have heard of Dr. Gundry, has done a lot of work on lectins and a terrific guy, cardiologist. And the study had to do

with this very, very primitive tribe that's often studied in Bolivia, where they have what looks to be a very primitive array of bacteria in their gut, microbiome. And it looks like their microbiomes, when it's sequenced, emulates what our ancestors from thousands and thousands of years ago had in their gut. We're actually able to determine that from looking at fossilized poop. We're still able to recover markers that allow us to determine what the bacteria was like. Anyway, the study today said that these people who are infested with all kinds of bacteria, but beyond that, all kinds of worms and other parasites, that they demonstrate larger brains, reduce risk of coronavascular disease, and really preservation of their bodies as they age in comparison.

to age-matched individuals living in modern society. So my point is that, you know, this relationship, we've been talking about since we started today, this relationship between what our gut bacteria are doing and, you know, and their diversity, what we, is huge and extremely valuable. We're just beginning to understand it and therefore be able to tap into it as another powerful tool in the toolbox. I interviewed a Dr. Molly Fox several years ago, a researcher who in 2013 published a report that correlated Alzheimer's risk with what's called hygiene, basically. And the marker of hygiene was looking at how many parasites were in the gut. Those countries, she looked at

100 countries around the world, those countries around the world that had poor hygiene, as evidenced by, higher levels of parasites in the gut had the very lowest risk of Alzheimer's, countries with great hygiene, you know, countries in Northern Europe, the United States, etc., that are very much invested in hygiene, keeping us sterile, keeping us clean, keeping our kids from playing in the dirt, had the highest levels of Alzheimer's. A correlation, certainly back in 2013, just a correlation, though I've interviewed her more recently. And now that we understand mechanisms whereby the gut bacteria are regulating what we've been talking about, our blood sugar, regulating the set point of inflammation, regulating autoimmunity, I think it becomes extremely valuable information as you relate to the understanding the relationship moving forward and what we can do about it between the gut and the brain. Yeah, and it really upends a lot of these thoughts that, you know, all parasites.

are bad. Some of them can help produce additional mucus lining in a positive way in our gut bacteria and have been used, especially studied in places like Israel for treating autoimmune and other type of food sensitivities. It's a whole new field that I'm excited to learn more about. But what is the takeaway from those groups? You know, it's not that we want to go and necessarily be unhygienic in our life on purpose and that sort of thing. But we do maybe want to not be worried about the dirt in this over, especially in coronavirus sort of times, a big review coming out of Harvard's school of building sciences. I forgot the exact name, but showing that there's really no documented cases of coronavirus spreading through surfaces. And everybody was completely

disinfecting all these surfaces. You go out in the early days, you see all these parents carrying hand sanitizer, putting it over all around their kids, killing all their good bacteria. How are ways that we can take the findings of that study, that review that Dr. Gundry sends you and incorporate into our lives, like very practical ways that we can start to practice that in our lives? I think the first thing would be to recognize what are the choices that we make that threaten our gut bacteria. So we've talked about, for example, medications, drugs that are so capriciously prescribed these days, like antibiotics when you come in with a sniffle. You know, you're going to need some antibiotics.

And, you know, beyond that, what's available without a prescription, like the non-stearroidal inflammatory drugs, ibuprofen, and the acid blocking drugs that, you know, Larry the cable guy would tell us we should be taking every time we have an upset stomach. There is wonderful research published in the journal Stroke that relates a utilization of these acid-blocking drugs to higher risk of stroke and higher risk of Alzheimer's disease by significant numbers. And why might that be? Well, we know that there might be some pH or acidity issues related to changing the, you know,

taking an acid-blocking drug. But beyond that, but perhaps related to changing in pH. even a subtle change in pH imparts dramatic changes in the diversity of the bacteria in the gut, favoring some to live, some to die. And, you know, there are gut bacteria that are so important for our health and our survival, our immune function. I had an interesting chat not too long ago, maybe two weeks ago with Dr. Stephanie Seneff at MIT about how glyphosur, which is an herbicide sprayed on so much of our food these days to kill weeds in the field to allow the soybean to grow and sprayed around our homes, not our home, but other people spray

it. You know, city sprays it on the sidewalks. Parks where children play. Gee, I should stop. But how glyphosate tends to weed out. What a term. The tends to favor the overgrowth of so-called bad bacteria and comprehensive. compromises the good bacteria, compromises bacteria that do good things like make B vitamins that

