David Perlmutter

7/26/2019 David Perlmutter

http://slidepdf.com/reader/full/david-perlmutter 1/25

!2016 Axe Wellness, LLC. All rights reserved. 1

Heal Your Gut by Going Grain Free

Guest: Dr. David Perlmutter

The purpose of this presentation is to conveyinformation. It is not intended to diagnose, treat, orcure your condition or to be a substitute for advice from your physician or other healthcare

professional.

Dr. Axe: All right, everybody. Hey, welcome here.We've got a fantastic interview today with Dr.

David Perlmutter. Dr. Perlmutter is the author of the New York Times bestselling books Grain Brain and Brain Maker . He is a fellow of the AmericanCollege of Nutrition. And you'll see him all over the media. He's been featuredon Dr. Oz and many other TV shows. And he's a neurologist. And really excitedto have him here with us today. Dr. Perlmutter, welcome here to the interview.

Dr. Perlmutter: Well, I am delighted to be here, Josh. Thank you for havingme.

Dr. Axe: Thanks. Well, I know we're going to talk today about the gut-brainconnection, something that I know that you've written extensively about. And Ithink a lot of things when people think of gut health, they tend to think, well,that's kind of where it ends. If I've got a gut problem, I might have some gas,bloating, or a more serious issue like inflammatory bowel disease.

But they think it stops there. I know we're going to talk about that today. Butright before we jump in there, I'd love to hear about what you got you involvedbecause, again, your training is on the brain. What got you involved with boththe brain but as well as how that's connected to the gut?

Dr. Perlmutter: In a word I would say frustration. I've been practicingmedicine for thirty-five years and most of that time as a brain specialist, as a




neurologist. And really it was a hugely frustrating endeavor at least for thefirst ten years of my practice. I was actually in practice with two other reallygood neurologists, good guys. But we really had nothing to offer patients. Itwas a situation of diagnosis and adios, meaning you do the very best to makea diagnosis, come up with a name for it. And then there was so little to offerour patients with Alzheimer's or autism or Lou Gehrig's disease, even majordepression.

So I have been really dedicating the rest of that time, the past fifteen years atleast, even twenty years, to trying to figure out what else is out there. And itturns out that one of our most powerful leverage points as it relates to brainhealth isn't in the brain. It's in the gut. And that was just published by Dr.Hippocrates a couple thousand years ago. So we have to pay attention to that.

So we're now really getting our arms around the notion that what we choose todo in terms of nutrition and how that reflects what goes on in the gut plays a

very pivotal role in determining not just the brain's functionality right now,moment to moment, but a person's long-term risk for brain degenerativedisease like Alzheimer's, Parkinson’s, multiple sclerosis and so many more.

It does begin in the gut. And the idea of only looking at the brain is myopic. Itis unfortunately how some physicians still want to practice, but I think what you're seeing, Josh, is more and more people are opening up and looking atother areas, other avenues, and recognizing that the body really functions as avery integrated machine where parts definitely are involved with other parts.

And we really have to look at the body and take a step back and celebrate theway that the brain dances with the gut, vice versa. And when you do that, thevery empowering part of that story is it then opens up the world to you interms of being able to take advantage of that new science and then instituteprograms that can work based upon this new understanding to lead to betterbrain health and better brain function.




Dr. Axe: Well, I know that you've got some excellent programs that you'vereferred to in your book such as Grain Brain and Brain Maker that, again, Iknow you've gotten so many good reviews on this. I know I've seen your PBSspecial really referring to your programs.

And if anybody's interested in learning more about Dr. Perlmutter's programs,

I encourage you to check out his website during the interview now or after atDrPerlmutter.com. You can learn about the programs on there. And I knowthat you've referred to this thing, this microbiome, I know it's something that you and I both referred to a lot in our writings. But I think it's new to a lot ofpeople. Can you explain a little bit more about what the microbiome is?

Dr. Perlmutter: Well, the gut is anything but sterile. It's an environment thatis absolutely loaded with bacteria, as well as viruses and yeast and all types oforganisms. And we refer collectively to these organisms as well as their DNA in

the term "micro", meaning small, "biome". There's this whole universe oforganisms living within each and every one of us.

And we've known about that for quite some time, but what we haven't reallyappreciated is the extent to which our health, the health of us as a host, isinfluenced by the health of this hundred trillion bacteria, for example.

You know that 90% of the peer-reviewed literature dealing with themicrobiome has just been published in the past five years. And I give you that

statistic just so that you get a sense as to how much of this information isreally brand new.

And we're right at the very nascent stage of understanding this incrediblypowerful role of these bacteria in terms of affecting our metabolic parameters,extracting nutrients from our food, determining set point of inflammation,affecting immunity, dealing with creating various chemicals that have an effecton the brain's metabolism, and even the creation of what are called




neurotransmitters themselves. Chemicals like dopamine and serotonin areaffected really quite dramatically by the bacteria that live within us.

