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There may not always be a simple medical solution for various brain dysfunctions. However, we have learned that there are things we can control, such as lifestyle choices, that have a major impact on our health. In this episode of The Brain Warrior’s Way Podcast, Dr. Daniel Amen and Tana Amen are joined by Dr. David Perlmutter, author of the best-selling book “Grain Brain”, for a discussion on how being informed about gluten sensitivities and the gut-brain connection can help you make better, healthier decisions.
Dr Daniel Amen: Welcome to The Brain Warrior's Way Podcast. I'm Dr. Daniel Amen.
Tana Amen: And I'm Tana Amen. Here, we teach you how to win the fight for your brain to defeat anxiety, depression, memory loss, ADHD, and addictions.
Dr Daniel Amen: The Brain Warrior's Way Podcast is brought to you by Amen Clinics, where we've transformed lives for three decades using brain SPECT imaging to better target treatment and natural ways to heal the brain. For more information, visit amenclinics.com.
Tana Amen: The Brain Warrior's Way Podcast is also brought to you by BrainMD, where we produce the highest quality nutraceutical products to support the health of your brain and body. For more information, visit brainmdhealth.com. Welcome to The Brain Warrior's Way Podcast.
Dr Daniel Amen: Well, welcome, everybody. Today is a very special Brain Warrior's Way Podcast. We have our friend, internationally best-selling author, neurologist, teacher, the author of Grain Brain, Brain Maker, The Grain Brain Whole Life Plan, and really someone I think Tana and I consider our teacher-
Tana Amen: Yeah.
Dr Daniel Amen: ... who is also a nutritionist and someone I have referred many patients to over the years. He is affectionately called "the empowering neurologist." David Perlmutter. Welcome, David. What a joy to-
Tana Amen: Yes-
Dr Daniel Amen: ... spend-
Tana Amen: ... thank you.
Dr Daniel Amen: ... time with you.
Dr David Perlmutter: No, my pleasure indeed. I like the part about "affectionately called." I've never heard that before, but I like the notion of affection. That's great. Thank you.
Tana Amen: Yes. I just have to say, I am, it's such a joy for me, because I actually had the pleasure of hearing you speak, gosh, probably 10 years ago, and I was so fascinated, and from that point on, I considered you a mentor, and I followed you, and I was so excited, and of course, you come home and your friends, and you became friends with them. I was just so excited to be able to actually have you become my mentor and join us and teach our community. This is amazing. Every time you are on-
Dr David Perlmutter: Well, let me just say-
Tana Amen: ... people are-
Dr David Perlmutter: ... as they say, right back at you, because you guys have taught me a lot, not the least of which was the important value of buying a ping pong table. I, to this day, want to thank you for that.
Tana Amen: That's awesome.
Dr Daniel Amen: He also is a member of the editorial board of the Journal of Alzheimer's Disease. They have published six of my papers. We got a new paper accepted on using imaging to predict treatment response with depression, so we're pretty excited about that. I know both you and I are huge believers in the concept of preventing Alzheimer's disease. In fact, we should live our lives in an Alzheimer's prevention program, because it starts in the brain years before people have any symptoms, but one of the things that you became famous for was Grain Brain. Grain Brain was a huge bestseller for a long time. It really helped change the way people think about their diet. What triggered that for you? What got you interested in writing that, and particularly talking about gluten?
Dr David Perlmutter: Well, let's wind the clock back. Grain Brain was published five years ago, and at that time, I had reached a real threshold, I think, of frustration in that just seeing Alzheimer's patients day in and day out and looking at the statistics indicating that by age 65, your chance are one in nine. They increase dramatically till you're one in two, 50-50 chance at age 85, and at the same time, literature coming out in our most well respected journals indicating that various lifestyle choices seem to be strongly related to risk, and as a neurologist, we don't have a lot of treatment options for many of the issues that we deal with, and certainly as it relates to Alzheimer's disease, we have nothing. There is nothing in the pharmacy cabinet there that I could give to an Alzheimer's patient that would have any bearing on the course of that disease. I don't like to be left empty-handed. I wanted some tools in my toolbox, and if we had no treatment, okay, I can accept that, and as we all have this conversation today, we still have no treatment.