maintain this mucous lining that you referred to a few moments ago that is so valuable in terms of maintaining the integrity of the gut lining such that glyphosate exposure then sets the state for leakiness of the gut, which is absolutely what we don't want if we want to have an adequate function of our immune system and regulate inflammation. As a matter of fact, it does matter. It matters a whole heck of lots. I think the keys to the kingdom really focus on A, what do we do to preserve a healthy microbiome? And so it's identifying, well, where are the threats coming from. Threats are coming from these medications, from chlorination in our water, from we can threaten our microbiome based obviously upon our food choices, not having

enough of fiber. Our gut bacteria need fiber that nurtures them. We call that prebiotic fiber. So favoring those foods, higher in prebiotic fiber is a good choice. Onions, garlic, leeks, avocado, these are all sources of good fiber. There are nutritional supplements that can give us good prebiotic fiber that are made from things like the acacia tree or baobab fruit and others that nurture the gut bacteria. And beyond that, just recognizing that all of our lifestyle choices are seen through the lens of the microbiome, whether we've gotten a restorative night's sleep, whether we are experiencing higher levels of stress. What is that stress hormone? Well, it's cortisol.

What is the effect then of cortisol elevation on the gut? Well, it's traumatic. Cortisol favors the overgrowth of certain organisms, including yeast, that, you know, that, are disruptive to the balance of the gut bacteria and directly threatens the integrity of the gut lining. Then it feeds back on the brain and is somewhat threatening to the neurons, the brain cells in the brain's hippocampus, and therefore ultimately it takes away the control over what's called the hypothalamic pituitary adrenal axis and leads to, you guessed it, higher levels of cortisol yet again, again threatening the gut bacteria. So, you know,

It's comprehensive. Take away the bad things, help to put back the good things. But I think the take-home message here is to just embrace the incredible role that these bacteria and other species are playing in the gut in terms of regulating so many important aspects of our lives, whether it's our metabolism, whether it's our mood, whether it's our brain functionality moment-to-moment, immune system, that's for sure. Even our gene expression to some degree is regulated by some of the products manufactured like short-chain fatty acids by the very bacteria that live within the gut. You know, you mentioned we've talked about how the things that harm the gut and the things that you're mindful of, and you just went through a whole list of toxins, you know, being mindful of antibiotics, etc. How do you think about diversity in the gut? It seems to be from everything that we're seeing so far, that diversity in our bacteria is strongly linked to diversity in our diet, especially of these polyphenols that you hinted at earlier. So how do you approach your life? You know,

in the past, our hunter-gatherer ancestors, they just ate seasonally in what was available. So they had a natural wave of diversity in their grocery store of nature. They would just go out and they would, you know, see things and eat them and it would change all the time. In our modern world, where we all get caught in habits, how do you approach diversity in your own life? Let me just break that term down a little bit and then allow me, if you will, to broaden it in its scope. So while we're talking about diversity, the various species that live within the gut, diversity begets resilience. We certainly see it in the Amazon rainforest. The more diverse, the flora and fauna, the more resistant the Amazon rainforest is to

environmental insult. And so it is with our gut. The more diverse organism we have, the more we are able to respond to various unforeseen challenges that are certainly part of our day-to-day lives. So diversity makes for resilience. And I think these days that's a comment that I will make in terms of our society, that we need to embrace the diversity of each and every one of us, that everybody has unique skills, unique talent, unique faults. And we certainly look different. Everybody looks different, whether people are taller, smaller, have different skin tones, whatever it may be.

The diversity of humanity allows us to be resilient. We should start to embrace that notion. But let's get back to the gut and recognize that, you know, the food, as you mentioned, play such a role. And what I do, what we do, is go for as much. in terms of variations in color on the plate as we possibly can. Yellow foods, very few white foods, lots of purple, deep color is good. Orange, of course, is good, so that relates to things like squash and carrots. We just harvested some carrots last night from our garden. And they were the

biggest carrots, I think I've ever seen. But that said, I think that, again, you know, looking at the foods that are threatening, we've talked about that, but diversity in terms of color is an easy way So that's really an important goal for us. Most of what I consume and my wife and I consume these days is plant-based. I do, we do eat some animal products, yes. But I think that over the years we've become more and more plant-based as organic as possible, which is pretty much close to 100%. Traveling from A to B makes that a challenge.