So even as it relates, for example, to depression, we now understand thatthere is a role for the happy chemical serotonin in depression, hence all thedrugs that are designed to increase serotonin availability in the brain. We callthose SSRIs.

But, look, 90% of the serotonin in your body is made in your gut so the notionthat hey, we'll give a brain drug and increase serotonin there for depressionreally misses the mark when 90%+ of that chemical comes from the gut. Andwhen we understand that when we change the balance of the gut bacteria, ithas a dramatic effect on our metabolism, on our blood sugar, on our risk forobesity, on our risk, for example, of becoming a type II diabetic.

Why is that intriguing for me? It's intriguing because type II diabetes is

associated with doubling a person's risk for developing Alzheimer’s disease.Now, Alzheimer’s is a disease for which we have no treatment, nonewhatsoever. And yet we now see this strong correlation in terms of risk withbecoming a type II diabetic. Type II diabetes is correlated with our diet,obviously, and also with change in the gut bacteria.

So when you take a step back and look at how powerful and how related gutbacteria are to some of our most worrisome conditions, you really want tothink about what it is we're doing in our day-to-day lives that threaten the

health of the gut bacteria, that increase the overgrowth of potentially bacteria,and then beyond that, as I talked about in Brain Maker, what can we do torehab.

What can we do to press the reset button, if you will, on the microbiome andpave the way for letting good bacteria flourish, keeping bad bacteria at bay orin check, and really in so doing, paving the way for us to be healthy andspecifically have better brain function?




Dr. Axe: Well, I know we're going to get into that in just a minute. I'm excitedfor you to talk about some of the dietary things, the supplements that peopleneed to follow.

But how far reaching is this? Let's talk about some of the symptoms, some ofthe side effects, of an unhealthy microbiome and gut issues. What are maybefive or ten of the most common symptoms or conditions that people experience

as a result of an unhealthy microbiome?

Dr. Perlmutter: Well, that's an excellent question because as you may knowthere are various tests that people are now trying to popularize that will give you some inferential information related to the state of your microbiome.

I think we're really kind of also in our infancy in terms of understanding theimplications of what those stool tests of your gut bacteria have to tell you. Imean, certainly they're accurate in terms of what they reveal in terms of the

gut bacteria, but the question is what is a healthy result versus a non-healthyresult. And beyond that, of course, what do you do to fix it?

So I think the question is really excellent that looks at it from the illness sideof the spectrum. What are the kinds of things going on in your body or yourhistory that may make you suspicious that your gut bacteria have beenaffected or traumatized?

And I would say many factors should be looked at. First of which would

certainly be your method of birth. How were you born? We know that there areobvious changes in the microbiome that are seen in kids born by C-section. If you're born by cesarean, you don't pass through the birth canal. You don'tobtain this microbial baptism where you gain healthy bacteria by passingthrough the birth canal that are there specifically to inoculate the newborn.

We know that the consequences of cesarean section include increased risk forthings like autism, ADHD, type I or autoimmune diabetes, celiac disease, and




even becoming obese as an adult- all associated with being born by C-section.Having lots of antibiotics as a child clearly damages the microbiome. One ofthe questions we use would be did you have your tonsils out? Another one,did you have ear tubes placed when you were little? That's an indication thata) your immune system was likely compromised as a child, and b) likely if youwere involved in conventional medical care, you prior to having the ear tubesor the tonsils and adenoids removed, you probably were hit with a few courses

of antibiotics, oftentimes much more than a few courses.

Now, do you have an autoimmune condition like lupus, rheumatoid arthritis,celiac disease, type I diabetes, multiple sclerosis? Are you more than twentypounds overweight? Do you suffer from depression? Are you gluten sensitive?Are you a type I diabetic? Are you a type II diabetic? These are all indications,again, that your immunity and your medical treatment in the past may haveset you up for changes in your gut bacteria.

Do you take nonsteroid anti-inflammatory drugs? Do you take acid-blockingdrugs called PPIs (proton pump inhibitors) that you can buy over-the-counter?And are you a person who might take an antibiotic every maybe one to two years for who knows what- colds or sniffles? This is obviously an indication ofover usage of antibiotics likely although you should check with your doctor.

But each of these points that I raise or questions that I raise we actually havein Brain Maker on page seventeen. It's a checklist about your lifestyle choices,maybe not your choices but choices that were made for you. Obviously you

had no role to play in getting antibiotics as a child or how you were born.

But I raise the questions because you know what? Many of the readers aretrying to decide whether they should have their child born vaginally orthrough C-section. But I like the fact that we have that information forparents-to-be so that the discussion that they can have, for example, withtheir obstetrician will go a little bit further than simply how long will my scarbe if I have a C-section.




When babies are born by C-section, again, it provides them a different set ofbacteria that builds their microbiome. They obtain bacteria from the operatingroom and from whatever might be on the surgeon's gown as opposed to beingenriched and inoculated with a more appropriate microbiome from the birthcanal.

