You Will NEVER EAT Sugar Again After WATCHING THIS! | Dr. David Perlmutter

In today's episode of Health Theory with Dr. David Perlmutter, we discuss how to reverse the damage your lifestyle is causing your gut, the four metrics you must know to call yourself healthy, the real cause of Alzheimer's, and the secrets to effective aerobic exercise. Everybody, welcome to Health Theory. Today's guest is Dr. David Perlmutter. He's a board-certified neurologist and the four-time New York Times best-selling author of Grain Brain, Brain Maker, and several others. He witnessed his first brain surgery at the age of 13 and went on to publish his first paper and give his first lecture on the brain at just 19. Since then, his innovative approach to medicine has made him one of the most sought-after minds on the planet in the fields of nutrition and brain health. He's won countless honors and awards and has been interviewed by everyone from Oprah and Dr. Oz to 20/20 and Larry King Live. And as somebody who's existed on the cutting edge basically your entire career, what I want to know is what is the cutting edge now? What are you thinking about this maybe a little bit controversial that you're exploring that you think is going to have a big impact? We said 5 years ago, maybe you should stop stop eating gluten and cut back on your carbs and eat more, dare I say, fat. And boy, did people's feathers get ruffled with that. So, I found that it felt good to be disruptive and challenge the status quo. Ronald Reagan said that status quo is a Latin term for the mess we're in. And I think that what I foresee is that we are going to see a virtual explosion in the ability to harness big data and moving forward manipulate that data using artificial intelligence to really be far more specific about making recommendations for Tom. What do you need based upon who you are? What does your genome look like? What does your microbiome look like? what are your lifestyle choices today, where do you live geographically, what's available to you, and therefore be very specific individually in terms of what your needs are. What's really important, I think, is we are now seeing, unexpectedly, the ability to leverage personalized medicine biometrics to the larger audience. You know, which it kind of gets back to the idea of looking at the few to extrapolate to the many. I mean, that's how drug trials work, for example. We know that at most 3% of people are ever sampled and utilized data-wise to make recommendations for the remaining 97% in terms of a drug. And yet now, with this ability to crunch this data and move forward, I think we're going to really understand the larger, the bigger strokes that, uh, you know, frankly, we know that not everybody today, and certainly moving forward, is going to be available to, uh, participate in specific personalized medicine, but I think we're going to learn what really has traction with respect to the broad strokes. Mhm. And what do you think people should be tracking now? Like, what's a meaningful Should I be wearing an Oura Ring or a constant glucose monitor? Like, what are What are the data points now that that you collect or that you recommend that people collect? Well, it's a good question because, you know, as you well know, there are so there's such incredible availability right now to look at changes in your microbiome on almost a daily basis, for example. Uh, certainly your genome is a great place to start. That doesn't change, or does it? Uh, we In reality, we know that our day-to-day lifestyle choices are hugely influential on the expression of your, uh, life code that we thought was really locked up in a glass case, and we now recognize absolutely, uh, is not. So, I think that, uh, to start with, we should all understand our genomes. Whether it's 23andMe or any other uh, service that's out there, it's not just getting your genome sequence, but then manipulating that data to understand what your current needs are before you even begin tracking as you move forward. How do we manipulate it? I've actually never heard somebody say that before. online sites that are available to upload your 23andMe data. You just drag the file and drop it into various sites. Dr. Ben Lynch, author of a book called Dirty Genes, has a terrific site. And from that, you learn not just what your genome says, but more importantly, what does it mean? I learned some things about myself that I never knew that did change my lifestyle choices to some small degree. One thing I learned is that I, Tom, am a poor methylator. What does it mean? It means that I have not the most favorable genes in a pathway called MTHFR, along with about 20 to 22% of Americans. People need to know that. When What's the impact of that? Like if you were not to address it, the outcome would be one of the most common things that we see with people who are poor methylators is, for example, that my homocysteine level can go up. And why is that an issue? Well, homocysteine is a powerful risk factor for Alzheimer's. So, it really takes us away from the notion of Alzheimer's being a genetic issue, either you have the Alzheimer's gene or you don't, to Alzheimer's being related to modifiable lifestyle factors. Now, other things that are important I think people should be following. Their homocysteine level, as mentioned, vitamin D level. I think knowing your fasting glucose level on a pretty regular basis, whether you have an onboard glucometer or not. I think to me, I I find that to be a little bit of an overkill. I think you can get a good sense if you measure your blood sugar maybe once or twice a week with a finger stick. I think you should know your ketone levels. Your hemoglobin A1C or so-called average blood sugar I think is hugely important. you think's a good number there? Well, I've learned in the few years that I've been at this that um you know, I'm the kind of guy and I I I think you probably are too uh who says well, some is good, more is better. But in terms of medicine it's