But once we get to be, wherever that may be, you know, doing our very best again to resists. resume an organic diet. We live on a boat for many months out of the year. And so we actually grow some vegetables on the boat, but we have learned ways of getting organic vegetables. And, you know, it's a challenge these days. I was thinking, you know, one day I was thinking about my dad and and I was thinking, you know, gosh, you know, for us to get organic vegetables is pretty easy today and we can go to a, you know, a market and there's organic vegetables. I wonder how it was when he was young. And then I realized that when he was young, all vegetables were organic. You know, the 1930s and 1940s before we started spraying poison on our food, everything was

organic, as it has always, always been until just a blink of an eye. And we have no sense in terms of what these toxins to which we are exposed can do and is doing to us. In terms of even the very simple nuance of how it changes our gut bacteria. We certainly know, again, through the work of Dr. Stephanie Seneff, that there are some obvious and important changes that take place getting back to the gut bacteria and downstream effects from that. That may play out as pathology, that may partially explain the increased rates of autoimmune conditions around the world and certainly seen to correlate with countries that have higher usage of glyphosate and things like autism. That represents a bit of an immune issue and certainly has some play in terms of the changes

that are seen in the array of gut bacteria and perhaps more importantly, as per the work of Dr. Derek McFaib, the products of those bacteria, the ratios of the short chain fatty acids that are produced can clearly affect the brain, at least in laboratory, a research that he's conducted. So a clarification on just something that you mentioned earlier, you said most of your diet today, yourselves, and your wife is plant-based. And just for the people that are listening that are looking for a little bit more, you know, of an understanding of that, is it that by volume or by calories, right, just using calories

as a traditional sort of marker, is your diet mostly plant-based? And then also sort of a follow-up to that is that, did that change comparatively to how you ate, let's say, even five years ago? You know, the truth is I don't think it's changed that dramatically, let's say, over the past five years. Grain Brain, when that came out, people thought that the diet that we were recommending was basically Adkins Redux, that, you know, this is the next go-around of bacon and, you know, all kinds of meat.

And it never was. Even then we were discussing the very important role of, you know, plant-based foods in human diet. So I'm not going to tell you that I calorie count. So I would not be able to give you an answer in terms of where most of our calories are coming from. I'd say probably most of our calories are coming from fat. I'd say probably a good 70% of our calories come from fat. The added fat nerd diets from things like avocados, olive oil,

avocado oil, nuts and seeds. So, you know, I think most of the vegetables that we are consuming are not really adding calories per se. And so, you know, but I've never really been involved in calorie counting, at least not in the past three decades, and wondering where the calories are coming from. You know, the notion of calories in versus calories out is the most important metric for weight loss or weight gain. I think that's primitive and obviously has been refuted. I think We have to understand that our foods have huge effects on our metabolism and our signals. Foods is information. And higher calorie fructose containing foods, as we just talked about, is informing our bodies that a time of caloric scarcity is coming.

Winter is coming. So that's what you tell your body when you consume things like fructose. The amount of meat we consume is minimal. Seafood has actually been reduced, especially the, those types of seafood that may be high in purines. Purines also increase what we talked about earlier uric acid. So that would be anchovies, sardines, things like mackerel, smaller fish, scallops. Those will raise, they have high levels of purines. Purines are a degradation product from both DNA and RNA. And those foods that are dense in DNA and RNA tend to have higher levels

of purines and will ultimately raise the uric acid level. That is a metabolic signal telling, again, like fructose that winter's coming, make fat, become insulin resistant, raise your blood pressure, not what you want, all through the mechanism of uric acid. So, you know, fish, great, but I'm just certainly not eating as much as before. I still eat eggs. I think eggs are a good food. I had a wonderful a chat with Dean and Aisha Sherzai, who have a new book out about eating a 30-day plant for Alzheimer's risk reduction, terrific book, and wonderful people. But our dietary recommendations are slightly different. I mean, they're full-on vegan. And I think that is a very healthy approach to living. Certainly from a planetary perspective makes a lot of sense. But there are some

provisos as there are with any diet. The proviso, in that diet would be to keep an eye on trace minerals, things like magnesium, zinc, also vitamin B12, and make sure you have some source of the omega-3 fatty acids. You know, being full-on keto has its upsides as well, provisos there. Keto people tend to not eat as much dietary fiber because it is a, quote, carbohydrate, and therefore that is something they would want to consider in terms of supplementing. A paleo, I think, can get away from people thinking that all meat is good, and we don't subscribe to the notion of processed, cured meats being a reasonable choice, a health food, and certainly