Dr. Axe: Wow. I know that in reading a lot of the medical journals and seeing

how many species of bacteria that a lot of us are missing, it's incredible. Ithink you've probably saw the recent research or information on theYanomami tribe that they looked at and how they had 40% more microbialdiversity.

In looking at that and you working with I know thousands of patients over the years, and I know you mentioned a few, and you talked about C-sections andantibiotics, what are some of the other things maybe surprising or some of thefoods that people could eat that could actually decimate or cause issues with

microbes in the gut from a diet standpoint?

Dr. Perlmutter: Let me go back, though, to your comment, and then I'llanswer your question, the comment about the diversity of organisms in peopleliving in rural environments, specifically those in sub-Saharan Africa. And oneof the big studies, of course, is this study that was carried out in BurkinaFaso where they did genetic analysis of the bacteria of the stool in childrenliving in sub-Saharan Africa in Burkina Faso and compared that with childrenin Europe, in Western Europe, age match same age.

And they found an incredible difference in the diversity, that those kids livingin a rural environment had a much more robust diversity in terms of the sheernumber of species as you well characterized of bacteria living within them andthe metabolites of those species found in the guts were also significantlydifferent.

One of the main metabolites that gut bacteria make are called short chain




fatty acids. And we saw a significant difference in the short chain fatty acidarray of those three fatty acids in comparing the children in Burkina Fasowith those living in Western Europe.

So then to answer to your question, which would play, of course, upon thatwould be then what are some of the things we're doing? And I mentioned thenonsteroid anti-inflammatory drugs. I mentioned the proton pump inhibitors

as medications. But really I think the biggest issues that affect the diversityand the health of the gut bacteria are our food choices.

And I think the most devastating issues in our food would be things like theamount of sugar in the diet, as well as the amount of other things likeartificial sweeteners that are so commonly introduced into the Western dietthese days.

So sugar directly is traumatic to the gut bacteria and changes the array,

creates a gut bacterial array or diversity profile that does tend to favor obesityand favors even metabolic changes that will set the stage for type II diabetes.But beyond that, people seem today to think, well, therefore if I'm not going tobe eating sugar, I should opt for artificially sweetened foods, artificiallysweetened beverages.

And it turns out that we've known for several years that the risk for obesityand the risk for type II diabetes is actually higher in those people drinking thediet drinks in comparison to those drinking the sugar sweetened drinks. Now

that may sound really counterintuitive, and at first blush it is.

Over the past few years, we've been trying to explain that by noticing howaspartame affects our appetite. And we know that aspartame, at least inlaboratory animals, has some effects in the brain in the appetite center, in thehypothalamus.

But now a new study came out of Israel that pointed the finger back to the




microbiome showing that the changes that happened in the microbiome whenwe consume artificial sweeteners is the type of change that increases our riskfor obesity and type II diabetes. So again it's not nice to fool mother nature.When we're challenging our gut bacteria with poisons like this, sugar or theartificial sweeteners, and I'm calling them poison, it has a significant effect onmany downstream issues that relate to how the microbiome influences ourhealth.

Dr. Axe: Wow. There are such a cascade of events can happen too with eatinga certain type of food. I'd love for you to describe a little bit about what goes onin the body. We've all heard of so many times millions of books at this pointprobably people are referencing gluten. People are referencing certain types ofcasein and things.

When somebody consumes gluten and sugar, what is the entire process ofhow it's from when you put it in your mouth to happens in your gut to that

could even, something happening in your gut, could then affect your bloodstream and brain? How does that work?

Dr. Perlmutter: Well, the biggest issue that relates to problems with the brainis a mechanism that's called inflammation. Inflammation is a cornerstoneplayer in autism, Alzheimer’s, now we know even in depression. And for yourviewers, if they wanted to Google the word "depression" and the word"inflammation," the number of journal citations that will come up is reallyquite astounding. Who knew that depression is an inflammatory disorder? But

so is Parkinson’s and so is multiple sclerosis.

So the process of inflammation really needs to be looked upon as playing apivotal role in brain disorders. It's hard to imagine. You consider inflammationas this redness that appears when you get a mosquito bite or theinflammation in the joint that an arthritic person might have. But front andcenter that's what's going on in Alzheimer’s. That's what's going on in autism.




We now fully understand that one of the major contributors to inflammationin humans is what goes in the bowel, and specifically the leakiness or thepermeability of the bowel lining itself. Recognize that what keeps out bowelcontents from getting into the blood stream is a layer one cell thick. That's theentire gatekeeper.

And these cells are juxtaposed or held together by cement that generally keeps

the bowel from allowing those things to get from the bowel into the bloodstream. Well, many things can escape from the bowel, get into the bloodstream, and immediately amp up this process called inflammation andchallenge our immune system.

