Can You Prevent Cognitive Decline? PT. 2 – Dr. David Perlmutter

Dr Daniel Amen and Tana Amen BSN RN On The Brain Warrior's Way Podcast

Many pharmaceutical companies are getting out of Alzheimer’s research because they aren’t finding that “silver bullet” treatment to cure the disease. However, perhaps we should instead be looking for the “silver buckshot” treatment, because it is only by addressing many smaller areas of concern that you effectively reduce your risk for Alzheimer’s Disease. In the second episode of a series with Dr. David Perlmutter, Dr. Daniel Amen and Tana Amen discuss some of these “silver buckshot” elements, such as exercise and monitoring your glycemic load.


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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

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 Welcome to The Brain Warrior's Way Podcast.

Dr. Daniel Amen: Welcome back, everybody. We're here with Dr. David Perlmutter, the author of Grain Brain, Brain Maker, The Grain Brain Whole Life Plan. At the end of the year, he's going to have a revised version of Grain Brain, but don't wait. It's a great book. It's easy to read. It will help you change your behavior. I tell people, my experience, people change in one of three ways. They get an epiphany. If you see your brain scan, you get an epiphany. It's like, "Well, that's not great. I need to do better." They change the people they hang out with because you become like the people you spend time with, or they make small incremental changes, what our fried BJ Fogg terms tiny habits.

A grain brain, for so many of my patients, was an epiphany. It's like, "I had no idea this could hurt me. If I love myself ..." In fact, I had this 76-year-old guy in my office yesterday who I evaluated. He has memory problems. When I'm telling him the things I want him to do, he said, "I'm going to do it 100% because I love myself." I love that. He had trouble loving himself around the whole sugar and ... because he's got diabetes.

Tana Amen: You want to pick and choose, right.

Dr. Daniel Amen: Right, but-

Tana Amen: The sad thing is, in our society, I think something that our friend Pastor Rick Warren says is also true. People don't change when they see the light. They change when they feel the heat. We want to make sure that people get that balance. We want hope, the light, but we want them to know there's heat on the other side because it is, there is, and that's a fact, so we want that balance.

Dr. Daniel Amen: Welcome. With us again and-

Dr. Dr David Perlmutter: I'm delighted to be here. You guys are the best.

Dr. Daniel Amen: Well, thank you so much. The glycemic index-

Tana Amen: It's confusing to people.

Dr. Daniel Amen: ... and the glycemic load, when I first learned about it, I went, "Oh, this is smart," because, from a psychiatrist's standpoint, and we do imaging, we have found the higher a person's blood sugar, the smaller their brain. There's actually imaging studies saying the hippocampus becomes smaller. Diabetes became very personal. It's actually personal to both of us.

Tana Amen: Very personal.

Dr. Daniel Amen: My father-in-law, when he was 55, was diagnosed with diabetes. He was also an alcoholic. He was very abusive to his family, and he just never got it. The doctor would say, "Stay away from sugar." He was clearly addicted to doughnuts and simple carbohydrates and ended up losing his eyesight, his legs, his heart, died with dementia.

Tana Amen: My grandmother also. How do we make the glycemic index simple for our listeners, for our community? Because that confuses people. I mean telling them to stay away from sugar, they understand what that means, but they don't really understand how to interpret the glycemic index most of the time.

Dr. Dr David Perlmutter: Well, let me take you back, and we're going to go to the University of Toronto where the glycemic index was created, and it was created as a way of working with diabetics, strangely, by looking at their diets. Who knew? As if the diet has some role to play in terms of blood sugar. They wanted to rank foods in terms of how they would affect blood sugar over a 90-minute period of time. They created this terms the glycemic index to assess what was the impact of various food choices, and then they applied that, and then various institutions started to republish their information, and it became very handy. We still use glycemic index and glycemic load that takes this information a bit further by applying the notion of what a typical person would consider a portion of a food in terms its effect on blood sugar.

