Can You Prevent Cognitive Decline? with Dr. David Perlmutter - TBWWP

welcome to the brain warriors way podcast I'm dr. Daniel layman 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 the brain Warriors 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 Amen Clinics calm the brain Warriors 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 brain md health.com welcome to the brain warriors way podcast well welcome everyday everybody today is a very special brain warriors 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 10 and I consider our teacher who who is also a nutritionist and someone I have referred many patients to over the years and he is affectionately called the empowering neurologist David Perlmutter welcome David what a joy yes thank you 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 yes I just have to say I'm it's such a joy for me because I actually had the pleasure of hearing you speak oh gosh probably ten years ago and I was so fascinated and from that point on I considered you a mentor and I followed you when I was so excited and of course you come home and your friends you became friends with them and so I 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 so every time you are on well let me just say 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 thank you for that that's awesome so he also a member of the Editorial Board of the Journal of Alzheimer's disease they have published six of my papers we had a new paper accepted on using imaging to predict treatment response with depression so we're pretty excited about that and 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 but one of the things that you became famous for was grain brain brain grain brain was a huge bestseller for a long time it really helped change the way people think about their diet so what triggered that for you what what got you interested in writing that and particularly talking about gluten well let's you know wind the clock back grain bran 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 you know by age 65 your chances are one a9 they increase dramatically until your one and 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 you know 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 Alice embers 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 so 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 you know 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 so I you know 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 know 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 my hearty line so 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 and I think that the message really hit a lot of people add notes 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 so you 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 so I wrote this book that really focused on how toxic sugar and carbohydrates are for the brain not because dr. Perlmutter drink this stuff up but because that is what our most well respected journals were telling us that even subtle elevations of blood sugar hadn't profound a detrimental effect upon the brain in terms of increasing risk for dementia a one study that came out in September of 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 they all 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 believed 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 so the other fundamental leg of the stool here in terms of grain grain 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 and for many years even after grain bring was written you know people would roll their eyes oh you know you guys been on gluten non-celiac gluten sensitivity but there was research they 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 and in my practice I was finding that plenty of patients improved with a variety of issues when we took them off of gluten and 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 so over the years more and more data began to evolve that supported our original contentions a 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 nachos with non-celiac gluten sensitivity but all humans Wow why is that important for me what 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 so we've put these very important dots together and recognize that hey the brain is influenced by the gut and 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 and as you well know that area of research has absolutely exploded especially in terms of things that you deal with mood disorders and you know and getting back to one of the lifestyle issues I mentioned earlier which is head trauma and its relationship to developing dementia and then certainly you and your team with your work with CTE etc can relate to that that's where preventive medicine comes into play so preserve the context boys you don't know many things design the car you gotta wear a seatbelt yeah so many things for us to well many things you can protect your brain there 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 so what's your thought on why women so you know it's well known that women have a higher incidence of Alzheimer's disease in fact while you were talking about beginning to put together two dots women have lower levels of serotonin than men according to one study from Montreal 52 percent less serotonin than men do serotonin is 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 their chocolate but I know it's more complicated than that what's your sense norepi and here is what what I took away from the Montreal study in you know our job is to connect dots is to bring seemingly disparate information together to have those aha moments Louis Pasteur told us the 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 so the you know we take a step back in terms of serotonin and 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 a moment can influence the ability to convert tryptophan into serotonin called the kind uronic acid pathway any inflammation ultimately reduces availability of serotonin so we wonder what else could influence that pathway could hormones influence a 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 I think that as we recognize Alzheimer's and depression for that at 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 race of