The Dr. Hyman Show - How to Prevent Alzheimer’s with Your Fork with Dr. David Perlmutter

Episode Date: April 3, 2019

Every time we eat, we have a chance to boost our brain function. In medical school, we’re taught the brain is immutable, that we can’t grow new brain cells or change the brain once dysfunction or injury has occurred. Now, we know that’s just not true. The decisions we make each and every day, like what we eat, how much sleep we get, and how often we move are all steps that can dramatically shift the health of the brain for the better. And there’s so much more we can do, too. Dr. David Perlmutter joins me on this week’s episode of The Doctor’s Farmacy to talk about an empowered approach to supporting the brain, starting with food first. Dr. Perlmutter is a board-certified neurologist and four-time New York Times best selling author. He serves on the Board of Directors and is a Fellow of the American College of Nutrition and as a member of the Editorial Board for the Journal of Alzheimer’s Disease. His books include the #1 New York Times bestseller Grain Brain, The Surprising Truth About Wheat, Carbs and Sugar, with over 1 million copies in print. He is the editor of the upcoming collection The Microbiome and the Brain that will be authored by top experts in the field and will be published in 2019 by CRC Press. Dr. Perlmutter’s new book, Brain Wash, co-written with Austin Perlmutter, MD, will be published in January 2020.

Welcome to the doctor's pharmacy. I'm Dr. Mark Hyman and that's pharmacy with an F, F-A-R-M-A-C-Y, a place for conversations that matter and today's conversation will matter to all of you because it's with my friend and colleague and groundbreaking neurologist, David Perlmutter, who you may know from the Grain Brain. He is a board certified neurologified neurologist, four-time New York Times bestselling author. He's got his MD from University of Miami. He's had many awards. He has been on the editorial board of the Journal of Alzheimer's Disease. He's published

extensively in peer-reviewed journals, including Archives of Neurology and a lot of other great journals. He lectures all over the world, including the World Bank, Columbia University, Scripps, NYU, Harvard, a few second-rate institutions there. And he has published some amazing books. In fact, they guided me in my early practice as a functioning medicine doctor, one that was called Better Brain. That was, I think, might have been the first one. I don't know if it was self-published, but it was a great book. And then Grain Brain just hit the world by storm. It's the surprising truth about wheat, carbs, and sugar with over a million copies in print. And he wrote another book about the gut and the brain called Brain Makers, which is also a very fascinating book.

He is really an extraordinary guy and is coming up with a new book called Brainwash, written with his son, Austin Promutter, who's also a doctor, about the role of social media and the constant stresses on our brain and what they're doing to our brain and our world. So I am so thrilled to have you here, David. Thank you for joining us on The Doctor's Pharmacy. Well, I'm delighted to be here. And, you know, the book was Brain Maker, but Brain Maker actually makes me think about the gut bacteria more, that they're building the brain. So I appreciate that. It's true. My wife's a stand-up comedian.

That's one of her many skills. And she was recently going to do a skit on how her depression was caused by her gut microbes and how it wasn't that she was depressed because of some psychological reason. It was because there were these bugs in her gut that were causing depression in fact we had a very interesting experience recently uh just to talk about that for a minute where she uh was with our friend alberto volaldo who's a shaman in chile and he taught her how to make saccharomyces using raspberries you cook up the raspberries you put the probiotic on there, and then you eat it. Well, we did it down there. It was great.

But when she came back, she took it and she got severely depressed, like unusually physically depressed. And it was because she was eating a cocktail that she made that didn't turn out right. There was something wrong with it. And it had a huge effect on her mood. So yes, actually, your brain makers is what's going on in there. Dr. Emmett Mayer actually wrote a book about it and really brought to our attention the role that our gut bacteria are playing in mood, in how well our brains are working and

how well our immune systems are working. So it's a bit of a revelation. It's pretty amazing. Now, David, you and I go back a long time. We do. 25 years maybe even uh and i i was trying to be earlier but i was i was so impressed by you and you were so smart and i was so nervous even go that's in the past tense gee that doesn't leave me much you are smart still but i was so

impressed by your thinking and your radical view of the brain that was so different than anything i heard in fact it partly inspired me to write my book, Ultra Mind Solution, 10 years ago, because I was so impressed that you framed the brain as something that is not fixed, that we can actually influence our brain. We talk about caring for our heart, but I want to talk about caring for our brain. And you've mapped out a strategy that not only makes sense, but actually works clinically. And I've used it on literally hundreds of patients with brain disorders. I've gone to almost every lecture you've ever given because I'm a kind of an acolyte and a fan. And I really find that using these principles of functional medicine for the brain is one of the most amazing breakthroughs that we've ever seen in medicine. In fact, the head of neurology at

Cleveland Clinic said, Mark, if you're right, and he was dubious that I was right, he said, if you're right, this is the greatest breakthrough in neuroscience in 50 years. So how did you end up going from a traditional board certified neurologist to being the guy you are and breaking all the taboos about what we think and what's true in medicine and telling a very different story about the brain. In a word, I'd say dissatisfaction. So here I am. Like the Rolling Stones can't get no satisfaction. I was going to say how did it happen?

A lot of drugs. No, but I was very dissatisfied as a mainstream neurologist working in a practice with two other neurologists doing what neurologists do basically diagnose and adios you know making rounds of the hospital seeing 40 50 patients a day and then going to the clinic and writing diagnosis and adios means you diagnose the patient and then there's nothing you can do for him yeah and i felt just you say goodbye that's right and i felt impotent by that i mean that wasn't why i wanted to become a physician i wanted to turn things around. I'm by nature a fixer. No matter what it is, I like to fix things. And we don't do that as neurologists. To this day, you're really treating symptoms. You're not treating the underlying problem, much less preventing the underlying problem, which is a place that I

think you and I will go to during this interview. But it's really, as I've said many times, focusing on the smoke, but not the fire. What's really going on? And it turns out that the brain is no different in comparison to the heart, in comparison to immune-related issues, the liver, and that is, it is a reflection of things that aren't right, primarily as it relates to the brain and the heart, et cetera, the pancreas and diabetes, through the process of inflammation. Inflammation is as detrimental to the brain as it is to the rest of the body. Our current popular lifestyle choices are fanning the flames of inflammation, which is actually redundant because inflammation comes from the word inflame, basically.

Who knew? So that has become the focus of the the work is to go upstream not looking at a downstream treatment for ridding the brain of this toxic beta amyloid or helping the brain make more chemical acetylcholine which doesn't work but rather which are the drugs that have been tried for alzheimer's exactly and we're going to get into that too i i'm certain uh but realizing that yes alzheimer's is by and large a preventable disease that's a disease affecting 5.4 million americans right now which is largely preventable what is it like for families to go through that i'm a neurologist i've gone through that with many, many families, dealing with their dad,

their mother, their husband, their wife. And my father died of a disease too. I mean, how do you put a value on the emotional content of that experience? You cannot, especially when you know that it is largely preventable. So these are the lemons from which we make the lemonade. We're going to move forward. We're going to light the candle. We do have to curse the darkness a little bit, and I'm certain that will come up today. But we've got to do our very best to let people know there is another side of the story that they have not heard. And the one side of the story that is being continually looked at is live your life however you choose and then when you are suddenly suffering from a problem cognitively impaired

we've got a pill for you i mean that's been a narrative of you right that is was on the alzheimer's uh awareness the alzheimer's association website that i looked at yesterday that said these these are the drugs for Alzheimer's that will slow the disease. And what does that mean? So you don't get in the nursing home three months faster, right? So it delays the admission. Well, that's what it says. Therefore, you should take these drugs. Well, it turns out that in the Journal of the American Medical Association online in November

of 2018 was a meta-analysis study published by a dr richard kennedy and that's a study of all the studies that have been done it is and what he found was that not only are the currently two the two largest classes of drugs that are prescribed for alzheimer's uh memantine and then what are called cholinesterase inhibitors not only except in the m which are the drugs people- Exactly right. Donepazil being the generic form. But not only do they not work, but they actually speed people's cognitive decline.

