This Neurologist Shows You Weight Gain Traps and How to Avoid Them | David Perlmutter

hope you enjoy the episode brought to you by our sponsor thrive get 50 off your at-home gut health test when you go to trythrive.com impact theory enjoy the episode it's been estimated that people who typically don't get enough restorative sleep will consume close to 300 extra kilocalories each day that adds up in just 10 days to a pound of body fat you know play that out over a couple months and you see what happens then that body fat further increases inflammation and further compromises our decision-making abilities hey everybody welcome to another episode of health theory i am here with dr david perlmutter who's making his second appearance on the show dr promoter welcome delighted to be back i i miss being sitting next to you that was a lot of fun it was a great day but it's just uh also very delightful to be connected this way as well yeah i agree i do wish we were sitting together but uh it's been so much fun reading the book and as i was saying before we started rolling the book brainwash is terrifyingly prophetic uh you talk about disconnection and the impacts on the brain you'll be talking a lot about the brain today how we can you know really get it ready uh to work optimally which is a big thing for you but it's just freaky that you wrote that before we went into sort of the ultimate of isolations and i want to start with something that you wrote in the book a very early question that you pose which you i think said in the book is is pretty much the backbone and that's why is health and happiness so elusive i think in a word i would say disconnection and you know we really took that apart in the book we really unpacked this the whole meaning of disconnection you know it's funny because as i recall uh that's how we left our conversation last time isn't it we were talking about this whole notion of disconnection from our genome from our microbiome and now we see that people are disconnected from each other and we also see an incredible degree of polarization which i think none of us was ready to really experience i mean the degree of polarization that has happened as a consequence of this stress upon the system pulled two sides apart and we've defined two types of two populations of individuals who belie some believe a and some believe b and we are losing a type of empathy called uh cognitive empathy which gives one person let's say me the ability to think of tom bilyeu's perspective or to embrace your perspective try it on and see how it feels even though i don't agree with you we don't have that anymore it's my way or the highway i dig my heels in anyone who doesn't agree with me we're going to you know rally against and again i'm not taking a particular side i mean it may be that the world is flat and i'm willing to listen to a discussion about what is your narrative but we don't see that anymore you know we we talk about people going to congress and saying they're going to reach across the aisle that's what we want we want to just reach across here they you may not agree with what happens on the other side of the aisle i would submit we've got to get rid of the damn aisle we have to just why don't you give people seats according to where they land in the alphabet and let them sit next to people that they don't agree with let them talk it out what if i'm interesting about your approach sorry to jump in but what i find interesting about your approach in the book is that one this is all coming from a neurology perspective so you're actually looking at the brain and one of the most fascinating elements were one how you define disconnection i think it's important to stop you actually have an image in the book and it's like this trifecta of things which i never in a million years if somebody said our problem is disconnection i would not have thought that really sort of cellular explanation for what's happening and how that as we get chronic illness and chronic inflammation that it actually inhibits our ability to access the part of the brain that gives us that executive function the ability to do things as thoughtful as reach across the aisle so if you can just walk us through how are you guys you and your son who co-wrote the book how are you guys defining disconnection and good on you because you got it obviously you got it we identified the brain mechanics the substrate if you will for disconnection syndrome that you know it began with our discussion in this very room i might add with of how we make decisions do we make our decisions impulsively or do we think them through are we reflexive or are we reflective and we realize that there are two important areas of the brain many areas involved but two important areas the amygdala which is a kind of a primitive fight or flight sudden response area that really serves only me isn't involved in empathy isn't involved in how my actions affect other people what the future outcome may be of my actions and then another area that is sort of our gift as humans and that is the prefrontal cortex other animals other mammals have a prefrontal cortex but it's a third of the cortex of the human brain which is an awful lot and that allows us to take a deep breath to look at data to think of how our choices affect ourselves in the future how they affect other people how we can be empathetic towards others compassionate and have this thing we just mentioned cognitive empathy to take another person's viewpoint the important part of the disconnection is that this prefrontal cortex let's call it the adult in the room exercises what we call top down control over the amygdala and that begins to develop around age five years or so teenagers still don't have a fully developed connection