Now, many things will disturb the gut lining and make it leaky. And amongthose most importantly are changes in the array or the complexion of the gutbacteria. When you induce changes in the gut bacteria, when you bombard your body with antibiotics or eat a diet that's high in sugar, you change the

appearance of those bacteria, the relationships that they have, and you reducethe ability of some of those bacteria to maintain the gut lining.

That's their job. That's what lactobacillus plantarum, lactobacillusrhamnosus, it's one of the things that these species do. But when you affectthem, when you hit them with antibiotics or the nonsteroid anti-inflammatories, we've known for a long time that NSAIDS, medicines likeibuprofen, lead to gut leakiness. And that's a drug designed to reduceinflammation. Think about that. And at the same time, it increases

inflammation by virtue of the fact that it increases the leakiness of the gut.Who knew? What a perfect storm.

But that said, we now understand through the work of Alessio Fasano fromHarvard that gluten, because it contains another protein called gliadin, canactually lead to increased leakiness or permeability of the gut by activation ofa cascade pathway that utilizes a chemical called zonulin. Zonulin when it'sactivated leads to deconstruction of the tight junctions that hold cells




together. And therefore becomes associated with leakiness that leads toinflammation and that is the cornerstone of bad things like Alzheimer’s,coronary artery disease, diabetes type II, obesity, and even cancer.

So when we talk about the integrity of the gut, the importance of maintainingthat gut integrity, understand that throws a wide net and really gets back to your original question with me, why in the world would I be interested as a

neurologist in gut-related issues?

And I'm hoping we're connecting some really important dots here because thisis really leading edge and very, very exciting because it opens up the door forbeing able to reduce inflammation by targeting the gut and that will affect thebrain.

Dr. Axe: It's amazing. And I loved how you circled back around on that andreally explained the process because I think as so many of our listeners are

hearing right now that their conditions are not a direct result of the diagnosisthey were given.

For instance, so many people today with autoimmune disease, if you mentionthings like Hashimoto's thyroiditis, so many people would think, well, I've gotto treat my thyroid. That's the problem. Because you're saying no, it's a muchmore specific problem that can start with your microbiome and with your gut,these different areas of the body.

And I just think it's an important thing to consider is that so much ofmedicine today has become about treating the specific organ where thesymptoms in play, but not treating the root cause. And that's something thatI've really respected about you is you've really took head on and said, “Youknow what? We're going to figure out what the root cause is and treat thatinstead.”

Dr. Perlmutter: It's true. And there is a simple lab test that you can get called




LPS (lipopolysaccharide). And I don't mean to be too technical for yourviewers, but the point is LPS lives in the gut. It's part of the lining of the cellmembrane of many of the bacteria that live there. And that's where it belongs.

But when you measure LPS in the blood stream or antibodies against LPS inthe bloodstream, that's an indication of two things. That the gut is leaky andthat inflammation has been turned on. And in Brain Maker , you'll see graphs

showing high levels of LPS in people with Alzheimer’s, Lou Gehrig's disease,autism, and as I mentioned before major depression, indicating that we've gotchange our focus from the brain to the gut.

And then we have the chance at really finding out what's going on as a causalmechanism, not just treating symptoms as you well mentioned. And to me it'spaying attention to the fire, not just the smoke. When psoriasis, for example,is treated with skin creams, that's a really gross example of being at the end ofa line of a very long cascade events that finally manifests itself in the skin.

Now, I think that skin treatments and even immunomodulation therapies thatare popular now for something like psoriasis are helpful in reducingsymptoms. I'm all in favor of that, but I'm more in favor of putting the fire out.So if you measure LPS, for example, in psoriasis, Hashimoto's thyroiditis, typeI diabetes, Parkinson’s, Alzheimer’s, ALS, even frequently in autism you willsee that it is elevated.

And again it's telling us there's something going on in the gut, and you need to

pay attention to that. These ideas about treating rheumatoid arthritis byinjecting the joint miss the cause of the disease, and I submit to you todaythat it's a gut-related disorder. And it takes some getting used to. This is adifferent paradigm.

But like I tell my patients, I'm going to tell you right now that you may thinkthat in the morning you look to the east that the sun rises in the east andthen it moves straight up during noon time, and then the sun moves to the




west at the end of the day. I'm going to tell you that's not true. In reality, theearth is spinning, and the sun isn't moving. It looks like it's rising in the eastand setting in the west.

And people then they say, “Oh, yeah, I remember that now.” And it's again it'sa new paradigm. And once you embrace that there's no going back, once yourealize that these fringe ideas that people have been talking about for a long

time are now gaining incredible traction.

So viewers can Google, for example, something like "rheumatoid arthritis" andthe letters "LPS." Or "multiple sclerosis and LPS," "Parkinson’s and LPS,""autism and LPS." And these journal citations are going to come up, and you'llrealize that there are a lot of people in a lot of institutions doing someincredible work.

