Connecting your Gut and your Brain with David Perlmutter – #359

Why you should listen –

Dr. Perlmutter is a Board-Certified Neurologist and Fellow of the American College of Nutrition who received his M.D. degree from the University of Miami School of Medicine where he was awarded the Leonard G. Rowntree Research Award. He has published extensively in peer-reviewed scientific journals including Archives of Neurology, Neurosurgery, and The Journal of Applied Nutrition, and is a frequent lecturer at symposia sponsored by such medical institutions as Columbia University, Scripps Institute, New York University, and Harvard University. He serves as Associate Professor at the University of Miami Miller School of Medicine. His latest book The Grain Brain Whole Life Plan will be published in November of this year. On today’s episode of Bulletproof Radio, Dave and Dr. Perlmutter talk about gut health, how it’s connected to your brain, artificial sweeteners, C-Sections and more. Enjoy the show!

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Follow Along with the Transcript!


Dave: Today’s cool fact of the day is that the gut is sometimes called the second brain, but you actually probably already knew that, but your gut is smarter than you think. It’s the only human organ that functions without the help of your brain, and it’s got 100 million cells. Holy neurons, right? In fact, the gut sends signals to the brain via the vagus nerve, and you actually send more information from the gut, to the brain, than from the brain to the gut. In other words, your brain is translating gut signals as emotions. So, when someone says trust your gut, it might be worth doing. Before we get into today’s episode in detail, there’s something that you should hear about, or see. It’s called the Bulletproof diet roadmap poster. I’m going to hold it up for people who are watching on YouTube.


This is a one page thing. You can get the poster from the website, or from the store, or you can download and print it if you want. It’s free. This is everything in the bulletproof diet on one sheet of paper. The reason it’s there is because you might not have time to read the book when it’s time to make breakfast and you just wanted to see, is this food inflammatory or not? It’s all here and it’s something I don’t talk about enough. So, check it out. You can go to and we’ll send you the pretty one that’s all printed nicely. There are tens of thousands of people who have this on their fridge every day, just to see … Did I really really want to eat this ingredient? It’s all there, from super good, to kryptonite, and the ones in the middle where you might want to pay attention. So head on over to to check it out.


Today’s guest is a well known guy, a guy I really respect. That guy’s name was on the back cover of the bulletproof cookbook. His name is Dr. David Perlmutter of Grain Brain fame. David, can you say Grain Brain fame three times fast? Because I just about fell over on that.


Dr. Perlmutter: I can, but I don’t know if you’re going to hold me to that.


Dave: I won’t, but that was a major tongue twister. People who aren’t familiar with your work may not know that, in addition to being a fellow of the American College of Nutrition, you’re a neurologist, and that you’ve written in things like Archives of Neurology, neurosurgery, and so you’re not a quote normal doctor, although you are an MD, but you’re doing both nutrition and neurology, so you’ve crossed over from two different disciplines, which is why you have a different way of thinking about things.


Dr. Perlmutter: True, I’m just saying I guess being abnormal in this context is a compliment, so thanks for that.


Dave: It is meant to be a compliment. The reason that you’re back on this show today is that I just had a chance to go through your newest book, called Brain Maker: The Power of Gut Microbes to Heal and Protect the Brain For Life, and it’s already a best seller, but I wanted the bulletproof audience to get a chance to hear about your new research. Because, you are one of the few guys who has successfully written about the brain for the mainstream with a neurologist and a nutritionist’s perspective. It’s an unusual thing to do, and your books are always things that, if I see one, I always read it, and now that we know each other I get the advanced copies, which is even more fun. Even long before we met, I was reading your stuff, because it’s good, so thanks for being on the show.


Dr. Perlmutter: I’m delighted. Thank you, Dave.


Dave: Why did you decide to write about the gut, as a neurologist?


Dr. Perlmutter: Million dollar question, and I have to say that as a neurologist, we were schooled in pretty much staying focused on the brain and exploring the brain, studying the brain, under the mistaken notion that: Why do you rob banks? Because that’s where the money is. The reality is that the brain is highly influenced by the gut for … And this has relevance for every neurodegenerative condition that has a vowel in its name, basically … So, we now understand that the mechanism that’s leading to Alzheimer’s and Lou Gehrig’s disease, Multiple Sclerosis, Parkinson’s, you name it, autism, ADHD, is one word in that is inflammation. Where’s that coming from? Inflam means, in Latin, to light on fire, and where is the fire? Before we get the answer to that question, I would submit that all of the so-called treatments that I had been schooled in, and that neurologists still continue to pursue, are not looking at the fire. They’re looking only at the smoke. Meaning they are squarely focused on dealing with symptoms that occur because inflammation has done its dirty deed.


Inflammation in the body has its genesis in the gut. That’s a big leap for a brain specialist to take, to recognize that south of the foramen magnum are things happening that influence the brain. We now fully understand that the set point of inflammation in the human body is dictated by the very bacteria and other organisms that live within the gut. It’s a very sobering notion for myself, as a neurologist, and others, it’s a sobering notion for dermatologists to recognize that inflammation of the skin is, in fact, mediated by the gut. That inflammation in the joints, the province of the rheumatologist, mediated by the gut. That diabetes is an inflammatory disorder, as is cancer, as is obesity. When we get to the source, which is the gut lining, which is maintained by healthy balance and diversity of the gut bacteria, then we begin to understand why number one, changes in the gut bacteria and loss of diversity can threaten the gut lining, and number two, how that leakiness of the gut, or permeability, then mechanistically leads to inflammation. The cornerstone of basically every degenerative condition you don’t want to get.


So, it really calls to our attention the need to focus on one word, and that is diversity. That the diversity of the organisms that live within us, is absolutely on the front center of the stage, in terms of what we need to preserve, and also what we need to expand if we’re going to have a handle on these really severe global health conditions that we call chronic degenerative conditions.


Dave: I had arthritis in my knees when I was 14. I had strep throat every month, because I lived in a basement with toxic mold that we didn’t know about, so I took antibiotics pretty much monthly, for a week or two every month for 15 years. That might have had an impact on my microbiome. Just saying.


Dr. Perlmutter: Might have. Let me tell you, one course of antibiotics will change a person’s microbiome for the rest of his or hers life. That’s a very sobering notion when we revisit what I just mentioned, and that is that therefore that changes the bacterial diversity, reduces the diversity, and sets the stage for leakiness of the gut, the cornerstone of all inflammatory conditions. Including arthritis in a teenager. Kids shouldn’t get arthritis. Yet, it’s happening. We should then explore what is it that’s compromising diversity, and for purposes of your audience, what in the heck can we recommend to reestablish this diversity, and therefore limit inflammation? That’s the take home message here.


Dave: That’s the big question. There’s a lot of scientists out there who sit up high on their lofty things and look at epidemiology and proclaim things, and there’s absolutely nothing actionable or useful. I feel like they must be science trolls. I’m just going to sit here and say, “I don’t like this, I like that,” whatever. But, what are we going to do about it? You’re writing books. Here’s the program that tells you what to do and I want to talk about specifically what our general audience should do. Then I want you tell me what I should do. Should I be eating my son’s poop? It sounds disgusting, but fecal bacterial transplant things are becoming successful. So, we’ll get into that stuff. I wanted to go back because what you’re saying matches all of the research I just did for my mitochondria book. It is inflammation. It’s always been inflammation. You control that and things work better.


But, at the same time, you’ve got some guys who are pretty … At least on paper they look pretty good, like David Katz, who’s this guy from Yale, but he looks only at epidemiology. So, basically looking at spreadsheets as far as I can tell. He said something that I thought might actually be a compliment, and I’m looking for it in my notes here. He said that, quote, “Perlmutter is way ahead of any justifiable conclusion.” This is a field of science, epidemiology, which I think has probably poisoned Americans more than anything else, because you look at what data you can get from large groups of people, even if the data is completely useless, like a lot of it is, and then you draw conclusions, and then you tell people to do stuff on that, without understanding the underlying mechanisms at all. It’s like a Ouija Board for nutrition.