not always the case that a lower insulin level, a lower hemoglobin A1C or lower blood sugar is necessarily better for you. I mean, I 5 years ago popularized the idea that we really have to get our insulin levels low because it would be A, an indication that we were eating less carbs, having less blood sugar elevations, and B, it would ultimately help restrict our risk for developing insulin resistance. Mhm. Uh and now we see publications that at the very lowest ranges of insulin, there is actually at least in women an increased risk risk, a profoundly increased risk of becoming demented. Uh and Is it the same risk? So, they see it on the low end, do they see that same risk then on the high end? Well, the the risk on the low end and again, this is just in women, but that's very important since you know, two out of every three Alzheimer's patients is uh are women. Uh but it's important that at the lowest range the risk was increased about 2.38 X. At the high range it was increased about 1.7 X. So, they're actually worse off if they're too low. Really, really low. Interesting. How would you depress your insulin that low? Well, I think this gets to the point of uh gene expression. I think people have certain what we call polymorphisms of genes that might not code for adequate, uh, insulin activity. Uh, so a plus being, of course, on an extremely low-sugar, low-carbohydrate diet. So, it gets to, again, back to, dare I say, the sweet spot. It's a terrible misnomer, I think, uh, as it relates to blood sugar and and our diets. We shouldn't opt for the sweet spot, but, uh, you know, it it's it's relevant for us to understand in the context of this discussion that as we get together and talk about this, 2018, we have no treatment, uh, for Alzheimer's. None. Nothing works. Nothing reduces the, uh, the rate at which people decline. And to me, it's very compelling that last month the Journal of the American Medical Association put out a study by a Dr. Richard Kennedy, uh, which was actually a a meta-analysis of some of the the top 10 best uh, evaluations of the efficacy of so-called Alzheimer's drugs. Though there is no drug that works, yet Alzheimer's drugs, uh, you know, are selling at the rate of close to a billion dollars in our country annually. We've known that they don't work, but what was published last month was really quite compelling by the Journal of the American Medical Association. Not only do the drugs not work, but they speed the cognitive decline of patients who are taking them. What are they attacking? What's the the notion behind the drug? Must be something that it what lowers and what it attacks or None of the drugs are involved in in dealing with beta amyloid. Uh, the first class of drugs representing the lion's share, about 76%, are what are called cholinesterase inhibitors. And these are drugs like Aricept or donepezil that inhibit an enzyme that degrades a neurotransmitter called acetylcholine because it was noted decades ago that the Alzheimer's brain is a brain that is low in acetylcholine. And a very simplistic approach would be, "Hey, we can bump up acetylcholine. That'll be a good thing and it'll help people." Well, it never has shown any efficacy and yet it received FDA approval, another story for another time. But now it's not just that it doesn't work, but it's hastening cognitive decline in the very people who can't afford that. And you think of the families who have dad or mom or husband or wife on these drugs and they're actually making people worse. It's like giving somebody a treatment for their diabetes that is raising their blood sugar. And you bring up the idea of getting rid of plaque. It's been noted since the naming of Alzheimer's disease after Dr. Alois Alzheimer who first described the pathology of what this looked like in the brain of a woman dying of that disease that now bears his name. And the plaques were noted then and since that time scientists and clinicians alike have really focused on the plaque as being the thing we've got to get rid of. And it turns out that researchers like Dr. Rudolph Tanzi at Harvard have made it very clear that the plaque is the response to the problem, not the cause of the problem. The plaque is what we call an antimicrobial peptide. And it's the brain's way of responding to perhaps infectious agents like herpes simplex virus or chlamydia infection. So, you know, it is said that the enemy of my enemy is my friend. We need to embrace beta amyloid as being there for in a very important reason. When we rid the brain of beta amyloid as has been tried in clinical study after clinical trial patients decline much more quickly. Uh that might underlie why Pfizer in February of this year said no more. We're just not going to pursue the notion of an Alzheimer's drug anymore. We've got to leave the beta-amyloid alone. Uh there was a move a couple of years ago for the FDA to approve uh brain scans that would measure the amount of beta-amyloid load in a patient as a way of being diagnostic. Do you have Alzheimer's or are you on the way to that? And they didn't prove it because they realized that people can have a head full of beta-amyloid and be cognitively perfectly intact. Whereas others with very little beta-amyloid actually would demonstrate the clinical manifestations of Alzheimer's disease. Um so looking at uh you said that okay Pfizer's pulled out, they're no longer making um Alzheimer's drugs, but the one thing that is recognized to help is exercise. Um we know that exercise has a sort of what I'll call a real-time effect on blood sugar. Um and you're the first person that I've heard anyway talk about the knock-on effect of um insulin doing more than just shuttling blood sugar out of your cells. What are the the factors you think that are at play here? And what are the behaviors that we should take to make sure that we stave off dementia as long as humanly possible? What a concept. What a concept that this disease affecting 5.4 million Americans, 40 million people globally, costing