The bottom line is that both of these indices look at how aggressive will your blood sugar rise be if you consume either a standard portion of a type of food or if the portions are all the same in terms of the glycemic index? It's important to understand it's not just the heighth that your blood sugar goes during the 90-minute period, as in the case of the glycemic index, but it's more the area under the curve, meaning it's not just that it's suddenly spiked, but did it remain elevated for that 90-minute period of time so that more of that 90-minute was taken up by having higher blood sugar? Because that means the blood sugar is higher and damaging for a longer period of time.

It was interesting to note, in the early studies, that foods that people thought were really good for them turned out not to be, that whole grain, whole wheat bread had a dramatically high glycemic index, even higher than white highly-processed bread, and that things like a Snickers bar that everybody would think would be about the worst food that you could eat had about half the glycemic index as bread. That raised a lot of eyebrows because it sort of began challenging our notion of what made for good versus bad choices in the diabetic.

Well, since that time, many of us have adopted these lists, and parameters, and findings for people who aren't diabetic and don't want to become diabetic because we know diabetes is devastating for the brain. In our writings, like Grain Brain, we applied glycemic index information to our recipes and actually provided the glycemic index to our readers so that they could make informed choices long before they had diabetes, as a preventive medicine approach to keeping their brains healthy, keeping their blood sugars low. This is why this information is so valuable, and I will tell you that it's a good thing to review this from time to time because there are always some really interesting surprises on the glycemic index list.

Dr. Daniel Amen: Things like bread, pasta, potatoes, white potatoes, rice, even brown rice are as high as table sugar.

Tana Amen: Let's talk about what number they should stay under. That's what confuses people. Well, how do I know what's bad and what's good?

Dr. Dr David Perlmutter: Well, it's a good question. It really depends on how much of that food you are consuming. The glycemic index of an egg is zero. Now, that doesn't mean you should go out and eat 10 eggs because you'd have no spike in your blood sugar, but I think that we want to try to choose foods that have a glycemic index in the 50s or, perhaps, mid-50s and lower if you're eating a typical meal, typical portions. You really want to strive to have those lower glycemic index foods, but it doesn't mean that, again, just because a food has a glycemic index of 50, you can eat all you want. You really have to practice moderation in that regard.

The beauty here is that it helps us delineate between carbs and effect on blood sugar. You can have low glycemic index foods that have quite a bit of carbohydrates because it's fiber. Carbohydrates are what makes up fiber. These are low glycemic index foods though they have carbohydrates in them. You can eat those in abundance, and it's good for you.

Tana Amen: Especially when you think green.

Dr. Daniel Amen: Well, especially anything colorful.

Dr. Dr David Perlmutter: I like green, but I also like color. I like a variety of colors. You want to really cover the bases. The real beauty of greens, especially with some of the information that people are exploring these days, is greens are high in folate. I mean that's where the term folate comes from, foliage. These days, people seem to think, "Well, I need to take a really strong B-complex with a lot of folic acid." It turns out that folic acid is not a good choice.

Folic acid can bind those folate receptors, which are important, and compete negatively with natural sources of folate, and this isn't necessarily a good thing, especially ... I think I'm probably going to go off topic here for a moment, but if you'll allow me ... We understand, these days, that the reason we need folate and it's really critically important is because folate helps with a very complicated process called methylation. Methylation's involved in things like detoxification, preventing damage to our DNA, so this, obviously, a good thing to have going for you. Folate, when it becomes methylated, is able to participate in this life-important process of protecting our DNA, kind of important.

We know that about 20 to 25% of Americans harbor a genetic variation that doesn't allow them to activate this folate in such a way, so that they are at risk for genetic damage and problems with detoxification because they can't activate the folate, even the folate they consume that comes from vegetables and green vegetables, for example. We call this situation MTHFR, and many of your viewers have never heard of that term, but I would urge them to look at some YouTube videos on what is called MTHFR. It stands for an enzyme that activates folate and allows you, then, to protect your DNA, detoxification, et cetera.

That's the kind of information you can get from having your genome sequence, like 23andMe. Now, 23andMe doesn't give you that information. They will give you your entire genome sequence. You just take that information, you go to one of various other websites, you email them that information. In five minutes, you get back all of these cool pathways, and if you are like I am, you might have a defect in MTHFR. Great, now you know this information. You're empowered. What do I have to do? I have to take a supplement that has methylfolate in it every day, and I'm doing the right thing to protect my DNA.