Dr. Perlmutter: Let’s explore that, because it’s really interesting topic. To get to the specifics of Dr. Katz’s commentary on my work, he was specifically, in 2013, responding to the fact that Grain Brain had come out and was really focused on the notion that sugar and carbs are threatening to health in general, and specifically to brain health, and how validating it is that just earlier this week, front page of the New York Times, results from a study JAMA internal medicine showing the level of conspiracy that lead us all to the notion that fat is bad and sugar is good, that began in the late 1960s, and was highly influential in actual peer review medical publications from such journals as the New England Journal of Medicine. Frankly I feel a great deal of validation, not only from that report, but all of the studies that are coming out that say hey, it isn’t fat. It was never fat. It’s sugar and carbs. We can talk about the mechanisms on and on, and frankly a vis-a-vis earlier conversation, sugar is profoundly detrimental to the diversity of the gut bacteria, and yet another mechanism whereby diets higher in sugar, relate to this mechanism of inflammation.


But, was I ahead of my time? Yep. Thank goodness.


Dave: We need that.


Dr. Perlmutter: What epidemiologists do, is they look at populations and issues within those populations, and also at the same time look at disease processes within those populations. They might say that, men who have a crease in their earlobe show an increased risk for coronary artery disease. Well, we happen to know that’s true, but it doesn’t necessarily mean that the creasing in your earlobe is going to give you a heart attack. This is causality conclusions as opposed to things just being related.


Dave: Should I cancel my surgery to have my earlobes removed?


Dr. Perlmutter: No, but it brings up a good point. Let me even be more dramatic. Here’s an observation, that it seems to me, that whenever it’s raining, people are driving around with their windshield wipers on. It doesn’t mean that if I go around and tell people to turn off their windshield wipers, it’ll stop raining. We have to be very careful about drawing conclusions about causality when we see these relationships. I respect that. However, in my field, in neurology, we often don’t have the luxury of waiting for a double blind placebo trial for people with Alzheimer’s and Lou Gehrig’s disease, when these studies may take 10, 15, or 20 years to be validated and published. We owe more to our patients, and as I began seeing the literature in the past five to ten years that strongly correlated elevated blood sugar, for example, to risk of Alzheimer’s disease, published in the New England Journal of Medicine, September 2013.


Dave: That was without the $50,000 fee that got the sugar research published in the New England Journal of Medicine?


Dr. Perlmutter: Right. Here’s an article, here’s a study, among many many studies, that showed, for example, people who had even mild elevation of blood sugar to like 105, which no one’s going to get excited about, these people followed for about seven years, had a dramatic increased risk of developing Alzheimer’s disease. I thought that was damned important, that I go beyond what is typical, and publish a book talking about this, and warning people to regulate their blood sugars. You bet I did. Now, turns out that we were right. Have I been wrong about things? Of course I have been in the past. Twenty years ago I wrote a book that talked about lowering your dietary fat for Multiple Sclerosis. In fact I was very wrong about that. I’m going to continue to be wrong moving forward, but I’m also going to continue being right from time to time. Hopefully the right decisions are going to outweigh the wrong decisions. That’s the beauty of what we do, that we stay current and we modify our recommendations based upon current science. Am I criticized for flip flopping? I’m not running for public office, you can take it or leave it.


That said, the idea that there is bias in what is reporting in peer review journals is valid, and I think we’re really learning all about that. But, there’s no hidden agenda here. We’re not selling anything. I’m just giving people the best advice, as I see it today. There’s two things you need to bring about change. You need knowledge and then you need action. As it relates to your health, I’m doing my best for the former, to provide people, what I think, is the best information; that is, we need more dietary prebiotic fiber, we need to reduce our carbohydrates, we need to get rid of our sugars, and we need to welcome healthful fat back to the table, and we need to exercise every single day. You and I will talk about why that’s important probably in a few minutes.


Dave: It’s really interesting. I had a chance to talk to Craig Vinter, the first human to have his full genome sequenced. I actually got my whole genome sequenced now, too, using the same data set. I asked him, “Given all that you’ve learned right now, what should we do today? Or should we spend another five years sorting through the data, and then just have pizza and beer in the meantime?” His answer was really telling. He said, “let’s sit down over pizza and beer to talk about it.”


Dr. Perlmutter: I sat down with pizza and beer, I didn’t have pizza and beer. I sat down and had lunch with him.


Dave: Oh you did? Cool.


Dr. Perlmutter: About a month ago in Nantucket. It was just coincidence, but I asked him a similar question as it related to Alzheimer’s disease.


Dave: What did he say?


Dr. Perlmutter: He said there’s really nothing that shows any of our lifestyle choices have any real bearing on risk. Here is a man who I revered. I talk about him in my lectures, about how he sequenced the microbiome of the oceans. It’s a really exciting story, but I was a bit disappointed in Craig … If you’re going to watch this, no love lost here, but I was a little disappointed because I knew, and I know, that there are powerful effects of certain lifestyle choices in terms of increasing or decreasing a person’s risk for Alzheimer’s disease. Having said that, I am that person. My dad passed away with Alzheimer’s.


I am that person. I deal with it on a professional basis every single day, so I’m not faulting many people who really need to have dots connected in a very strong way before a statement is made. Do I make statements before there is that level of scientific certainty? I do based upon well backed up hunches, and here are the hunches: Cut your sugar, exercise, on and on. Ultimately [premum non noscerum 00:16:48] above all do no harm, I don’t see the harm in telling people you should exercise, cut your sugar, welcome healthy fat back to the table, use coconut oil, take some MCT oil, monitor your vitamin D level, make sure your magnesium level is adequate. There’s no downside, there’s only and upside. I’m not going to quit, we’re going to keep at this until we realize some change. Grain Brain is now in 27 languages, so we’re getting the word out, and it’s there for people who open their minds and want to embrace a notion that isn’t spoon fed to them based upon industry influence, which we just learned has been profound and going on since the late 1960s.


Dave: It takes a certain amount of courage because where you are is, you’re working with patients, so you’re on the front line. What happened to me, when I was in my mid 20s, I was fortunate. I had made $6 million that I lost a couple years later, but I’m like I’m fat, I’m inflamed, I’m tired, my brain isn’t working the way it used to, and I am scared for my life. I don’t know if I’m going to be able to eat … I don’t know if I’m going to be able to eat in two years because I bought disability insurance, for God sake.


Dr. Perlmutter: Wow.


Dave: Not a lot of people under 30 do that. I can feel that something is slipping away. If someone was like I’m doing research in 20 years, maybe we’ll know something. I think the expletives I would have chosen at the time, because my brain was inflamed which makes you angry, would have been long and carefully selected. I would have basically f you, and I kind of said that to the doctor who offered me nothing, except that vitamin C could kill me. When you’re dealing with someone like your dad, who is dying, the do no harm … I’m sorry, if you’re going to sit there and be like let’s wait until we’re 10,000% sure, you actually are doing harm. Because, we know the direction things are heading. You owe it to a patient to say, “Well, we don’t know but this might work.” Do it for a couple months, because it’s unlikely to kill you. Hint: you’re already on your way to dying and life sucks in the meantime.


That, though, takes courage, because there are more than a few people who’ve had their medical license put on the line, and often times they keep it by saying the standard of care is based on 20 year old science. It wasn’t working for this person so I did something else. Often times I saved their life, and yeah I took them off gluten, and magically two weeks later their brain wasn’t inflamed and they were happier. So thanks for being courageous and standing up, and doing that. I think it’s cool.