foods, as mentioned, high impurines through their metabolism into uric acid would be something to keep an eye on. So, again, it's not the diet per se. It's the goal. And I think as we move forward, Drew, to refine the goal, whether it is reducing inflammation or bringing blood sugar under control, you know, where do we want to go? We can get there. There are many roads leading to the place? And feel free to take any road you want. But I think it's important to define what is the goal, what are you trying to achieve, and then work in a way that's comfortable for you, may not work for me, but we want to arrive at the same place. You know, you share this term uric acid. And also in the beginning of the interview when we were chit-chatting a little bit before we started, you mentioned that you have a new book coming out and have you back on to talk about all the

research that you have. And that book is primarily focused on this component of uric acid. I think that's going to be newer for some of our audience, even if they've heard of it, and more so the implications. Traditionally, especially in the world of functional medicine, primarily because there was some concerns about when it came to seafood and fish, most of the approach. was, hey, let's stick to the smaller fishes because they're going to be lower on the food chain. They're going to build up less mercury, less pollutants, and also less plastics in the ocean.

And we know microplastics are a big issue. And now you're sharing that you've minimized some of the smaller fishes. I think the term often used was smash fish, sardines, mackerel, anchovies, you know, sometimes, basically the rule of thumb that even Dr. Hyman talks about today, and that's the beauty of nutrition science, is that it's always a discussion, it's always evolving, and it's always about personalizing it for you, is he would recommend, you know, if it can fit on a pan, it's probably a better option. So give us the, just refresh us on the Uric acid concept and how also we can pay attention to it. Is this something that people need to be testing for inside of their own

bodies and how closely should we be watching it and paying attention to it? We've known that fructose is a threat and known it for a long time. But, you know, when you ask your health care practitioner, well, why is fructose such an issue? Well, just because it is. In other words, we haven't really unpacked the mechanism and now we have. We know that, you know, one of the important ways that fructose poses a threat is through its ultimate metabolism to uric acid. It's a unique metabolic pathway that is unlike how we use glucose. And so fructose becomes uric acid, as do these purines, these breakdown products from the DNA

and RNA contain in the very types of fish that you described. Uric acid is a signal. It is a powerful signal telling us winter's coming, make and store fat, become insulin resistant, blood pressure goes up because we may not have enough salt to keep our blood pressure elevated, and it helps keep fluid in the body because we may become dehydrated. So we've just begun to understand through the incredible research of a Dr. Richard Johnson at the University of Colorado. He began his work in 1999, looking at uric acid, but it turns out that in the very late 19th century, a Dr. Alexander Haig published a series of monographs and later a book that correlated uric acid to these maladies I've just talked to you about. He added in things

like headache. At that time, we were beginning to get an understanding that uric acid was related to gout. These days, people embrace that high uric acid might set the stage for gout or kidney stones. And it is in that context that most of the discussion of uric acid is had. Having said that, however, most people who go to the doctor, let's say for an annual examination, get some blood work done, aside from some of the cool things that you're in touch with in terms of blood testing, the normal standard panel that people get that looks at their liver functions, thyroid, blood count, et cetera, generally includes a uric acid level. So therefore, you can get a sense as to what your uric acid is by calling up your doctor's

office, say, hey, by the way, what was it last year? That said, again, recognize that most healthcare practitioners are only looking at uric acid again in the context of gout and kidney stones. But we now understand a powerful relationship between uric acid and all-cause mortality, between uric acid and cardiovascular disease and cardiovascular mortality. In other words, dying from a cardiac event, a strong correlation between uric acid and directly to blood pressure in both adults and even add. adolescence and even body weight. We know that one of the mechanisms whereby uric acid does its damage,

one of the fundamental mechanisms, is it inhibits the production of something called nitric oxide in the blood vessel, and that has effects in terms of not allowing blood vessels to open up and allow more blood flow to things like the kidney. It also compromises the way insulin is able to get out of the bloodstream and into cells, particularly muscle cells, where insulin works to bring glucose in and help make glycogen. So we're teasing apart some of these important mechanisms of a nitric oxide, but it's like kind of taking the cloudiness off the glass,

and we're now starting to see this all become revealed. And it's, again, an interesting story how this increase in uric acid, that we as humans have in comparison to other mammals, but we have it and great apes have it, was really selected out as an adaptive mechanism, 14 to 18 million years ago during an ice age or a period of succession of ice ages that were periods during which our food supply was reduced, allowed us to survive and pass on that new genetic array

whereby we don't have uricase, the enzyme to break down uric acid. Therefore, it accumulates in our bodies. So we stay away from fructose. We stay away from Hyperion food. We realize that things like quercetin and vitamin C and luteolin, for example, are powerful inhibitors of an enzyme called xanthine oxidase. That is the enzyme that manufactures uric acid in the body and therefore can target. we can use this to target our elevation of uric acid by adding these to the program, a tart cherry extract as well, works to inhibit our body's production of uric acid, very valuable.

