426: Brain Wash

Dr. David Perlmutter And Ashley James


  • Amygdala vs prefrontal cortex
  • Amygdala-based behavior opens the door for these chronic conditions: diabetes, coronary artery disease, obesity
  • Why eating grains lower people’s immune system
  • Our immune system is represented in the liver, in the heart, in the brain, and in the lungs
  • Feed-forward cycles can be used to our advantage or to our disadvantage
  • Disconnection syndrome

The lifestyle choices we make and the food we eat have a big impact on our overall health. In this episode, Dr. David Perlmutter, author of best-selling book Grain Brain, joins us on the show. He talks about the difference between decision-making based on the amygdala and the prefrontal cortex, and how our decisions relate to our health. He shares with us lifestyle changes we can do, the importance of sleep, the foods we need to eat, and the foods we need to avoid to improve our immune system.


Hello, true health seeker and welcome to another exciting episode of the Learn True Health podcast. You're going to love at today's interview with Dr. Perlmutter. He's giving away a copy of his latest book, and you can win a copy of his latest book by going to the Learn True Health Facebook group. There'll be a post in the top, a pin to the top for the next few weeks. If you're listening to this and it is April or May of 2020, jump in the Learn True Health Facebook group and win that book. If it's past 2020, if its past April or May of 2020, no worries, still come join the Learn True Health Facebook group because we do great giveaways there all the time. Our guests love to give away their books and other goodies, so come join the Learn True Health Facebook group. We'd love to see you there. It's a wonderful supportive holistic community.

Now is the perfect time to implement what you're going to learn today from Dr. Perlmutter. He is going to teach you how to avoid disease, how to even support your body in the face of the coronavirus, and how to support yourself in living an even longer healthier life, so fantastic interview. I'm really excited to share it with you. One thing I will say, since we have extra time on our hands, and we all are at home, and a lot of us are doing home cooking, now is the perfect time to join the Learn True Health Home Kitchen. I teach you how to use food as medicine, to make delicious food for yourself and your family that is also incredibly nutritious and healing for the body.

We have recipes that kids love, we have recipes that husbands love, we have recipes that the in-laws love, we have recipes that the whole family loves. Come join the Learn True Health Home Kitchen. Go to learntruehealth.com/homekitchen. That's learntruehealth.com/homekitchen, use coupon code LTH for the list of discount. I made it affordable for everyone, and when you join, you're also supporting the Learn True Health podcast. We regularly upload videos to the membership. There are well over seven hours of content, of videos, of recipes in the membership right now. Great videos teaching you all kinds of wonderful recipes, and tips, and tricks in the kitchen to use using your kitchen as your pharmacy to heal your body and to also stay healthy.

Come join Learn True Health Home Kitchen. That is learntruehealth.com/homekitchen. I look forward to seeing you there. Awesome. Enjoy today's interview. Please share it with as many people as possible so we can help our friends and family to learn true health.

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[00:02:53] Ashley James: Welcome to the Learn True Health podcast. I'm your host, Ashley James. This is episode 426. I am so excited for today's guest. We have one of my heroes in the holistic health space, Dr. David Perlmutter, who wrote the book Grain Brain and also wrote his latest book Brain Wash. I am very, very excited. This is absolutely revolutionary—the information that you're bringing. I love that you bring in so much science to back up everything that you're showing. Today, you're going to show us how to gain health on a whole new level using food as medicine. Welcome to the show.

[00:03:41] Dr. David Perlmutter: I am totally excited to be with you today, Ashley.

[00:03:46] Ashley James: Absolutely. A few years ago, maybe about three years ago, I heard a lecture you gave on a summit. For the life of me, I can't remember which summit it was because I listened to so many of them. Your talk was the best talk in the entire summit, and there were some pretty awesome people there. It totally blew my mind, and I've been wanting to get you on the show ever since because of how much I learned from you. I'm very excited to have you here today.

Before we dive into talking about your latest book and what we can learn from you, can you tell us a bit about your background? Because you're an MD. Most MDs don't get into nutrition and healing the body with food, and I'd love to hear your story. What happened in your life that led you to helping people heal their body with food?