us a trillion dollars, higher than the market values of Apple or Google, uh predicted to triple by the year 2050, that our lifestyle choices can be leveraged to reduce our risk that will affect 50% of people age 85 or older, the flip of a coin. So in in in that uh through that lens, let's go back to where we were, the the value of exercise. And I'd say uh your points about insulin sensitivity are well taken. Very important keeping blood sugar down, uh enhancing the sensitivity of the insulin receptor. I want to come back to that because I think um I'm seeing a big elephant in the room that we need to talk about. And that is that physical exercise changes your gene expression. You are able to change the expression of this previously thought to be immutable life code for the better and lead to the expression of what we call a tro- a trophic hormone or growth hormone for the brain, BDNF. Brain-derived neurotrophic factor. Uh there are many things you could do to amp up BDNF. You can use uh uh turmeric in your cooking, take a DHA supplement, uh even uh CBD has been demonstrated recently to increase uh BDNF. But, the most important thing you need to buy uh to improve your BDNF is a new pair of running shoes because aerobic exercise is able to manipulate the expression of this BDNF. Why specifically aerobic? Well, to a lesser degree uh resistance exercise as well. But, I'm simply telling people 20 minutes a day, 5 days a week, hopefully more. At a heart rate value of 180 minus your age as a target, of course consult your health care uh practitioner. But, what a powerful way to reduce your risk for dementia. How can I connect those dots and make that statement to you as we sit here? Well, the Journal of the American Medical Association has wonderfully correlated baseline BDNF levels with future risk for dementia. You want to have more of this chemical that does two important things. It increases the growth of new brain cells in your brain's memory center, which is a powerful target for Alzheimer's, Okay. and it also increases the connection of brain cells one to the other, a process called uh neuroplasticity, that we can actually allow our brains to take advantage of the experiences that we then choose to pursue to build a better brain. And that is Is the BDNF a building block of that or No, it is not. Is it a signaling molecule? molecule. I mean, our brain cells want to connect to each other. And our lifestyle choices that are highly stressful, that are deprived of restorative sleep, that are higher in sugar in terms of diet, that are overall stressful, uh increase cortisol, for example, that inhibits the growth of new brain cells, actually compromises uh our brain cell population in the very areas that we need them most, like the memory center, the hippocampus. So, we can We can reverse that. We can tip the scales in our favor and say, "I'm not going to continue losing brain cells. I'm actually going to repopulate my memory center with new brain cells." That study was done out here at uh U- UCLA in collaboration with researchers at University of Pittsburgh, led by a Dr. Erickson, demonstrating two groups of people, 100 people in each group. One group stretched for a period of a year. The other group was involved in aerobics. They found that those who stretched had lower levels of BDNF, declining memory function, and shrinkage on very sophisticated brain scans in terms of their hippocampus size, which is the Let's pause there cuz I I want to walk through this and make sure that I understand. The Yeah. This is incredible and potentially very useful, but I want to make sure that I understand the sequence of events. Right. Okay, so first of all, does BDNF trigger the regrowth of brain cells across the brain or just the hippocampus? Good point. We used to say the brain doesn't grow new brain cells, end of story, right? I mean, you're probably too young to know that, but when I was was school, we were told that uh your brain grow maxes out at about age 18 and every beer you drink after that it's 40,000 brain cells or whatever the magic number was. For whatever reason, I don't remember that, but um how incredible that uh in your 90s, you were still growing new brain cells. You have this gift of regrowth of neurogenesis. It's a choice you can make. You can make it today after watching this podcast by dragging those sneakers out and uh if only going to the mailbox is as far as you can go, then have at it. Tomorrow, you'll do that twice. And the sequence is you're doing the exercise, the exercise is creating BDNF, BDNF is then triggering hippocampal cell growth Hippocampal, yes. But beyond that, another area too called the subventricular layer of the what's called the ependyma in um the layer of cells that underlies those fluid-filled compartments that you see when you look at a brain scan. But for our purposes, the uh synaptoplasticity and the neuroplasticity, the connection of brain cells happens throughout the brain. Um we also depend on a process called synaptic pruning. What does that mean? Uh it means that also for brain function, we have to have the ability uh as we are in our uh childhood and adolescence to cut back on the number of connections that we have uh in order to kind of refine the the computer to make it work at its optimal level. So, Which it's doing, I'm assuming, based on repetition. What you do the most is going to get the most connections, it's going to get the most the highest degree of insulation. Exactly. All of that. Neurons that fire together will wire together. And those that don't will atrophy, will fall off the the tree. And so you're saying that um that process, the firing together and wiring together, is um one repetition, two, you get the BDNF if you're exercising that washes the brain in some way, signals to them, hey, to in some way that makes them more active, more likely to connect. So, what is the advantage then, the um evolutionarily coded or selected advantage that exercising people should have