There's the movement in a Paleo is to eat like our ancestors. I think it's terrific. I think we should avoid sugars, et cetera, but I also think it's really exciting to apply leading-edge technology in understanding who we are as individuals and what our individual needs might be and how we can cater to that based upon these higher levels of knowledge that we're now able to obtain.

Tana Amen: Agree.

Dr. Daniel Amen: We always talk about you can't change what you don't measure, so knowing your important numbers is critical, and 23andMe is-

Dr. Dr David Perlmutter: Yes, and it brings up the notion of genes verus environment. We can't change our genes, but we can certainly change how we influence our genes so that ... Some would say that our DNA loads the gun, and our environment pulls the trigger. These things might not manifest if we make certain changes. We're never going to know unless you look.

Dr. Daniel Amen: My daughter is pregnant, and she will have Haven, our fifth grand-baby in June. When I lecture, I talk about how little girls, when they're born, they're born with all of the eggs they'll ever have, and the mother's behavior is turning on or off certain genes that make illness more or less likely in Haven but also in Haven's babies, so this is serious stuff. I think the most exciting part of genetics, for me, is this whole notion of epigenetics, that I can turn on or off certain genes that really help me be healthy or sick. It's sobering when you think of how important this is and when we're sending so many children through fast food lines to get food, or we've just sort of adopted our two nieces, and you hear about what they serve at school.

Tana Amen: School lunches are ridiculous.

Dr. Daniel Amen: It's we are promoting illness rather than promoting health.

Dr. Dr David Perlmutter: Well, that's right, and I think this whole notion that we control, to a significant degree, our genetic expression, wow, that kind of goes against our medical education, certainly. It is empowering, but it does connote a significant degree of responsibility now.

Tana Amen: Yeah, there's accountability.

Dr. Dr David Perlmutter: Lifestyle choices will change either for the positive or the negative, my gene expression, and it's been estimated that about 70% of DNA that codes for health and longevity is under our control to some degree. I was very taken recently. In January of this year, 2018, January the 16th, in the Journal of Neurology, they offered up practice guidelines about what we, as neurologists, should do with respect to a patient who has what is called mild cognitive impairment, which is sort of the continuum to becoming a demented person, so it's when not only the patient thinks that he or she has an issue, but the testing starts to show that there are some problems in how their brain is working, but they're not yet full-blown dementia. What do you tell that patient? These are 2018 guidelines, and they went through the list of all the possible things that we could or, perhaps, should do.

They went through an entire page of medications that could be, perhaps, prescribed, and they didn't validate a single one. They indicated that not one medication was reasonable to prescribe and, in fact, the only medication that has been demonstrated to reduce the risk of becoming an Alzheimer's patient if you have mild cognitive impairment is a medication called exercise. You could put it on a prescription pad. Exercise is the only thing the Green Journal of Neurology-

Tana Amen: I love that.

Dr. Dr David Perlmutter: ... put out by the American Academy of Neurology is telling us, as neurologists, we should be telling-

Tana Amen: Isn't that amazing?

Dr. Dr David Perlmutter: ... MCI patients that they should take or do to reduce their risk of becoming an Alzheimer's patient. Wow. The reason that will segue back to our conversation is that exercise is one of the most powerful epigenetic events that we can engage. Exercise changes the expression of our genome, specifically amplifying a pathway that leads to a chemical called BDNF that makes the brain grow new brain cells and will work against what Dr. Amen described earlier, and that is the shrinkage of the hippocampus that we don't want. We don't want our memory centers to shrink. You were correlating that with blood sugar. Now we know we can unwind that, and we can reverse that with physical exercise and repopulate the brain's memory center by turning on a set of genes. I think that's very empowering.

Tana Amen: Awesome.

Dr. Daniel Amen: Two really important takeaways from this podcast, exercise can change your genes. It's something all of us should do every day. I wear my little Fitbit just because it reminds me. It's a biofeedback device. Go to bed and get 10,000 steps. Then the glycemic index ... Whenever you have a question about a food, just Google glycemic index of apples, glycemic index of white rice, glycemic index of whatever you're going to choose. As Dr. Perlmutter said, try to stay 55 or under, and just because Snickers, which is 55 ... Don't go for the Snickers, right? I mean you have to use your thought-

Tana Amen: There's no nutritional value.