depression women's rates of Alzheimer's disease women's work rates of autoimmune conditions as well which are twice as high as men that there may be something going on within 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 explore that but beyond that I think that you know there are other issues that relate to the exposure that women have to genes that are under not parts of their bodies challenging a woman's body with genetic information of a note with an organism that is only 50% hers in other words pregnancy what is pregnancy when that fetus is developing with it a woman that woman is to some degree confronting her immune system with an organism that's only 50% genetically the same as she might that induce some changes in her immune tolerance and in her immune reactivity so I think there are a lot of factors to consider I mean these are the kinds of things you think of in the brief moment before you fall asleep at night we bring these things together and it's I think a lot of people think about that stuff so 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 and 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 so one of the questions that I get and I so I'm grateful for green brain because you know 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 gonna 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 you know and include some some protein in there even if it's plant-based protein but what would you say to these people because they tend to fill that gap with carbs well let's since that quite that part of question or second questions fresh in mind I would say that we've got it like we do with fats good fats bad fats we need to talk about carbohydrates in terms of good and bad and you know 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 great base that are based upon fiber rich foods have added I think that we've got it's a really good point that you raise and that is you know we need to look at net cards we need to look at you know 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 fuel and a source for the techn anabolic production on the business of you thanks 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 fire I think the notion of net carbs is is actually very good okay because you know a recent study came out really quite interesting and it looked at risk for cardiovascular disease in the gluten-free community versus those who ate gluten add blood and what they found was there was actually an increased risk of cardiovascular disease in the people who went gluten-free in the lines were ah you gluten-free one of Paltrow people look what you're doing to yourself because you need gluten because here's a study showing that the gluten-free community is a 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 all right 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 micro back to might 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 so people cut out fiber they increase inflammation by virtue of the fact that they don't nurture their gut bacteria which is you know 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 yourself well when you look at gluten-free packaged food they're terrible it's often terrible right as other processed foods they're just they're processed foods they're terrible so therefore I don't say you say look gluten-free packaged foods so there's a great tip there most of your food should come unpackage what does that mean that means all the aisles in the grocery store are pretty much gonna be off the list you know I'm certainly you know you're coconut oil and stuff yeah but all the fruits and vegetables and hopefully grass-fed beef or fish are all gonna be around the periphery of the grocery store in the freezer case or just sitting on shelves 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 that's it not an easy question because you know it tends to lead people to the place of everything in moderation right I will tell you that having just said those words to hair is going up in the back I know me too yeah because there's a little bit of sniffing glue okay by the time it's not in God it's in moderation a and B know it in affair having an affair in moderation ya know so 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 when 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 so I'm not eating wheat barley and rye I'm doing my very best to avoid it so 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 a neurologist it's a certain stretch also medical doc what I want to emphasize that we're not talking about going and having cheap days of gluten and bread and rice so that's what I wanted to emphasize if I have another question because there is also gluten in personal products and that's right cosmetics so if you just think why women then men have a higher incidence then just wonder if they're not also exposed to more toxins because you know what they spend on personal products is ten times what males spent on pertinent you look to see how long it takes us to get ready to Turin good but that 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 actually we you and I had breakfast and talked about that a couple of years ago in lockdown outside of Los Angeles as I recall right up and Westlake where we were speaking together all right well we have to stop this podcast we are going to move on to the next one so you're gonna be joining us again let's make sure you are and we're gonna talk about toxins gluten and the glycemic index what people need to know which is sort of going to be a continuation of the discussion we're having stay with us [Music] you 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 and I tell people my experience people change in one of three ways they get an epiphany and if you see your brain scan you get an epiphany it's like wow 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 friend BJ Fogg terms tiny habits a grain brain for so many of my patients wasn't a pivot right it's like I had no idea this could hurt me if I love myself fact I had this 76 year old guy in my office yesterday who I evaluate he has memory problems when I'm telling him what the things I want him to do he said I'm gonna do it a hundred percent because I love myself and I love that he had trouble loving himself around the whole