And I'm going to take a pause with that. Think about it. The drugs that are being prescribed to the tune of close to a billion dollars a year here in America, that families put their faith into that this might help mom or dad are actually worsening the decline in their cognitive function. It's like marketing a drug for blood pressure that's going to raise the blood pressure. The thing is, doctors feel like they have to do something, and there's nothing to do here. And I say, great, here's what we we should do we should prevent that disease in the first place and we know that we can do it despite you know the ideas that what we're talking about are termed pseudoscience so let's back up a

little bit you you talked about inflammation being a huge issue in alzheimer's but it's also an issue in depression in adhd in autism in parkinson's disease in cancer in diabetes coronary artery disease of all it's pretty much every chronic illness exactly particularly the brain and i don't think people realize that and so the question is what is driving all this inflammation right in a word uh our diets and we can start there and then work through the whole mechanistic pathway that ultimately leads to people losing their cognitive function so our diets being higher in simple carbohydrates with reduction in healthy fat reduction in dietary fiber paves the way through multiple mechanisms for our blood sugars to rise, our insulin activity to reduce, and ultimately that leads to inflammation. And they call Alzheimer's now type 3 diabetes.

That's right. Diabetes of the brain. Exactly right. So it puts the ball back in the court of you, the consumer, not you, Mark, I'm the doctor, but you, the consumer, to do something and do it right now. and that is simply change your diet other things are really important restorative sleep aerobic exercise meditation we could talk about a lot of things that's anti-inflammatory to meditate you bet but if we can simply focus on the fact that the global diet is becoming westernized that is increasing inflammation globally and we're seeing incredible increased rates of things like alzheimer's globally those are important dots to connect and important dots to leverage because we can turn this thing around yeah it's both it's both

the diet and how the diet affects our microbiome. Exactly right. Which is influencing our brain all the time through creating inflammatory molecules that get to the brain. And how does your poop get to your brain? That doesn't even make sense. Could you break that down for us? Sure, break down the poop. And as you've written about, and you coined the term diabesity, the relationship between diabetes higher blood

sugar obesity creation of inflammatory chemicals damaging the brain heart etc we now know that um what what sets the what we call the set point of inflammation in the body is a one cell layer thick that as you've said in the past separates separates the garbage dump, those are your words, from the rest of the body. Chemicals in the gut remain, by and large, dangerous, damaging chemicals, we call them antigens, need to stay there. When they transgress the gut lining, get through the gut lining, they stimulate immune cells to create the very mediators of inflammation, chemicals that we call cytokines, that then initiate these damaging activities for cells throughout the body. The downstream effect of inflammation is a turning on of the production of chemicals

called free radicals, damaging chemicals that damage our protein, our fat, and even our DNA, and even our energy producers called mitochondria. So it all starts with diet. Diet nurtures our 100 trillion microbial friends that live in the gut and want me to be healthy. They want you to be healthy, but we have to feed them right. Yeah, think about like a rainforest. It's got so many inputs of light and water and nutrients nutrients whereas a monocrop exactly cornfield what you're getting at is in a word is diversity yeah and just as we depend upon the the diversity of uh in the amazon forest which is being uh destroyed it's an ecosystem

you're right it's an ecosystem in the gut and it's this relationship between our gut friends in our gut and also on our skin in the brain who knew in the placenta who knew uh this relationship between our gut friends in our gut and also on our skin, in the brain, who knew, in the placenta, who knew, this relationship that we have to reconnect to. So in a very real sense, that's one aspect of what our son, Austin Perlmutter, and I are talking about moving forward, and that is disconnection syndrome. All of the manifestations of disconnection, whether it's disconnecting from the messages of our gut microbiome, disconnecting from our DNA that is doing everything it can to keep us healthy, but that we are sending to it the wrong signals by virtue of the process of

epigenetics. In other words, our food choices influence the expression of our DNA. Who knew? The disconnection that we have from the good parts of our brain. We'll talk about that later. The parts of our brain that want us to be empathetic and compassionate and planning for the future. The disconnection that we have from each other as people because we're spending too much time down here looking at a screen as opposed to sharing the life of another individual. The disconnection that we have from our communities, from other countries, and the disconnection that we have from the health and vitality of the planet.

And that's where we take this, that the survival of our planet is really predicated on reconnecting at all of these levels. In a sense, what you're talking about, David, is the role that your brain plays in allowing you to be connected or causing you to be disconnected. And that the way we care for our brains has a profound impact on our behavior, attitude, connection.

That's a very radical idea that what you eat controls your ability to be present, to be focused, to be connected. And here's what completes the circle. Yeah. What you eat, leveraged by, looked at through the lens of your microbes, does affect your behavior and your choices. And at the same time, those choices that you make affect the health and vitality of your gut microbes. So what you set

up is what we call a vicious cycle, whereby eating the wrong foods changes the microbiome, it changes your brain, and makes you less able moving forward to make the right choices. So you make further bad choices, further damaging your gut bacteria, further changing your brain. And let me say that it's not just moment-to-moment changes in your brain that happens, you know, that you make the wrong decisions, but ultimately as you continue to make these wrong decisions, you rewire your brain through a process called neuroplasticity. So you compromise your ability to tap into that part of your brain that lets you make good and appropriate

decisions and you connect more aggressively to the part of your brain that is much more impulsive and much more fear-based and much more narcissistic so basically we move from the place of love and connection to a place of fear and reactivity that's right and you mentioned alberto violdo we wrote a book about this years ago called The Neuroscience of Enlightenment. Power Up Your Brain. Power Up Your Brain. And it dealt with what can we do first in terms of our lifestyle choices to enhance this process of neuroplasticity, to enhance the brain's ability to make stronger connections. Okay, once we've got that put to bed in other words higher

levels of omega-3s less inflammation aerobic exercise being very important then let's do the right things let's make the best choices and that will then set the stage for hardwiring the brain to those good parts it's pretty amazing how you know you, you've been the pioneer in saying this, but the brain is plastic. It can actually change and reverse some of the insults that happen. So not only is it about prevention, but it's about treatment or slowing down of these conditions like Parkinson's and Alzheimer's. And I had mercury poisoning years ago. And early on, I had a brain scan called the spec scan which looks at the blood flow in the brain and i had all these areas of my brain that had no blood flow that were

dysfunctional they look like holes not a good thing they look like holes like swiss cheese in my brain and as i used functional medicine as i repaired my brain as i repaired my body to fix my brain essentially my gut and my also the mercury affected my gut in terrible ways. I actually repeated the scan more than a decade later, and all those holes had filled in. My brain had recovered. It's not something that you learn as a typical neurologist, right? Well, even, gosh, when I was 19,