You know, when you look at research whereby researchers are now using pharmaceuticals, like a drug called alopurinol, formerly only looked upon as a gout medicine, but alipurinol, like luteolin, like quercetin, like vitamin C, inhibits that enzyme. It's a drug that inhibits the enzyme that makes uric acid. Researchers are now using alipurinol and finding that when they inhibit the production of uric acid, it leads to lowering of blood pressure. That's profound because it really insinuates this mechanism in terms of being front and center in terms of what elevates blood pressure, especially in adolescence. So it's very, empowering to learn this about uric acid. So, yeah, you know, your doctor can check it, easily done.

He or she may not embrace the notion of its widespread implications in terms of health, but that's okay. They'll come along. And, you know, there was a time when you would ask a doctor for a C-reactor protein. They would say, well, why? I want to know my homocysteine level. What in the world is that? And why do you care? Well, because we're reaching a time where the consumer understands why these things matter and is taking things into their own hands. And I think that's a great thing, that you don't have to be a diabetic moving forward to understand, to be able to check your own blood sugar at home. And that's great information, to check your own ketone level at home. You know, we all do that, right? But now we know you can go on Amazon or wherever you want,

buy a uric acid kit and check your uric acid levels. Mine last night was 4.4. We want to keep uric acid levels below 5.5 milligrams per deciliter. In other countries, the units are different. The numbers are different. But here in America, it's milligrams per deciliter. That's what you'll get at the doctor's office. It's what you'll get when you buy a kit to measure it at home. So that's empowering to be able to measure your uric acid level at home and know, do you need to work at it? You need to add a little quercetin, some tart cherry, some more vitamin C, maybe some Ludiolan. Do you want to eat foods higher in Ludiolan like onions? Do you eat too much fructose?

Are you having a high purine diet? All things that are important in this new metric that I think is really going to take hold. I think there was a time that we've been talking about keto now for a number of years being important. Blood sugar is so important. I think that people like Dr. Richard Johnson have really helped get the word out that uric acid is a player. And it's a player that is in our toolbox for each of us, whether, you know, mainstream medicine is coming along with that or not. I mean, you know, figure it out. You go to your mainstream doctors say, you know, I've heard some good things about being on a keto diet.

And generally, you know, that's not something he or she's going to embrace. Similarly, we're going to see that happen with the uric acid story because there's so much research that underlies it these days. It's so supportive. Well, I'm glad that you are bringing that story, and we know that it often takes years. One study found that it can take 12 to 17 years before these concepts that are in the research, in the emerging research, end up getting applied, and that's probably even being generous to, you know, hospital level or physician, average physician level.

even though those individuals are well-intentioned, well-meaningful, they can't stay on top of the latest science studies. Well, Drew, that is provided you're looking at the old paradigm. And what is the old paradigm? That somebody comes up with an idea, performs some research in the laboratory on animals, publishes that research, it's accepted, then designs a phase one human clinical trial that has to pass an institutional review board, IRB approval. and then phase two and then phase three all along publishing the research, having it accepted,

and then ultimately applying that, you know, after phase three showing not only efficacy but safety, then some drug company thinking that there's got to be some profitability here, developing something that correlates with these findings and then releases that into the market. That's the old model, and that could take as long as 20 years. You're correct. But I think that model is being challenged gratefully and is being consumer driven. As consumers gain more and more information, they're driving this rapid explosion in implementation based upon ideas and based upon their level of confidence in what it is

that they're hearing. And so therefore, you know, we don't have to wait for the, the majority of clinicians around the country to finally realize the importance of something, for example, like uric acid before consumers can implement these changes into their day-to-day lives. You know, again, think of how many people finally get the fact that even though I'm not diabetic, my blood sugar is still really important. That's part of the narrative in our community these days.