Dr. Perlmutter: You have to do it. Ronald Reagan said that status quo is a Latin term for the mess we’re in. It is. We have to have outliers in order to move the ball down the field. If we’re all parroting the same notions, then there’ll be no progress. Now we learn that this hallowed gold standard peer reviewed medical journal has been feeding us BS for 40 years, it’s breathtaking how pervasive is the notion that we should have our whole grain goodness and don’t worry about sugar, but the real culprit is fat, most people still cling to that. Not most people, but a lot of people still cling to that idea, and hey, I still am criticized on Amazon comments about my books, that oh if you increase your fat you’re going to die like Dr. Atkins died. Dr. Atkins died because he slipped on ice and cracked his head. [crosstalk 00:20:20]


Dave: There’s a clear association. For guys named Atkins, who eat a high fat diet, the odds of them dying by hitting their head … So high fat diet causes you to hit your head. It’s just epidemiology.


Dr. Perlmutter: That’s right, it’s correlations versus causation. There’s never been a study that says that compared … Took two people, one was a placebo and one was a control group, the placebo got a parachute and the intervention group got no parachute, and they both jumped out of a airplane. So, the conclusion is that maybe, if you wear a parachute, you’re likely to survive jumping out of an airplane. No one’s ever done that study, but I think we all agree it makes sense.


I think the balance of information that we have now allows us to say that it makes sense that sugar is bad news. That hidden sources of sugar are ubiquitous in our culture. It’s not just sugar per se, through the mechanisms of insulin and insulin sensitivity reduction, and leptin sensitivities reduction, and all the things that sugar does; glycation of our proteins, etc. We now look at the higher sugar and carb diet through the lens of the gut bacteria, getting back to our original topic, and the profoundly detrimental effects in terms of reducing that diversity that we need to have in the gut bacteria brought on by diets high in sugar, or even worse, brought on by artificial sweeteners. Explaining now, finally, why it is that people consuming artificial sweeteners have a much higher risk of obesity. On the outside that makes no sense whatsoever, where you’re drinking a couple of liters each day of a drink that has not a single calorie, not a single gram of sugar, and yet you’re getting fatter. Israeli researchers looked at that and they did human and animal studies, and they found that the reason is squarely with the changes occurring in the microbiomes. In fact, took their study to a crossover between animals and humans, induced the microbiome changes in humans by giving them artificial sweeteners, transplanted their stool in the laboratory animals, and even the laboratory animals suddenly got fat with no change in their diets.


Dave: Who? I haven’t seen that study.


Dr. Perlmutter: When we’re done I’ll send it to you. It’s really interesting. Beyond that, the other relationship with the artificial sweeteners that’s so absolutely, fundamentally related to the changes in the microbiome is this incredible increased risk of type 2 diabetes in people consuming artificial sweeteners. Makes no sense. Hey, I was drinking Coke, but now I’m drinking Diet Coke and I’ve increased, I’ve doubled, my risk for type 2 diabetes. It all settles back with the changes in the microbiome. We’ve got to make some … We’ve got to screen this information out because people are truly under the wrong impression here, that getting off sugar sweetened drinks in favor of artificial sweetened beverages is a good choice. It is not.


Dave: What if someone says, “I don’t have a lot of artificial sweeteners, once or twice a week I have a piece of gum full of Nutrasweet and sucralose and acelsulfame potassium,” and all these other things. How big of an impact is that going to be? How often does it need to be dosed. I would say, for God sake, you get neurotoxicity from this stuff. Never allow it in your body, but a lot of people … They’re somewhere else on the curve for that. How bad is a single dose?


Dr. Perlmutter: I don’t think anybody knows. I think that … There is what’s now described as orthorexia, where people are so involved in eating the right and excluding the wrong foods, that they go bonkers.


Dave: That’s crazy.


Dr. Perlmutter: There comes a point. Is there a little bit of sugar in the 85% dark chocolate that I have every day? There is. I’m sure there is. I think that … Why do you need to chew gum? Why do you need to alter your mouth microbiome? Give it up. Or, if you have a piece of gum, okay. Enjoy it. Deepak Chopra once said something in a lecture I thought was really compelling. He said: Look, I’m not telling you that you have to quit smoking today if you’re a smoker, but what I do want you to do is the next cigarette that you have, I want you to go outside, sit down in a chair, and spend time with your cigarette, and connect with your cigarette. That was profound. So many people that are smoking are on the phone, they’re on the computer, and whatever. They’re not really relating to the fact that they’re doing that thing, smoking a cigarette, which we would mostly agree is not a good thing for your health.


I think when people begin to connect with what they’re doing, I think it has more traction in terms of making lifestyle changes. I’ve often said that we tell women when they’re pregnant: Oh, be careful now because you’re eating for two. Well I would say that what we should be saying to everyone, male and female, pregnant or not, is that we’re all eating for 100 trillion, meaning that the foods we consume have a huge influence on the health and the diversity of the microbes that live within us. When we start looking at our food and other lifestyle choices through the lens of the gut bacteria, and the role of the health of the gut in terms of inflammation, then our food choices become really, really important.


Dave: As I’ve gone through the research for the new book, that I’m just finishing on mitochondria, I’ve changed the way I view the body. I want to run this past you, and it’s okay if you totally disagree, and you might. Just for the audience, we haven’t talked about this so I haven’t set it up. I used to agree with what you would say there, about eating for 100 trillion, because you’re eating for these gut bacteria, but inside almost every cell in the body, there are at least 1,000 mitochondria, and up to 10,000 in other ones. These are essentially little bacteria that, from one perspective, our cells harness the bacteria hundreds of millions of years ago to make energy in our body.


Or, where I ended up after writing the book is that hundreds of millions of years ago, some bacteria got together and realized that they should have mobile petri dishes called cells, so they moved in and they made cells, and then they stored some of their stuff in the cell nucleus, and today we’re walking petri dishes for a quadrillion bacteria called mitochondria. Yes, they make power. They also tell us how much inflammation we’ll have. They tell us when our cells live, when our cells die, and all sorts of other amazing things. Because they’re bacteria, they talk to other bacteria. We know bacteria do that. They do it all the time. So, you’re actually eating for a network of bacteria, whether they’re the ones in your cells or the ones in your gut. They shine little femtosecond lights back and forth at each other, and they signal each other that way. A lot of my core motivations come from bacteria making sure they get fed, but it’s not my gut bacteria. It’s me. What do you think about that view?


Dr. Perlmutter: Well, as a matter of fact, in Brain Maker and in my new book that’s coming out, called The Grain Brain Whole Life Plan, I include mitochondria as part of our microbiome.


Dave: Awesome.


Dr. Perlmutter: I think they’re neglected, and I think when you look at mitochondria they are bacteria. They have a circular DNA that’s not the 23,000 that comes from mom and dad. It’s true, they regulate the pre-programmed cell death nuclear genes, called caspase enzyme, that code for caspase enzymes. I reviewed an interesting article just this morning that talks about how dengue virus is able to manipulate the mitochondria to reduce the activity of interferons to help them propagate through, and cause more inflammation. There’s a very interesting interplay. When Lynn Margulis, in 1968, came up with this idea that mitochondria were once free living bacteria that took up residence in what would become eukaryotic cells, her thesis was rejected by 15 peer reviewed journals until, finally, the Journal of Theoretical Biology decided to publish it. Old habits die hard. People are pretty much down on what they’re not up on. Now, of course, this is considered pretty straightforward and dogma.


But, I would agree with you that we should embrace this bigger number in terms of the organisms that are influencing moment to moment our life, and we are basically a carrier vehicle for this huge meta organism, made up of these microorganisms. The phages within the body, these phage particles, outnumber [inaudible 00:29:21] to one. We talk about bacteria and other microbes outnumbering our cells ten to one, and we’re just beginning to explore the role of these phage particles in terms of regulating gene expression of other viruses, of bacteria, and perhaps even of our own cells. No objection from me. I’m right there with you.