sugar you know cuz he's gotta pick and choose right right but you know the sad thing is I in our society I think something that our friend dr. pastor rick warren says is also true people don't change when they see the light they change when they feel the heat and so we want to make sure that people get that balance they want we want hope the light but we want to know that third 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 better welcome with us again and allow you to be here you guys are the best well thank you so much the glycemic index it's confusing 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 right and there's actually imaging studies saying the hippocampus becomes smaller diabetes became very personal it's actually personal to both my father-in-law when he was 55 was diagnosed with diabetes he was also an alcoholic he's very abusive to his family and and he just never got it he just you know the doctor would say stay away from sugar he was clearly addicted to donuts and simple carbohydrates and ended up losing his eyesight his legs is hard my grandmother also but 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 well let me take you back and we're gonna 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 the diet had some role to play in terms of blood sugar we wanted to rank foods in terms of how they would affect blood sugar over a 90-minute period of time and they used they created this term 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 a 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 of its effect on blood sure the bottom line is that both of these indices look at how much 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 so it's important to understand it's not just the height that your blood sugar goes during the 90 minute period as in the case of lysine mechanics 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 and 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 through that you could eat had about half the glycemic index as bread and that became you know 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 so 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 Sugar's low so 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 so things like bread pasta potatoes white potatoes rice even brown rice are as high as tables so let's talk about what number they should stay under that's what confuses people wool how do I know what that's a good question it really depends on how much of that food you are consuming but glycemic index of an egg is zero so that doesn't mean you can't you should go out need 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 the food has a glycemic index of 15 you can eat all you want you really have to practice moderation in that regard and the beauty here is that it helps us delineate between carbs and effect on blood sugar so 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 local low glycemic index foods though they have carbohydrates in them and you can eat those in abundance and it's good for you especially anything green especially anything collagen right it's also like color I like a variety of colors you want to really cover the bases the you know the real beauty of greens especially with some of the information that people are exploring these days is greens are high in folate right that's where the term folate comes from foliage and you know 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 and 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 foliated it's really critically important is because Foley helps us with a very complicated process called methylation methylations involved in things like detoxification preventing damage to our DNA so that's 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 percent of Americans Harbor a genetic variation that doesn't allow them to activate this fully 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 etc so 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 web sites 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 so you know there's a the movement in a paleo is to eat like our ancestors I think it's terrific I think we should avoid triggers etc but I also think it's really exciting to apply leading-edge technology and understanding who we are as individual and what our individuals individual needs might be and how we can cater that to that based upon these higher levels of knowledge that we're now able to obtain agree so we always talk about you can't change what you don't measure so knowing your important numbers is critical and twist and it brings up the notion of genes versus environment we can't change our genes genes but we can certainly change how we influence our genes so that some would say that you know our DNA loads of the gun and our environment pulls the trigger right so these things might not manifest if we make certain changes we're never gonna know unless you look so my daughter is pregnant and she will have Haven our fifth grandbaby in June and what 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 havens grand in havens babies so this is serious stuff and 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 helped me be healthier sad and it just it's so boring 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 schools we're promoting illness rather than promoting help well that's right and I think this whole notion that we control to a significant degree our genetic expression wow you know that that kind of goes against our medical education certainly and it is empowering but it does connote a significant degree of responsibility now my 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 the journal Neurology they offered up practice guidelines about what we should as neurologists should do with respect to a patient who has what is called mild cognitive impairment which is sort of on 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 and how the brain is working but they're not yet full-blown dementia what do you tell that patient and 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 isn't a medication called exercise you could put it on a prescription pad exercise is the only thing the green journal of Neurology put out by the American Academy of Neurology is telling us as neurologists we should