And yet, you know, you go to your doctor, you have 105 fasting blood sugar in an A1C, that's 6.4, and he or she's going to say, hey, you're not diabetic yet. So everything's cool. Keep doing what you're doing. And if you become diabetic, then we'll give you a medicine. Yeah, it's not bad enough. In our community, that isn't working anymore. And so I think that whole notion of 20 years is really being challenged gratefully. Well, we know that blood sugar is changing all the time. For uric acid, how long in between, just clarifying point, as you had mentioned, you can call the doctor's office or you can order these kits that are available, how frequently and what spread is it changing or what would be your

recommendation? If you're trying to improve it and you're making these lifestyle changes, how long should you wait to retest? So I think in terms of your cast a couple of points. First, I think checking it at the same time of day will be important. And that would be in the morning and that would be prior to eating and engaging activity. I think the night before it would be good not to have engaged in or the day before some really vigorous physical activity. When you break down muscle by aggressive exercise, that'll raise uric acid. And I think the night before it would be reasonable to have not consumed alcohol, because alcohol, like fructose, is metabolized into uric acid. So again, first thing in the morning, and keep in mind that fasting, prolonged fasting, will raise

uric acid as well. So try to keep these variables constant. And I would say testing every two weeks to every one month would be reasonable. And finally, I think a good recommendation would be to cross-check your home testing uric acid kit with a bona fide blood test done at your doctor's office just to make sure that we're talking apples and apples and that, you know, what they get is pretty much like what you'd get with your home testing kit. I have found my home kit to be very reliable. And then, you know, the modifications that you make over time will play out in terms of your uric acid, just like people have done with their fingerstick check for ketones, beta-hydroctobuterate, and even blood sugar. I believe there's going to become a time.

There's going to come a time in the future when we will have the ability to look at our CGMs and get a readout on uric acid as well. So just like you look at your smartphone and know what your blood sugar is right this minute, so too will you be able to look at your phone and get a uric acid measurement without having to stick yourself. I'm not keen on the finger stick. Never have been. I play guitar. I don't want to damage my fingertips if I don't have to. But there are ways of doing it that I've learned that are almost painless and can get the job done. One little trick for your viewers is I tend to do the finger stick under a fingernail, like a thumbnail. And I don't really feel as much when I do that as opposed to just at the tip of the finger,

and that seems to work. That's a great suggestion. So you mentioned quercetin, vitamin C, tart cherry, those things being supportive in getting that uric acid number down. We talked about high purine, right? Puring was the term that you used, you know, the foods that we want to stay away from. But if you had a rank in order of category of food or either specific types of classifications that are most going to be concerns when it comes to uric acid.

If you would give us a top five, what would you list at the top, just so that everybody has it here, and it's a takeaway that they could put out there? I think probably number one, two, and three would be fructose. Fructose, and fructose. Below that would be purines, depending on the person, and then alcohol. By and large, if you look at the pathway, about two-thirds of the pathway in modern humans, is being used to create uric acid from fructose. You know, fructose is a major player these days.

We know that close to 70% of the more than 2 million foods that are found, find themselves on the grocery store shelves, those that carry a barcode, in other words, packaged, contain added sweetener, and most of that is fructose derived via very inexpensive high fructose corn syrup that increases the fructose corn syrup. that increases the fructose content of the sweetener. Why? Because it's cheap and fructose is much sweeter than glucose. So table sugar, 50-50, glucose fructose, is, you know, being challenged with higher levels

of fructose because it's sweeter. You can use less and it's cheaper through, you know, the manufacture of high fructose corn syrup, obviously from corn, but from other sources as well. So, you know, by and large, get away from sweet foods, get away from package. foods. There are some sweeteners like allulose, for example, which oddly enough is an isomer of fructose that is not metabolized as fructose is. It doesn't raise uric acid. It doesn't lead to fatty acid, I mean fatty accumulation in the liver doesn't lead to insulin resistance. It doesn't lead to, I mentioned uric acid increase, doesn't challenge our leptin and

ghrelin control mechanisms for our appetite. So, you know, alulose seems to be a reasonable choice. in terms of a sweetener. But, you know, by and large, it's good to kind of get away from catering and being responsive to or at the mercy, if you will, of our sweet tooth day in and day out. That comes from a more primitive brain center speaking to us as a survival mechanism. Nobody on the planet, you would ask, would tell you they don't have a sweet tooth. You know, when I lecture, I say, okay, how many, raise your hand if you don't have a sweet tooth. No hands go up. And it's true. Everybody has a sweet tooth. Everybody has a sweet tooth. sweet tooth. It's hardwired in. But we can override that primitive desire as we rein in our other