so they're still a little bit disconnected why they make decisions that aren't necessarily always good ones but we all retain some sort of impulsivity if you will directed by this primitive reptilian brain the amygdala hopefully though as we mature the adult exercises more and more control over our impulsivity we make better and better decisions that think about not just ourselves but other people think about their points of view think about how my actions are going to play out in the future in terms of choosing what to eat today choosing whether i exercise or not choosing all kinds of things that have an impact not on only on me but others and even on the planet we therefore fundamentally rely upon the connection of the prefrontal cortex behind the forehead to the amygdala in between your ears to keep it in check to keep that you know capricious impulsive child in check and that's the top-down connection that we need to cultivate now what threatens that connection and leads to disconnection syndrome leads to us being impulsive i want it now i don't care about you it's my way or the highway are many factors not the least of which is a very important mechanism called inflammation you and i have talked about inflammation before in the context of brain disease in the context of things like coronary arteries diabetes cancer obesity alzheimer's the very same inflammation threatens that connection it's also threatened by what we are bombarded with when we're having our online experience it's threatened by stress it's threatened by the evening news so many factors threaten to basically lock us into impulsivity and what's so worrisome is acting impulsively strengthens our connection to the impulsive center of the brain and further disconnects us so that's because neurons of fire together wire together or something that's heavy in philosophy uh dr dr hebb canadian researcher talked about that and you know the more you do something the more you do something the dalai lama said that the brain we develop reflects the life we lead and he also said interestingly that if you want to experience happiness practice compassion if you want others to experience happiness practice compassion so what you said is so true that doing things choosing to do things to act in a more compassionate empathetic forward-thinking way does what it strengthens our connection to that gift this prefrontal cortex and allows us to act in mature thoughtful ways you give a really cool example uh in the book of what happens when that connection is um abruptly severed as a way of really explaining what's going on and it's something i've talked about on the show many times i don't think you and i discussed it but phineas gage so for anybody that doesn't know phineas gage's story he's working on the railroad they use like these explosives to um use on tamping rods basically and he hits a tamping rod something goes wrong and it shoots up under his cheek and out through the top of his head now i'd heard that a million times and in your book you said oh and the rod is now on display in a museum in harvard and i was like wait wait wait wait i need to look this thing up i had no idea that you could see it and there's photos of phineas gage who by the way never lost consciousness and he goes from everybody was like hey this guy was really nice and if he had plans he followed through he wasn't impulsive and then after it all said now he's impulsive he can't hold down a job and in the book though you go into something that is never talked about with phineas gage and i found this so interesting if you don't mind walking us through that part i think it will give hope to people who are impulsive now and feel sort of hopeless good point and you know so this is an interesting story that i think a lot of people have quoted of phineas gage back in 1858 who [Music] you know how he survived this is is breathtaking and hit not just the bar but his skull is on display at harvard to this day and he became suddenly impulsive irreverent and nasty couldn't be around other people and you know the the wonderful part of the story that i thought we really needed to bring to people's attention is the fact that years later he turned out to be a nice person again and what does that mean it means that we have this ability to rewire our brains we have the ability to yes grow new neurons but also through what is called neuroplasticity we can make new connections and reroute defective wiring now you know here's a man who essentially loses his prefrontal cortex and regains functionality so we included that in the book exactly for the reasons you stated to give people hope because make no mistake about it our day-to-day lives right now threaten our prefrontal cortex and threaten the connection of the prefrontal cortex down to the amygdala and therefore threaten to disconnect us whether it's lack of sleep or a high inflammatory type of diet and read a modern western diet stress lack of nature exposure lack of exercise even the various types of sub-nutrients that we consume so many factors conspire to sever that connection to drive an iron rod through our prefrontal cortex if you will you know that's a you know obviously a very graphic example but in in many ways what we've seen in the past year is a lot of impulsivity is a lot of behavior based upon acting without self regulation without the input of the prefrontal cortex making decisions based upon emotion and uh you know as opposed to taking a step back looking at what you know authoritative figures are trying to tell us and then making our decisions now let me just be clear tom we need sudden impulsive decisions that's for sure that's the beauty of the amygdala you know you're backing your car out of the driveway and your eye