That said, we saw this emerging literature saying that there is this strong correlation between lifestyle choices and various biometric measurements and risk for that very disease that we all fear and for which there is no treatment. We began seeing literature that correlated, for example, even mild elevations of blood sugar, obesity, head trauma, and all of these various factors over which we have some degree of control. Now, we don't have control over our genetics. We don't have any control over our gender, but we sure as heck have a lot of control over the food that we eat, the amount of physical activity that we engage in, and whether or not we experience head trauma.
John Kennedy said that the time to fix the roof is when the sun is shining, and that quote resonated with me for a long, long time, especially as a neurologist, because we have so few treatment options available to us. I had already defined myself as being the odd man out in terms of integrative and functional medicine. Being a neurologist involved with that approach, I think, was unusual, because everybody knows you have the brain that you have, nothing you do is going to change its destiny. I chose to be disruptive and not to go along with the party line. I made it my mission probably six and a half years ago to write this book, Grain Brain, really letting the public know that here is a powerful degree of empowerment that you now have to make choices that will absolutely change the destiny trajectory of your brain.
I think that the message really hit a lot of people, that book's in 30 languages, especially for those who are at risk by virtue of their gender, by virtue of their heritage, by virtue of other lifestyle issues like obesity, diabetes, etc., that certainly are associated with increased risk. We can't change our gender, but I think it's important to note that Alzheimer's is diagnosed twice as often in women as in men, and I think that perhaps might have a role in the fact that you don't hear as much as you should about the importance of preventive activity. I wrote this book that really focused on how toxic sugar and carbohydrates are for the brain, not because Dr. Perlmutter dreamed this stuff up, but because that is what our most well respected journals were telling us, that even subtle elevations of blood sugar had a profound and detrimental effect upon the brain in terms of increasing risk for dementia.
One study that came out in September 2013 in the New England Journal of Medicine followed a group of several thousand individuals for 6.7 years, and the only test they did at the beginning of the study was their fasting blood sugar. That's it. Nothing exotic. They didn't do a spinal tap or a brain imaging study. All they looked at was their blood sugar. They followed this group for close to seven years, and what did they find? That individuals who had even mild elevation of blood sugar had a dramatic increased risk for dementia. Well, that doesn't mean that the blood sugar elevation caused the dementia. This is a correlation, not a causation kind of report, but I sure as heck believe it did, and I sure as heck feel compelled and supported in stating that lower blood sugar is better. Believe me, not just based upon that one literature citation, but countless that came at that time and certainly after that.
The other fundamental leg of the stool here in terms of Grain Brain was the notion that wheat, in itself and by virtue of the fact that wheat contains gluten, weren't going to be good for the brain. We were beginning to see a host of non-gut-related issues to be seen in association with gluten consumption and gluten sensitivity. This was early in the days when most people didn't believe there was such a thing as non-celiac gluten sensitivity, meaning a person could have a problem with the protein gluten, but they didn't have the autoimmune condition celiac disease. For many years, even after Grain Brain was written, people would roll their eyes, "Oh, you guys with the non-gluten, non-celiac gluten sensitivity," but there was research. There were symposia that were held showing things like schizophrenia, other psychiatric issues, movement disorders, cognitive performance issues, etc., certainly migraine headaches, things that would come in the radar of a neurologist could be related to sensitivity to gluten.
In my practice, I was finding that plenty of patients improved with a variety of issues when we took them off of gluten. We published these case reports, and many people thought they were interesting, especially in the integrative world, and began using similar protocols going gluten-free with their patients and seeing similar results. Mainstream still had their feet in the mud and wouldn't embrace it. Either you had celiac disease, and if you didn't, eat whatever in the heck you want. Over the years, more and more data began to evolve that supported our original contentions. Research, for example, at Harvard, conducted by Dr. Alessio Fasano and his group revealed that gliadin, which is a protein that makes up gluten, induces leakiness of the gut in all humans, not just those of celiac, not just those of non-celiac gluten sensitivity, but all humans. Wow.