I was doing research on what's's called micro neurosurgery we had the the operating room just got a microscope and so neurosurgeons didn't have a roadmap to use the microscope because the anatomy of the brain had never been really teased apart microscopically so our job was to create this roadmap for doing aneurysm surgery so as part of what i did my research on we were uh exploring how we can bring blood supply from outside the brain into the brain yeah so i became really kind of handy at tying small blood vessels together and i was invited to go teach in madrid spain at what's called the Centro Ramon y Cajal. And there, you know, this is an institution named after Ramon y Cajal, maybe the father of neurophysiology. And I walked into the

lab, and there was a statue of him with his statement saying that the brain is immutable, it never changes, it never regenerates, that's it. And you know, as well as I do, that we were taught that in medical school, that the brain will never grow new brain cells that your brain cells in college too bad yeah if you drank too much or whatever but we know now that the brain a can regenerate itself and b can rewire or reroute pathways how does a stroke patient recover well he or she recovers because they bring online different alternative pathways they rer reroute the signal ultimately, and that's how they can improve. So we take advantage of that process called neuroplasticity and turn it on by turning on the body's production of a chemical growth factor

for the brain called BDNF. But at the same time, we have to capitalize then on the brain wanting to rewire itself by behaving in ways you remove the insults and you provide the right inputs changing our behavior um the dalai lama said that uh if you want to be happy practice compassion and if you want others to be happy practice compassion yeah so it really uh you know it's it's you can be happier if you can wire into the happy part of your brain by doing things outwardly that demonstrate empathy, that demonstrate planning for the future. Okay, so let's get into some of the details here because you've written a lot about,

for example, grains, grain brain. This is a new edition of grain brain everybody needs to get a copy uh it's completely revised and updated it's pretty awesome and i think this guy has really nailed it now a lot of people um are not too happy with these ideas um you've been attacked on television you've been attacked in the media you've been attacked in medical journals, including, you know, indirect attacks against me and our colleague Dale Bredesen, who's really pioneered the idea that we could actually stop or reverse Alzheimer's, which you actually were talking about decades ago. What are the things that are challenging? You're talking about changing your diet. So let's talk about the food part, because there's such controversy we should we eat saturated fat should we not do we is sugar

really that bad or not because the sugar association says sugar is fine so why wouldn't we believe them so i would say to your viewers google perlmutter and cbs and watch a recent interview and as i said this morning yeah but just put cbs and perlmutter it'll come up and uh as they show the book dr perlmutter's written new book about uh carbohydrates in the brain but before they cut to me they said but we reached out to the sugar industry and the sugar industry told us that we should eat sugar decades of research it's all good have at it what would you expect them to say and how why would you ask the sugar industry and my response was yeah because you know it wasn't that long ago that the tobacco industry was telling us we should

be smoking cigarettes that's a good thing uh but the reality is the the question that i was supposed to answer but i diverted because i wanted to really hit the sugar thing was uh dr perlmutter what you're saying is that all grains are bad. And I've never said that. I've, you know, despite the name of the book, I believe that when we look at gluten-containing grains, we should avoid them. As you know, there's plenty of research in terms of what gluten, specifically a subpart of gluten, alpha-glide, and does in terms of threatening what we talked about earlier, and that is the gut lining. So is that in everybody or just people who are sensitive to it?

It's difficult to say. I think we know that probably most people have some degree of increased gut permeability or leakiness of the gut when they consume gluten or specifically gliadin. That said, the non-gluten-containing grains, grains meaning seeds of grass, things like rice and corn, can be consumed in a quantity that doesn't present a lot of carbohydrate. So if you're watching your daily consumption of carbohydrate and you want to have a little bit of wild rice, have at it. Or some non-GMO corn, good luck trying to find that but i think that if you're counting your carbs as you should be looking at net carbs that i i don't think that's necessarily the worst idea having said that uh again because you know there's just to back up on the carb thing now there's been some

recent studies published by walter willett and others at harvard looking at thousands and thousands of people showing that people who eat very low-carbohydrate diets don't do well. They die earlier. People eat very, very high-carbohydrate, but somewhere in the middle, about 50%, which to you and I seems like a lot of carbohydrates, do better. Can you kind of address that? Because it's- Well, I think people should eat tons of carbohydrates.

Yes. You should be eating carbohydrates. And I just did a blog with somebody, and it was said, why we need more carbs. David Perlmutter, MD, and people, I think the hashtag was, why that's more carbs david perlmutter md and people i think the hashtag was why that's fantastic wtf right yeah um so uh yeah we need lots of carbs because we need lots of fiber in our diets by definition broccoli is a carb you bet it's a carbohydrate so that's right and there's something magic when you take uh you make a bagel or a croissant i mean it's no longer a carbohydrate or simple carbohydrate it's a croissant or whatever it is yeah but you're right so broccoli kale i mean these are good sources of dietary fiber which is by definition

a carbohydrate though it's non-digestible and polyphenols and antioxidants you bet and fuel for the microbiome fuel for your gut bacteria so yeah i actually in my book ultra metabolism i wrote carbohydrates are the single most important food for health and longevity and what i was referring to was vegetables but then people take it out of context and say yeah he's not he's not paleo he's not keto uh so i think that you know the biggest faults then with uh the well with that type of research is you've got to qualify. And the other area that needs great qualification is, you know, I'm often challenged by people saying, well, you know, the China study said that you eat meat, you're going to die. And Dr. Dean Ornish says we need a very, very low fat diet. And people ask me, what do you think

about that? And I would say, you know, I agree with both of them. Why do I agree with both of them? Well, I think by and large, the type of meat that people eat that goes into these studies, where they come up with the relationships to colon cancer, for example, you bet those are very, very threatening forms of meat. But it's actually not even meat it's it's actually processed meat which is it's processed meat and salami and you know there is a sense of alchemy that somehow you can feed a cow or other animal that you're gonna eat garbage and it'll magically turn into gold literally garbage yeah they find them skittles and you bet that are aspire so uh so i think there is a place on the table if you choose to eat meat for grass-fed organically raised forms of meat of of animal product and similarly do i think that

dr ornish has some merit in his discussion of a low-fat diet yes because the type of fat that is eaten in western cultures is awful yeah it's highly processed omega-6 oils soybean oil soybean sunflower that dramatically increase uh the production of inflammatory chemicals in the body and get back to where you and i started our conversation today and what's really interesting uh to think about you know we've wondered the mechanism for that over the years we've said well and this is a little technical for your viewers, but they'll love it. The omega-6s produce chemicals called prostaglandins and leukotrienes that can be pro-inflammatory. We kind of glammed onto that for many years.

Like the hormones of your immune system, they create inflammation. Right. But now we know with all the interest in what's called the endocannabinoid system, which is what everyone's interested in now because of the availability of CBD and the use of medical marijuana, that the omega-6s help to increase the production of two important cannabinoid chemicals that are produced within the body we call them endocannabinoids because they're produced in the body 2-AG and another one called anandamide which bind to a receptor called the CB1 receptor that absolutely explodes the production of these inflammatory molecules and interestingly omega-3s that down when you said was eating vegetable oil activates these

receptors it creates inflammation. Yeah. And this is yet another way to understand the beauty of the omega-3s. Because similarly, the omega-3s create cannabinoid-like chemicals in the body that block that activity. And that's another important pathway by which the omega-3s are so good for us. So when people like Dr. Ornish say we should be on a low-fat diet, pretty much based upon the type of fat that people consume in America,

I'd say he's right. But you can get even more bang for the buck if you not only cut those oils out and fats out, but add to the equation the omega-3s. So we improve this ratio of omega-6s to omega-3s, which is so high now in America, down to a level of 3 to 1 or 2 to 1, whereas typically in most people's diets, it's about 20 to 1 in favor of the omega-6s. These are new. I mean, we didn't have these oils 1,000 years ago, 100 years ago.