higher levels of BDNF and ultimately, let's just say, be more uh able to survive and cognitively uh superior in evolutionary terms. All right. And I guess it's the people who were healthy enough to hunt and gather and to lead, uh you know, the expeditions in our Paleolithic times. Uh so, these individuals, and I've never thought this before, I just was uh having a bit of a free association while we were talking. These are our ancestors and uh evolutionarily they were selected because they were leading the group. So, uh uh we can play upon that now that we understand that. It's interesting. Do you think that there's any relation between movement and memory because of the if you're moving and you're hunting or whatever, you need spatial relations, you need to understand sort of where you are. So, I ask all these questions because one, like, even when people talk about exercise, I never do cardio. I hate cardio, it's painful. But, I lift all the time. But, if you're telling me that that's actually not as powerful, then I'll start doing cardio. Um so, I guess understanding like the the nuance level so that I know how to act is ultimately the the driving force behind my questions. Um so, I think I understand BDNF, which is fascinating in in the last 10 minutes, my understanding of why that matters is skyrocketed. I want to go back to um the HA1C levels. Uh I want to pin you down for a number and I'll tell you why. So, on staff, we have a vegan and I once watched him cane an entire package of blackberries. And as he was doing it, I could feel my blood sugar rising. And [clears throat] I was like, there's no way this kid's going to die. Like he is he's too good at his job for me to let him die. So, I'm like, you have to go get your levels checked. And he did, and they they fall within in what I would consider normal ranges. So, I want to know if I'm delusional on that, if there's just as that much genetic variability, cuz that would have spiked I know because I take my blood sugar levels quite frequently, that would have spiked me to over 140. Sure, it may have pushed me closer to like 120 to have You can't imagine how many blackberries he ate. Um but his his H um A1C level was 5.1. And he eats like that all the time. Well, three things come to mind. First, I I want it not to be missed that our time together may have compelled you to engage in aerobic exercise. That that's great. I mean, that is huge. And uh you know, what compelled me was the science, the data, my personal risk for Alzheimer's having lost my father to that disease, and then just understanding how pervasive and preventable the situation is. But uh if if you've changed your exercise routine based upon our time together, then I'm grateful that I came out here. That's great. Next point. Uh the ideal uh being in the normal range. I You brought up that uh term, and I I I just really recoil at the notion of a normal range. It's normal won't really uh by definition is average. It's, you know, whatever the number is a thousand samples, and then one standard deviation on either side, the normal range. And that doesn't work uh in terms of my messaging. I want optimal. So, a normal range of vitamin D between 30 and 100. So, a patient will say, "Well, my level's in the normal range, doc. I'm at 31." Uh there's a term for that. It's means it it is that sucks. Not that I use it that often, but it really does. We need optimal. Well, then you know, I good enough normal range is not where we are. We want tip-top. And so as it relates to hemoglobin A1c tempering my next commentary with the notion of the U-shaped curve I would say a range would be between let's say 5 to maybe about 5.3 5.4. Now to get to your third point of your friend who's eating a lot of berries first of all, it's a lot of sugar. It's a lot of fruit sugar called fructose, which has almost no effect on insulin as you know. There is glucose in there and ultimately he will to some degree glycate. He'll bind his blood sugar to protein in the case of hemoglobin A1c hemoglobin. And ultimately will increase that activity and it'll be measurable. But you say he does it all the time. He's eating whole fruit with fiber to help offset the blood sugar spike. So I think you have to look at many things in terms of looking at an N of one what did his A1c turn out to be based upon what you've observed? There are a lot of variables here. We don't know his what his microbiome looks like for example. I think a vegan diet can be a very salubrious approach. However, with certain caveats. You're not going to have great sources of vitamin D, B12, fat. You know, a lot of vegans don't get enough dietary fat. And it's a huge huge issue. Yeah, it's interesting. When I heard this story, I was like, "Whoa!" that you you did a fecal matter transplant with a child that was suffering from pronounced autism. I while I have certainly heard the through-line of hey C-sections lead to a microbiome that's wildly disrupted, which increases the potential of somebody developing autism. I certainly had never heard of using a fecal matter transplant to reduce some of the symptoms of that. Um one, walk us through that story, which I think is utterly fascinating. And two, I'd love to hear what the pushback is on that, where you think fecal matter transplants are in terms of efficacy, in terms of safety. Um and I'll say that knowing that or you should know that I'm sitting here waiting for the answer because my wife has struggled profoundly with um antibiotic induced microbiome disruption. And if I thought that that was going to work, I would do it immediately, but I'm worried about the safety. Well, let's address the safety first. Uh I think with a properly screened donor uh that it is negligible. I mean, it is the treatment of choice uh being carried out at uh more than uh 100 hospitals in America today for an another disruption of the bowel flora called Clostridium difficile or C. diff. Uh the standard of care treatment using antibiotics is has an efficacy of