Why is that important for me? Why do I care about the gut? I care about it plenty, because the gut regulates inflammation, and it is inflammation that is the cornerstone of things like Alzheimer's, Parkinson's, multiple sclerosis, autism, depression. We've put these very important dots together and recognized that hey, the brain is influenced by the gut. That opened the door to the next book, which was Brain Maker, that looked at this relationship between gut, and specifically the bacteria that live within the gut, how those interplay through the process of inflammation.
As you well know, that area of research has absolutely exploded, especially in terms of things that you deal with, mood disorders, and getting back to one of the lifestyle issues I mentioned earlier, which is head trauma and its relationship to developing dementia, and certainly you and your team, with your work with CTE, etc., can relate to that, that's where preventative medicine comes into play. If you're going to do a contact sport, you wear a-
Dr Daniel Amen: So many things.
Dr David Perlmutter: If you drive a car, you got to wear a seatbelt.
Dr David Perlmutter: [crosstalk 00:12:16].
Dr Daniel Amen: So many things for us to-
Dr David Perlmutter: So many things you-
Dr Daniel Amen: ... unpack-
Dr David Perlmutter: ... can do to protect your brain.
Dr Daniel Amen: ... there.
Dr David Perlmutter: We have this sort of notion that the brain is what it is, and there's nothing that we do in our lifestyle choices that has any role to play in changing its destiny. We set out to change that, that paradigm.
Dr Daniel Amen: What's your thought on why women? It's well known that women have a higher incidence of Alzheimer's disease. In fact, while you were talking, I was beginning to put together two dots. Women have lower levels of serotonin than men, according to one study from Montreal, 52% less serotonin than men do. Serotonin's obviously associated with depression. The way to increase serotonin in the brain is simple carbohydrates that cause an insulin response that drives tryptophan into the brain, so now I'm thinking of women and cupcakes, and they're chocolate, but I know it's more complicated than that. What's-
Dr David Perlmutter: Well-
Dr Daniel Amen: ... your sense on-
Dr David Perlmutter: ... you know what? It may not be. Here is what I took away from the Montreal study. Our job is to connect dots, is to bring seemingly disparate information together to have those aha moments. Louis Pasteur told us that chance favors the prepared mind, so you're reading some obscure journal on the one hand, and you find this study, and you bring to bear other information that you may have. We take a step back in terms of serotonin to recognize two things. Number one, that the creation of serotonin from tryptophan is at most a process that is occurring at about a 5% rate, meaning that about 5% of tryptophan ultimately becomes serotonin. Not a lot of wiggle room here, and that any factor that could influence that conversion to serotonin negatively could further decrease the availability of serotonin. Well, it turns out that inflammation itself, perhaps the cupcakes, perhaps the changes in the gut bacteria that women may have for reasons that we'll talk about in a moment, can influence the ability to convert tryptophan into serotonin, called the kynurenic acid pathway.
Any inflammation ultimately reduces availability of serotonin, so we wonder what else could influence that pathway, could hormones influence the pathway. I think that's interesting. We know that women have different arrays and diversity of their gut bacteria, which are directly involved in inflammation as well, plus or minus. I think that as we recognize Alzheimer's, and depression for that moment as well, and its relation at the serotonin, both of these are now considered inflammatory disorders. I think if we take a step back and say, look at women's rates of depression, women's rates of Alzheimer's disease, women's rates of autoimmune conditions as well, which are twice as high as men, that there may be something going on within the gut, and downstream from that, at the gut lining, in terms of permeability, that may relate and explain these observances.