You're right. We've increased our intake of soybean oil, which is now 10% of our calories, 1,000-fold since 1900. And canola oil that health advocates still talk about, which was developed at the turn of the century as an industrial oil to lubricate machinery. Yeah. Ripe seed oil. Yeah. That's a good thing.

And now it's highly GMO contaminated. Yeah, it's an issue. So you mentioned omega-3s. The other issue people are concerned about is saturated fat, particularly in the context of Alzheimer's, an ApoE4 gene, which is a gene that may increase your risk of Alzheimer's. Well, it does, depending on how many copies you have and so forth. Is this something we should be worried about?

I mean, Bulletproof Coffee and everybody wants butter. Cover of Time Magazine says eat butter. Like, what's the deal here? Butter is back. And let's take that apart a little bit, unpack that just for your viewers to be really clear that there are some genes that help increase a person's risk for Alzheimer's. And one of them is this so-called APOE4 allele. And you can learn about it by having an at-home genetic test that anybody can do.

And 20% of americans will carry the apoe for allele copy one copy and some carry two copies which is clearly associated with as much as a 12-fold increased risk for developing alzheimer's disease the apo e genes are involved in the production of apolipoproteins. And that's a big term, but it has to do with proteins in the body that carry fat, deliver fat to where those fats might be needed. And there is some indication that the benefits of saturated fat for the brain, we'll talk about that in just a moment, and even the benefits of a ketogenic diet, and we'll talk about that as well. I guess I'm putting a lot of things on the plate here.

It's okay. We got it. We got it. It might be a little long here. We might have to add another memory card. But those things are less beneficial in the APOE4 carriers, meaning that they're not going to gain as much benefit directly from ketogenic diet or a diet that's higher in saturated fat. Is there harm? Doesn't look like there's harm. And that said, I think that there are benefits that everybody gains that I believe, if there is some sense of harm, would offset those potential issues, which are very minimal to begin with. And that is what the benefits are from consuming saturated fat

is the types that we recommend, MC2 oil, coconut oil, the saturated fat that's found in eggs, for example. The benefits are that we enhance our body's ability to produce these important chemicals that are called ketones. There's this huge interest these days all over the internet and certainly in various venues for lectures, et cetera, in what is called the ketogenic diet. this huge interest these days all over the internet and certainly uh in various venues for lectures etc in what is called the ketogenic diet the number one diet books you bet and with good reason and it's it's a brand new phenomenon for humans it's only the type of diet we've been

on for a couple million years so we are on and off of it right but we've been in and out of ketosis for a long long time so it's got a heck of a track record uh and we we can talk about that but basically it's a diet that counters inflammation that enhances energy production that activates this bdnf gene pathway to create more of that growth hormone to grow new brain cells that helps uh reduce the production of free radicals, that helps get rid of damaged energy producers called mitochondria, that helps us with our ability to rid our bodies of cells, for example, that are damaged. So in multiple arenas, being on a ketogenic diet is really a good thing. So I think that the ability of the coconut oil and the MCT oil to make that happen really is very very powerful

and there's data that's showing that those actually help improve out outcomes in alzheimer's patients there's actually a data that indicates interventionally that simply using mct oil improves cognitive function in established alzheimer's patients and what did i just say there's data that shows that a nutritional intervention is effective in turning dementia around yeah there's also data from iran that demonstrates that probiotic intervention demonstrates improvement on the mini mental status test which is a standardized test doctors use in the office to determine how well a person's brain is functioning impressive i just i just reviewed a book uh by the new head of the Lu Ruo Center at Cleveland Clinic,

which is the Alzheimer's research program there. And I was shocked to read he talked about using ketogenic diets in patients with Alzheimer's as a way of treating the problem, which is pretty radical. You've got the head of a major academic medical center saying, yes, we can use food as medicine we're seeing this trend food as medicine who knew and yet there's this incredible backlash um about this we're going to get into that in a minute uh there was an article in the journal the american medical association called the rise of pseudo medicine for dementia and brain health

and you and i would be considered in the pseudo medicine quack category i think i i for me it's a personal badge of honor that i'm on quack watch me too along with most of our best friends but the saturated fat thing i just want to come back to and the the founder of quack watch commented on this article in jama you need to see that i'm sure i'm sure i feel like i'm doing a job when i get more people attacking me uh from you know, certain categories of like Monsanto and the farm industry. But the saturated fat thing is fascinating because I want to be able to hear that saturated fat is not necessarily bad, that it is something that can be helpful in many conditions. But that's with one big caution is to avoid what I call sweet fat. And the reason that saturated fat, I believe, causes, and I want to hear your opinion on this, causes problems in

the research, which can correlate saturated fat with disease like heart disease and other problems, is that when those studies were done, they're done in the context of people eating saturated fat in a high-starch sugar diet. I call that sweet fat. Think of donuts, french fries, ice cream, cookies. These are high-fat, high-sugar combos that are deadly. So the caution is if you're going to eat saturated fat, you can't eat a diet high in starch and sugar. Yes, high in carbohydrates, right? Plant foods.

I always say 75% of your diet should be plant foods in terms of starch not in terms of starch in terms of vegetables in fact most of your diet should be plant foods by volume but they have very little calories and most of your calories should be fat but it's not much volume can you comment on that yeah sure and i and i would say let's even take this unpack this further and uh it doesn't even have to be in relationship to eating carbohydrates, simple carbohydrates. Because the data comes from these studies that look at calculating the amount of saturated fat in somebody's diet based upon the foods that they eat. Then they calculate, well, this person eats a bunch of beef, they eat

a bunch of bacon, et cetera, they're going to want to saturate fat. As we talked about earlier, those are the wrong kinds of foods for many, many reasons. So this is a calculated determination of saturated fat. It's not a biochemical demonstration that saturated fat does something in the body. It's people who ate a diet higher in saturated fat which delivers lots of toxins because these are the mod of these are foods from animals that have been fed as we said earlier garbage that's where those saturated fats how they're delivered to the human body so it's not a clean type of study right it doesn't relate to telling a person to take a tablespoon of organic coconut oil.

No relationship whatsoever. Look, 50% of the fat in human breast milk is saturated fat. Yeah. Wait a minute. So basically breast milk is almost as much saturated fat as pure butter. You bet. And why is it there? Because it helps for brain development, helps for immune system development.

It helps prime the- I thought it was 25%. 50%. It's of the fat. Of the fat development it helps prime that it was 25 50 50 it's of the fat it helps prime 25 of the calories in breast milk is from saturated fat yeah we're told to get less than five percent by the american heart association so according to the american heart association we should ban breastfeeding i think it needs a label they need to go around and stamp breasts all around the world saying, this is not heart health. High-accessibility fat. Yeah, avoid this.