catches something in the rear in the back up camera a kid on a tricycle now that's not when you want to sit back and think gee get on a tricycle probably a good idea lift my foot off the gas and put it on the brake because you know that's going to have a good outcome no you want to act suddenly impulsively call it reflexively if you will and you do then you realize what the heck just happened you say thank goodness i acted that way the problem is though that people these days seem to be acting that way without restraint at the drop of a hat and again so many of the influences on that activity are under our control we can pull ourselves back from that and regain this valuable gift that we have as humans and that is the connection to this prefrontal cortex so you do a phenomenal job in the book of walking people through sort of the cellular mechanisms of why things are breaking down and then in the end you tell them okay so this is how they break down this is how we build them back up the right way i want to follow that format a bit and walk people through cellularly what's happening like you you made a statement in the book that um two in fact i'll walk through both one was a quote of gary tobbs which i thought was really interesting and then you bring it together for the reader so the first one is gary taub saying hey we don't get fat because we overeat we overeat because we're getting food getting fat now i i want people to really like stop and think about that that there is a signaling going on a hormonal thing that's happening and then you follow it up to bring it back to your point about disconnection where you say that the actual increase the increased volume of our fat cells stops us from having access to our prefrontal cortex so walk people through how on earth that could be true sure let's first talk about gary tab's statement that people aren't getting fat because they overeat they're overeating a decision because they're getting fat body fat is pro-inflammatory inflammatory chemicals threaten the connection the top-down control the decision-making apparatus that we have from the prefrontal cortex to the amygdala such that we make more impulsive food decisions and we cannot easily self-regulate so that's the reason he made that statement why we included because the fatter people get the less able they are to rein in their appetites and to make good choices as it relates to the foods they that they eat that creates please forgive the pun a feed forward cycle whereby eating the wrong foods tends to beget further eating of the wrong foods let me give you another example and we've all been through this i mean certainly anybody who's done a residency program and has been up all night you realize that the very next day you eat whatever you can find and they're not good nutritional choices by and large people who don't get a restorative night's sleep have as much as a 60 higher activation of their amygdala so the amygdala takes charge so that takes charge in terms of the foods we eat in terms of everything we do that very next day we've all missed a night's sleep and you realize how cranky you are but you make bad decisions so those decisions extend to our food choices and what happens we eat high sugar foods uh foods that we know are not good for us but we just can't control ourselves because the amygdala has taken control there's a five-year-old making our nutritional decisions for us it's been estimated that people who typically don't get enough restorative sleep we'll consume close to 300 extra kilocalories each day that adds up in just 10 days to a pound of body fat you know play that out over a couple months and you see what happens then that body fat further increases inflammation and further compromises our decision-making ability i remember when i'd be up all night during residency we would you know we'd be in the operating room all night long with who knows what i mean gunshot wounds to the brain you name it and the following morning the only place i could get what i felt i wanted was i would go to the pediatrics floor and i would open the refrigerator and get baby food now in those days baby food was loaded with fructose uh sucrose and high fructose corn syrup because they felt that uh that would get babies to really like it and moms would be happy because kids would be eating the baby food the banana one especially was so good but i knew even back then that wasn't good for me but i literally could not control myself and you know i think that we all recognize that when we've not gotten enough sleep that we make bad decisions now here's what uh really looks worrisome and that is you know about 50 percent of americans will indicate that they don't at least once a week get enough restorative sleep and feel that experience the next day and understand that as you gain weight you sleep your risk of having bad sleep is increased your risk of having sleep apnea the risk of having other issues related to poor sleep increases so we could play on gary taub's statement and saying we don't sleep poorly because we're getting fat we're getting fat because we sleep poorly or vice versa think about it the more you don't sleep well the fatter you'll get the worse you will sleep well and the worse will be your food uh choices decision making but it's not just related to those lifestyle issues it's really decision making across the board that that uh this impacts who in the book you guys call your shop pretty early and say you know when we first started researching this book we never would have guessed where it was going to take us and we realized pretty early on that we'd stumbled onto something that was really really big and reading the book it is it's what you just walk people through it's a pretty terrifying