be telling amazing steai patients that they should take or do to reduce their risk of becoming an Alessandra's patient Wow and 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. Haman 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 you can reverse that with physical exercise and repopulate the brains memory Center by turning on a set of genes I think that's very empowering so 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 and then the glycemic index and whenever you have a question about a food just Google glycemic index of apples glycemic index of white rice glycemic index um whatever you're going to choose and as dr. Perlmutter said try to stay 55 or under and just because singers which is 55 don't go for the snick right I mean you have to use your thighs Einstein said God gave you a big tires so I've long puzzled about the Snickers bar not that I eat them but it contains a lot of nuts nuts it's because of the nuts but there's not a lot no I I knew right away wait where you're going with that but one thing I wanted to brain maker which I'm so excited to talk about because we've been talking about it so do you have a quick question 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 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 mentioned one more interesting study that I think is really compelling we have time for that we do so this appeared in the journal Neurology in April of 2007 team and it looked at individuals who carried the genetic predisposition that I hate to call them Alzheimers genes but things like a pony for CLU and something called ABCD a7 and 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 gonna have higher levels of those Alzheimer's related proteins beta amyloid and phosphorylated cow so there's a correlation between the gene profile and these markers that are measurable in the spinal fluid and what they found and published was that if you had those markers those gene risks but you had a high level of cardio respiratory 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 playout in the spinal fluid was less beta amyloid and less phosphorylated tau which we know are associated with Alzheimer's disease so 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 Randy Oh contraire well and then the other thing that that brings up is almost all of the pharmaceuticals or get its 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 and you can't patent that so my friend Dale bredesen has said that it's not silver bullets that we should be looking for it's silver buckshot I'm just gonna say it's a shotgun it's just gonna tell you havin to fight the world as you possibly can because Alzheimer's doesn't happen from one event or one gene or one blow to the head or right one choice in terms of gender or education or heritage okay I'll take my chances both things conspire 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 right we're so excited about it when we come back we're gonna talk about brain maker and the gut brain connection stay with us [Music] we are back with our friend dr. Perlmutter and I love this episode because we're going to talk about what you can eat and what you should not eat to help your brain so brain maker the whole live program and of course for me this is this is my forte this is my specialty so I love this so welcome back dr. Perlmutter and we're also going to talk about the microbiome yes and so how does a neurologist get interested in the gun's bugs yeah what's a good guy like you doing in the guy well many several years ago you know and going to see patients day in and day out and not having again many tools in the toolbox we began to see a couple of dots come together that is number one we began understanding that Alzheimer's is an inflammatory disorder as is Autism Parkinson's MS depression and at the same time that literature began to be very clear in terms of the relationship of the gut bacteria to inflammation so connecting those dots I thought well maybe there are some answers here in terms of what we can do for the brain by looking at what goes on in the gut and that is the the genesis of the exploration and ultimately the manifestation that went behind the creation of the book brain maker the relationship of the gut to the brain having said that you know I would indicate that to this day most of my neurology colleagues don't really want to go to that place or recognize anything really below the foramen magnum is having any relevance in terms of the brain but the literature now is is expanding dramatically and research institutions around the world there is no book yet about the microbiome in the brain for professionals I mean I'm the editor of a book that has that as the title that will be out in 2019 well we've collected authors from around the world to write various a chapters for both researchers and clinic so again getting back to the connection if inflammation is the cornerstone mechanism and the gut bacteria are involved in that through many ways that we can discuss then the gut bacteria are important and that makes food important because their health and their ability to do all the great things that they are doing to keep you alive really depends upon what they eat and they eat what you eat I tell my patients you know we've said for years that women when they're pregnant have to be careful because now you're eating for two everyone has to be careful because we're each eating for a hundred trillion right they eat what you eat and when we make inappropriate choices foods high in sugar devoid of fiber foods that contain additives and various things that can prove toxic when they take medications for example antibiotics proton pump inhibitors that are used to reduce stomach acid commonly use non steroid anti-inflammatories like ibuprofen these are factors that can damage the gut bacteria and can enhance inflammation can enhance risk for obesity can enhance risk for diabetes so those are the types of broad strokes that go into the idea that our food choices and other lifestyle choices are very relevant looked at through the lens of our gut bacterial friends I love something that you said and I applaud you for this because as somebody who spent many years being very sick you know you said that many of your friends don't