Brain Maker has forty-seven pages of references, and every mention of these

ideas is referenced by really good information. So it's a paradigm shift. Again,getting back to how we started this interview, it takes a little getting used to.For me, as a brain specialist. But now that it's happened, gosh, there's somuch good to be done.

Dr. Axe: Yeah, I know the results you're seeing are amazing as per ifsomebody picks up Grain Brain or Brain Maker and starts reading the greatsuccess stories of your patients, I know that they'll get to see that forthemselves.

Let's start talking about the diet and some of the things that we can do to fix itnow that we know that a lot of these diseases begin in the gut. And we'vereally got to nurture our gut back to health. What are some of the mostimportant foods that you recommend that people need to start eating rightaway to start repairing their gut?

Dr. Perlmutter: People need to start eating right away, huh? I'm all for that!




It's actually lunchtime right now. You're talking to me.

But that said, again, I'll get there in a moment. But the first R is remove,meaning let's remove the sugars. Let's remove the artificial sweeteners. Let'sremove the chlorinated water. Let's remove the medications and this perverseover usage of antibiotics that even the Journal of the American MedicalAssociation and the Lancet are warning people like myself, physicians, about

because it's just getting out of hand. Clearly there's a time and a place forantibiotics, but I think we all agree that that's a medication class that isextremely overused.

Once we remove, then we replace. And we replace the good bacteria in the gutin various ways. First, I like to focus on what are called the probiotic foods,fermented foods. Foods that are undergoing fermentation are things likekimchi and the popular drink now kombucha, cultured yogurt, sauerkraut,fermented vegetables, fermented eggs, fermented fish.

The idea of fermentation in terms of creating a food that will last a long timehas gone back at least 7,000 years. And prior to that, this isn't going to soundvery savory, but people would eat food that was already fermenting because itwasn't refrigerated and wasn't preserved, and that's how we ate. That's howwe've been eating for a couple of million years.

Turns out that those foods are teeming with good bacteria. That's why Irecommend foods like kimchee and kombucha and fermenting your own

vegetables because they've got wonderful levels of bifido bacteria and othersthat are good for recolonizing the gut with the right type of bacteria.

Now, beyond that, in the vein of probiotics there are certainly better and betterprobiotic nutritional supplements that you can buy at the health food store.More and more we're seeing probiotics with better technology as it relates tocreating products that will survive through the stomach acid or even let's getstarted with how it gets to the store in the first place so that even in the




package these bacteria are still alive. Then when they are consumedthroughout the time of their shelf life, they continue to supply you withadequate numbers of viable bacteria. Then these bacteria are encapsulated insuch a way that they'll make it through the stomach acid and go on tocolonize the gut.

So we want to find products that in fact have good technology and have a

pretty wide array of species and have a high CFU count. What does thatmean? When you see the ten billion, twenty billion, fifty billion, ninety billionbacteria, that's given in what are called CFUs (colony-forming units) that wehope will still be viable when you buy the product.

Now, we want to nurture our bacterial friends. Understanding that we callthese bacteria commensal meaning "co" means with, "mensa," eat. They eatwhat we eat. And I want to just stay there for one brief moment because I'dlike the viewers of this video to understand that we should look upon our food

not just in terms of its nutrient content, the amount of fat, calories,carbohydrates, micronutrients, vitamins and minerals, but look upon our foodin terms of nurturing the gut bacteria.

We call them commensals because they eat what we eat. They share the tablewith us. Every bit of food that we eat goes on to be looked at and processed byour gut bacteria for good or bad. When we eat foods high in sugars andartificial sweeteners as I've mentioned, we don't favor the overgrowth of goodbacteria. We tend to damp that down and allow bacteria species that are less

favorable to flourish. And that sets us up for problems.

On the other hand, when we eat what are called prebiotic fiber, not just fiberbut a specific type of fiber called prebiotic fiber, that's the type of fiber that bydefinition will nurture the gut bacteria and lead to health benefits. So onepopular prebiotic fiber is inulin. And inulin-rich foods are things likeradicchio, Jerusalem artichoke, dandelion greens, asparagus, onions, leeks,garlic.




These are foods that contain a lot of inulin. And absolutely when you eat thosefoods, your gut bacteria are so thrilled to see that stuff coming down the tube. They're just excited as can be, and they are going to reward you. They're goingto say, “Look, what you gave me, all right, I'm going to give you vitamins. I'mgoing to give you reduction of inflammation, balancing of your immunesystem.” And that's what you get in return for giving your friends, yoursymbiants that live within you, what they need to flourish.

Dr. Axe: Wow. I love it. I was just picturing how excited you and I would be forlunch right now, similar to our gut microbes. Foods are obviously critical. And you mentioned probiotic-rich foods. You mentioned prebiotic-rich foods, whichis something I think a lot people skip over and those forms of soluble fiber.Let's also talk about a little bit with supplements. You mentioned probioticsupplements. Are there any other supplements you recommend to patients?