[00:04:36] Dr. David Perlmutter: Well, Ashley, don't let me disappoint you but there was no epiphany. There was no moment of transition. I've been, obviously, asked that question many times, “What was it that turned you in favor of looking at the world through those eyes?” I can't say there was a moment. I will say that I've always been a bit of a disrupter. Even as a kid, I was never satisfied with the status quo of explanations for anything. Obviously, that wasn't necessarily a good way of behaving in high school, but as years went by, I became a neurologist, and entered a very mainstream neurology practice, and practiced according to the book for 10 years.

I became really very dissatisfied with what I was doing with my life. I was treating symptoms, I wasn't treating disease. I was treating the smoke and ignoring the fire. Around that time, 10 years in, I began looking at was there any evidence that lifestyle choices had any role to play in the development of these challenging neurological problems that I was dealing with on a daily basis? Whether it was brain degenerative disorders like Alzheimer's and Parkinson's, or seizures, or headaches, or any of the common things that we as neurologists would see.

In fact, even back then, the literature was quite robust in terms of making, at least, the correlations between various modifiable lifestyle factors and risk for developing these situations. I felt that offered me a lot more tools for my toolbox, whereas it wasn't necessarily going to focus on letting people get better right now, which is something I'd probably already mastered because it was in the book how to do it, but rather how to keep these things from happening in the first place—what an idea.

I began pursuing that and began realizing that there were a lot of people out there in the world who are like-minded. I began attending integrative conferences and functional medicine conferences and realize that there were a lot of people out there who recognize that we don't need to be practicing reflexive medicine, but rather pre-emptive medicine. That we could really create lifestyle plans to keep people healthy. What a notion. Especially in our time right now. The notion of healthcare, which is something, with all due respect, not being practiced in America.

We talk about our healthcare system, but truly, much as my neurology practice was so very long ago in the early 1990s, we aren’t practicing healthcare, we are practicing response to diseases. We are responding to patients who develop a list of criteria that allows them to get a named disease, and then we respond to manage their symptoms. So very little going on in our so-called health care system that has anything to do with health, that has anything to do with care—in the most important sense of that word. I found that this is where I wanted to be and that I could be much more effective as a doctor—meaning a teacher—if I could focus on ways of keeping people healthy.

[00:08:20] Ashley James: I love that you identify as a teacher. The root of the word doctor is doceri, which means teacher. We should look to our doctor to teach us because we can't take our doctor home with us. Our doctor isn't going to cook for us, and tell us when we should go to bed, and tell us how much water we should drink, and follow us around. We have to go to our doctor, a doctor is going to teach us, then we have to take that—what we learn from them—and we have to apply it to our daily life.

[00:08:47] Dr. David Perlmutter: That is fundamental because we just realized, in writing Brain Wash, that that moment that you just described, for those of us who practice integrated functional type medicine, that's where the system breaks down—three steps. First step, we as the healthcare provider do everything we possibly can to stay up to date, to learn the best information we possibly can. Step two, we impart that information, we act as the teacher, we give that information to our patients, and we depend on step three, that they then implement that they utilize the information that we've given them to change their lives for the better. What we've learned is that it's step three—the utilization of the information—where the system breaks down the most. That between 50% and 80% of the information that we give to patients—that we impart—is not acted upon.

For many years, until quite recently, I like many, would accuse the patient who comes back week after week, continues to gain weight, continues to have blood sugar climbing, or whatever the metric is that we are following knowing full well that they are not engaging what we've recommended. They haven't adopted the diet, they decided not to meet with the dietitian, they're not exercising, you name it, and there was really a sense that we would blame them for that. What we've identified now is that the actual decision-making part of the brain has been hacked by our modern world.

It’s unfair for us to point fingers at patients as it's unfair for them to point fingers at themselves, “Why can't I do these things? I know it's important that I do these things. I've went to the doctor. I got this information. I bought all these wonderful books. I attended these online symposia. I know what to do, but why in the heck can't I do it?” The reason is that, again, our decision-making apparatus is under siege by so many aspects of our modern world. Therefore, it's not necessarily appropriate anymore to blame patients for not following through, or for people to blame themselves for not being able to act on good information because they don't have the brain connections anymore to make that happen.