primitive desires day in and day out and realize that, okay, I think I would like to eat the chocolate cake, but in the long run, even in the short run, it's not good for me. It's not good for my metabolism. It threatens my gut bacteria. You name it. We can figure out the rationality. So we are able to override that. And the more we can. to our sweet tooth, the less easy it becomes to override it. So use alulose, use perhaps some monk fruit or Steve if need be. But I think getting away from really thinking that it's a treat to have sweets is the way to, we ought to go. Yeah, whether with York Asick or where we're talking about blood sugar, you know, the beautiful thing of if you can measure these things, if you can use

something like a continuous glucose monitor, and you have your baseline is at a pretty good place, then you truly have metabolic flexibility because I know your work and I've seen you talk about this for it. This isn't about eating quote unquote if somebody's listening here perfect all the time. It's actually just knowing your baseline. Then when you know your baseline, if you so choose to have a glass of wine, you know, occasionally with friends and you're on a boat somewhere as you were referencing your boat earlier or if you choose to have a piece of chocolate cake because you're enjoying it for somebody's birthday. You have that metabolic flexibility because your baseline, you know where your baseline is, and you also know how you feel, how your sleep shows up when you

are at your baseline. So it's okay. And it's not even a cheat day, you know, it's not a, it's not a cheat day. It's just you get a chance to enjoy it and you've, you appreciate and you love your baseline so much. You're like, okay, great. I had a little taste and I'm back to my normal world. And it's not about good and it's not about bad. It's just about feeling great. So on that note, any comments about that? And when you do go out, like, do you have some, you know, wine every so often? Do you have the sugar every so often? You bet. I think the big word I didn't hear you say is guilt. And we got to offload the guilt. I mean, you can deserve a glass of wine. I, gosh, you know, we go out to dinner. I'm definitely quite likely to have a glass of wine.

Less lately, and it's not because of the deserving or whatever. I just don't feel well. I don't tolerate wine or any type of alcohol like I used to. So for whatever reason, I'm becoming a lightweight. But, you know, the birthday, the thing is they can get away from people. Because, you know, you look at the calendar, and it's always something. It's always somebody's birthday or anniversary or some public holiday, whatever it is. Canada Day, you name it, it's something.

So, you know, I think we have to rein it in. Some people talk about the 80-20 rule, and I think that's, in my world, way too generous. I mean, I don't want to eat 80% good food and 20% crappy food because it's 20% crappy food that's going to get you into trouble. And you don't need to eat a lot of those threatening foods to have issues. It doesn't take a lot. I mean, you know, a Coke, not going to happen. You know, glass of fruit juice, that's not going to happen.

my world because, you know, that's coming from my higher brain that's really understands what fruit juice or sugar sweeten beverages do. I mean, I live and breathe it, so I know how threatening it is. You know, my dad died of Alzheimer's. And so I don't want to do that to my kids, nor do I particularly want to go through that. I don't want to die of the various things that are preventable by living the lifestyle that we talk about, and I'm not perfect. I assure you. And I think you're really getting at something I think that's important and is fundamental. And that is we have to walk the talk. As we stand before people and talk about what matters, we have to walk the talk. But at the same time, I think the message that no one is 100% is

really valuable. Do I miss days when I should go running? I do take a day off once a week. But, you know, frankly, I think that's actually a good thing. Have I stayed up late and binge watched something on Netflix with my wife? Yeah. And did I feel it the next day? I did. But did I enjoy it. Then I finally figure out how it ended. Of course. So, you know, there are things that we know are not necessarily our best choices. But, you know, it's all about balance. It's all about balance. And then finding what that personal balance is for you and then continuing to evolve it, you know. like you said, you've mostly focused on teaching the same message over a period of time with small little tweaks. But when you came across new information, when you came across additional research and it made sense to you or you were getting it from a trusted source, you were willing to say, okay, let me try this.

Let me explore this a little bit further and take it on and see if I noticed the difference. That's the beauty of it for largely a lot of these lifestyle interventions that we're talking about here. You know, there's not the side effects that are going to be the different. there. So you can try them and you can put yourself on a protocol and a challenge and see, wow, how much better do I sleep if I just don't have alcohol this month, you know, compared to before where somebody might have, you know, a glass of wine a week. So those are, that sort of challenging yourself and trying out those protocols is so important. And we can

do that, you know, today with all the great information. I, I want to get a chance to just come back. As we're wrapping up here, you know, we started this interview primarily going from, you know, the latest research that's out there in the space of Alzheimer's and how diet is a central factor in that primarily because of this component of blood sugar regulation and the impact that has on a whole host of things. But as you alluded to, there's a lot of other areas in Dr. Bredison's research and some of the work that you've put together that also play a role. You know, these different pillars like toxins, you know, environmental factors, sometimes mold in the house, stress levels, the amount of community and love that you have and actually you and your team made a whole