Now, I think the party line would have us believe that, obviously, changes in hormones may be related as well, and I'm willing to explore that, and obviously we have explored that, but beyond that, I think that there are other issues that relate to the exposure that women have to genes that are not parts of their bodies, challenging a women's body with genetic information with an organism that is only 50% hers, in other words pregnancy. What is pregnancy? When that fetus is developing within a woman, that woman is, to some degree, confronting her immune system with an organism that's only 50% genetically the-
Tana Amen: Oh, interesting.
Dr David Perlmutter: ... same as she. Might that induce some changes in her immune tolerance and in her immune reactivity? I think there are a lot of factors to consider. I mean, these are the kinds of things you think of in that brief moment before you fall asleep at night, you bring these things together, and it's, I think a lot of people think about that stuff.
Tana Amen: I want to get practical, if I could, and go back to something, a couple of things you said in the beginning. As a nurse and a coach, my job is to sort of advocate for patients and their questions, and I get lots of them. I had the, as I said earlier, the pleasure and the privilege of hearing you speak a long time ago, and so I've written eight books. A lot of them are influenced by you and Dr. Hyman and some of my other mentors, and so I've been pushing on this gluten issue for a long time, because I cut it out of my life and saw a radical change in my life. Never understood why I had so many issues. When I changed my lifestyle, a lot of things changed, but I got a lot of pushback.
One of the questions that I get ... I'm grateful for Grain Brain, because a nurse saying it versus someone who does research on the brain, it really helps. It backs up that message, but one of the questions I get, and I'm going to give you two questions, one of them is, how much gluten can I actually get away with eating before it becomes a problem? Like is it all or none? Is it black and white? That's one question. The other one is, you're talking a lot about really cutting back significantly pretty much on all carbohydrates. Now, for vegans, we have a very big vegan community. They tend to really go after the carbohydrates. I tend to tell them, "Make it more plant-based than anything else, and include some protein in there, even if it's plant-based protein," but what you would say to these people? Because they tend to fill that gap with carbs.
Dr David Perlmutter: Well, let's, since that part of the question, or second question's fresh in mind, I would say that we've got to, like we do with fats, good fats, bad fats. We need to talk about carbohydrates in terms of good and bad. By and large, the types of carbohydrates that our ancestors were exposed to were not high in freely available carbs, rapidly digested, rapidly releasing of sugar that these complex carbohydrates that are non-grain-based, that are based upon fiber-rich foods, have added. I think that we've got, and it's a really good point that you raise, and that is, we need to look at net carbs. We need to look at encouraging people to enrich their diets with foods that are going to give them fiber, and especially prebiotic fiber, that don't offer any caloric content to your physiology, but certainly act as a fuel source for metabolic production on the basis of your gut bacteria.
Tana Amen: If I could just give them that simple tip, so when you're looking at carbohydrates, what I often tell people is, subtract the fiber, so the amount of fiber.
Dr David Perlmutter: Yeah, I think the notion of net carbs is actually very good. Because a recent study came out, it was really quite interesting, and it looked at risk for cardiovascular disease in the gluten-free community versus those who ate gluten [inaudible 00:19:50]. What they found was, there was actually an increased risk of cardiovascular disease in the people who went gluten-free. The headlines were, "Ah, you gluten-free Gwyneth Paltrow people, look what you're doing to yourself, because you need gluten, because here is a study showing that the gluten-free community is at higher risk for cardiovascular disease." That's not what the study concluded. If you read the study, the authors stated that people who go gluten-free tend to consume less fiber overall, and that's a big mistake.
I would say, I know where you're going with this, but the caveat here is, gluten-free is good, with the caveat that, make sure you get enough fiber in your diet to nurture your microbiome so that your microbiota can nurture your gut lining, so you can reduce the permeability, so you can have a better-functioning immune system and less inflammation. Inflammation is the cornerstone of cardiovascular disease. People cut out fiber, they increase inflammation by virtue of the fact that they don't nurture their gut bacteria, which is what the authors concluded, but that's not what the mainstream press jumped on. They said, "All you gluten-free people, see? You're killing yourselves."
Dr Daniel Amen: Well, when you look at gluten-free packaged foods-
Tana Amen: They're terrible.