That should certainly be one of the areas that you and I focus on moving forward with our time together today. What is it that has so hacked our decision-making ability, and perhaps most importantly then once we understand that, what can we do to regain connection to the better decision-making part of the brain—the prefrontal cortex—so that we can act in a way, make choices that think about the future, that take into consideration how my decision today will impact me moving forward, but also impact my neighbor, my community, the planet upon, which I live moving forward. That is, bringing back our connection to this area of the brain called the prefrontal cortex.

[00:12:20] Ashley James: Can you give us some examples of how our decision-making has been hijacked?

[00:12:26] Dr. David Perlmutter: Certainly. The decision-making parts of the brain are many, but for purposes of our discussion today, I'm going to simplify between two areas. One, as I mentioned earlier, the prefrontal cortex. That is an area of the brain that allows us to bring to bear on our decisions—on our choices—a lot of information from our past experiences, our understanding of the decision that we have to make especially as it relates to the future outcome. What will be the long-term consequences—good or bad—of whatever I decide to do right now? That's the prefrontal cortex.

In contrast to making more impulsive decisions—choices—that come from the area of the brain called the amygdala—the impulsive amygdala I like to say. That is an area of the brain to which we are getting more and more attached by multiple mechanisms these days in our modern world. We know, for example, that even one night of not having enough restorative sleep tends to significantly lock us into making decisions that are short-term, that are impulsive, that are based upon narcissism, and us-versus-them mentality coming from the amygdala. Even one night of not enough restorative sleep is associated with as much as a 60% increased activity of the amygdala.

We depend upon a vital connection between the adult in the room—the prefrontal cortex—and the more childlike behavior that stems from the amygdala. The connection allows the adult in the room—the prefrontal cortex—to supervise, to make recommendations, to influence and exert control over more impulsive behavior as would otherwise have been brought about if the amygdala were in charge. So many factors in our day-to-day lives tend to sever that connection between the prefrontal cortex exerting its top-down control over the more impulsive decision-maker—the amygdala.

I'd like your listeners to be thinking about this model in the context of what we talked about earlier and that is that critical point whereby we give our patients great information and they don't act upon it. They don't make good decisions, they make decisions based upon impulsivity as opposed to thinking about the long-term consequences of an apple versus a jelly-filled doughnut.

I want the jelly-filled donut now I'm going to eat it, or in the long run, if I cut back on refined carbs and sugar my health will be better, my immune system will be more balanced, my inflammation markers will be reduced, my likelihood of having a sudden explosion of inflammation should I contract COVID-19 virus, for example, might be dampened. It’s interesting to think about our decision-making as it might pave the way for diseases like diabetes, obesity, coronary heart disease, and even how our long-term decision-making affects our immune responses, and how that might be certainly germane vis-a-vis at COVID-19 discussion.

Again, it's all about, do we tap into our more adult part of the brain—the prefrontal cortex—and let that exercise top-down control, or do we simply lock into the amygdala and live our lives without thinking about future consequences? Now, one of the most powerful influences on whether we're going to lock into the amygdala and exclude the adult in the room is, as I just mentioned, the quality and quantity of our sleep. Who knew? Not some exotic expensive nutritional supplement, but simply getting a good night's sleep.

Now, what can we add to that? We can add exercise, eating a diet that's lower in likelihood to cause inflammation, exposure to nature, keeping a gratitude journal. All of these things are really very important ways that we can re-establish a connection to the prefrontal cortex. Perhaps one of the most important daily activities is a daily meditation. The research showing how powerfully meditation practice amplifies the activity of the prefrontal cortex goes back at least 15 years and is really quite profound because you're able to demonstrate by functional types of brain imaging studies virtual lighting up of the prefrontal cortex—that really good decision maker by simply engaging in meditation.

[00:18:01] Ashley James: When they've hooked people up, their brains up to scans, and they have them meditate, and they see then even after meditation—if someone were to meditate every day, how long after meditation do they see the amplified usage of the prefrontal cortex over the amygdala?