I mean, it wasn't long ago when we were told not to eat avocados or nuts. Yes. Because they had high levels of the dreaded fat. That was about the worst. And we know where that came from now. We know how medical literature in the late 1960s was tainted by industry, by sugar, who influenced what was published in the New England Journal of Medicine, as recently revealed in the Journal of the American

Medical Association and ended up on the front page of the New York Times. And doctors bought into that. We bought into what our journals were telling us, and it was patently wrong. Now you bring up a journal article from the journal of the american medical association that is castigating our approaches to dealing with brain health calling it pseudoscience we began our medicine pseudomedicine we began our conversation today with a discussion of the publication in the same journal i'll have you know in november of this year wherein it was revealed that the so-called alzheimer's drugs that this article is a proponent of yes uh don't work but actually make people worse worse which is the pseudo medicine

exactly well i think you know part of the problem is that you know our type of medicine has not had the funding to study these interventions. Nobody's funding dietary interventions because they're expensive. They take a long time. Nobody's looking at these complex systems approaches to treating dementia, which you and I have done for decades. It's not just treating one thing. Like our friend Dale talks about medicine. Maybe there's 36 different problems or 54 or 12.

And if you don't deal with all of them, you're not going to get better. And our colleague and mentor, Sid Baker says, if you're standing on a tack, it takes a lot of aspirin to make it feel better. And if you're standing on two, taking one tack out doesn't make you 50% better, right? So if you have mercury poisoning and gluten sensitivity, and you just deal with the gluten, the mercury still might be a problem and you don't get better. And I think that's a really important lesson. I think this article is very disturbing to me because it didn't really analyze the data behind it.

And there's so much data behind the kinds of things we're doing, whether it's optimizing our diet or exercise or restoring sleep or meditation or using nutritional support, which is the B vitamins and methylation or getting rid of mercury or fixing the microbiome or balancing hormones. These are the things that we use in constellation to help optimize brain function. And what we know is that these things work. The only study that's ever been shown at a scale to reverse or slow cognitive decline is called the finger study, which was basically using multiple interventions, diet, exercise,

stress reduction, addressing risk factors diet, exercise, stress reduction, addressing risk factors for the heart, for example, and some resistance. And therein lies the criticism. Yes, but therein lies the criticism because the notion of leveraging multiple inputs into a system and looking for an outcome is absolutely at odds with the current model of how science, as it relates to medicine is carried out you mentioned dr bredesen has a new book coming out where he actually reviews case studies of reversing alzheimer's disease and i had the opportunity to write the forward

for that book and i talked about how this is unprecedented that he is not looking at what we call monotherapy to find the golden single drug that can be monetized you know and yet he's looking at using multiple but getting a great result so why would we argue with that but you know it is an inconvenient truth for people who want to believe otherwise that we need to create single approaches monotherapy and that can be the home run billion dollar product that makes the investors very happy well it's exciting maybe you'd be excited to hear that i'm working with some of the top scientists at cleveland clinic talking about how do we study these systems approaches how do we break the paradigm how do we actually design a trial where

we can test this theory and instead of calling it pseudomedicine chronic the future of medicine which is really what it is so i have have to say that as I get older, I'm less offended by these. Yeah. And I really find it to be almost complimentary. It's sort of like complimentary medicine because to be the outlier and to be disruptive, I think is really a good thing these days

because the status quo is not where we want it to a good thing these days. Because the status quo is not where we want it to be. And we need to challenge the status quo. And it's why people call us out. It's why, you know, you appear on the various videos, and so do I. And some people put a thumbs down and comment, well, you know, I read the China study, and it said we should all, we shouldn't, you know, it's great. People want to believe. Because it's an inconvenient truth to tell somebody, you need to stop drinking diet drinks. You need to stop eating as much sugar as you're eating because it's going to compromise your health. Most people don't want to hear that message.

They'd rather, as I mentioned earlier, hope for the magic bullet. As it relates to Alzheimer's, it's interesting that in February of 2018, one of the world's largest pharmaceutical companies, Pfizer, gave up. Gave up, yeah. A lot of companies- We're not going to chase down the magic bullet for Alzheimer's anymore because it doesn't have a good enough ROI, return on investment. Hundreds of studies, billions of dollars spent going down this rabbit hole that is the wrong

strategy for identifying the risks, the causes, and the treatments for cognitive decline or Alzheimer's. It's pretty stunning. And everybody's failing. And now people are starting to pay attention to what we're doing. I have a slide that I'll show you at a conference you and I will be attending in a couple of days. And it's really quite interesting because it shows, it measures a group of people in terms of insulin resistance, whether they have insulin resistance, which is the consequence of diet or not, over time, who collects the most beta amyloid, this sticky protein in the brain that is associated with Alzheimer's risk, who collects more beta amyloid.

And it's dramatic how much more amyloid is in the brains of people who are insulin resistant. The reason I mention it in the context of our discussion right now is because the amyloid in the brain has really been the focus of the pharmaceutical industry trying to create an Alzheimer's drug. Amyloid does or doesn't play a role, whatever, but... Sort of like sticky toffee that comes out of the brain. Right, but developing drugs to get rid of amyloid or to keep it from forming in the first place has been the focus of billions of dollars of research. Because if you could get rid of that protein, that might cure Alzheimer's. It doesn't. But the point is that we can determine on the front end how to

lower our risk for developing amyloid in the brain in the first place. It's a reaction to something. It is. I mean, it's driving inflammation. That's right something that's driving inflammation that's right it's an overreaction it's an overreaction to infection for example to herpes simplex virus to chlamydia to various uh organisms that do in fact colonize the microbiome of the brain there is a microbiome on the brain of the brain in fact in a book we have coming out there's a title i mean a chapter dedicated to that from Dr. Tanzi's group at Harvard. So it is really quite incredible to realize, another series of slides looks at the degree of brain shrinkage if you carry the Alzheimer's gene in comparison to the degree of brain shrinkage in one year plotted against your hemoglobin a1c or your average blood sugar and it turns out that the rate of shrinkage of your brain is greater with a higher

a1c than it is carrying the alzheimer's gene you can't change pretty frightening you can't change the alzheimer's gene if you got it you've got it you can change the expression of the gene you can but you can sure as heck lower your a1c by simply making some dietary changes yeah low sugar you bet more uh carbohydrates in form of fiber and more good for nurturing your gut bacteria reducing inflammation but again that is the inconvenient truth people don't want to embrace the ball is very much on your side of the net it's not up to me on the other side of the net the doctor to fix this yeah it's up to you to hit that ball appropriately with

some topspin so that i can't return it you know give it a good shot yeah here and here's how to do it how lower your consumption of simple carbohydrates yeah eat more healthful fat eat more dietary fiber exercise make sure that your sleep is restorative really important very much underrated we spend a third of our lives sleeping or trying to sleep and we recognize that so much is going on during that activity which we used to think is simply passive but that we understand that this is hugely involved in reducing inflammation in enhancing the brain's ability to take the garbage out through the activity of the lymphatic system.

To triage our daily... That's the lymph system of the brain, David talked about. Exactly. Which has to work at night. It works at night. It's got the night shift. You can't take the garbage out of your brain. So that you're ready to go the next day.