Dr. Perlmutter: Well, I do. I would say in an ideal world it would be nice if we

didn't have to have supplements. Our world is less than ideal. And ourlifestyle is clearly less than what it used to be. Obviously in days gone by wewould spend a lot more time out of doors and we wouldn't be wearing clothes.Now, to be clear, I'm not suggesting we all run outside naked all day for anumber of reasons that are obvious.

But that said, in that we're not outside without clothing, we're not going to bemaking as much vitamin D as would be ideal. So I think it's important toconsider taking a vitamin D supplement. And obviously the best thing to do is

to have your physician monitor your vitamin D level, recognizing that at leasthere in America, our units in terms of normal are between 30-100.

With that said, 31 doesn't mean that you're home free, everything's great. Sorather than just being in the normal range, I think it's important to look atbeing in the optimal range, so keeping your level around 80 or 90 is what Iwould target. You might need 5,000 units of D3 a day or even 10,000 units ofD3 a day or 50,000 units a week, something like that, to get your vitamin D




level up. It's critically important. Vitamin D activates more than 930 genes inhumans, most of which are actually also in the brain.

I like an antioxidant detoxicant called alpha lipoic acid. In Europe it's calledphytic acid. I think it's a terrific supplement. It's a very powerful antioxidantthat is both fat soluble and water soluble, meaning it will get probablyeverywhere in the body. It helps to regenerate other antioxidants like

glutathione, and it's also important as a chelating agent. It will help bindcertain metals and help your body rid itself of toxic metals.

In Europe people use alpha lipoic acid in the treatment of diabeticneuropathy. Here in America if you'll watch television, you'll see that drugs areused not to treat the neuropathy (if you watch carefully) but only to treat thesymptoms, to treat the smoke. But that ignores the fire. The alpha lipoic acidprotocols treat the neuropathy. They help the nerve get better and hence thepain then falls by the wayside down the line.

I also like a specific omega three that's called DHA (decosahexaenoic acid).Now, you'll find DHA in fish oil, in a much less extent but in krill oil, in othermarine oils, and also of algae derivation. It's derived from algae. That's howsome of the products in the health food store are made. That's the form that'sfound in many baby formulas that you can buy at the grocery store. DHA is acritical player for the brain. It's a fundamental component of cell membranes.It is also important as it activates genes that reduce inflammation. I've talkedabout why that's important earlier.

And finally we know that DHA activates a gene pathway that turns on thebrain's production of something called BDNF. I know I'm throwing a lot ofinitials but suffice it to say that DHA turns on production of BDNF and thatallows your brain, enhances your brain's ability to grow new brain cells in thebrain's memory center. Pretty cool.

So when Martha Clare Morris at Rush University publishes journal articles




that show significantly lower risk of dementia in those individuals/people/humans with higher levels of DHA, we have to take notice of that. And that'swhy I think it's really reasonable to have 800, 900, or 1,000 milligrams of DHAa day. Now, you can get that from having wild salmon every day or eating a lotof fatty seafood. On the other hand, there are some wonderful, highly purifiedfish oil products on the market today that you can get and have. Take severalcapsules so you get 800-1,000 milligrams of DHA daily.

Dr. Axe: Great advice, Dr. Perlmutter. A lot of good information there onsomething that I think that a lot of people some of us know some people aren'tas well aware and how they work. I’ve got just two more questions for you.One would be lifestyle factors, emotional stress, exercise, anything else. Whatrole do they play and what maybe recommendations do you have for bothviewers and patients on things they need to do lifestyle wise for their gut?

Dr. Perlmutter: Well, understand that these days I make no distinction

between actual patients and people who read my books, people who arewatching this video right now. Why? Because the word "doctor" meansteacher. It's what I do in my clinic. It's what I'm doing right now.

So to answer the question after that preamble, one of the most underrated butcritically important lifestyle issues is aerobic exercise. Publishing in the journal Proceedings of the National Academy of Science, Dr. Erickson at theUniversity of Pittsburgh about three years ago showed that aerobic exerciseactually increases the amount of BDNF. I just talked about that in terms of

DHA. It actually increases the amount of this chemical that causes brain cellsto grow in the brain's memory center.

And he took a large group of individuals, half of them over a two-year period,were given a twenty-minute aerobic program to perform every day. The othergroup kind of did whatever they want. They were fairly sedentary. These wereadults. And what he found after two years, and the group (it wasn't just Dr.Erickson), was that when they measured the size of the brain's memory center




on a MRI scan that the hippocampus (the brain's memory center) in the groupexercising had increased in size by about 2% compared to where it was atbase line. In the non-exercisers, the hippocampus actually shrunk. Memoryfunctional actually improved in the exercisers. And it declined in the non-exercisers. Blood values of BDNF increased in the exercisers and had nosignificant change in the non-exercisers.