Dave: Are we going to get there in your lifetime, to the point that you think we’ve got this solved? Like, wow it goes down to these subatomic particles, these atomic particles, all the way up. You don’t think [crosstalk 00:29:52]


Dr. Perlmutter: No. We are in the place right now of taking the one step backwards in order to take the two steps forward. We’re having to retrace our cells away from the germ theory, and that’s going to take a lot of doing. Medicine has pretty much been focused on this notion of germs … Just the word germ connotes negativity, from the outstanding work of Dr. Louis Pasteur. There’s no derogatory sense in my statement, but that said most germs in our bodies are there to help us. We’ve got this beautiful symbiotic relationship giving them a nice warm, dark place to live and feeding them, in turn they are making our neurotransmitters, making vitamins, regulating inflammation, controlling the set point of immunity, controlling our appetite, our metabolism, our regulation of sugar. The list goes on and on, and that’s what we get back from them.


This relationship’s been going on for a long, long time. It all begins at the beginning, when we’re born and we’re inoculated, or anointed with this information in the form of the bacteria in the birth canal. That’s a highly conserved mechanism as well, that is seen in mammals that are born through the birth canal. But, also in reptiles and birds and insects and mollusks and even sponges. We’re talking about a mechanism of transferring genetic information through the carriers, the carriers of this information being bacteria, that has a very, very long history, a very highly conserved and we have to respect that. It takes us to the conversation about what happens when we bypass being born vaginally, when we have a cesarean section. We now know that there are lifelong consequences of a C-section. C-sections save lives, I’m not knocking it, but I think that when we recognize that becoming obese as an adult, risk of that is dramatically increased if you were born by C-section, your risk for celiac disease, type 1 diabetes, ADHD, autism, all dramatically increased in kids born by C-section. I would suspect that if a study were performed who would also see a significant increase in Alzheimer’s disease in C-section babies.


That said, one third of all births in America happens by C-section, depriving that child of the initial microbes that he or she needs to form the seeds of his or her future microbiome.


Dave: Where are the David Katz’s of the world with that statistic? Because, that is epidemiology, but it’s such a big a fact. This was in the very first book I ever wrote, the Better Baby book, if at all possible, deliver vaginally, if not have a sponge in your vagina and get the bacteria on the baby. Lonna and I did that, we delivered both of our kids vaginally. I caught them both. But, even when the kids were first nursing there were special probiotics on the nipples. It matters.


Dr. Perlmutter: It matters dramatically.


Dave: Why do we have such a high rate of this in the US?


Dr. Perlmutter: I would say mostly it’s defensive medicine. Truly, with all due respect, a third of births in America are C-section and it’s been estimated that 10 to 15% might require it because of medical necessity. It’s a matter of convenience. There’s a myth that women who have already delivered by C-section must, absolutely, have their next child by C-section. I think that, to call it like it is, doctors worry about issues that could occur, that might threaten them with respect to malpractice. All of these things conspire, and I’m not faulting anyone. The notion of putting a sponge in the birth canal, then taking it out … I talked about that in Brain Maker, was originally work done by Doctor Maria Dominguez-Bello at NYU. She actually published an article last week, in the journal Nature, where, finally, they’ve added a really significant level of science to the notion that there is a transfer of meaningful bacteria.


They were able to sequence the DNA of the stool of the baby at various points during his or her first month of life, and those kids who did not get the sponge from the vagina over their faces after birth, versus those who did, and found that there is a strong representation of mother’s birth canal bacteria in the baby, at least during his first, or her first, month of life. What people do by transferring those bacteria seems to be very, very effective. She talked about it kind of as a proposal a couple of years ago, but now she’s validated her work. It’s very exciting.


Dave: There are many people listening to the show right now who were born with a C-section or took antibiotics a lot, and they should be going: Wow, okay, I’m not going be putting no vagina sponges on my face. Besides, timing matters, doing it as a baby versus an adult, are totally different things. What are the things that, based on your experience clinically and all the research that you look at and that you perform, that you might want to do to have better gut bacteria?


Dr. Perlmutter: Just to phrase this for everybody, Dave Asprey, you and I are having a talk. You’re talking to a neurologist dealing with things like Alzheimer’s, ADHD, autism, and we’re talking about gut bacteria. It’s a bit of a stretch. Just wanted to reframe that, because even I sometimes have to take a step back. I think first we should talk about preservation of the gut bacteria. Starting with birth. If you can opt for vaginal delivery, you should do so, and here’s why. We’ve covered that. I think so much of what people do these days threaten their gut bacteria. I mentioned over usage of antibiotics. Not just taking them when you have a sniffle, but the antibiotics we are exposed to in the foods that we eat. The fact that glyphosate, the active ingredient in Round-Up, is patented by Monsanto as an antibiotic, so much of our food has residues of glyphosate, meaning we’re consuming antibiotics when we eat those glyphosate treated foods. Which include wheat, even though wheat is not GMO, because it allows the wheat to ripen more quickly. Along with corn, soy, etc.


Even so many of the commonly used medications that people think they must take are related to dramatic changes in the microbiome. For example, what are called the proton pump inhibiting, or acid blocking, drugs that Larry the Cable Guy tells us we’ve got to take. Frankly, we don’t need to be doing that. We don’t need to be suppressing stomach acid, by and large, so many people are taking the Pepcids, the Prilosecs, the Zegerids, all these drugs that change the pH of, not just the stomach, which has its own set of consequences, reducing B12 absorption, effecting enzyme activity, but also changes the pH for the entire rest of the gut, where are friends are living in their neighborhood, our bacteria. So, there are dramatic changes that happen in the gut bacteria when people are taking these drugs. That increases their risk for a potential … For death from, what’s called, clostridium difficile infection, or C. diff, which kills about 30,000 Americans each year. As we just learned from the Journal of Neurology, actually Journal of the American Medical Association’s specialty journal called JAMA Neurology, in February of 2016, a study that looked at over 70,000 individuals and followed them for five and a half years, found that those individuals taking these proton pump inhibitors, these acid blocking drugs, had a 44% increased risk of developing dementia.


Dave: Wow.


Dr. Perlmutter: Dementia is an inflammatory disorder related to the gut. The article speculated that maybe it has to do with compromising b12 re-absorption, or absorption, etc. We know that a lot of our folate in our bodies, or folic acids, made by bifidobacteria. The points is when we change the pH, we change the bacteria and there’s hell to pay. A study from Stanford last year, demonstrated that there’s about a 16% increased risk of myocardial infarction, another inflammatory issue, in individuals taking these drugs, and that death from MI is doubled if you happen to be taking those types of drugs; which you see advertised on the evening news. They show a video of somebody can’t eat food, a certain thing, a sausage sandwich or some food that he shouldn’t be eating anyway, but you take the magic pill, you can eat whatever in the heck you want. You can eat crappy food and end up looking like Larry the Cable Guy. I’m probably going to get an email from somebody anyway.


The point is those are dangerous drugs. The non-steroid anti inflammatories, and of course the antibiotics. We’re just beginning to see the data that’s looking at long term effects of drugs in terms of their side effects that may be related to changes in the microbiome. So, what’s the good news? The question then is: What can we do to reestablish diversity of bacteria in the gut and pave the way for better health and reduce our risk for inflammatory issues like coronary artery disease, Alzheimer’s, diabetes, cancer. I think the first thing is we’ve got to focus on the diet. We need a diet that has a dramatic reduction of sugar and carbohydrates, much, much higher in fiber and specifically prebiotic fiber. That’s the fiber that nurtures the gut bacteria.