positive self-reinforcing loop where one bad decision begets another begets another begets another and you talk about um big food big ag and so when i think about what was the the you know that first push that gets this sort of negative cycle going and i mean you lay it out man like the number one thing that people say that they eat for breakfast is cold cereal that's already terrifying uh and so things that people think that they're eating that are healthy end up being wildly problematic now is this a function of inflammation like if we were going to lay something okay so now let me push that even further do you know the mechanism that's happening like why does inflammation stop the the effective communication between the amygdala and the prefrontal cortex it's it's a very good question and it's not been fully teased out has it been validated you bet it's been aggressively validated and there are you know plenty of hypotheses we know that by and large connectivity in the brain beyond this circuitry but the connectivity that allows us for example to recruit previous memories to recruit other engrams in our past to help us make decisions today are compromised by the process of inflammation so in a global sense inflammation compromises brain function now this pathway is exceedingly active or at least it should be so it is extremely threatened by a inflammation b lack of adequate amounts of fuel adequate ability to utilize glucose for example but specifically you know the relationship through inflammation i think is still being teased apart inflammation has other effects in terms of the brain and certainly in terms of our behavior inflammation threatens our ability to manufacture a neurotransmitter called serotonin i hate to call it the happy uh neurotransmitter but we know that there's evidence that suggests that serotonin activation in certain pathways does tend to be related to things like depression and it's the reason we have ssris which are only minimally effective but how incredible it is that the the use of ssris has increased 400 percent uh since the late 1990s i'm just going to say correlates with some incredible dietary changes that have happened uh you know in in western cultures but that said inflammation getting back to our topic changes a biochemical pathway by which tryptophan is made into serotonin and this is called the i don't mean to be too technical but it's called the kind urinic acid pathway i'll tell you why that's important so in the presence of inflammation tryptophan can go one way make serotonin or it can go another way to make kind urinic acid if there's a lot of inflammation it's taken away from making serotonin less serotonin now and goes into measuring conuranic acid so you have a buildup of kanaranic acid which threatens nerve transmission and that may also be a player in the connection you asked about between the prefrontal cortex and the amygdala you can measure kind urinic acid there are laboratory med laboratories that your doctor can do a blood cyanuranic acid on you right now i mean it's nothing really exotic and it's an implication of a lot of inflammation in your body and that your ability to produce serotonin is compromised now that relates to so many factors that deal with inflammation in your body like diet like the microbiome like stress and lack of sleep lack of sleep powerfully augments inflammation and it's again the reason that it's related to so many issues like diabetes and obesity and cancer risk and alzheimer's risk it's through this amplification of inflammation let's talk about thrive did you guys 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responsibilities but understanding how these cascades begin and that once they begin you're getting hit from so many different angles in terms of taking optimal cognition and reducing it so dramatically that it becomes not impossible but wow you're digging a hole from which it becomes increasingly more and more difficult to get out of um so i'm going to list what i think i remember from the book as being sort of the big players of inflammation and breaking this bond let me know if i miss anything um so lack of sleep is huge i feel like a different person i feel like i actually have a different personality when you do poor sleep it is surreal arguments in my brain where i'm like hey you know hey you should just have like look you know that a little bit of sugar right now would make you feel better give you a little bit of energy so go ahead and just grab a quick you know bit of chocolate or whatever during the like if i'm well rested that argument does not hold any sway i'm like get out of here like i have a goal i know what i'm eating today and that's that but suddenly that argument makes all the sense in the world when i haven't gotten sleep can i can i stop you right there tom please because what you just said could be the one take-home message for our entire time together today you can just understand that your decision making is uh threatened or or enhanced by whether or not you get a good night's sleep you know go out and buy a wearable get an or ring whatever but figure it out fix your room get off the computer don't drink coffee after two o'clock whatever it may be if you could just take home that one message that you just wonderfully articulated that would be the home run no question um walk me through so we've got the inflammation we've got lack of sleep we've got poor decision-making exacerbated we've got our bad diet and the inflammation is making us make worse decisions we get in this you know very bad a negative positive feedback loop of the worse we eat the worse we want to eat when we're locked in that vault of death how do we begin to unwind it what does that process look like so that's that's