[00:18:20] Dr. David Perlmutter: It's an excellent question, and the answer is for people who are regular meditators that these pathways become more permanent. The more we amplify our connection to the prefrontal cortex through a process of neural plasticity, the more we strengthen that connection then between the prefrontal cortex and its ability to top-down, regulate, or calm down the amygdala activity moving forward. This is, as you well mentioned, this is a benefit that we get even while we're not meditating. The more we do it, the more indelible, the more strengthening we observe of those pathways that connect the prefrontal cortex to the amygdala.

[00:19:12] Ashley James: One thing I learned about stress is that when we're in the sympathetic nervous system response, the body shunts resources away from the prefrontal cortex so that we don't overanalyze things—at least this is how it was explained to me. That we become more reactionary in the moment, like if our house was on fire, we're in the second floor, we need to just react—jump out the window. If we weren't in that state of fight-or-flight, we might start overanalyzing something. Is this true that when we're in a state of stress—and we might not feel cause stress isn't an emotion—if we're in a state of stress, and we're in the sympathetic nervous system response a fight-or-flight, do we really lose or dampen our prefrontal cortex—the adult in the room—that kind of decision-making, and have more of an amygdala response to our decision-making?

[00:20:08] Dr. David Perlmutter: In a word, yes, and there is a very powerful upside to being reactive versus being reflective. There are times when we want to react, we want to react very quickly. As an example, you're in your car in your driveway, and you're backing up, and suddenly a child on a tricycle appears in your backup camera. Your foot goes on the brake, and you stop, and a child's life is spared. Now, that is not the time when you want to engage the prefrontal cortex, think about, “Well, if I step on the brake now, then I'll slow my car down, and come to a stop, and then likely I won't hit this kid, and that's probably a good thing.” If you're going through that, the kid’s already been hit.

What happens is a reflex basically happens that your amygdala kicks in, bang, foot on the brake, and then you catch yourself. You said, “Whoa. What just happened? I responded so quickly, luckily,” whatever. That's good. So we need that sort of response. It's life-saving. The problem becomes, however, when we constantly engage the amygdala, we enhance our moment-to-moment connection to the amygdala at the cost of our connection to the prefrontal cortex so that much more of our decision making becomes fight or flight, becomes fear-based, becomes tribal, becomes us versus them, becomes a response to a perceived or real threat. This tends to lock us out of being able to access the prefrontal cortex. That beyond simply having a role in our decision-making is the part of the brain that subserves empathy and compassion.

The more we lock into self-serving decision-making, narcissistic behavior, us-versus-them mentality—what we call tribalism—and impulsive behavior, the more we will act in that way. The more we will interact with the world around us from an amygdala-based perceptive point. How do we enhance our connection to the amygdala? Well, watch the evening news, don't get a good night's sleep, eat foods that increase inflammation, spend a lot of time on social media to lock you into one frame of reference, one perspective. The average American spends north of six hours a day in front of one screen or another, be it their tablet, phone, or computer, or television. That tends to fan the flames especially these days of fear, of doom.

It's been said that when you're doing one thing, you're not doing something else. Spending that much of your waking hours in front of a screen means that you're not then exercising, preparing your meals, interacting with other people, getting out in nature, doing all the things that tend to relinquish our connection to this fear-based amygdala and allow us to reconnect to the prefrontal cortex. These are the central tenets of our new book Brain Wash. We published this book on January 14, 2020, before there was a single case of COVID-19 in North America. How incredible it is that now we are experiencing a challenge that threatens our good decision-making, threatens our ability to look at long term consequences of the things we want to choose to do today.

When we understand that engaging things like social distancing, hand-washing, all the things that we are being to that can limit the spread of this virus, on the one hand, looking forward, as opposed to the ideas of simply, “You know what, screw it. I'm going to go back to work. I don't care. I'm not going to wear a mask. Come what may. Because I want to do this today,” short-term decision-making. So it has really well characterized this disparity between short-term decision-making and long-term decision-making. It's important, no doubt, for people to get back to work, and it's also important for us to go through the behavioral modifications to help limit the spread of COVID-19.