want to look at anything below the brain I'll just make that simple for our listeners below the brain is being relevant to the brain and that's really frustrating to someone who ended up on nine medications because of that philosophy so everyone was sort of disconnected and not looking at how everything was affecting everything else and as somebody who had thyroid cancer in multiple surgeries and treatments you know when your thyroids messed up it affects everything in your life and and as a result other things began to go wrong and everyone just was throwing medications at me and that's not really fair to the patient to think that way so when you're supposed up you're depressed and that affects your brain you know I use you all the time cuz you do besides are beautiful and smart you just full of stories let's go back to how the microbiome actually becomes populated initially because you know when you're initially conceived you don't have a microbiome right I mean there's an egg and a sperm ultimately the microbiome becomes populated over time and I remember in reading brain maker you know there was a difference between babies that were c-section yeah and babies who were breastfed and the hell natural birth and then early childhood traumas can actually change the microbiome and when Tana was four so she grew up in a fairly chaotic home yeah my entire like early from birth was a drug addict and her one of her first memories is witnessing her mother and her grandmother screaming falling to the floor when they found out her uncle had been murdered in a drug deal shortly thereafter she begins going to the doctor a lot for upper and lower GI s and she's like do you think any of that's related and no I actually didn't think it was you're the one who looked at me and you're like you don't think that's really so so talk to us about how it develops and what keeps it healthy and what first let me just not let that an anecdote go unnoticed and because we talked about the gut brain connection a lot but I think what you're referring to here is the brain gut connection and the the idea that brain related events like emotional trauma for example might manifest in the gut and it's true it does so that when we are experienced trauma for example ongoing trauma or repeated trauma etc for an event of acute trauma we know that various changes in chemistry within the body affect the microbiome cortisol for example has a powerful effect on changing the array of organisms that live in the gut amplifies production of certain yeast species for example and changes the lead balance between various organisms and is associated with increased leakiness of permeability of the gut we know that that persistent elevation of cortisol has an effect damaging effect on the brain cells that live in the hippocampus the memory center which are also involved in regulation of mood so I I just think has been for just a moment the notion that brain events can also lead to inflammation the cornerstone of depression is worth stating so let me get back to the genesis then of the of the gut bacteria and other organisms that live in the gut we realize now that you know we as you mentioned a lot of importance is in placed on how a child is born vaginally versus through cesarean section but we now understand that there is colonization of the intestines of the developing fetus as well that the placenta is not sterile that there are organisms living within the placenta if there are organisms living within the brain that you know we have to revise our concept about areas of the body that we had previously thought were sterile anything about the truth and it's very important to understand that those organisms actually influence our gene expression in these various areas and throughout our bodies that's a heady concept that are the bugs the microbes living upon us and within us are influencing our own genome expression so we inherit top down vertical inheritance is the DNA that came from those people who came before us our ancestors their DNA was passed down to us we say it was passed down to us maybe passed up to us but in one way or another it's vertical but we also inherit information horizontally or transversal meaning that as you mentioned at the time we are born we get a lot of genetic information we get information in the DNA of the various bacteria that live in the vaginal birth canal that mother transmits to us this is information that informs this brand-new baby about his environment about her dietary availability her caloric availability or scarcity it gives that new child a snapshot of what his or her world is going to be like and preps that child for that world to come and as a matter of fact the amount of of DNA that that child receives through this mechanism far exceeds the you know the the 23 genome that we receive from parental inheritance so we receive a heck of a download at the time we are born I like to think of it in terms of you bought a new computer that's what you got from mom and dad they gave you a new computer but at the time of birth we load the apps and the apps are up to date and give us really good information about what now how we can perform how we function using the template that mother and dad gave us so dr. Ayman you are correct that this does have implication in terms of health of that child and the adult that that child becomes so that being born by cesarean section by virtue of the fact that you are deprived of that information download because you didn't go through the gates you didn't get that package of information by being vaginally birth birth you get bacteria that's in the operating room and bacteria that's on the surgeons gown and at the same time mother has been blasted with antibiotics as well so if she chooses to breastfeed that that child will further be compromised in terms of his or her microbiome by virtue of the fact that the skin bacteria on Mother's breast will change and the breast milk will change as well by virtue of the fact that mom got that antibiotic so this may well explain why c-section children will have a much higher risk of autism ADHD type 1 diabetes celiac disease adult obesity and even some mood issues moving forward certainly allergies and asthma as well I want to make one very important point