A recent study in the journal Nature, was published by the Sonnenburgs, a husband and wife team at Stanford, and they looked at the effect of fiber, prebiotic fiber, in laboratory animals in which they first measured the gut bacteria, then deprived these animals of prebiotic fiber. The diversity of organisms bottomed out. But, was able to be restored when they resumed prebiotic fiber. So, that’s good news for us. What they also demonstrated, I think that’s pretty compelling, is that with succeeding generations that ability to rebuild a good microbiome and have better gut bacterial diversity, was less and less, to the extent that ultimately some species didn’t come back. They became extinct. It’s a good lesson for all of us as we see generation after generation, what’s going on with the health of Americans.


Change in the diet and adding in good fat, but most of all prebiotic fiber, prebiotic fiber rich foods, are those like jicama and dandelion greens, garlic, onions, leeks, asparagus. These are foods that have lots of prebiotic fiber and will nurture the gut bacteria. Eat fermented foods like kimchi and cultured yogurt, that contain good bacteria. Get a high potency probiotic. All important things. What we’ve recently learned is we’ve seen research that was just published that shows a significant increase, or relationship rather, in gut bacterial diversity in comparison to individuals have a high max V02. What this study looked at was, it took 20 or 30 younger individuals, and they weren’t necessarily all great athletes but they measured their max V02; means here they are on the treadmill with the mask and they’re measuring how much oxygen utilization is happening. The higher the max V02, the better cardiorespiratory shape you’re in. They compared that to the diversity of the gut bacteria, and they found a very strong relationship. Those individuals who had the best max V02, in other words the best cardiovascular conditioning, had the highest level of bacterial diversity.


Dave: Wow.


Dr. Perlmutter: Does it therefore mean that exercise is good for you because it’s going to increase your max V02 and therefore your gut diversity will increase? I’m not going to say that’s the conclusion that the authors were able to draw, but I’m going to tell you I think it does. Therefore that’s why aerobic exercise is important. Maybe a David Katz can go ahead and criticize me for that now. Have at it, that’s fine, we’ll talk in five years. I think we’re going to see, soon enough, the interventional trials, where they take people, measure their gut bacteria diversity, and then put them on an aerobic program, and then measure them x period of time later and see what changes have occurred. I think we’re going to be surprised. Meanwhile, until that comes out, I’m saying: Yes, let’s do some aerobic exercise. I could be wrong but, hey, what’s the harm? It’s a balancing between those things that are damaging our microbiomes and those lifestyle choices that will increase our diversity and help the microbiome.


Dave: There are people listening now going: Exercise, what the heck do I do? I hear high intensity. I hear low intensity. I have some new recommendations on this as well. When you talk about aerobic exercise, how hard, how long, how often? What is your research lead you to be on that?


Dr. Perlmutter: Well, I would probably look at the research from Dr. Kirk Ericksen at the University of Pittsburgh, who was one of the pioneers in looking at the effect of aerobic exercise on, what we call, neurogenesis, the growth of new brain cells. He has recently published a new study, that hammers home the notion that aerobic exercise, through the mechanism of epigenetics, in other words, changing our gene expression to amplify the expression of a protein called brain-derived neurotrophic factor, or BDNF, that tells the brain: Hey, grow new brain cells. Turning the switch to give yourself stem cell therapy and grow new brain cells where you need them most in your brain’s memory center, the hippocampus.


I think the conclusion there is what they’ve looked at, is it turns out to be nothing more than about 20 minutes of aerobics six days a week. You can take one day off. That’s what my current recommendation is. I think the question would be: What constitutes the right level of exercise? That really varies depending on the person, his or her condition, what medications they may be using. I think that in these days of Fitbits and other technology, people in working with a well trained athletic counselor, or even a physician who’s schooled in this, can learn to use that technology, or the devices in the gym, that’ll tell you, for example, your heart rate. You can develop what you want to target for that 20 minute period of time. As a very broad rule, I tell people to go for 180 minus your age, do that math. That’s a ballpark, very crude, way of looking at what you should target. That’s different for me, I generally run a pretty low pulse rate. If you’re taking medication, like a beta-blocker or calcium channel antagonist, your pulse rate will be lower. If you’re out of shape, you don’t want to target such a high pulse rate. If you’re in tip-top shape, your target rate’ll be higher.


The other mechanism that’s amplified during aerobics is your body actually creates more free radicals. Dangerous free radicals is actually a good thing, because that, indeed, is also what we call an epigenetic signal. When we create free radicals, there’s a sensoring system in the body that says: Woah, we’re doing stuff, we better crank out the production of antioxidants. As you’d expect, more free radicals, we have to have a mechanism that says: Hey, we need to quench that fire. That is a pathway called the NRF2 pathway that is activated when we exercise, when our bodies produce more free radicals, also activated by broccoli, taking lipoic acid, and [acetylcysteine 00:46:34], various herbs, and briefly


Dave: Oh you’re going to say it?


Dr. Perlmutter: I’m going there. Talking to Dave Asprey, why would I not? By drinking … Go ahead, say it.


Dave: You say it man [crosstalk 00:46:47] Go ahead.


Dr. Perlmutter: Anyway, I have been saving it for this moment, a prop. Coffee, turns out, is a powerful activator of the NRF2 pathway. Meaning, that it tells the body it’s got to increase it’s production of glutathione and other antioxidants. It’s got to reduce the production of inflammatory mediators through its role in what’s called the NF-kappaB pathways. These things are not just there so we can tinker with them with drugs, it’s been how we have survived. That’s how we have to look at the recommendations that we’ve made. Basically say: Well, what’s allowed us to get to where we are today? What have we been doing for 2.4 million years that allowed us to be healthy and survive so that you and I can have this conversation? Over the past 2.4 million years, we basically used fat, and to a lesser degree protein, as a calorie source, and didn’t burn carbs, though industry looks like it tried to pull that one over on us. We finally caught them this week.


Humans have survived on basically seeking out fat. Dead animals, eating bone marrow, is what allowed us to survive. It’s a hugely wonderful way of energy, it’s highly efficient. When we burn fat, our production of free radicals is reduced, as opposed to when we burn carbs and simple carbohydrates, sugar, as a calorie source. This notion that, oh your brain needs glucose. Hashtag whatever hashtag you want. That just ain’t the case. When you look at the research from highly respected individuals like Dr. Veech, I know you know his work. It turns out the brain thrives in an environment where ketones are prevalent. In fact, even the FDA has approved a medical food that doctors can write as a prescription for the treatment of Alzheimer’s disease that increases the availability of these fats that we call ketones.


I’m preaching to the choir here. This is basically what you’re going to get when you’re either eating coconut oil or MCT oil, it’s basically amping up ketosis in your body. The thing is, doing that is, and this is a really important point, you can drink all the bulletproof coffee you want. You can do what Mary Newport says and be eating coconut oil day in and day out, and I’m encouraging people to do that. But, it’s not going to work if you’re still eating sugar, because preferentially you’re going to burn the sugar and not do exactly what you’ve been talking about. Not convert your body to a place where it’s grateful for, and happy to utilize, these ketones as a primary energy source. I’m all in favor of bulletproof coffee, coconut oil, etc. This is the way to go. I do it every single day, but if you’re not cutting your carbs, you’re putting yourself at risk for more serious problems.


Dave: About three years ago, I synthesized ketone esters in my lab. For people who are listening to this, and also heard the interview with Dr. Veech on Bulletproof Radio, this is a way of artificially raising ketones dramatically. The probably was they were $30,000 a kilogram, so I don’t know how to commercialize that.


Dr. Perlmutter: Are you sure that’s what you were synthesizing in your lab and you’re selling it by the kilo?


Dave: [crosstalk 00:50:23] white powder with tape and it was carried by donkeys. No. It was ridiculously expensive and I had a little tiny vial of the stuff. I know that Dr. Veech is talking about ways to do this. Do you see a day where we can just pound some ketones and be done with it, and we’ve got all the ketones we need?