Having said that, these are not mutually exclusive concepts. We can do both, and the key here that allows us to get people back to work, and at the same time, reduce the spread of this virus is forward-thinking by implementing testing as aggressively as we can. Let people go back to work who have developed antibodies who are probably immune, and certainly isolate those individuals who test positive in the molecular testing that looks for the activity of the virus. We can satisfy both camps on this one if we are able to amplify the number of tests that are being performed, at least here in America, by at least three-fold.

[00:25:49] Ashley James: I love that you said that we can do both, it's not black or white. We can get the amygdala thinking, and start reflecting, and having three-dimensional thinking to solve this problem. That takes the prefrontal cortex. That takes getting out of the stress response that we are triggered in when we watch the news or spend time on social media.

[00:26:10] Dr. David Perlmutter: Let me develop this theme just a little bit more because I'm just thinking about something. That is, what are the major risk factors that pave the way for bad outcome as it relates to COVID-19 infection? They are chronological age, biological age, chronic degenerative conditions like obesity, coronary artery disease, type 2 diabetes. Now, the only thing here that it's not a variable that we can control to any degree is our chronological age. We can't erase the number of birthdays that we've had and that we're going to have, but our biological age is certainly something we can modify especially as it relates to the immune system.

The point is that amygdala-based behavior, “I want to smoke. I don't want to exercise. I want to eat crappy food.” All of these things open the door for these chronic conditions: diabetes, coronary artery disease, obesity, cigarette smoking, and all of these then are dramatically associated with worse outcome as it relates to this particular infection. So in a very real sense, what's going on here is decision-making coming from the amygdala is paving the way for worse outcome as it relates to COVID-19.

Making better decisions—better choices—as it relates to lifestyle, as it relates to the food you eat, the sleep that you get, the fact that you decided not to smoke, getting some exercise are ways of reducing your risk or even reducing the worsening of these diseases should they have already been established. Therefore, reducing risk for a bad outcome as it relates to COVID-19. It was quite a surprise when this infection began affecting the United States because there was an interesting statistic that became obvious, and that was here in America, younger people were ending up in the hospital and having bad outcomes.

It was a great puzzle in the news because people were saying, “Why would our young and healthy individuals in America having such a bad outcome?” That is an interesting statement, isn't it? Our young and healthy Americans. Understand that young, in America, doesn't necessarily mean healthy.

[00:28:48] Ashley James: No kidding.

[00:28:49] Dr. David Perlmutter: That is very, very important because we have extremely high rates in North America of things like type 2 diabetes, certainly obesity, non-alcoholic fatty liver disease in younger individuals. These issues pave the way for a bad outcome. These are issues of immune dysregulation, and that is the cardinal point here. That's where COVID-19 takes full advantage of an individual and paves the way for a bad outcome. That's where COVID-19 insinuates itself into a dysregulated immune system and does its damage.

Understand that our immune system is represented in the liver, in the heart, in the brain, and in the lungs. This is why this in infection is having manifestations across the board through our various so-called systems. Yes, it affects the brain. Obviously, it affects the lungs, and yes, liver issues are becoming quite common in people who have bad outcomes, and certainly, the gastrointestinal system as well.

[00:30:01] Ashley James: Let's talk about diet because the book that turned me on to your work, Grain Brain, focuses on the things that we can cut out and the things that we can implement into our diet that decrease inflammation, but that also, your diet prevents these diseases. The idea of going grain-free or gluten-free, for many people, is a shocking idea. Why is it that eating grains is lowering people's immune system?

[00:30:37] Dr. David Perlmutter: What an excellent question. Why is it that eating grains is lowering people's immune system? Think about that. In the context of where we are right now, eating grains, refined carbohydrates—that's basically what most people end up eating when they’re so-called eating grains—the wheat products that people are assuming that make up 40% of the food that people consume in America. That this is generally in its refined ultra-processed form, and what does that do? It dysregulates our immune system through multiple mechanisms.