and that is that c-sections are important they are valuable they save a lot so I'm not mommy bashing here but I am saying to any of your viewers who moving forward are going to have a baby that there's more to the discussion should we or should we not have a c-section then simply how big will the scar be that the choice for c-section has to be looked at in terms of its potential downsides in terms of that child not developing an appropriate microbiome that is most salubrious most involved in giving health so and if you choose for whatever reason or you have to have a c-section then finding other ways to populate the guy right like I gave Chloe probiotics early in life because I had to have a c-section I don't have an emergency c-section so some of us do there is reason that god bless affect that right have emergency c-section so your baby's here and you're here to have our discussion today wouldn't happen right exactly so there will be GYN doctors sort of get this minded um I know I mean I'm not gonna say categorically no because I think you know certainly but I think by and large this isn't part of the discussion what mine actually did mine actually was was told me that you should absolutely try to have a vaginal birth there's reasons that child is supposed to go through the birth canal so she was pretty savvy I don't know since you had the c-section did she say we need to figure out how I'm a healthy way to populate this baby's microbiome well let me tell you no one has the answer for that in specific but dr. Maria Dominguez bello at NYU has pioneered the research and the idea that you know you're going to have a c-section what do we do well just prior to sea section a surgical sponge and more surgical sponge is placed in the birth canal to harvest this information in the form of the bacteria then is put in a warm moist environment you have your baby and then the baby is totally inoculated over his or her face into the mouth into the nose with mother's vaginal birth canal bacteria so interesting her more recent research published in the journal Nature has demonstrated that there is recoverability of mother's organisms that are DNA sequence in that child's poop as much as six months after birth so I think we're just beginning to understand that but I think that ideology I think it's gonna be explored much more aggressively because it makes a lot of sense that's so cool and I'm curious um and maybe it's too long for this podcast and I would love to have you back if it is but but what about traumatic births with this so a child is born vaginally but they're born breech or they have had to use forceps are they still better off being born vaginally and receiving that download or is the download interrupted III think it'd be very difficult to weigh those one against the other because one doesn't know how you characterize trauma I mean as your husband would indicate in terms of athletes you know that there is everything from none to catastrophic right how long was the child hypoxic will force it's used what were the you know the decelerations of the heart looking like etc so I think these are you know these are not necessarily comparable I think that within reason women should have a vaginal birth whenever possible the notion that 33 percent of the births performed in America today are that are c-section births is is a little difficult to embrace when the World Health Organization has indicated that about 10 to 15 percent of births in America might be so distressed that they would require a c-section so what that means is that c-sections are being performed for other reasons right I don't know whether we can SPECT late what those reasons are but we'll leave it in fact the point is though that this event of birth is hugely important in terms of the information download that happens at that time well I'm also a child psychiatrist so we have tens of thousands of children's brains and you know I often say the day you are born is one of the most dangerous days of your life so we see birth trauma force of deliveries breech base and we can see damage years later so it's it's it's critical to make the most thoughtful careful decision that you can but but let's talk about you have kids or you're an adult what is the right diet and what are the right supplements to take to try to optimize your microbiome and for everybody I just recommend you read brain maker it's it's just it's fascinating it's easy and you will never again look at food the same way or your poop you will never look at your poop the same way that implies they're looking at their poop it's like 60 percent of it is dead bacterias huh and you know what everybody looks at their poop yeah I had to charge the size the color the shape that you know everything for everybody so you know I'm [Laughter] and I'm gonna answer that question in two ways first from the notion that we I believe understand what are called the broad strokes and second that we live in a time when we're embracing the notion of personalized medicine in other words beyond what the broad strokes are what are the variations based upon an individual that are important as well first let's look at the broad strokes by far in a way what is critically important for the health of the microbe living within us is that they receive adequate amounts of prebiotic fiber everybody knows fiber is important but there's a unique type of fiber called prebiotic fiber prebiotic nurtures the probiotic this is the type of fiber that our good bacteria can use to reproduce themselves but more importantly to do their processes of metabolism to make the chemicals that they make that are really important for us some vitamin vitamin K b12 to make short chain fatty-acids to heal the gut lining so chromatic rich foods are things like hit Kamala which is Mexican yam dandelion greens garlic onions leeks chicory root and really pretty much a lot of fruits and vegetables we've known that that's a good diet for a long time and here's yet another reason that your plate should be colorful and mostly filled with fruits and vegetables mostly vegetables if you're if you're considering the sugar content and I think that's very important I think that it's very important that we welcome fat back to the table you know we've gone