approximately 28%. FMT fecal microbial transplant has an efficacy uh without recurrence north of 96%. Whoa. Think about it. I mean, the the the reason that people get C. diff in the first place is from uh antibiotic exposure frequently. Other drugs can do it as well. And they're treating that, the mainstream [clears throat] approach is to treat it with further antibiotics. You talk about fighting fire with fire. But FMT now has really become a national uh uh well-accepted approach to treating uh C. diff. So, I wouldn't be concerned in the least with respect to uh safety of that procedure, provided the donor is screened. So, a woman arrived in my office with her uh child, and um I observed him uh that he couldn't make eye contact, and he He repetitive motion, you know, very characteristic autistic child. And I asked her, "How did you come to see me today?" And I think as I recall she was from um Mississippi. And she she said, "You know, I need to tell you the story how it all happened." She was in the parking lot of a grocery store. And she couldn't get her child out of the car. And next to her was parked uh a gentleman in a truck. And he apparently apologized to her and said uh that he didn't mean to get uh in get involved in this, but maybe you ought to take him down to Florida to see me of all, you know, and uh and she asked him why and apparently I'd helped somebody in his family. So, she comes to see me with her son. And it was right then that I was deeply immersed in the literature that was revealing that these kids have a profound disruption of their gut bacteria. I mean, it's almost like an autism fingerprint. And this was many years several years ago that we see very powerful correlations between these uh patterns of gut bacteria and the manifestation of autism. That we see children who are born by C-section, you alluded to that earlier, have an increased risk of autism. And that C-sections disrupt their microbiome. One researcher, clinician uh actually uh Dr. Feingold uh actually was treating uh autistic children using vancomycin to help re an antibiotic to reestablish some balance and was getting good results. So, I said uh let's at least start with some probiotic enemas. I instructed her how to give her child uh probiotics from the health food store, putting them in an enema, and administering them. He improved. He uh doesn't sound like a big deal, but he was able to tie his shoes for the first time in his life. And he was able to spend the night out at a friend's house. I mean I mean those are major landmarks. They don't seem like much, but they were. As we continued to work with him, he plateaued. Uh maintained his improvements, but it was not continuing to get where she wanted. And I said, "Well, we ought to consider fecal microbial transplant." What is that? Identifying a healthy donor, taking the fecal material, and transplanting it into your son's colon. She identified a healthy 12-year-old girl. And I got on the phone with her. And I said, "I know it sounds really strange, and it's way out there, but we just need to do this." And she said, "If it'll help him, I'm in." Wow. And she did, and he began FMTs. His mother did them at home. And um I was getting ready to give a talk in Germany. His mother sent me a link to a video of this kid presenting um presenting a book report at school on Benjamin Franklin. And it I I got like that getting ready to give my lecture like I'm getting right now. It took the the wind out of my sails. I just couldn't believe it. And he's now in regular school at the in the top 10% of his class. He was always bright. But he had this inflammation the way it was cognitive performance. You know, it's like listening to a FM radio station in a lightning storm. It was always there. So, um you know, that was one of the things that we did that was certainly disruptive and eccentric. Um since then, the University of Arizona did an interventional trial on 20 autistic children demonstrated profound improvement in these kids, where nothing has helped them, ever. Uh in collaboration with researchers from Harvard, validating the notion of fecal microbial transplant as a treatment for autism. We know that we can measure the permeability of the gut by looking at levels of something called LPS, lipopolysaccharide. It's a chemical that enshrouds the gut, many of the gut bacteria. If the gut lining is leaky for whatever reason, typically because of disruption of the gut microbiome, then we can measure that LPS in the bloodstream, where it doesn't belong. We see dramatic elevations of this LPS, meaning inflammation and uh breakdown of the gut lining in Alzheimer's, autism, major depression, and even Lou Gehrig's disease. My point is that we focus on the brain when there's a heck of a lot going on in the gut that we're just beginning to unravel. The beginning of our time together, you challenged me. You said, "Well, what does the future look like?" And really, as we understand this relationship between the gut and the brain, we've got we've we've moved to a new stadium. And there are new rules written. Because as a neurologist, I have had traditionally very few tools in the toolbox. It was very much an audios, diagnose and audios situation. It doesn't really help anybody to go to the neurologist's office and he or she comes up with a very exotic name, or something not as exotic, like Alzheimer's, uh is a a word that has incredible um gravitas in a negative way when family members hear that. And we have no treatment, and yet it's preventable. And um it's like John Kennedy said in his inauguration, that the time to fix the roof is when the sun is shining. And you know, that really has been you know, a fundamental aphorism for me that to prevent these situations for which we have no treatment is the call to action. And uh there's no doubt uh that to a significant degree this epidemic is preventable. And that's the message that we want to shout out because um we are um inculcated with the mentality that we should live our