Dr. Perlmutter: No, because I think that we welcome the fact that certain foods that do, in fact, have carbohydrates in them, are doing us good. When the very foods that I recommended earlier are fiber rich, but basically carbohydrate, fiber being these polymers of glucose and fructose. The actual benefit of these prebiotic fibers is because they are basically polymers of sugar, of fructose. The more complex they are, the more benefit they are to our gut bacteria. For example, acacia gum, from the African acacia tree, is a very complex polymer of fructose that our gut bacteria love. You can buy it in the health food store. The other thing to consider is, being talked about, and I think it’s very relevant as per our conversation of inflammation, in going to a diet that’s lower in sugar and higher in fat, we will therefore stop signaling our bodies that winter is coming. Meaning, we don’t have to store this adipose tissue, this visceral fat that makes our bellies big.


In a recent study, I think it was in March of 2016 this year, in the journal Neuroinflammation. Think about that. There’s a journal called Neuroinflammation, how cool. They called attention to the relationship between visceral fat … In terms of how it communicates to the brain, and it does through these specific chemicals that are called adipokines, adipo meaning fat, kine meaning they have activity, and you’re familiar with some of these. Tumor necrosis factor alpha a cytokine, adiponectin, and even leptin, which has a role to play in controlling our appetite. These are chemicals manufactured in our body fat that cross the blood brain barrier and have dramatic effects upon the brain. It really is an interesting way that body fat is then looked upon as an endocrine gland. It’s more than just a storage depot for calories for the winter that never comes, but it’s influencing our behavior, our appetite, and certainly influencing inflammation. Inflammation, a very important cornerstone, again, for these chronic degenerative conditions that are, according to the World Health Organization, the number one cause of death in the world, now surpassing infectious diseases.


Dave: That is profound, when you think about how little that is accounted for in the recommendations you hear almost everywhere. I’m still, in my head, stuck on this idea around exercise increasing microbial diversity in the gut. You showed me the study two days ago and I’m like: That is the coolest thing I think I’ve ever seen! I did a lot of digging. I talked with exercise physiologists, guys, and there isn’t that much nutrition plus exercise academically. It seems like there’s a little bit of a firewall there a lot of times. The guys in the sports science department aren’t necessarily walking over as much, they are in the last couple years, and talking on a really deep level on nutrition neurology side. It’s coming together.


Dr. Perlmutter: It’s so slow. I can’t wait around for it. I’ll take my lumps. You’ll take your lumps. I’m hoping that people see we’re trying to light that single candle and, we do have to curse the darkness from time to time.


Dave: When I talk with those guys there’s, I believe, a shift happening. Mark Sisson was on recently, talking about … I was wrong, an Iron Man athlete, and I was training with age minus 40. It turns out I needed to do high intensity … Like a sprint once a week, but the rest of the time I needed to, almost, go for a walk. Very slow exercise. Where I’ve shifted, and I want to vet this with you, not to debate the merits of either one, just to understand your thinking behind this. I’ve shifted this … You should for 20 30 minutes a day, move around. Go for a walk, but it doesn’t need to be like I put on a leotard, it doesn’t need to be as aerobic as I would have thought it would have been ten years ago. Because, just going for a walk for half hour a day in a study, increased … Jeez, was it mitochondrial density or mitochondrial performance? It was one of the two … By 68% or up to 68% depending on the people, in 12 weeks. It doesn’t, maybe, need to be as intense.


Because, for people listening, few of them other than the most hardcore, are going to … I’m going to put on my exercise gear, I’m going to go for my 20 minute run, I’m going to go take a shower, but almost everyone can go for a 20 minute brisk walk, while they’re on a conference call and get some sunshine while you’re at it. It’s kind of a good deal. Do you think that that heart rate is terribly important for the microbial diversity or [crosstalk 00:56:00]


Dr. Perlmutter: As fate would have it, here’s a terrific book. I’m not [crosstalk 00:56:05] death bound. It’s great. And what a talks, terrific guy, is that we’re just sitting on our butts too much. It’s really true when you think of the number of hours in the day that you’re doing your stuff on the computer and you’re doing this and that. That’s does not emulate what our ancestors did. If we’re trying to emulate that, we’ve got to be up and about and doing things. I think that it’s very, very relevant. Now we’re seeing desks that come up and you can stand at your desk, or sit on a ball that you’re moving around on. I think that it’s called sedentary sickness. The fact that people think that they’re going to pound that exercise and get it all in, and then spend the rest of the day sitting on their butts, doesn’t work that way. I totally agree with you. I think that we’re just beginning to unravel these epigenetic signals that are changing our gene expression for health, or not, based upon our lifestyle choices.


Beyond that, now, we’ve had a discussion of the changes in the human microbiome based upon our lifestyle choices. Not just food, but exercise as well. The third leg of the stool is sleep. I think we’re at the very nascent stage of understanding the role of sleep in physiology, in general pathophysiology. Also in terms of changes in the microbiome. We see a dramatic increased risk of Alzheimer’s, and other forms of dementia, in people who have issue with sleep disorders. Either sleep apnea, or other issues. In my new book I talk a lot about, go have a sleep study. No big deal, spend the night at a sleep clinic. Put on the pulse oximeter, have your EKG monitor, and just make sure because it’s the … Some of these things require a little appliance in your mouth or who knows what, but it’s a big issue. We’re supposed to sleep and we’re supposed to sleep deeply. A lot of people aren’t.


One of the simplest things that we have found related to insomnia, difficulty falling asleep, difficulty staying asleep, poor sleep hygiene and early morning awakening, is having low magnesium level. Which is found in about 60% of Americans, because we’re eating food that’s depleted in trace nutrients, trace minerals. That’s a simple thing to check. I’m a big proponent of choosing magnesium rich foods, dark green leafy vegetables, nuts and seeds, etc, broccoli, and using some form of magnesium supplementation. Because, it helps people sleep, it reduces inflammation, and magnesium is a critical co-factor for what you were just talking about, and that is mitochondrial function. How we allow our mitochondria to make energy from the very fatty acids that are presenting to them.


Dave: It’s fascinating because I’m a huge fan of a good night’s sleep, and I also believe fundamentally, and this’ll piss off half the audience, I would like to be able to not sleep, if I didn’t want to, without paying a biological price for it. Sometimes I’m having too much fun and I just don’t want to go to sleep. I’m willing to own that. I still go to sleep, at least most of the time. If I don’t, I take protective measures as best I can. I think most people we know that are listening, have pulled an all-nighter once or twice and felt crappy for a couple days. But, they still pull the all-nighter because it was worth it. One of the biggest things that makes a difference in your sleep quality is mitochondrial function. If you have your power plants in your cells, if you have enough energy to rebuild things when you’re asleep, you can rebuild better and you’ll probably need less sleep to get the work done.


There’s some studies about that that I’ve referenced in the last book, but what I found, and this has actually radically shifted my understanding of magnesium and something that is a pretty substantial change in the recommendations. There’s a circadian timing, in other words the daily ups and downs of magnesium, and the time of day when magnesium is the highest in our cells. Magnesium, like you said, it makes mitochondria work. It’s highest at noon. So what I started doing is I take 80% of my magnesium with my bulletproof coffee in the morning. I just took a handful of magnesium pills. Then I take 20% at night, because you want to have magnesium for sleep quality, but you want to follow the daily rhythm, so then at noon when you’re supposed to have the most magnesium presence in the body, you can. No one knew this until last year, a study had come out, and no one had ever thought that minerals might move on a circadian basis that dramatically. I’m with you on magnesium, but I shifted my timing, both to enhance sleep, but also to maybe have more energy in the middle of the day. Is that going to affect my gut biome? This is pretty cutting edge stuff.