It disrupts our gut bacteria that influence our immune system through the permeability of the gut lining that then influences where 70% of our immune system is located—the gut-associated lymphoid tissue. That's one extremely powerful mechanism, but in addition, perhaps through its effects on the gut and elsewhere, it dysregulates our ability to control our blood sugar. That has an effect on immune functionality as well.

One of the most powerful predictors of how a person is going to do once they've been hospitalized—good outcome or bad outcome—is their blood sugar when they come into the hospital. Higher blood sugars are dramatically associated with poor outcome. Another interesting report coming out of China several days ago calls our attention to one of their laboratory study that's dramatically associated with a bad outcome, and that is a liver transaminase called ALT. ALT is a marker for non-alcoholic fatty liver disease. A metabolic issue that's for sure, which is extremely prevalent now in younger Americans who are eating diets that are higher in fructose and ultra-processed carbs of other sorts.

This all then fits together that we see this dramatic dietary shift that has been going on now progressively for the past 12,000 to 14,000 years since the advent of agriculture. Now that seems like an awful long time, doesn't it? The reality is that for 99.6% of the time that humans have walked this planet, we did not consume any significant amount of grains. Truthfully, the idea of these highly processed grains giving us sudden spikes in our blood sugar, for example, is something that's only happened really pretty much in the past couple of centuries, if not even the last century, to the extent that they've entered our food supply as we see today.

In a very real sense, what we are seeing is the response to COVID-19 very much reflects the types of foods that are eaten in a given country. That is particularly alarming when we recognize that this so-called pro-inflammatory Western diet is very rapidly becoming the global diet just as COVID-19 has become a global pandemic, so has this westernization of our nutrition, which bodes, therefore as we've connected these dots, for a worse outcome as it relates to being infected with the COVID-19. So in a very real sense, when I wrote Grain Brain and called out to get back to your question, the dangers at multiple levels to having higher levels of refined carbs, eating a lot of grain-based product that this is a way of increasing inflammation—the cornerstone of our chronic degenerations—which now are those diseases which pave the way for the worst outcome with COVID-19.

That also the idea of persistent elevation of blood sugar by a higher carb diet in general leads to a higher risk for insulin resistance that vis a vis the name of the book Grain Brain focusing on brain health, insulin resistance is devastating for the brain. We recognize that Alzheimer's is, for the most part, a manifestation of a fuel issue fueling the brain, being able to allow the brain to use glucose appropriately that is front and center in terms of being looked at as an etiology player as it relates to Alzheimer's as recently as January 2020 in the Journal of the American Medical Association.

That's what underscored the importance of diet as it related to general health, as it related to obesity, and certainly, as it related to brain health that we talked about so many years ago now in Grain Brain. Thereafter, we began looking at diet as it related to our gut bacteria, as we began to recognize how important the gut bacteria is in regulating so many of the parameters that are important for our health, our ability to resist disease, and even our longevity. That's when I wrote a book called Brain Maker. Again, the importance of diet on determining the health of our microbiome, if you will.

Why dietary fiber is so important? Why diets high in refined carbohydrates and sugar threaten the diversity, health, and functionality of our gut bacteria, and as such, threaten both our immune systems and our ability to regulate inflammation. Now, we come to 2020 when our son Austin Perlmutter, an internal medicine MD, and I looked at this whole notion, as we talked about earlier, Ashley, of decision making, and realized that making the right decision in terms of lifestyle—like food choices, like going to bed on time—has a huge role to play in regulating immunity, regulating inflammation, and in even making good decisions.

That's where we landed on this, and that is the idea that, again, our decision-making is a manifestation of our lifestyle choices, and that choosing a lifestyle that favors inflammation will cut us off from the prefrontal cortex. Inflammation, in and of itself, tends to allow us to make more impulsive decision, tends to amplify our connection to the amygdala, and therefore moving forward, our choices are poor, we make continued bad choices related to food and other lifestyle issues, fanning the flames of inflammation locking us more into an amygdala-based decision-making paradigm.