Now, this is breathtaking information because there is no pharmaceuticalagent known to man that can lead to improvement in memory. And what Dr.Erikson demonstrated was aerobic exercise in people at risk for dementia,meaning that they are adults, was able to reduce their risk of cognitive declineand amplify the size of their brain's memory center while it increased BDNFlevel, just by slapping on your sneakers and going for a brisk walk. You don'thave to buy anything else special.

There's no prescription that your doctor's going to need to give you. There's

nothing involving health insurance here. It's getting a pair of sneakers and jumping on the treadmill, stationary bike, or in the pool (maybe without yoursneakers). But whatever you want to do, if you can aerobically exercise insome form, get your heart rate up, that changes your gene expression to codefor a chemical that will help you reduce your risk of memory decline. Whoknew?

You mentioned a couple of other lifestyle issues. And I would indicate thatsleep is also very underrated as it relates to the brain. When we sleep, we

allow changes to happen in a part of the brain called the glymphatic system.Now, perhaps many of your viewers have heard of the lymphatic system. Andthe lymphatic system is sort of a circulatory system in the body, but notrelated directly to the heart that tends to clear debris from the tissues, thedetritus or the garbage that tissues generate, and allows us to get rid of it.

Well, we now have recently discovered in the brain there is something calledthe glymphatic system that actually does the same thing as it relates to brain




cells and the time that this system is activated is during sleep. So we'veknown that there's a dramatic increased risk for Alzheimer’s, for example, inindividuals with sleep apnea or other nocturnal interruptions and now webelieve that one of the factors may well be because they're not clearing out thegarbage. They're not taking out the garbage, and it's accumulating.

Certainly the lack of REM sleep has other implications and people with sleep

apnea have oxygen levels that go down. Certainly that's not going to be a goodthing for your brain either. But we're really focusing lately on this glymphaticsystem in terms of its effect upon the brain.

The other thing you did mention was stress. Now, it turns out that stress atlow levels might actually be good for the brain. Stress involves activatingwhat's called the HPA axis. What in the heck is that? That's the hypothalamicpituitary adrenal axis. It means the brain when it is stressed or perceivesstress sends a signal to the adrenal gland to make cortisol.

Now, as mentioned, at low levels cortisol actually enhances memory. It's why alow level of emotionality or stress during an event allows us to remember thatevent because it's important. If it caused us to have some emotionalityassociated with it, probably it was important and something we would need toremember. But when cortisol levels are sky high or chronically elevated or inother words elevated over a long period of time, that level of elevation ofcortisol turns out to be damaging to the brain's memory center called thehippocampus.

And this was really elegantly demonstrated in the work of a Dr. RobertSapolsky in California, written a couple of books demonstrating in primateshow chronically stressed primates will have ulcerations in theirgastrointestinal systems and also drop out of neurons, less brain cells in theirmemory center.

So we know that there's an increased risk of Alzheimer’s in PTSD individuals




and individuals who have been traumatized significantly when they were young. Individuals under chronic stress have higher risk for Alzheimer’s.Experiencing divorce, experiencing the death of a spouse is a profound stressand associated with increased risk of developing dementia.

So these are things to avoid. Do your best to avoid stress. Get out of stressfulsituations. When people say harmful things about you or attack you in

various ways, it's best to take a deep breath and move on as opposed toengaging. Our natural desire is to engage. People who do things that are meanto us, who cut us off in traffic, who cut us off in line at a place or who arerude to us, it's really time to bring in the Zen master a little bit and take adeep breath and move on.

Similarly, it's important to understand that we are exposed to a threateningsituations when we watch the evening news. We are inculcated with thisnotion that the world is a horrible place and that around every corner is going

to be a terrorist waiting to do something awful to us. When we continue tobombard ourselves with that type of information, we're raising cortisol andwe're damaging our brain. It's that simple.

So maybe turn the TV off, especially during meals. Or be selective about what you watch. Sure, there are terrible things going on in the world. And I don'tthink it's reasonable to bury your head in the sand, but to have the networknews on 24/7 and bombard yourself with that information is not healthy.

I was giving a lecture recently in New York, and it was about the effect ofstress on the brain. And I was talking about there's a researcher named Dr.Andrew Newberg who has demonstrated that meditation is associated actuallywith regrowth of cells in the brain's memory center and also shown how stressaffects the brain.

And as I was getting ready to get in the taxi to go to the venue to where I wasgiving this talk, I went from my room to the elevator and even in the elevator




was still the news. So the only break, I turned it off in my room, but the onlybreak you get is when you're in the taxi I thought, right? So you're getting the TV in the elevator. Yet get down and you get in the cab, and there it is in theback seat looking at you. It doesn't end. So, hey, news is something that canbe monetized, but the point is it's really somewhat harmful. Keep that inmind.