Dr. Perlmutter: It’s a good question. What we do know is that, for example, proton pump inhibiting drugs also have a dramatic effect in terms of magnesium and can lead to hypomagnesemia or low levels of magnesium. What you say is very interesting that magnesium does peak out [inaudible 01:01:26] during the middle of the day. I would suspect there may be a little bump in the nighttime too. It emulates, this is brand new science, it just was published about 3,000 years ago, it emulates the Vedic texts that talk about the three doshas: Vatta, pitta, and kapha, and pitta being fire. That does peak out in the middle of the day, but also peaks out in the very middle of the nighttime as well. There are three doshas, but then they vary twice a day, like the tides, in most places.


It’s interesting to consider that, but your intracellular level of magnesium depends upon your total body availability. I think that, because our foods are grown in such trace mineral depleted soils, that we’re just not getting the magnesium that we need. Frankly people who are going to watch this podcast are going are going to run to their doctors and say: I’d like you to check my magnesium level? please understand that your standard blood test for magnesium is about useless. What you want to ask your doctor to do is simply what’s called a red blood cell magnesium level, or erythrocyte magnesium level, because it gets back to what you just said and that is: We depend upon magnesium inside the cell. Again, it’s a simple blood test, most common labs will do that now, but your typical serum magnesium level tells you virtually nothing.


Dave: It’s so important. Red blood cell minerals are what I look at to know whether my body’s getting it. Who the heck cares if you went swimming in something if it didn’t absorb through your skin? That’s kind of what’s happening in your blood stream, right?


Dr. Perlmutter: How we work really depends chemically moment to moment on the function of the enzymes in our body. Bodies that allow things to come together, things to be broken down, energy to be harvested, DNA to be made. More than 320 of our enzymes in our bodies are fundamentally magnesium dependent. It’s just another argument in favor of checking. It’s a simple test. It’s right there for me with vitamin D as being on the very top rung in terms of its importance and, unfortunately, one of the most overlooked parameters in modern medicine. Vitamin D and magnesium, so critically important, so very, very simple, so very inexpensive, and yet, not getting the legs that it really needs.


Dave: I appreciate you doing all of the work like that. The number of books that you’ve written to get this information out there, because waiting another 30 years to see if science maybe gets there, where they’re going to agree with you … I’m planning to remain young and youthful for the next 30 years.


Dr. Perlmutter: From what I heard longer than that. I heard something about 130?


Dave: 180 is my goal.


Dr. Perlmutter: 180, okay. I’ll meet you there. I had a head start.


Dave: Here’s the cool thing: Maybe I won’t make it, but I’m going to feel really good along the way. That’s what really matters, but I might make it. I think I have a real shot, assuming a piano doesn’t fall on my head.


Dr. Perlmutter: Health-span versus lifespan. I’m with you on that. I’m going to be 81.


Dave: No.


Dr. Perlmutter: I am, 20 years from now, but …


Dave: Oh, I was like you can’t be 81.


Dr. Perlmutter: I’m going to be 81


Dave: Absolutely. For people listening, the number of years is really important, but if you’re last 30 years you have Alzheimer’s disease, there not going to be as good as they could be if you’re actually dating someone half your age. I say that jokingly, but I’ve run an anti-aging non-profit research and education group called Silicon Valley Health Institute for almost 15 years. One of our board members, Mike, was 88 years old and he literally was dating a 35 year old. He wasn’t some lecherous old man, it just kind of happened that way. He was one of the smartest guys I know, an SRI researcher, incredibly full of life and vibrance and focus and mental cognition. Where, when I’m 88, I want to be like Mike was because it was incredibly inspirational for me to see that you can do it. If you don’t take the steps when you’re 25, you’re much less likely to get there when you’re 85. I just wish someone had told me that when I was young and fat that I would have known what to do, I wish I would have had access to your books when I was 16. Because it would have made a difference.


Dr. Perlmutter: I hear you, and we all had early life transgressions that we wish we could undo, but I will say that the longer people wait to really engage in their resolutions, the harder it’s going to be. I see people at our gym that let themselves go, and now are back with a trainer and God bless them for trying. The message is that [inaudible 01:06:18] the Yellow Emperor in the fourth century BC said that, “Prevention is the ultimate principle of wisdom. To cure a disease after it has manifest is like digging a well when one feels thirsty, or forging weapons when the war has already begun.” That’s the message here. Am I 100% right about exercise and low carb and increasing dietary fiber and fat? I’m probably not.


Dave: It doesn’t matter. [crosstalk 01:06:45]


Dr. Perlmutter: Maybe 80%. We’re certainly not categorically wrong. We do know that this is, on the risk benefit scale, we’re looking really good. My message will change in the years to come. The next time I sit down with you, there’ll be nuances of difference. That’s a good thing because it’s evolution. It’s not stagnation.


Dave: Given all of the new findings that are coming out, and the new findings in Brain Maker, which is a book that I highly recommend. People listening, you should read Brain Maker. It is a really good book. Given all that stuff, I’m going to ask you the same question I asked you last time you were on Bulletproof Radio, but I want to see if you change any of it. Someone comes to you tomorrow, and they say: I want to perform better at everything I do in life, by the way that includes aging, but I want more of all the things I like to do. What are the three most important pieces of advice you’d have for me?


Dr. Perlmutter: Let me answer the question by indicating that I actually wrote a book to answer this questions. It’s my new book, it’s called The Whole Life Plan. I have to preface my answer by telling a little story. In March of this year I was going to get my teeth cleaned, in my car … They weren’t going to clean my teeth in the car, but I was in my car going to get my teeth cleaned. I got a text message from, which I shouldn’t have answered in the car but, gratefully I did, from a friend saying come to the ER, Mike is dying. What that meant to me was that Mike was my closest friend. He married my wife and me. He’s our daughter’s Godfather. I turned around, went to the ER, and went into where he was in the emergency room, and found that Mike was on a ventilator. I asked the family to step out of the room and I examined him, and he was brain dead. Had a massive bleed into his brain. We kept him on the ventilator for the next 12 hours in order to let the family members arrive from around the country. Then around 11 o’clock at night, after everyone had been with Mike, I went into the room with the respiratory therapist, we took the tube out of his throat, and he passed away.


I didn’t feel so great the next day. That evening I went out to dinner with my wife and daughter. I didn’t feel well when I got home, and then I felt really bad. Probably the worst I’ve ever felt in my life. I vomited all over the floor. It was a horrible experience. The next morning we got a call, I felt a little better, from Mike’s wife saying: Look, we’re going to have a memorial service. Collect up the videos and pictures, and I looked at a video that, Mike and I were in a band and we had opened for Richie Havens at a benefit fundraiser. I watched the video of him singing Can’t You See. I then had to sit down on the couch, I didn’t feel well at all. My wife looked at me, and I must have not looked good, and she said: I’m going to take you to the hospital. Can you imagine? I said: No you’re not. She thought I was being stubborn. I said: No, you need to call an ambulance. Which was astounding.


The ambulance arrived. I was in [florid 01:10:10] atrial fibrillation, my heart rate was 180. They took me to the hospital and they couldn’t break it. They gave me intravenous medication. Here I am, back in the ICU, cardiac ICU on telemetry. The medicines weren’t working. My heart was just out of control. They’re charging up the paddles to shock me back into rhythm. Everybody left. Visiting hours are over. I then had a conversation with a nurse who was taking care of me. He was explaining things about his life and caring for me and adjusting the IVs. I suddenly felt this overwhelming compassion and gratitude for this individual. This just happened in March. At the moment that I had this feeling come over me, my heart converted to sinus normal rhythm, then the rates started to come down to normal. Later that evening I was able … I kept checking over my back shoulder to see my heart rhythm was good. The rate was getting slower and slower, because, as I mentioned before, it’s generally pretty slow. I still had a lot of medicine on board to further slow it.