And to triage our day-to-day experiences and put them where they will be meaningful for us to rely upon in terms of leveraging new information to make decisions. So underrated. I want to come back to something we were talking about before, because I think we kind of glossed over it, which is this study on the low-carbohydrate versus high-carbohydrate diets and what it showed and what it didn't show,

and challenging the very notion of grain-brain, which is that we should be eating a low-star sugar diet when i looked at that study and i actually am giving a talk at this conference called the failure of nutrition science tomorrow you are tomorrow yes at 10 15 at 10 15 which will not be when this podcast is airing no this is evergreen but the the uh extraordinary thing is when you start to dig a little bit the headlines were low carbohydrates kill people they're not safe and everybody reads the headline go okay it's science it's published in a major journal it's top harvard scientist it must be true but when you actually look at the data first if it's a population study which doesn't prove anything it just shows a correlation yes

or no you know i wake up every morning and the sun comes up 100 of the time that means that if mark mark doesn't wake up the sun's not going to come up right so they're correlated 100 but there's no correlation i notice cause and effect that whenever it's people it's windshield wipers are going it's raining yeah obviously the windshield wipers make it rain absolutely absolutely but what was fascinating about the studies when you look a little bit deeper first it wasn't really low carbohydrate the low carbohydrate group was 38 percent carbs which is not low carbohydrate and second when they did the study it was thousands of people tens of thousands of people over 25 years they gave

them two questionnaires separated by six years of what did you eat last week and people actually don't tell the truth that's well documented in fact in this study the average caloric intake was 1500 calories now the average person is about 2200 calories where the other 700 calories could have been all sheet cake and we don't know what they were eating. So the study may be suggestive of certain things, but it's really not proving anything. And people get all caught up in the headlines and don't really look critically at the studies. And that's part of the problem. I had a similar experience recently when a study came out and the headlines were, a gluten-free diet increases risk of heart attack. All you gluten-free people,

you're all going to die of a heart attack. Yeah. And again, Harvard researchers and, uh, I had to respond to this and the answer is read the study. Yeah. And what the study showed was that people who adopt a gluten-free diet by

and large to have much less dietary fiber, they don't know what's gluten and what isn't gluten, so they're eating less dietary fiber. Or they're eating gluten-free cake and cookies. Exactly. And what the authors commented on in their conclusion was that they fully recognized that there was less fiber consumption in the gluten-free group.

It had nothing to do with, but the way they spun the article was that gluten was a toxin. Yeah. You know? And it was, I mean, going gluten-free was somehow toxic right and that and you wonder how could avoiding something make it a toxin yeah in the first place but very confusing but the headlines get spun you know case in point what you have here the pseudo medicine my goodness yeah so it's it's pretty exciting where we're at in terms of the brain. And I think that

you've clearly been out ahead of this for decades. In, in terms of the, the newer ideas around fasting and intermittent fasting and fasting mimicking diets, there's a lot of noise about this and ketogenic diets are part of that spectrum, which is like a fasting state. When we don't eat, we get ketogenic, and when we eat a high-fat, low-starch diet, we get ketogenic. So what is the utility of these? What do you think about these things? Is this really where we should be going? And what are the differences? First, I'll say that the beauty of this coming into the forefront, which it really is right now, at least we think so, because we're seeing it day in and

day out, is that these are approaches that emulate our ancestors, meaning that our ancestors had times of caloric scarcity, and that would do things to their physiology that would allow them to survive. And that's a very important fundamental premise because it plays into the gene activation part of that story. It plays into why researchers like Dr. Walter Longo, I know you're going to interview him, why they're getting really incredible results across a huge spectrum of our modern-day maladies, be it cancer, heart disease, and even dementia. They're treating the root causes of all of them. Yes.

And you're harvesting pathways that lead to good gene expression. You're tinkering with the expression of the life code in a positive way and offloading some of the negative expression of DNA that would have otherwise happened based upon how people were otherwise eating. So there are, first of all, there's a term, intermittent fasting, which I think is clearly a bit nebulous. Does that mean fasting for a couple days every month, or does it mean just deciding not to have breakfast till noon? Time-restricted eating. Yeah, it's, well, it's actually uh that's a

little bit different we'll get to that in this moment but you know when we have our last meal in the evening there's a period of time that we don't eat generally unless we're getting up in the middle of the night and hit the refrigerator but that time people do and klein levin syndrome is one don't don't ask me um uh but people go to sleep they wake up in the morning and then that first meal is called the break fast you break your fast and if you can protract the time till you do that then your body will indeed produce more and more of these chemicals we talked about earlier that are good for us called ketones so protracting that i find until maybe noon one or two o'clock i think is a good thing.

I knew you were coming today, so I didn't eat breakfast. Well, I did, because I don't think it's good. I think it may well be the, I thought it was going to be the only meal I was going to have today, but it turns out that that's not the case. But typically, what I, if you want to, what I do at home is I don't eat until about one o'clock or sometimes two o'clock or sometimes not at all or sometimes just the evening meal and people wonder well how do you function i function really well as a matter of fact i mean i may add to that a little bit of mct oil just to get my ketones a

little bit higher yeah so um the uh fasting mimicking diet that you will obviously learn more about when you uh you interview the person credited with inventing that, Dr. Walter Longo, is a technique to gain the activation of the genes, the positive aspects of this approach, while at the same time making it more tolerable and available to people. So it's like eating 800 to 1100 calories a day, which puts your body into a semi-starvation state that activates all these anti-aging prepared mechanisms. And let me just say that the other thing that fasting does that I think is underrated but nonetheless really important is that it enhances a sense of gratitude, which I think is hugely important. When you realize suddenly that you've taken food for granted. In our society, we all do that because it's plentiful.

But when you're not eating for a day or two, and you suddenly realize that, wow, we live in a time when I can eat when I want to, it raises your sense of gratitude. And that, through what we talked about earlier, the rewiring of the brain, the more gratitude that you experience in your life, the more it wires your brain into the gratitude center. Yeah, it's powerful. So part of the theory of the fast mimicking diet, and I want to get into that for a little bit, because it is confusing,

even for me, someone who's been studying this forever the different opinions you know he's no saturated fat he's very low protein no animal protein um and the theory is that your saturated fat is inflammatory and promotes aging uh and he's found this in mouse models yes which may be certain kind of mice and does it apply to humans and what do we mean? And then he also talks about the role of protein activating a particular pathway. It's called mTOR, which is a protein that actually can cause, the protein actually causes activation of this pathway that seems to lead to accelerated aging. So he's saying no animal protein, and that we should eat a low protein diet and that the

fasting mimicking diet is extremely low protein. How do you reconcile that with the rest of sort of the science of what we know around protein and aging? In fact, he even suggests that as we get older, we need more protein. So... I'd say, first of all, that we have to always keep an open mind that my position on animal protein has changed over the years and will likely continue to change i eat less and less of it i eat more of a plant based diet for many reasons not just with respect to my health uh but beyond that there are two sides to the mtor story as you well know i mean when you um ronda patrick i think has done a terrific job in talking about the upsides of mTOR in terms

of building muscle mass. Yeah. It activates when you exercise, which we know is a great thing. So I would say that we have to keep an open mind. And these are still some unanswered questions that we are going to leave on the table. We're not going to be dogmatic and say it's this way and a story, but rather we will need to study it further. The broad strokes are more dietary fiber, less simple carbohydrates, and changing the quality of the fat that we eat. I think those are, nothing's indelible, but I think, you know, those are important bullet points that if we could just get that message across, that's really very, very fundamental. The other lifestyle issues that we talked about earlier, I think,

are important as well. But we have to really respect a researcher like Dr. Longo. And then a caution would be to recognize that we cannot always extrapolate from the mouse model to humans directly, though we do it a lot i do it a lot uh but you know for example the glymphatic system was demonstrated we talked about earlier the clearing of the brain during sleep if they were able to get the rodents to sleep on their left side does that mean people should sleep on their left side i don't think so my left side i sleep on my right side usually but you know maybe there's some knowledge there. But again, so we will follow the work of a terrific researcher like Dr. Longo and watch what he comes up with.