a great question because we offer a lot of on-ramps to better decision-making and you know the the book had its genesis in this room when austin and i were just talking about what is the most frustrating part about being a physician and we realized that you know it's kind of a three-step process to get to have patients do what you want them to do number one we have to learn the information as best we can you go to medical school you read the journals you attend the conferences number one number two we have to purvey that knowledge we have to be good purveyors good communicators give that knowledge impart that knowledge to the patient and number three that patient acts upon the information we realized that nobody was talking about step three that when the patient comes back to the clinic a month later and has gained weight blood sugar is higher it's whatever that what do we do we write in the chart that that patient is non-compliant that's a kind of an awful thing to hang on somebody it's basically pointing a finger saying you know you just can't carry it out i i did my part hit the ball over the net and you dropped the ball and we realized it's time to stop that because we understand that they just don't have the decision-making apparatus working well in their brains to make that good decision stop blaming them you know damn well those patients go home doctor visit after doctor visit they look in the mirror and they blame themselves they say you know i i went to the doctor today and i i know what i'm supposed to do i can't do it or i read the book i watch the pbs special i want to follow xyz diet whether it's keto paleo whatever it is i can't do it i crash and burn something must be wrong with me self-blame which is a very very heavy burden so we realize that their brains are re are need to be rewired to allow them the opportunity to make better decisions and this is what i alluded to a moment ago by having an on ramp to better decision making and therefore real in a real world example there's that patient with type 2 diabetes gaining weight it's not going to be helpful to give that person a pre-printed sheet a diet and say here you go mr jones take this next time i see you i want your blood sugar to be better i want you to lose five pounds that is not going to work what needs to happen is we need to have another on-ramp to better decision-making for that individual it might be that you know this man is going to expect the diet because he's gotten that with his last five health care providers but you say instead listen i'm not going to give you a dietary plan at this visit because i know likely you're not going to follow it and i'm not blaming you but i want to help you make better decisions and here's how we're going to first take a deep dive into how you sleep what is the hygiene associated with your sleep related choices how late are you on the computer what time do you have your last cup of coffee what time of day do you exercise all the things we know really very important for getting a good night's sleep does your partner wake you does she or he uh have sleep apnea or kick you at night whatever it may be and i'm going to give you uh a wearable device that you can upload to your smartphone we'll get a real sense as to the length you sleep the quality of your sleep how much deep sleep how much rem sleep etc we'll get a lot of dynamics and that'll give us opportunities to modulate things in your life to help you get a better sleep then when that patient comes back you've worked on the problem which is not their diet it's their decision-making apparatus now they're in a better place just like tom bilyeu was saying you make bad decisions that next day when you haven't slept it's universal we're all that way and it might be sleep it might be they sleep well it might be they just don't get out of nature enough it might be a simple meditation program there are a lot of on-ramps we have a 10 a 10-step program that offer people ways of getting back to better decision-making and just like we had a problem before where one bad decision begets another bad decision we can play that to our advantage whereby making just one simple change we suddenly improve our chances then of making a better decision as it relates to something else it's like uh action leads to a reaction in this case an action of getting a better night's sleep leads to the reaction of making better decisions or another newtonian law uh that deals with exercise that objects in motion like your body tend to remain in motion when you first engage in exercise program likely it's going to help you continue that what are some of the 10 on ramps so sleep obviously is going to be one of them uh what are some of the others sleep is so huge and let me just you know finally reiterate that you know this is something we spend a third of our lives doing or we should we don't spend a third of our lives exercising or eating which are important obviously but so underrated in our world of trying to be productive and getting a leg up on the next person you want to be productive sleep more and sleep better in terms of the quality i you know we look at a lot of things certainly we talk about meditation research demonstrates dr andrew newberg's led us in in this area indicates that meditation lights up the prefrontal cortex you can do functional mris on people who do meditation and they can be only a short period of time six weeks they have now lit up their prefrontal cortex in terms of brain activity can you imagine what a tonic person themselves like to do impulse control like i need to sit here i need to focus on my breath what is it that's lighting it up what the act of mindfulness is lighting up their prefrontal cortex and it can be mindfulness towards a prayer