docu-series on this exact topic called the Science of Prevention. Just give us the high level on some of the episodes that you cover there. And for anybody that wants to sign up and watch that, we have the link inside the show notes. But I think it's worth touching on because we spent so much attention on diet, which is well-needed, but there's these other pillars that also relate to Alzheimer's and cognitive decline. Again, there are a lot of inputs that are important. And so we created the docu series Alzheimer's The Science of Prevention, whereby we got the expert in each area to then present why that information is really relevant in an Alzheimer's prevention program. I mean, I had to pause because Alzheimer's prevention, I mean, even the notion that here's this disease affecting six million Americans that is by and large,

preventable. And yet, you know, people kind of assume that, oh, if I get it, I get it. If mom had it, I got it. And that's the way it goes. There'll be a drug, hopefully, or not. But our lifestyle choices are incalculable in terms of their value to keep our brains healthy, functional, and disease-resistant, including Alzheimer's. So we looked at sleep. We looked at exercise. We certainly looked at that. We looked at stress. We looked at all these factors with, you know, experts who are spending their lives researching the importance of these areas. We looked at the ability that our brains have to regenerate themselves through what is called neurogenesis and neuroplasticity with Dr. Michael Mersenick. As you mentioned, we did interview Dr. Dale Bredesen as well.

You know, wonderful contributors who really bring information that's based on the best science available, but is presented in a way that you can then leverage that information. Okay, I get it. Maybe I didn't understand everything that he or she said, but at the end, I walk people through, okay, you heard that maybe a bit complicated, but here's what it means for you in terms of what you should be doing now. And it means, for example, that you darn well better pay attention to how long and how well you are sleeping as an example. I mean, who knows? How do you know how you're sleeping. Well, you wear a wearable device. And in the morning, it tells you that last night you got this much deep sleep, which is important for cleaning the brain out, if you will, this much REM sleep that

consolidates our experiences into memories, how long it took to fall asleep, how long you were asleep, etc. As an example. So I think, you know, the purpose then of this presentation is to, yeah, present the data where we are today. But more importantly, then, what do you do with it? What does each person take away from that in terms of, okay, I get it? And what do I change? So, you know, that's, that's so important that we step these concepts down to a place of understanding, but also to a place of being actionable by the viewer. It's so true. And really that, you know, not, you have written some fantastic books and I hope everybody goes out and gets some of your books because they're just really great and everybody consumes information a little bit differently.

Sometimes I find that when somebody listens to a podcast and they get a deep understanding in a way that is maybe a format that works for them, video or audio, then they get excited to go read the book or dive deeper into a subject. And I think the Alzheimer's Science of Prevention is just such a well-told story. It's engaging. It feels like you're watching a documentary instead of binging, binge watching. something on Netflix, you know, you can binge watch this and you really leave with the sense of hope. If this is a subject that you care about, if this is a subject that you're worried about

because we know that Alzheimer's, cognitive decline, dementia are some of the scariest diseases to people that are out there. You know, losing your mind and feeling like you don't know who you are is super scary, even sometimes more scarier than cancer on these global surveys that are being done that are out there. So you watch this and you leave with a sense of hope and that's what you've been giving to people for years, Dr. Perlmutter, and I just want to acknowledge you for that, for being the voice that continues to remind people that they're not a victim of disease. They're not a victim of the processed food industry. They can take back control and they can begin to make changes today. So thank you for being here. Any other places that you want to send

our audience to check out? You have a new podcast that just launched. I would love to give that some Well, we've, we've, our podcast has been out for a number of years, the empowering neurologist, but we've, we've stepped up our technology and, you know, old habits I hard, but my team talked me into a new studio and all the things. So getting some wonderful new guests and really having a good time with that. And gosh, I love it because I'm learning so much by talking to some really incredible people. So yeah, it's called the Empowering Neurologist. It's on Dr.perlmutter.com. my website. It's also available on YouTube and, you know, multiple other places. So, and, but let me just say to you, thank you for having me today. I always enjoy our time together. Your, your questions

and your interest, it's really encouraging and really, I love the places where we go. We really explore some things in depth, and it's a lot of fun. Well, it's super fun for me, too. So again, thank you, Dr. Pellman, we'll have links for all those inside of the show notes that you can find and to your social media. It was a pleasure to have you on, and I can't wait to have you back for your next book so we can dive deep into that. Looking forward to it. Thanks again.