That's what's going on in America right now because we've eaten this standard American diet, fanning the flames of inflammation, locking us into poor decision making. We make poor decisions as it relates to our dietary choices, and thus, we continue to be in this feed-forward—what a term—feed-forward cycle where we really can't get out of the idea of making poor decisions. What we are emphasizing now as we are beginning a training program using Brain Wash as really a course guide for physicians involved in functional medicine, and that is to first not give patients ideas in terms of what they should be doing for their particular ailment, but rather, at first encounter with our patients, give patients options that will enhance their decision-making ability.

Let me give you an example. A patient you are seeing with diabetes and obesity comes in, and at the first encounter with this patient, that patient is very surprised because at the first visit we didn't even talk once about diet and exercise. Why? Knowing full well that these recommendations won't be carried out, generally. What we do it the first visit is we work on the ability for that patient to regain the likelihood of making better decisions. We work on decision making at the first visit.

Here's a patient, you're seeing this patient. Clearly needs to be on a diet, clearly needs exercise, but at the first visit what do you talk about? Well, maybe it's sleep. Maybe that patient sitting across from you in the office, what we're talking about is, “Hey, let's get you a better night's sleep so that in two weeks, when you come back to see me, then you've regained better decision-making skills. Reconnection to the prefrontal cortex that then will allow you to make and stick to those decisions that have to do with diet, that has to do with exercise, etc.” Maybe our entrance ramp is sleep, or maybe it's meditation.

Whatever we can do to reconnect to the prefrontal cortex, to offset what we described in Brain Wash as disconnection syndrome, will then pave the way through feed-forward activity to allow that patient then to move forward and engage the rest of the program. As opposed to say, “Here you go. Here's a list of foods that are low in carbohydrates, high in fiber, high in good fat. Take it home. Hope for the best. That doesn't work. We know that doesn't work. Why do we know that doesn't work? Because time and time again, that patient’s going to come back and have a higher blood sugar, their A1C is going to be worse, their insulin resistance markers are going to be deteriorating, and they're going to be gaining weight. So that doesn't work until we work on re-engaging better decision making by actually restructuring their brains.

[00:41:39] Ashley James: Absolutely. Sleep also has a huge impact on blood sugar. I was type 2 diabetic. I reversed it naturally with diet and lifestyle changes. I noticed that if I got poor sleep, for the next 24 hours, I was hungry, my blood sugar was out of control, and it was consistent. But if I got a really good night's sleep, the next day I could be just smooth. My blood sugar could be stable.

[00:42:09] Dr. David Perlmutter: Ashley, I have to stop you there because what you just said is it's worth the price of admission. I mean, that’s an e-ticket at Disney World. What did you say? You said you used to be a type 2 diabetic. First of all, just the notion that you are no longer a type 2 diabetic flies in the face of how mainstream medicine treats this problem. Mainstream medicine treats type 2 diabetes with drugs. What happens when you stop the drug? Blood sugar goes right back up. So you didn't treat the problem. (A) You, on the other hand, treated your problem type 2 diabetes by dietary and lifestyle intervention. (B) You noticed a direct effect of your blood sugar of having a good night's sleep or not, and that is absolutely profound.

When you don't have a good night's sleep that is a stress. What is your body's response to stress? It turns on the production of blood sugar because you need it because you're in a fight or flight scenario, or so your body thinks. Your cortisol level is higher, your amygdala is activated that very next day, and your food choices are less appropriate. It's been demonstrated that people who chronically don't engage in restorative sleep, night after night, consume at an average of 380 more calories per day without an increase in caloric burn in comparison to people who age match, individuals who do get a good night's sleep. No wonder what you just said has such profound meaning. That's take-home information. That's great.

[00:44:04] Ashley James: You said the term restorative sleep. What is the difference between just getting sleep and getting restorative sleep?

[00:44:14] Dr. David Perlmutter: Another great question. I mean, there are plenty of people who will tell you I get 7 to 8 hours of sleep every night, and yet, their cortisols are high in the morning, their blood sugars are spiking, inflammatory markers are elevated, and their decision-making is poor. All of these markers that maybe that sleep was not as restorative as they thought. How would you know? Well you might not know—you will not know—unless you're able to evaluate, not just sleep quantity, but sleep quality. How can you do that? You need to know that many people think they get a full night's sleep but have constant interruptions of their sleep by periodic leg movements, by apnea—meaning that they stop breathing—by sleeping with a partner who may be bumping them, or kicking them, and causing their sleep to drop out of the deeper stages though they don't fully awaken and recognize that their sleep is not restorative.