it can be mindfulness towards a mantra it can be a simple breath whatever is mindful allows the prefrontal cortex to light up and i would submit that that is a big goal of ours today and that is to be mindful of whatever activity uh we are engaged in uh you know there's people say oh i i'm really good at multitasking well nobody can actually multitask we go from one task to another task and then back to the first task or the third test we're always skipping around we're not really engaging many tasks and our efficiency when we are so called multitasking or engaging many issues at one time is a lot less than if we stayed on one task being mindful allows better decision making being on your smartphone during a meal leads to an increased consumption average of 200 calories because you're not mindful of what you are doing i remember years ago i attended a a lecture by deepak chopra and you said somebody asked the question dr chopra what can i do about my cigarette smoking and he said to this person the next time you want to smoke a cigarette and you should stop what you're doing go outside sit down and think about cigarette smoking while you're smoking and what he was saying is being mindful of that act you know we all know that's a health destructive act but i would submit that the reason he said that is because that individual is now not going to mindlessly smoke on the phone or during a meal or doing the while driving and that will be an improvement for that individual likely he or she will smoke less and finally make that connection to the negativity of what that cigarette smoking is doing to his or her body so first of all it focuses us to dedicating a certain time to that activity in the day so it's helping us triage our day and of course the amplification of the prefrontal cortex activity meditation reduces inflammation that's our goal meditation reduces cortisol why do we want to reduce cortisol the stress hormone because cortisol among other attributes disrupts our gut bacteria and leads to increased gut leakiness or permeability another mechanism that leads to inflammation it's why we see higher levels of inflammation in people who take certain medications like non-steroid anti-inflammatories which are designed to reduce inflammation ultimately you're working against yourself acid blocking drugs and certainly antibiotics certainly diet plays upon the microbiome to increase inflammation as well we call upon um readers to keep a gratitude journal who knew to take a little bit of time and to write down what you're grateful for you know the moment you do that it's transcendent because you focus from all the things that you think you have to do to what has already happened and what it has done for you what you are grateful for that powerfully like meditation connects you to the prefrontal cortex yeah that one trips me out the fact that merely by thinking about something specific you can change your neurochemistry in such a way that if that it has an effect on your whole body physiology like that that's one of those like sleep is so under used as a you know quote-unquote treatment uh but incredibly powerful i i have to say as we're having this conversation it's it's like i've never thought about this before because it you know it's what we wrote about obviously but every time i um elucidate this it's just so powerful that we have that degree of control that simply thinking about something does rewire your brain you know it's the reason that professional athletes some rehearse you know that what they're going to do on the tennis court or whatever their sport needs to be before they go out there they go through the whole thing you change your brain by thinking about playing the piano yeah you do when you play the piano and learn a piece but simply thinking about that piece will actually restructure your brain it's like as i mentioned the dalai lama said that the brain we build reflects the life we live the choices that we make being kind and considerate and empathetic towards others takes us closer to the prefrontal cortex and away from the self-centered narcissistic impulsive areas of the brain like the amygdala so we we can choose and please understand that you know another part of the book really as you've already called out talks about how the world conspires to take us away from that that the pop-up ads that magically appear on our online experience that seem to be very interesting for us who knew are taking away from our ability to stay on task and really letting us believe that uh instant gratification is the way to happiness and it isn't i mean it is exactly wiring us into the amygdala and it's keeping us from really achieving what i call enlightenment and to me if you were to ask enlightenment is being as connected to that gift the prefrontal cortex as we possibly can because it's then that we can conceptualize the future and make decisions to pave way for a better future and it's the key to really engaging the notion of community of my actions being imparted and having influence on the the survivability and happiness of another individual and the planet as well i mean research demonstrates that people who engage nature which enhances prefrontal cortex activity are more kind to nature are more environmentally involved if you will one thing that i found interesting about the research that you touch on in the book around nature is that you can show somebody 10 seconds of an image of nature and they're less impulsive in their decision making i was like what how's that possible so that's an interesting study and there are a lot of them it looks at a technique called delayed discounting which is really uh used in psychological testing as a measurement of impulsivity so are you able to basically do