through about a four decade period of time of fat phobia which was unlike any diet humans have ever consumed as long as we have been walking this planet I was brought on us by interest who didn't have our health in mind simply to get us on higher levels of shelf-stable carbohydrates and lower levels of fat with the mistaken notion that fat was damaging to our bodies and then if we ate a lot of it and all of our children were gonna be born naked or some crazy thing what happened Wow but that said to be clear good fat we're talking about unmodified healthful fat the extra-virgin olive oil the avocados avocado oil nuts and seeds wild fish grass-fed beef etc good sources of good fat that doesn't mean all fats are good certain fats are in fact damaging to help those shelf-stable vegetable oils safflower oil sunflower oil corn oil etc which is genetically modified in that carries it's yet another level of baggage so fat is important fiber is important and minimizing those foods that are going to spike our blood sugar so simple carbohydrates need to be avoided it doesn't matter if it's a maple sugar from the most sacred maple tree in northern Canada or honey that comes from bees that live on an ashram and meditate in town today it doesn't matter cuz I get this quite I get that all the time from people but it's but it's wholesome it's pure and clean and it's true yeah arsenic is natural right yeah right so lutonium there you go but that said so that's the basics then I think we moved to a place of what we want to avoid and let's talk about the broad strokes there as well if we're castigating and I think rightfully sugar in our media and there are books we write etc then it tends to give a message that then sugar-free is the way to go well yeah sugar-free is the way to go but that doesn't open the door to artificial straight and that's unfortunately where the media is taking us if you watch TV there's this zero and something that's sugar-free and and what we now understand is that there are dramatic changes that happen to the gut bacteria when they are exposed to things like aspartame aspartame is directly toxic to the gut bacteria and it's why we see paradoxically that those individuals who are drinking one or more cans of a diet drink every day have a dramatic as much as two fold increased risk for diabetes and obesity in comparison to those who are drinking sugar sweetened beverages I'm not saying drink the sugar sweetened beverage but it's very very misguided if you think you're drinking diet XYZ because it's going to help you lose weight does exactly the opposite it puts your microbiome your gut bacteria in a state of wanting to harvest every possible it's on your food back pain can your body thinks it's starving and as such accumulates calories and you get fat yeah I actually read one study that said that sucralose actually could decrease your good gut bacteria by 50% is that quite dramatic and it's why we see these correlations with things like diabetes other inflammatory disorders and obesity it's it's why we see researchers in Amsterdam for example one fella that I recently saw present at Harvard talked about doing fecal transplants and reversing type 2 diabetes Wow so you know that's a certainly an extreme approach I would say that in our society the other important issue that needs to be vetted and that is the effect upon the gut bacteria of the commonly used medications like over-the-counter acid blocking drugs severe effect on the microbiome which might explain why chronic users of the so called proton pump inhibitors may have as much as a 40 percent increased risk for Alzheimer's disease and that was published in the Journal of the American Medical Association we got a screen this information out to the world because it's really important people think if they don't tolerate the sausage sandwich as the commercial would lead you to believe that if they just suppress their stomach acid and they can then eat the sausage sandwich everything is good well when you change the pH of the gut starting at the stomach you're gonna change the pH of the intestines where the bacteria live you will select out some populations to overgrow and you will suppress populations of other potentially good bacteria it explains why for example taking these acid blocking drugs is associated with overgrowth of something called Clostridium difficile which causes what's called C diff and kills 40,000 Americans a year from from diarrhea that cannot be controlled this is information that's very important we know that taking antibiotics is strongly associated like artificial sweeteners with increased risk for diabetes and I think that's information people need to get then non-steroid anti-inflammatory drugs impart significant changes on the microbiome as well you don't see that talked about on the evening news when people are told hey you know you have a upset stomach take this acid blocking drug or your joint hurts take some ibuprofen but yet we need to practice under the doctrine of above all do no harm as physicians but unfortunately that doesn't seem to extend to the manufacturers of these drugs yeah so what about people who have Lyme so more and more common more and more commonly diagnosed who end up on long-term antibiotics it's a huge a huge issue and I think that dr. Richard Horowitz had me like the way I'm ready for this one in this wonderful book called why can't I get better and more importantly in what to do about it rather solving the mystery of Lyme and chronic disease so I've read that it's a wonderful thing - yeah looks at that and looks at the idea of you know supplementing with probiotics and I think beyond that in this day and age we should absolutely be looking at the idea of fecal microbial transplant in individuals who by necessity have to take antibiotics even for a fairly short period of time now I'm not saying everybody who takes an antibiotic because of an event of pneumonia needs a sequel transplant but is you and the reason you ask the question is you know these individuals with chronic Lyme disease are on months and months of or if not years of antibiotics and are really imparting a dramatic change upon their microbiome you know maybe it's the nurse in me or maybe it's coming from somebody who's been sick and