I mean, with a person as dedicated as he is, he deserves a lot of attention. Yeah, it's extraordinary to look at the work. The question is always compared to what, right? Things can be looked at in isolation and seem to be good or bad but when you actually look at comparing things to other things what do you find i mean you can find for example that a plant-based diet is much better and creating better outcomes than a than a diet that's a typical American diet. Even a low-fat vegan diet is far better than a typical processed American diet, right? That is not a surprise. But what about comparing a vegan diet that's low-fat to a, for example, a paleo diet that's

very high in starch from carbohydrates that are good, like the vegetables, right? And higher in fat and a little more animal protein and see what happens comparing the biology of these things how do they affect the aging process it's very fascinating one of the things i found challenging with dr longo and i'm going to chat with him about this is that he says yes even a low carbohydrate diet will lose will you lose weight you'll change all the bar markers of diabetes and then some resistance but that doesn't matter because it promotes aging and activates all the aging mechanisms and a great conversation to have a thought that comes to mind that maybe you'll bring this up with him and that is you know in a

in a sense uh his fasting mimicking uh diet program uh kind of uh is uh Bredesen's approach in that he's incorporating this program into cancer therapy where people are receiving chemotherapy, for example. Much as Dr. Thomas Seyfried wrote The Metabolic Basis of Cancer, talked about using a ketogenic diet in correlation, I mean, along with... Conjunction with chemo. Conjunction with chemotherapy, radiation therapy, and even surgery, but doing your best to avoid steroids if possible. So not that the fasting mimicking diet is the end-all, nor is ketogenic diet, as Dr. Seyfried describes, the end-all, but could be looked upon as adjuncts to amplify the effectiveness in a more comprehensive way of more standardized

approaches much as dr bredesen talks about leveraging multiple inputs essentially you know the doctor i mean there's a lot of people using it for many problems right we see studies for example from uh the group virta health looking at ketogenic diets reversing diabetes in 60 of patients and giving them off medications or down on the medications in 98% of patients, reversing all the biomarkers of aging. We see this. And we also see guys like Siddhartha Mukherjee looking at ketogenic diets and cancer in animal models. They've been able to reverse stage four pancreatic cancer, stage four melanomas, and now they're looking at doing this in human trials. So we're going to be getting more and

more information. Tell us, since you published Grain Brain five years ago, almost six years ago, what has changed in the science? What do we know, and why did you revise the book? Because it was such a great book. I read it, so did a million other people, apparently. What is different, and what can you tell us about the emerging science? The playing field is really different now. So I was criticized when the first edition came out by an unnamed individual at an unnamed

Ivy League medical school. One who will not be named. One who will not be named, but it's in New Haven, Connecticut. We'll leave it at that. And that this was nonsense, that my ideas about carbohydrates, et cetera, really made no sense at all. And believe me, he wasn't the only one, as you would have expected, to criticize what we're talking about.

Same folks that don't like me. Yeah. And what has really happened over the past five years has been this incredible degree of validation. There was no keto, paleo, any of that stuff. That's really new stuff. And it's really focused on the notion of getting rid of these simple carbohydrates. There was no real recognition about gluten except for what Dr. William Davis had talked about in Wheat Belly, which really, I think, opened the door to the

whole gluten discussion. And just the notion, because I went for the brain, what would you expect? Just the notion that our lifestyle choices can rewrite your brain's destiny is really the central theme of the book. And reduce your risk for untreatable diseases was really very discomforting for people who wanted to believe in the monotherapy, give me a pill mentality. So that's changed quite a bit. There's been incredible studies that have supported the notion now about insulin resistance, the importance of insulin beyond just its role in providing glucose to the brain in terms of being a trophic hormone for the brain, allowing brain cells to be healthy beyond just powering them up.

Insulin. Insulin. So it's good to have a lot of insulin? We need insulin in the brain. Yeah. We compromise the ability of insulin to get into the brain when we become insulin resistant by having a high sugar diet that the blood-brain barrier that keeps things in or out of the brain, its ability to absorb insulin and therefore bring sugar into the brain is compromised

when we become insulin resistant. Who knew? And yet, as you mentioned, Virta Health, Dr. Sarah Hallberg, done incredible work showing that we can absolutely reverse that. You've demonstrated it time and time again. The other interesting part of the story is now, which we didn't have back then, we see brain scans that show the brain's inability to use blood sugar as a harbinger of Alzheimer's 20 and 30 years later. So if your brain can't properly handle sugar, you can tell 30 years in advance whether you're at risk for Alzheimer's. That's right. And we see that in children whose mothers had Alzheimer's, APOE4 carriers. And importantly, we see it in people with insulin

resistance and in young women who have PCOS, that they already, though they're young, have these deficits in the way that their brains are able to utilize sugar. We don't yet have the data in terms of their future risk for Alzheimer's disease, but I think because about 80% of these women are overweight and have insulin resistance, that they're set up for Alzheimer's risk. What is really quite exciting is the work of a Dr. Stephen Cunane, who I was on a panel with just a week ago in Los Angeles, who has done these side-by-side brain imaging studies showing what we've known about, that the brain can't utilize sugar as a harbinger of Alzheimer's. And even in Alzheimer's's the brain can't utilize glucose as a fuel but if you now use a new up-to-date type of study that shows the brain's ability to use fat specifically ketones as

a fuel these brain cells are fine yeah they're ready to go they just need a different fuel source such a different paradigm that i learned in medical school right that the brain uses 25 percent of our glucose that glucose is the main fuel for the brain and yet you're saying there's this parallel pathway for energy for the brain that isn't sugar it's fat and it actually runs cleaner makes the brain work better can reverse look if you're a hunter gatherer and you uh three four days into trying to track down the wildebeest or whatever it is you you think is going to be your source of calories and you're not it's not working out for you the first thing you've got a power is your brain because you've got to be clever enough to

get food or you'll die so we evolved this incredible alternative pathway that allows the brain to burn body fat and use it as a very powerful what dr veach has called a super fuel so um that's the uh the type of validation that grain brand has received the type of research that has been done over the past five years that connects some dots for me that we're missing because we didn't have that research but you know we had thought in looking at these brain scans that show that there are areas of the brain that are not utilizing glucose in the alzheimer's patient that that was an indication that those areas were were where there were neurons that were damaged not working anymore

and that's flawed yeah because when you supply ketones those neurons come back online and say oh gosh i've been away for so long. Have you seen this clinically? Oh, absolutely. I mean, that's the fundamental for why we now see interventional trials using MCT oil for increasing ketones. Why Dr. Bredesen and his protocol uses a diet that increases ketones. I've seen this, too. It's striking. I had a patient who had diagnosed with early Alzheimer's. We addressed a whole bunch of issues that she had, including mercury, gut issues, inflammation,

nutritional deficiencies, hormonal issues like thyroid. She did great for years. She would typically have been in a nursing home. Yeah. And she had a big stress, which was her husband died, and she declined. So I said, why don't we try a ketogenic diet? Let's just be a little more aggressive.