the adult thing delay gratification or not and what they did in that study was really quite interesting they asked people do you want a dollar now or a hundred dollars if you wait at the beginning of the test everybody says hey i can wait the question is how long are you willing to wait people were shown either images of the city images of nature or then just geometric images that were thought to be at the beginning to test the control but interestingly the geometric images and the city images had the same outcome in comparison to showing people just a picture of a natural environment those people who saw that picture were able to say i'll wait i think it was up to you know ten years to get ten dollars as opposed to one dollar whereas the other people that were shown the city or the geometric shapes you know their their time until they said nah just give me uh give me the dollar and i'm out of here they couldn't wait they were impulsive that time was a lot shorter so that's kind of a delayed discounting is kind of a standard test for impulsivity a new study came out in december 2020 that actually looked at the relationship between functional mri imaging of the connection looking at this connection between prefrontal cortex and amygdala and then measurements of impulsivity and found exactly what it is that we described so they validated the notion that when you lose the connectivity or it's at a lower level you have more traits of impulsivity and that relates to things like drug addiction for example adhd other issues now putting this in a modern context one of the things you talk about if i remember right from the i think you called the 10-day brainwash reset is technology and people's um abusive wasn't your word my word abusive relationship with technology i think in fact this was what made you bring up the suicide statistics that the people who are addicted to um social media internet i forget the exact wording but they have a significantly increased risk of suicide am i remembering that correctly you are and you know addiction is defined as you know engaged in activity that interferes with your ability to be productive to care for yourself and interferes with your family relationships etc classic definition it applies to use of the internet so it's estimated that six percent of internet users are in fact qualified or characterized as being addicted that's a lot of people that's you know that's five times the population of england it's a quarter billion people who satisfy that criteria for addiction and they have up to a four four-fold increased risk for suicide depending on their age younger is higher risk for suicide so you know the average american spends 42 percent of his or her day in front of one form of screen or another whether it's a a pad a computer phone television and that has an effect because there's a lot of inputs into your brain that are happening during that experience a and b it's been said that when you're doing one thing you're not doing something else you're not exercising you're not preparing your meals you're not interacting socially with other people uh and all the other things that are an important part of your day so it becomes a very big issue especially we recognize that online our brains are being manipulated by advertisements and advertisers who want us to make decisions for their benefit not for our benefit not for our health benefit uh etc you know the notion of of social interaction is interesting because you know that's a social media platforms are a huge hack into our primitive desire to be social to you know we evolved as social beings with division of labor and you know having each other's backs that you know was effective for us and allowed us to survive it's a survival mechanism that's being hacked into by various social media platforms much as our desire to eat sweet food is it you know that's ingrained as a survival mechanism our ancestors gravitated towards sweet foods because it made them make body fat which allowed them to survive during times of caloric scarcity we all carry that heredity that sweet tooth that makes us desire sweet that's hacked into the you know hacked into our brains by man you know sixty percent of the two million foods at the grocery store have added sweetener not because it's you know cheap or it's uh you know going to make the food have a shelf life but because we're going to eat more of it we're going to buy more of it so there's a lot of hacking that goes on to some of these primitive ingrained issues in our in our in our brains that make us behave or make us think we want to behave in certain ways yeah seeing you guys put together like this sort of defense against the dark arts to use a harry potter term in the book was you know a lot of really um accessible things that i thought were fantastic from all right obviously getting sleep getting some exercise get the body moving limiting your technology um forest bathing you know getting out getting in nature it it is a very comprehensive look at what people need to do one element though i'd like to dive into if you were going to give people broad strokes on diet what would be if you want optimal cognition what are the the you know small handful of things we know we want to avoid and then the small handful of things we know we want to go for i think the biggest issue today is fructose so it's a very interesting story tom and [Music] it begins 14 million years ago in the middle myosin period when our primate ancestors were experiencing a time over a couple million years of cold and reduction in food availability these primates had already migrated out of africa through a land bridge because it was so cold that sea level had fallen because of all the ice being trapped in the poles they're