lives however we choose and come what may, there'll be a treatment, right? Eat crap and we'll give you a diabetes pill to get your A1C below 7. Well, what kind of goal is that? Uh but the reality is treating your diabetes to lower your blood sugar has uh other downstream effects that may not be good. Lowering your cholesterol level with a statin drug may not be the best thing to do. And you're on that. I've heard you talk about that, statins effect on um insulin receptors. Um which was what put it on my radar that there potentially other issues or other things that insulin is doing cuz I always just thought of it as the, you know, taking the blood sugar out and putting it in the cell. Well, let me see if I can connect those two, the notion of diabetes and and statin drugs, for example. And why I'm really um so di- seemingly dialed in on diabetes because if you become a type 2 diabetic, which is by and large a choice, you have quadrupled your risk for Alzheimer's. Did I say a disease for which there is no treatment? Yeah. So, that's why you don't want to become a type 2 diabetic. Mhm. In the Journal of the American Medical Association in uh 2012 was the publication of a study called the Women's uh Women's Health Initiative study. Uh and it involved 150,000 women and demonstrated that those women taking a statin drug had an increased risk of developing type 2 diabetes by 71%. Whoa. In men, according to a more recent study, 2015, journal is diabetologia, their risk is increased about 46%. Taking a statin drug that's ostensibly the good thing to do for your heart is actually associated with a significant increased risk for another situation, for which guess what? We've got another pill for you. So, now you're on your statin and we're going to add in your diabetes pills. Uh so, this is diabetes that did I say quadruples your risk for Alzheimer's, a disease for which there is no treatment. We connect these dots and this is the information that people need to know before they capriciously acquiesce to taking that drug because my doctor said my cholesterol level is too high. And truthfully, I mean, I think we all well understand that it is a um a pathway of this cholesterol number gets me to write that prescription for this patient. And I'll explain that well, high cholesterol is going to give you a massive heart attack. Well, that isn't true that at least 50% of myocardial infarctions in America today occur in people with normal, so-called normal cholesterol levels. Beyond that, we have this idea of what is called the statin brain, where taking a statin drug is associated with cognitive issues, memory issues. Uh and this is called out on the the the bottle of medicine that this drug can affect memory. Why so? Well, your brain loves cholesterol. It's a very important fat as a lining of your brain cells. It acts as a brain antioxidant. And equally important is the notion that we talked about vitamin D and how critically important that is in your entire body, that there are more than 900 receptors in your body for vitamin D. That's how pervasive its actions are. And most of those are in the brain. Where does it come from, vitamin D? Oh, comes from the sun. The sunlight shining on your naked body changes a chemical into vitamin D. What is the chemical? It's cholesterol. I actually did not know that. Well, cholesterol is from which we make vitamin D, as it is from which we make testosterone and progesterone and estrogen and cortisol. So, this vilification of cholesterol is very much off base. But you got to give somebody credit. It sure paved the way for the notion that it's bad and that if you eat eggs, your children will be born naked or some horrible thing will happen and that we should lower cholesterol to incredibly low levels. The lower, the better. So, the notion of the U-shaped curve has yet to find its way to that level of pharmacology understanding that we need our cholesterol. We love our cholesterol. The issue that relates to risk for coronary artery disease is unrelated to cholesterol. Cholesterol shows up when the coronary arteries are inflamed. It shows up to heal the coronary arteries. It's why when a person dies of heart attack and you section their coronary arteries and you look at under the microscope, you'll see cholesterol is there. It's trying to heal this inflammation. It's like blaming the firemen because they're on scene, blaming the firemen because they're there at the fire. Doesn't work that way. It has a lot to do with um not the number of LDL, its value, but whether it's been damaged or not, oxidized or not, or bound to sugar. How do you check that? You have your doctor check a glycated LDL or oxidized LDL. And maybe your doctor is going to go, "Well, I'm not sure I've heard of that or that our lab will do will do that." In which case you need to move on. Cuz that's what is very clearly correlated to risk for coronary artery disease, the oxidized level of LDL, which is directly related to blood sugar. We're back where we started. Yeah, which I don't think in this interview we've really put our finger on the what I'm sure most people know, but I think it is worth saying, what are the lifestyle choices that are causing this cascade of essentially inflammation? Mostly food. And that should be empowering, meaning you can break the cycle. So, inflammation is what Alzheimer's is. Alzheimer's, coronary artery disease, Parkinson's diseases, autism, diabetes, cancer, these are inflammatory diseases. The brain in the Alzheimer's patient is virtually on fire with inflammation. The word comes from the Latin inflammare, meaning fire and inflamed. So, our lifestyle choices by having higher levels of blood sugar bind to our proteins called glycation. That's what A1C measures. When we bind sugar, because it's always elevated to our proteins, that challenges our immune system and the immune system says, "Something's going on here." And that increases the production of these chemicals called the cytokines that mediate inflammation. There's