And her son said it was like a miracle it was literally she was not coherent really memory was really bad couldn't navigate her life and boom it was like she came back online when she went on a ketogenic diet and was aware of her surroundings her memory was dramatically improved she was able to function in her life and be active and do things i mean these are quote anecdotes which are highly i hear you they're ends of one i mean look dr mary newport wrote about her husband and n of one she put him on a ketogenic diet has a new book coming out and i recall one um elderly italian woman who couldn't uh they didn't, her family didn't want her driving, writing checks anymore. They're very worried about her. And they brought her to see me. And she came to the office with her three sons who were very big. And they were very,

they wanted mom to be fixed. And I, you know, the pressure was on, they want to mess this one up. So, you know, put her on a ketogenic diet. She returned to driving a car and, you know, was able to manage her finances. And I'm glad I got that one right. Yeah. They're doing this across the spectrum. You bet. And I would say, you know, there's great value to the N's of one. Yeah.

Well, there's a whole new research program at the National Institutes of Health called NM1 Research, which uses individuals as their own control and measures what happens within their biology as a way of validating the science. So we're getting away from this reductionist model of drug-designed studies, essentially looking at one drug for one disease with a single outcome. That's great for drug companies,

but it doesn't help the average person and doesn't actually test the science of what we know to be true, which is everything is connected. And the validation and giving us the ability to use medications is really based on at most 3% to 5% of people, once it's out in the market, using a drug.

So 95% of people have never been exposed to a drug that then they do get, as then they become an end of one, they become a trial. And I think there's a big push these days for what is called personalized medicine, where we learn as much as we can about an individual, his or her genome, microbiome, et cetera, lifestyle choices, and then try to cultivate specific protocols that are best suited to that individual. And I think that's great, but I think that we can extrapolate as we learn about specific gene modifications or gene expression, we call these polymorphisms, gene variances, let's say, of individuals that teach us lessons that we can then use for the population at large too. We see when a certain pathway is not working appropriately in an individual, how it manifests,

we can generalize that in terms of understanding that pathway to a larger audience, as opposed to looking at a large audience and trying to make that data work for you as an individual. Yeah. So David, you've been a real leader in helping us understand these things and helping us make this complex science understandable, readable, and actionable so people can change their lives. Because this isn't just a theoretical book. Brain Brain is a practical book that if you implement will literally change your brain and change your life. And you have been working on some very cool stuff recently. You've been working on this Alzheimer's documentary, which is a 12-part online documentary that's coming out when? It'll be out in the summer of 2019.

19, great. So this is fantastic, and everybody should keep an eye out for that. They should check out his work at drperlmutter.com, and you'll learn all about the new Grain Brain Edition as well as the documentary, right? Correct. And you also should pay attention to about the science of human relationships, of connection, of meaning, of purpose, of the disconnection between our brains and who we really are by feeding them the wrong stuff.

It's really a fascinating sort of diversion for you, but it's also really relevant today because people are not functioning well. I mean, I just read a paper in the in the uh i think it was new england journal or jama about adhd and kids who are using more screen time have more developmental issues have less ability to function have more cognitive issues as they grow older so this is a huge problem in our society and we're not really addressing it and this book brainwash i think is going to be enlightening in that well i i i would say i wouldn't call it diversion and maybe we'll call it a progression okay in the next step once it's not a deep academic biochemistry

science book it absolutely is it is but it's absolutely through the lens of of human behavior yeah through well it uh i think that what goes on around us really was uh really motivated this book to be written and it is an exploration of uh and there are 400 peer-reviewed references so it is a scientific exploration of what is the effect of our modern lifestyle of our time spent on looking at screens of our lack of adequate restorative sleep of the westernization of the global diet, what is the effect on the hardwiring of the brain? And what is happening is we're seeing that we are becoming more wired into the fear center, the center of impulsivity, of lack of compassion, as opposed to being wired into our gift, which is this prefrontal cortex that allows us to

make decisions by thinking about, well, what are the future consequences of that decision? The part of the brain that allows us to be empathetic, that allows us to be compassionate individuals. And we've realized now as we are preparing the manuscript that to a significant degree, what we are talking about is basically existential as it relates to humanity. Because these changes in the wiring of the human brain,

away from the areas that let us be forward-thinking and compassionate, to the areas of sudden impulsivity, and caring about each other, and caring about the planet, this is happening globally, and it's in lockstep with the westernization of global nutrition trends and in lockstep with the amount of screen time and the influence of screen time on the wiring of your brain. This is a radical idea, David, that you can extrapolate to what's happening in the world today with the rise of autocratic societies and the polarization of countries in terms of either fascist or more socialist ideas. You see that happen in our country with this extreme polarization. And even Congress is just an epitome of what is happening to the rest of us. And I remember being in a lecture years ago where they showed the voting patterns

in the Senate and Congress, you know, in the 50s and 60s and 70s compared to the voting pattern now. And there was tremendous crossover collaboration. And now they're completely separate. It's all the Democrats vote Democrat, all the Republicans vote Republican. There's no crossover.

There's extreme polarization. And it's happening everywhere around the world. And I wonder if what you're saying is that our diet and our addiction to screens is driving these behaviors of polarization and disconnection. It's exactly what I'm saying. And it is a feed-forward cycle, because the more our diets are the way that they are, and the more screen time we spend, the more our diets are the way that they are and the more screen time we spend the more we distance ourselves from the areas of our brain that can help us break out that can help us make better decisions make better resolve and stick to that resolve so it becomes a feed forward cycle and you know this is uh the broad scope that we've just really embraced uh austin and i

in terms of- It's a pretty important thing because people don't connect what's happening in our culture and politics in the United States and globally to what we're eating. That's a major paradigm shift. You know, you and I have been talking about all the things that are connected to diet, well, insulin resistance, inflammation, coronary artery disease you name it and that's a big story in of itself but when you ask yourselves what are the major threats to our survival certainly those diseases are the number one cause of death on planet earth but just how we are behaving yeah take a step back that is a a broad view that is extremely compelling yeah and challenging to

write a book about i will tell you you're in nutrition that is a that is a great topic and that's really what we've been both writing about for a long time well you've mentioned earlier today in our time together the relationship between our gut microbes i think you mentioned the context of your wife yeah the relationship of gut microbes to how we perceive the world, to our mood. And then we just have to connect the dot between our food and the health of our gut microbes. Now the circle is complete. It's pretty amazing. So David, thank you so much for joining us today on The Doctor's Pharmacy, a place for

conversations that matter. If you want to learn more about Dr. Perlmutter's work, go to drperlmutter.com. That's D-R-P-E-R-L-M-U-T-T-E-R.com. He's one of the most thoughtful, compassionate, kind, smartest docs I've met. He's been my mentor and my friend for decades. And I'm not just saying he's cool because he's my friend, but he really is cool. That's a great compliment and um if you've enjoyed this podcast please uh share with your friends and family on facebook leave a comment we'd love

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