I finally fell asleep around 4 o’clock in the morning. I woke up and I looked at the heart monitor and I was flat line. I had no pulse. There were no alarms. I closed my eyes. I thought that, well, this is how it is. Or, maybe, maybe, I’m dreaming. I closed my eyes and I opened up my eyes again, and I was alert. There was no one in the room. There was no noise. I said I’m obviously not dreaming. I guess … What happens now? Maybe one of the leads came off. So I traced all the leads from the monitor to my heart and one of them had popped off. I clipped it back on and beep beep, beep beep. Back in the game.


Dave: This is why doctors are terrible patients, by the way, right?


Dr. Perlmutter: Yeah. It’s a good thing anyway. Ultimately I convinced the nurses to take out my IVs, at five six o’clock in the morning. They got me unplugged. By the time the cardiologist came in, I was doing yoga … Here I am in up-dog on the floor in the ICU and he said: Well, I guess that means you want to go home. I said: I really do want to go home. He said: You can go home. Directly home from the ICU. How often does that happen? He said: But, you have to come back for a stress test and an echo and the whole … Which I did. God, I’m on the treadmill and I’m at 180 and they call the … Because I’m cranked, it’s inclined. They call the doctor in and he said: Are you all right? I said: I feel great. Bring it. He said: You got a good heart, everything’s fine.


To answer your question, it was a long way to get to the question of gratitude.


Dave: I knew it was going to go to gratitude. Yes.


Dr. Perlmutter: I think that is the most important feeling that we can actively, not only understand, but choose to participate in. Recognize those moments day in, and day out, for which gratitude is the call to action. In that gratitude, recognize that giving back is a form of demonstrating gratitude. I’m going to put at the top of the list. I don’t know how I answered your question before, but I’m going to put gratitude at the top of the list. I think it’s the most healthful experience that humans have. Beyond that, exercise, cut your sugar, eat more fat, all of the other things we know are good. It was an experience that really was so good for me in terms of recognizing the importance of the kindness of others, and how compassion should rule the day. We see so little of that these days, and we see what’s going on around us in terms of compassion and goodness. So, my hope is that if that’s the plea here, and that’s what will resound.


Dave: I love that you answered it that way. It reminded me of one of my favorite quotes is a Mr. Rogers quote. He talks about when he would see disasters and car accidents and things on TV, his mom would look at him and say: Look for the helpers. Every time you see these big, terrorist things, there’s always right there in the video frame. There’s always people coming to help. In your case you had a nurse who was a helper. But, they’re always there. You can frame the world as it’s so terrible. Or, look, something happened and people immediately came to help. It changes your biology when you do that. It matters. Your gut biome changes. I know very well if you measured before and after, your gut biome would have shifted.


Dr. Perlmutter: I will tell you the mechanism. The mechanism is really quite simple. We know that cortisol has an immediate and direct effect in terms of change in the microbiome, and increasing permeability. This is not out there. This is actually very straightforward. When we bombard ourselves with stress, and choose to see the disaster and not the helpers, we increase our cortisol, we change our microbiomes.


I had an experience in an airport, I think it was Dallas airport recently. I got off the plane, I was walking to get to the baggage area with my wife, and there was a place on the left side where they would change your money. Currency exchange, from one country to the other. I noticed that the woman who was in the booth, running the booth, had a headscarf on. I felt myself respond negatively to that, because of news and all the craziness that’s going on. I realized that all that influenced my perception and I immediately tried to reframe that, knowing through neuroplasticity the changes could work on more adaptive pathways and strengthen those. To look upon that individual with love in my heart. What’s happening right now is we’re seeing people are getting … Their minds are changing, their perception of the world is changing, based upon seeing the disaster, not seeing the helpers.


Dr. Michael Merzenich, who I believe you’ve interviewed.


Dave: He’s going to be doing a course with us, actually.


Dr. Perlmutter: Wonderful. He really calls to our attention the notion that we choose to sculpt our brains. As such, it becomes the mechanism by which we then see the world. We choose to sculpt our brains based upon what we are exposed to, and how we choose to frame the experiences that we have. As Mr. Roger’s mother, a great sage, once told us to look for the helpers. It works through a very complex mechanism of neuroplasticity. For those who need to connect the dots from a very mechanistic scientific perspective, that’s how it works. But, we have got to realize we can change our perception, we can make this glass absolutely half full.


Dave: I’m glad we didn’t lose you to a broken heart. I mentioned my friend Mike, who was 88, his kids were in a horrible car accident and he was gone a month later, of a broken heart.


Dr. Perlmutter: After I had this event, I did, as you would expect, the literature research correlating stress and onset of atrial fibrillation. It was, as you would expect, vast. We take these as important life lessons. I think there’s a lot of good to looking at these as instructive, as seeing the helpers not the tragedy. I think if I hadn’t had so much love for Mike in the first place, then his passing wouldn’t have affected me. Really what happened to me is I spent the night as a neurologist, not as his friend and as a human. Finally the next day it hit me as his friend, that I had lost him. I hadn’t processed it. There was a time that I had to function as the physician, and I didn’t give myself that moment to grieve appropriately. I held on to Mike until the moment that I converted back into normal heart rhythm. I held onto him because I felt this thing happening to me. Good experience. I think it’s made me a much better person.


Dave: What did you do for the nurse?


Dr. Perlmutter: I wrote this about him. I expressed this to him. We spent the night together in the ICU and had conversations that were very, very empowering for both of us. Turns out that he had performed CPR on his brother, who passed in his arms. What I did for him was, I guess, to allow him those moments to really connect with those experiences in his life. This was one of the most profound experiences in my life, for sure. Do I say that I’m glad that it happened? You bet I do. You bet I do.


Dave: I’m really looking forward to reading that book. When does it come out?


Dr. Perlmutter: November 15. The Grain Brain Whole Life Plan. I’ll get a copy to you right away.


Dave: I’d love to read it. I think listeners will too.


Dr. Perlmutter: It’s based on the premise that Grain Brain and Brain Maker talked about why, and then the new book talks about how. How do you implement what … Now that you understand it all, how do you exercise? How do you ensure sleep hygiene? How do you balance your magnesium level? How much DHA vitamin D should you take? What should you do from a dietary perspective? It’s really now the action plan that works for me, and I think is substantiated. Hopefully it’ll work for may people.


Dave: We might be wrong by 10%, but it’s a hell of lot better than what you’re doing now.


Dr. Perlmutter: I’m there.


Dave: That’s the direction. Thanks, Dr. Perlmutter, for being on Bulletproof Radio. Where should people go to find out more about your work? You’re an easy guy to find, but what’s your favorite url?


Dr. Perlmutter: Facebook. David Perlmutter MD. My main blog page is


Dave: Have you started snapchatting yet?


Dr. Perlmutter: I should, but I’m instagramming and tweeting. I guess I should Snapchat. When does it all end?


Dave: I started. I’m David Asprey on Snapchat, and it’s time consuming but it’s kind of fun. There’s only so many hours in the day, like you’re saying.


Dr. Perlmutter: I do these live videos, interactive videos, with our Facebook population. Those live forever, but, as opposed to Snapchat, you can go back and look at the Facebook videos into perpetuity if, in fact, that’s true.


Dave: I’m with you there. Well people know how to find you on Facebook now, and they know how to find your books. Brain Maker is the latest one, and you’ve got a new one coming out in November. Tell me the title of the new one again.


Dr. Perlmutter: It’s called, The Grain Brain Whole Life Plan. It’ll be published one week after the presidential election. Think about that.


Dave: Sounds like a very good time. We’re going to need something, because what else will we distract ourselves with?


Dr. Perlmutter: True. Thanks Dave, I sure appreciate it. I had a wonderful time.


Dave: Thanks again. If you enjoyed today’s episode, you know what to do. Head on over to iTunes and leave a rating. This was a fantastic interview, if I do say so myself. I appreciate Dr. Perlmutter took the extra time. Just leave us a review. Give us five stars and say thanks. That’s a small way you can show gratitude, which, as we just explained, will help your gut biome. Have a beautiful day.


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