Dr. Daniel Amen: Einstein said, "God gave you a big brain for a reason."

Dr. Dr David Perlmutter: You know what? I'm going to tell you, so I've long puzzled about the Snickers bar. Not that I eat them, but it contains a lot of nuts.

Tana Amen: Nuts. It's because of the nuts, but there's not a lot of nutritional value there.

Dr. Dr David Perlmutter: Lots of calories, but it's fat.

Tana Amen: Yeah. No, I knew right away where you were going with that, but one thing I wanted to just throw in there-

Dr. Dr David Perlmutter: It's 47, by the way, the glycemic index.

Dr. Daniel Amen: Okay, we have to get on to Brain Maker, which I'm so excited to talk about because we've been talking about it. Do you have a quick question?

Tana Amen: No, no, no. It was just to confirm the exercise thing. I went and saw my cardiologist who is very, very big into nutrition, and he ... I was so surprised that he actually confirmed what you said. He said, "As much as I believe in nutrition and lifestyle for improving the heart function," he said, "all of the recent studies are showing that exercise is actually more important, which is hard for me to say." It was really interesting because of the BDNF, so I just thought that was fascinating.

Dr. Dr David Perlmutter: Can I just mention one more interesting study that I think is really compelling? Do we have time for that?

Dr. Daniel Amen: We do.

Dr. Dr David Perlmutter: This appeared in the Journal of Neurology in April of 2017, and it looked at individuals who carried the genetic predisposition ... I hate to call them Alzheimer's genes, but things like APOE4, CLU, and something called ABCA7. These genes, if you carry them, are associated with increased risk of Alzheimer's, and they're all involved, interestingly, in cholesterol metabolism, but aside from that, what we've known for a long time is that carrying one or more of these genes, there are markers that you can measure in the spinal fluid like beta-amyloid and something called phosphorylated tau protein. If you have the genes, you're going to have higher levels of those Alzheimer's-related proteins, beta-amyloid and phosphorylated tau, so there's a correlation between the gene profile and these markers that are measurable in the spinal fluid.

What they found and published was that if you had those markers, those gene risks but you had a high level of cardiorespiratory fitness, then the markers in the spinal fluid were lower, so you have the genetic risk, but you've made a lifestyle change and are exercising more. The play out in the spinal fluid was less beta-amyloid and less phosphorylated tau, which we know are associated with Alzheimer's disease.

Tana Amen: Interesting.

Dr. Dr David Perlmutter: Again, it's a stunning article in that it really takes us away from this genetic determinism model that says if you have this, you're basically in deep trouble, and there's nothing you can do. Au contraire.

Dr. Daniel Amen: Well, and then the other thing that that brings up is almost all of the pharmaceutical companies are getting out of the Alzheimer's business because they're not finding that silver bullet that really will make a difference, that it's lifestyle that matters way more than you can take this pill or that pill.

Dr. Dr David Perlmutter: And you can't patent that. My friend Dale Bredesen has said that it's not silver bullets that we should be looking for. It's silver buckshot because you want to-

Tana Amen: I was just going to say it's a shotgun.

Dr. Dr David Perlmutter: [crosstalk 00:20:54]

Tana Amen: I was just going to say that.

Dr. Daniel Amen: You have to fight the war on multiple fronts.

Dr. Dr David Perlmutter: You want to have as many modalities as you possibly can because Alzheimer's doesn't happen from one event, or one gene, or one blow to the head, or one choice in terms of gender, or education, or heritage.

Tana Amen: Yeah. I'll take my chances with the shotgun.

Dr. Dr David Perlmutter: It happens because multiple things can fire, and you don't get out of that situation unless you look at unpacking many approaches to ... And that's what Dr. Bredesen has demonstrated to be effective in reversing Alzheimer's disease.

Tana Amen: Right.

Dr. Daniel Amen: We're so excited about it. When we come back, we're going to talk about Brain Maker and the gut-brain connection. Stay with us.

Tana Amen: Love that.

Dr. Daniel Amen: 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.