So exercise. Maybe get yourself involved in meditation. Stop exposing yourselfto such negativity. That creates cortisol. That's bad for your brain. A dietthat's low in sugar and carbs that's high in prebiotic fiber and probiotic,fermented foods- these are keys that are going to really pave the way forhealth.

And in my profession, finally we have actionable ideas as they relate to brainhealth. We've always thought of brain disease as something that just happens.Oh, well, live your life, come what may. We'll give a pill.” There is no pill. And

lifestyle choices like you've been so kind to allow me to enumerate have a hugerole to play in keeping your brain healthy.

Dr. Axe: Well, Dr. Perlmutter, this has been great. And I know that one of thethings I can appreciate about you as well is you've really taken, I mean thesematters are complex, but you've done a great job of really simply explaininghow it works, breaking it down, giving us easy, actionable steps.

My last question for you is this: What does your diet look like on a regular

basis? What did you have for breakfast? What are you going to go have forlunch right now? For dinner? What are just an example of a breakfast, lunch,dinner, and maybe even a dessert that people could try?

Dr. Perlmutter: Truth be known, I've been missing a lot of breakfast latelybecause I'm not hungry in the morning. And it isn't written in stonesomewhere that you have to have breakfast or something horrible is going tohappen. It doesn't work that way. Breakfast is when you break your fast,




hence the name obviously. And the longer you have that fast, I think thebetter it is for you.

Dinner for me is a dinner that's got a lot of fat in it in terms of olive oil on topof my vegetables. It's a mostly vegetarian, high-fiber, colorful vegetable aboveground vegetables. If there's meat, it could be grass-fed beef, free rangechicken, but mostly wild fish I'm very fond of. And I always try to add in some

fermented food with that. I like to have as a side dish either kimchi orsauerkraut.

And as I mentioned, I put a lot of olive oil on my food, and I think that's one ofthe reasons that I'm not hungry when I wake up in the morning. When youhave fat and you train your body, you shift your physiology to be fat-burningas opposed to carb-burning all the time, your hunger level goes way down.

And truth be known—and I'm not advocating this for your viewers right now,

especially the diabetics—but a lot of times I won't eat lunch either. And I'll justhave dinner. But if I do have lunch, it would be a salad again with someprebiotic food, prebiotic fiber, probiotic fermented foods.

When I do have breakfast, and it's not that uncommon. I do have breakfastfrom time to time, I like eggs. I think eggs are an incredibly wonderful food. Iwill do an omelet with dandelion greens and kale. What I find it best is to cookthe dandelion greens, sauté them first, then make the omelet and then putthem on the inside. Then when I serve the omelet of course I'm covering it with

lots and lots of fat in the form of extra virgin organic olive oil. That's fat. That'swhere you get good fat.

I think a cup of coffee is reasonable. I have one each morning. I drink a lot ofthis new beverage that just came out called water. Who knew? And I'm a bigfan of kombucha. So it works for me. It's working for my patients. It's workingfor so many of the people who've read Grain Brain . They're now reading BrainMaker . It's interesting because the recommendations in Grain Brain about




gluten and certainly what it was focused on is eating much less sugar andlower carbohydrates, eating lots of vegetables that were high in fiber. Thatwhole approach was so validated now through the lens of the microbiome aswe talk about in Brain Maker .

So there was very little change. In fact, I don't think there was any change inthe diet except with the addition now of even more prebiotic fiber and the

fermented foods. So we've narrowed in on how and what to eat. Now we knowwhy you do it because it's nurturing your friends who want you to be healthyand happy because that keeps them alive. And I'm talking about the hundredtrillion bacteria living within your gut.

Dr. Axe: Well, excellent advice, Dr. Perlmutter, and I think that's a greatpicture of what an ideal diet looks like for retraining and boosting ourmicrobiome health.

I want to encourage everybody check out Dr. Perlmutter's website. Again, it's just DrPerlmutter.com. Also you can find his book on Amazon.com, BrainMaker . And if you really want to dig deeper in learning about everything thatDr. Perlmutter talked about.

If you want to find some great examples and healthy recipes of what herecommends and meal plans and other suggestions, again, check out the bookBrain Maker . It's been on the New York Times bestseller list, again, for weeksand weeks and weeks. It's been there for a reason because it is an incredible

book, well written.

He breaks things down easily and gives you recommendations that you canactually use, love, and enjoy. He's not telling you to eat sticks and grass. He'stelling you to eat things that are flavorful, tastes great, and easyrecommendations. So Dr. Perlmutter, thanks for being our doctor and teachertoday. I know it's something everybody's loved.



Dr. Perlmutter: Well, I do appreciate the opportunity. So again, thanks forhaving me.

Dr. Axe: Great. Hey, all right, thanks everybody. Thanks, Dr. Perlmutter. Havea great day.

Date post:	02-Mar-2018
Category:	Documents
Upload:	alicedwyer
View:	222 times
Download:	0 times

David Perlmutter

Documents