you mentioned that you know the fecal transplant sounds like an extreme an extreme way to handle something like type 2 diabetes or some of these issues but and yet maybe it's maybe it's because it sounds gross to people let's just be honest but to me it doesn't sound that extreme when you talk about losing your eyesight your legs you know your heart function and and your overall quality of life it doesn't sound that extreme if the answer is that your gut is affected because of something that happened to you I think there also and there in animal studies aren't they using it as an anti-aging intervention as well from young mice to older mice and show an improvement but and a few minutes we have left what are probiotic foods and supplements that you recommend I know this is an interest an area of interest for you well there are a lot of foods that are fermented and they're just teeming with great organisms one of them which is my favorite is kimchi meet you and Kosh there is a lot of research appearing that looks at kimchi in terms of how helpful it is you're going to be is really a staple and oh you must like kimchi I didn't catch it as I hated well I trained in Hawaii where there's a large Korean population and so we used to go to a Korean restaurant every Friday as as a group of psychiatrists and I just can never get used to it but I love sauerkraut well there you go and you know to take a step back why are virtually all congenital large cultures in the world cultures interesting work involved in this fermentation or another and it's because it's a way of preserving food when food is fermented it lasts a heck of a lot longer you know in the days prior to refrigeration that it's always a challenge so it's you know what went into creating things like yogurt and kimchi kombucha and cheese and certainly wine and beer as well these are fermented foods so but the the data looking at things like kimchi is really very very exciting so foods that are fermented as some of that I've mentioned kefir is certainly very popular these days and a lot of people are drinking kombucha I say you know the easiest thing to do is to make this stuff at home it's I can do it it's not that hard beyond that of course there are commercially available health and store kinds of probiotics and I think as we move forward we're sort of seeing that there are good products and products that are not so good and then you know briefly I'd say that you want to look for a product that has a long shelf life long stability meaning that if this product says it has 50 billion organisms it shouldn't be a product that says 50 million organisms at the time of manufacture that's all well and good but it's you know three weeks after it shipped and to accept you get it home it has only half that amount it's not going to do you that much good you want to look for a product that's going to give you a couple of years of guaranteeing that level of organism you want to find a lot of diversity in the species so we typically look for 12 14 or so different organisms that are clinically validated to be positive in terms of your health so those are the issues that we want to look for in terms of buying a probiotic we want to see one that's obviously non GMO as well and at the same time we want to nurture those bacteria we talked about Cree biotic fiber that's the fiber that you eat in terms of these vegetables but then gives these bacteria what they need the good news is that if you don't like kimchi you can buy a probiotic pill if you're not eating enough prebiotic fiber you go to the health food store and say I want some prebiotic fiber and they will direct you and then you'll find a bag of fiber that you can mix into your morning drink and that is pure prebiotic fiber the best product out out there which is again what you want to look for I think is made from acacia gum acacia is this tree in Africa you know the tall canopy tree where the giraffe gets the shade and the Sun and the heat and that tree secretes a resin that is called acacia gum and it is sustainably harvested it is organic and it's pulverized made into a powder and it's the in my opinion prebiotic fiber that there is and very well tolerated so you can you can go to the health food store and say that's what you want those are very important considerations and I think in moving forward that we're gonna see a lot more emphasis hopefully even in terms of ingredients labeling moving forward in terms of prebiotic fiber very very underrated but hugely important so helpful you know it has just been a joy to be with you again and we'll have you back on again everybody should know that dr. Perlmutter has his own podcast that I listen to or watch regularly how can people learn more about your books and your educational events and materials sure my website is oddly enough dr. Perlmutter comm Dr Perlmutter comm our website as you know is very enriched with not just my blogs but in my blogs I talk about a scientific study we hyperlink right to it so we have a robust library of full not just the abstract PDFs of all the studies that I quote and I'd like you're listening to sign up for our weekly newsletter I put it out every week and they can watch our podcast comes out every Sunday of course it's virtual you watch it whenever you want and I enjoy doing that I get to interview brilliant people like yourselves and I'm sure you've enjoyed your podcast I mean it's a it's such a great experience and you get all these books that people send you to read it's great yeah great well thank you so much my friend you guys love you guys thank you for listening to the brain warriors 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 warriors way and the brain warriors way cookbook we give away every month

Channel: AmenClinics

Views: 12,996

Keywords: Brain, Brain Health, ADHD, Anxiety, Depression, Dementia, Alzheimers, Diet, Nutrition, Amen, Daniel Amen, Amen Clinics, Psychiatrist, ADD, Dr. David Perlmutter, Dr. Daniel Amen, Tana Amen, Grain Brain, gluten, blood sugar, inflammation, exercise, glycemic load, glycemic index, alzheimers, genetics, brainmaker, microbiome, nutrition, Perlmutter, How To, Lifestyle, Health, Podcast, Health Podcast

Id: t2l_GNH4_O0

Length: 79min 31sec (4771 seconds)

Published: Fri Feb 23 2018