Dr Daniel Amen: ... it's often-
Dr David Perlmutter: Oh, yeah.
Dr Daniel Amen: ... terrible, right? It's like-
Tana Amen: They're just as bad as other processed foods. They're just, they're processed foods. They're terrible. They're full of starch.
Dr David Perlmutter: Right. I would say that, you say, gluten-free packaged foods. There's a great tip there. Most of your food should come unpackaged.
Tana Amen: Plants, and-
Dr David Perlmutter: What does that mean? That means all the aisles in the grocery store are pretty much going to be off the list-
Tana Amen: Right, perimeter.
Dr David Perlmutter: ... I mean, certainly ... Your coconut oil and stuff, yeah, but all the fruits and vegetables, and hopefully, grass-fed beef or fish are all going to be around the periphery of the grocery store, in the freezer case or just sitting on shelves.
Tana Amen: Right, and so what would you say about how much gluten you can get away with? Is it black and white, or what is the amount you can get away with?
Dr David Perlmutter: Tana, that's not an easy question, because it tends to lead people to the place of, "Everything in moderation." I will tell you that, having just said those words, the hair is going up on the back of my neck.
Tana Amen: I know. Me too.
Dr David Perlmutter: [crosstalk 00:22:07]. Because just a little bit of sniffing glue [inaudible 00:22:12] time. It's not a lot.
Tana Amen: Little bit of cocaine.
Dr David Perlmutter: It's in moderation. A and B. What in the heck [crosstalk 00:22:17]-
Dr Daniel Amen: Having an affair in [crosstalk 00:22:17].
Tana Amen: Having an affair in moderation, yeah, no.
Dr David Perlmutter: I think we do our very best, we stay as gluten-free as we possibly can. Do I have gluten in my diet? Sometimes, I bet that I do. Do I go to someone's house, do I know what the ingredients are in the sauce that's going over the wild salmon? I don't know for sure, but I do my best. I'm not eating wheat, barley, and rye. I'm doing my very best to avoid it. I think less is better. We want to do everything we can. The whole focus of the discussion is, everything we can to maintain the integrity of the gut lining, and that's from me and neurologists. It's certainly a stretch.
Tana Amen: I just want to-
Dr Daniel Amen: Yeah, but the neurologist is-
Tana Amen: I want to emphasize-
Dr Daniel Amen: ... also a medical doctor.
Tana Amen: Well, and I want to emphasize that we're not talking about going and having cheat days of gluten, and bread, and pasta and rice. That's what I wanted to emphasize.
Dr Daniel Amen: But I have another question, because there is also gluten in personal products, and-
Dr David Perlmutter: That's right.
Dr Daniel Amen: ... cosmetics. If you just think why women than men have a higher incidence, you just wonder if they're not also exposed to more toxins because what they spend on personal products is 10 times what males spend on ... Now, you look a whole lot-
Tana Amen: Do you see how long it takes us to get ready compared to-
Dr Daniel Amen: ... cuter than I am, but you just wonder. When I wrote Memory Rescue, I think the biggest takeaway, for me, is the impact of toxins on the brain and just how ubiquitous they are in our personal products.
Dr David Perlmutter: Actually, we, you and I had breakfast and talked about that a couple of years ago outside of Los Angeles, as I recall.
Dr Daniel Amen: Right, up in West, like where we were speaking together. All right, well, we have to stop this podcast. We are going to move on to the next one, and-
Tana Amen: You're going to be joining us again, let's make sure people know.
Dr David Perlmutter: Okay.
Dr Daniel Amen: Two more, and we're going to talk about toxins, gluten, and the glycemic index, what people need to know. It's just sort of going to be a continuation of the discussion we're having. Stay with us. Thank you for listening to The Brain Warrior's Way Podcast. Go to iTunes and leave a review, and you'll automatically be entered into a drawing to get a free signed copy of The Brain Warrior's Way and The Brain Warrior's Way Cookbook we give away every month.