a very interesting study that was published in the journal Neurology back in 2014. And this is a study that looked at a group of individuals and a couple of several decades ago and did a simple blood test measuring inflammatory markers. It followed these individuals for 24 years. And it found that those individuals who 24 years ago had the highest level of inflammation in terms of their blood markers had a dramatic decrease in the size of their brains and at the time they came back to get reevaluated had poorer memory function. We know that there are is a very powerful correlation between markers of inflammation in the blood and Alzheimer's disease. So, it's very clear that we've got to do everything we can to reduce inflammation and that brings us back to the gut. Because the lining of the gut that one cell lining that separates stuff in the gut from the rest of your body is the gatekeeper basically for inflammation in your body. Whenever we threaten the gut lining and that chemical LPS and other things gets in and challenges our immune system, we amp up inflammation and that sets the stage for every bad chronic disease that you don't want to get. And when the World Health Organization is now telling us that chronic inflammatory degenerative conditions are the number one cause of death on planet Earth, we've got to pay attention to that metric [snorts] because it's something over which we have control based upon our lifestyle choices like the foods we eat. We want to eat much more primitively, much more locally and and as such reduce inflammation. You wrote an article when you were 16 or a letter to the editor in the paper, I guess is a more accurate way of saying it. I don't know if you remember this, but came across it in my research and it basically said speaking of, you know, Western lifestyle, it basically said, Uh, we're all sort of running this experiment and we're each contributing to um seeing whose lungs can evolve to handle pollution and I don't think that spending a Sunday at the beach or going on a week trip to the mountains is going to be enough and basically intimating that our current lifestyle is so far removed from what we've evolved to handle that there's a just a fundamental problem. And before we started rolling you and I were talking about um the your notion of brainwash, the new book that you're working on and I just want to hear a little bit about that about you know, what are some of the things that are happening um from a lifestyle perspective at a broader um level than what we've just been talking about, you know, just what we eat, but what we're engaging with um you know, negativity and how that influences the brain and you know, the way that the media's presented and the kinds of influences that they're having. Like what are you finding as you look more deeply at that? I think that uh there is a lot of uh traction of the the paleo ideology, but at its core the notion of paleo is one that says, "Let's get back to sending the right signals to our genome." Which is hasn't changed in let's say 70,000 years fundamentally. Uh and it get gets back to our original conversation we started today about how our lifestyle choices are interpreted by our genome. How our food beyond the macronutrient content is actually information sending up-to-date signals as to our environment to our genome so that our genome can then in kind respond uh to maintain our health by responding to the signals to that it receives. Our evolution cannot keep up with the environment to which we are exposed. And the environment to which we choose to expose ourselves. So, the idea that we can change that by going back and trying to think about what it was that our ancestors lifestyles must have been like and therefore cause our genome to express genes for longevity, reduction of inflammation and stabilization of immunity. Is I think really very very important. So, I think that you know this is really becoming an area of great interest for a lot of people. It's you know instead of trying to patch up these problems, I think the idea of letting our genes keep us healthy is really um it's it's it's kindness. It's really about about reconnecting to that incredibly beautiful gift that we've received from all who have come before us. And it's very instructive to recognize that the genes of our gut bacteria are influencing our genome expression. That those little critters that live within us are moment to moment changing our gene expression. There's a very interesting piece of this puzzle that was just solved for me last month in a journal Cell Host and Microbe. The researcher's name is Yun Teng, T E N G from University of Louisville. And he gave us information about the idea that plant cells contain RNA. We know that. Who didn't know that? And that they are able when we digest plant cells that microsomes that then are extruded from plant cells called exosomes that contain plant RNA work their way into our gut bacteria and change the expression of the genetic material of our gut bacteria. So, food is running the show. Plant food is changing the expression of our bacteria gene uh genome. That leads to three important things as it relates to our gut bacteria. It changes their rates of multiplication. It changes the metabolic products that they produce like vitamins and neurotransmitters. And it changes their location in the gut. Hopefully, closer to the gut lining so they can help us keep that intact. So, that was a very intriguing couple of dots to connect. Therefore, our food is uh changing our gene expression and we should think about that. You know, we say when a woman is pregnant, she has to be careful because now she's eating for two. Mhm. Well, well, Tom, you're eating for a hundred trillion right now. This morning before we came here, I was having breakfast at the hotel. And at the the the woman next to me, um one woman was uh had uh skin milk in her coffee cuz we don't want dietary fat. And to which she put several uh pink packets of