able to migrate into asia and europe and there was environmental pressure on these primate ancestors to survive in times of caloric scarcity some of them developed mutations in a gene that made a chemical called uricase that is an enzyme that breaks down uric acid such that those primates who lost uricase had higher levels of uric acid in their systems each and every human walking the planet has inherited that we don't have functioning uricase it's why amongst all mammals we have among the we are among the highest in the levels of uric acid in our bodies what does uric acid do uric acid we used to think was important if you had gout or kidney stones that's why doctors measured it we now know and this is a brand new story it's what i'm writing my new book about we now know that uric acid amplifies inflammation it powerfully initiates fat storage it powerfully leads to insulin resistance it amplifies our mechanisms that increase our blood pressure it causes our bellies to get bigger all the bad parts of what's called metabolic syndrome are amplified by this uric acid and one of the most powerful ways that we augment uric acid in human physiology is fructose fructose is what caused our ancestors our primates to make body fat and allow them to survive during times of caloric scarcity where were they getting it back in the day fruit fruit whatever fruit they could find and they ate an awful awful lot of fruit when they could find it but the fact is when you would compare those animals that didn't have this mutation to those who did those who who had the mutation couldn't break down uric acid built up the uric acid survived this was a mechanism whereby they made more body fat not that they became fat but they made enough fat to survive so not it was survival of the fattest the problem is that that's who we are today we are we were carrying this legacy that says when you eat fructose you're going to make body fat you're going to become insulin resistant you're going to increase your level of inflammation in your body your blood pressure is going to go up and cognitively you're going to decline as well so it's it's a really exciting new story and i think that what we have to emphasize is limitation of fructose in its raw form as in sugar sweetened beverages and fruit juices and also look at other ways that we increase uric acid in our bodies by ingesting foods that are high in purines these are things like sardines anchovies organ meats etc by and large we have to do everything we can to not become insulin resistant our metabolism meaning specifically how we handle glucose in our bodies is key to our health across the spectrum of discipline whether we're talking about the brain the heart any organ in the body everything really depends on how we handle glucose now each of us is different so how would you handle what is your body's response to glucose based upon the foods you eat i don't know but i can tell you that if you were to get a device called a continuous glucose monitor you would know moment to moment what your blood sugar is and how you responded to that exercise you did this morning whether you had in my case almonds versus cashews i learned something really profound about my blood sugar based upon knowing what my blood sugar is in various types of foods knowing your glucose response is so fundamental to your overall health i would say longevity and certainly absolutely your brain health you've got to know your blood sugar and how your blood sugar responds to your various lifestyle choices higher blood sugar translates to inflammation inflammation as we've talked about means poor choices it means increased risk of alzheimer's coronary heart disease diabetes obesity and it means disconnection syndrome it means cutting off your prefrontal cortex ability to influence and to modulate to be the adult in the room the control over the amygdala so when you ask what are the keys diet for brain health it is any diet that's going to keep your blood sugar in check by and large a diet that does its best to eliminate refined carbs certainly sugars a diet that's really high in fiber i would say mostly plant-based and i think that you know obviously when we get more subtle influences i would say as organic as possible i would avoid things like gmo not because gmo foods inherently are bad but because of the fact that by and large foods are genetically modified this day and age to allow the use of herbicides like glyphosate on them and then we get traces of this glyphosate which does what according to dr stephanie senoff it changes our gut bacteria what does that do amplifies inflammation and we're back to where we started oh where can people connect with you dr perlmutter where's the best way to to follow along as you learn all this stuff well i just joined clubhouse so that's kind of a lot of fun nice yeah austin and i do a thing every friday at four o'clock eastern about brain health and boy we've been talking about everything so for any clubhouse members which uh i think we'll see a lot more of really soon um drpearlmutter.com drpearlmutter.com is my website uh the empower neurologist on youtube is my podcast uh instagram i think is david perlmutter facebook davidpromuttermd but um that's where you'll find us the book is brainwashed that is everywhere so awesome well i cannot wait for the next round the next book uh that will be a lot of fun and guys speaking of things that are a lot of fun if you haven't already be sure to subscribe and until next time my friends be legendary take care thank you guys so much for watching and being a part of this community if you haven't already be sure to subscribe you're going to get weekly videos on building a growth mindset cultivating grit and unlocking your full potential you