sweetener, which the research shows is profoundly damaging to the microbiome, associated with a profound increased risk of obesity in a French study of tens of thousands of It was 70,000 women. And also dramatically increases your risk for avoiding sugar in the first place, type two diabetes. Her brain has been hijacked by media that would let us believe that this is the right choice. But, that media doesn't have her health uh at the core of their interest. Uh what that media has uh it is their end up bottom line, right? And she is simply a pawn uh on that chessboard being manipulated. That is the focus of this new work called uh brain brainwash. We're trying to wash people's brain and push the reset button and really call out all the ways that day-to-day uh our lifestyle choices are being manipulated. Uh you know, learning that uh all of our online uh yeah, areas that we explore are being leveraged to create advertising that's appealing to us. That's not telling you something that your audience isn't certainly aware of. But it has health consequences. It's not just that you happen to buy, you know, the latest pair of glasses or a shirt. It has to do with your health like this woman this morning choosing this artificial sweetener. And I will say that we had a premise for the book about calling out how our brains are influenced and beyond that, how reconnecting with nature, how dietary changes, how meditation, how various things can help undo what's been done, how we can harness this notion of neuroplasticity, and we talked about earlier, uh by having higher levels of BDNF to then allow the good pathways to stick, allowing us to connect back to the prefrontal cortex and act in a more empathetic way, in a more compassionate way, in a way that recognizes that our decisions today are going to affect what happens tomorrow. Um the notion that we can do that uh is is a heck of a gift that we need to raise awareness of, especially these days when impulsivity and narcissism seems to be, you know, the way things are done today. And we've certainly got to pay attention to what what will tomorrow bring? How will our actions today affect ourselves tomorrow and affect the world tomorrow? So, um the Dalai Lama said that if you want to be happy, practice compassion. And if you want others to be happy, practice compassion. So, in a very real sense, what we choose to do rewires our brain and changes our thinking. What I'm saying is that we presuppose that our thoughts determine our actions. But in a very real sense, our actions determine our thoughts. Yeah, what I was thinking. That is absolutely fascinating and the perfect place to um get to my last question, but before I ask that, where can these guys find you online? And And I more than ever I want to stalk you. I've spent the last couple days just living in your world. And there's some amazing stuff there. So, where can people find more about you? Uh I'm uh drperlmutter.com, oddly enough, is my website, drperlmutter.com. And I have Facebook, which is uh David Perlmutter, MD. Uh David Perlmutter is Twitter and Instagram. I have a newsletter that goes out every week on drperlmutter.com. Amazing. Oh, I have a YouTube channel, The Empowering Neurologist. Yes, there's a lot of amazing content there. Cool. My last question, what is the one change that people could make that would have the biggest positive impact on their health? Uh it's a it's a very difficult question to answer cuz there's so many levels of things we talked about. I would say um embrace uh the recognition that connection is the most uh powerful notion that that can we can leverage for health and for our future. Connection to other people? I'm going to leave it open. Connection to our genome, connection to our microbiome, connection to our families, connection to our neighbors, connection to those who live in other countries, and connection to the planet. I love that. Amazing answer. Dr. Perlmutter, thank you so much for coming on. That was absolutely extraordinary. Guys, he is shaping my thinking, I think, more than anybody else right now. I I cannot encourage you enough to go in. He's making connections other people aren't making. He's talking about things that are um certainly going to rile some people up, but I think are backed by um cutting-edge science, to be sure, but certainly he always speaks from a place of what's coming out in the studies. It's absolutely extraordinary. Um I I just have really been blown away with his ability to go into the hard science, talking at a cellular level, and then also, like his last answer about connection and the way that for him that really is taking everything into consideration and not just um connecting to other people, but also connecting to the things you can find out about yourself, bringing us back to the beginning of the interview where he was talking about understanding your data and understanding really who you are at at a much deeper level than I think most people really understand themselves. And I think it's utterly fascinating that the man that's given us so many books on dietary impact on the brain is now showing us um a broader perspective on what's impacting our brain in the ways that we can really begin to shape our lives, to shape our genetics, which I think is such an interesting idea. Um it it it's absolutely breathtaking, and I will for sure put my stamp on every second that you spend in his world um learning from him is a second well spent. That um the highest compliment that I can pay somebody in his field is to say that I really believe it will help you live a longer, happier, and healthier life. Um so, dive in. You will not regret it. All right, if you haven't already, be sure to subscribe. And until next time, my friends, be legendary. Take care. [applause] Dr. Perlmutter, thank you again so much. Thank you guys so much for watching and being a part of this community. If you haven't already, be sure to subscribe. 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