If you're somewhat asleep, how do you know if you're getting into the deeper stages of restorative sleep like a deep sleep, like for example, REM sleep? These are important parts of sleep that do good things for our bodies that are very, as we talked about, restorative. You won't know unless you apply some technology. Now, this can be going into a sleep lab and having a formal what is called a polysomnogram that looks at your brainwaves, and looks at your EKG, that looks at your oxygen saturation with a little device connected to your finger, which I've done. That said, we know that there are some pretty darn good wearable devices that can also give you an indication as to the quality and the quantity of your sleep.

I use a device called an Oura Ring that downloads into my smartphone in the morning and gives me a very good sense as to how long it took me to fall asleep, how long did I remain asleep, how long was I in the various stages of sleep, and then it allows you to make certain lifestyle changes, to improve certain aspects of your sleep based on what you then know. I think in this day and age, there is technology available to us to not just determine how long we are asleep but what is the quality of that sleep. That is absolutely fundamentally important as it relates to things like our immune function, our blood sugar, our cortisol levels, how active our amygdala is in terms of decision making, etc.

[00:47:04] Ashley James: I just bought an Oura Ring. Actually, it was gifted to me, and I'm really excited to use it. I haven't used it yet. I just got it in the mail. You mentioned that I'm like, “Oh, I'm going to start playing with it.” That's really cool. You mentioned that when we don't get restorative sleep, that we consume on average 350 more calories a day. That doesn't seem like a lot, but when you add it up over a year that's 36 pounds. If someone continued that behavior over five years, they'd have gained 180 pounds. What seems like, “What's 350 calories a day?” It doesn't seem like a lot, but this is where one bad behavior done over a course of five years can significantly impact the quality of your life, the longevity of your life can either contribute to basically being in an early grave and being in a disease state for the rest of your life.

Something as simple as going to bed an hour earlier, putting on blue-blocking glasses, not eating refined sugar, cutting back on the caffeine. These little tiny choices that we would not make if we were in the amygdala because we want the instant gratification. “I want to stay up later and watch more Netflix. Just one more episode,” or “Oh, I feel like a chocolate bar. It's 11:00 at night. I feel like a whatever.” That's when people start making really bad choices around snacking and staying up later and later and late because they're in the amygdala, not in the prefrontal cortex. The more we lose sleep, the more we're going to just make worse and worse choices, and we're just spiraling downhill. It just keeps going and keeps going, and it just compounds on itself.

[00:48:48] Dr. David Perlmutter: Exactly. Keep in mind that this doesn't have to take five years. If you gain 15-20 pounds—you're going to gain about a pound a week if you're not sleeping well, as an average. When you gain body fat, a couple of things happen. Of course, you increase inflammation, you increase your connection to the amygdala, but body fat directly translates into less quality of sleep. What happens? You have less quality of sleep, you eat more. You eat more, you gain weight, and you have less quality of sleep. That is a gross example of what is called a feed-forward cycle. That the problem worsens itself over time, and that's the bad news.

The good news is that while in Brain Wash, we outlined eight different on-ramps that you can engage. You don't have to. You can pick one, and it might be, for example, sleep, and doing the Amber glasses—blue-blocking glasses—cutting your caffeine consumption in the afternoon, getting perhaps more exercise, not snacking after dinner. All the things that we all know are important parts of sleep hygiene that you could say, “I'm going to do this for a week.” If you do, then you're going to improve your decision-making, then the rest of the plan is far more easy to engage. That becomes a feed-forward cycle that works to your advantage. That's what we're looking for.

[00:50:21] Ashley James: I love it. My husband, when we had our child, we lost a lot of sleep. He gained some weight. It wasn't a lot of weight, but he gained some weight, and all of a sudden he started snoring like crazy. I mean just really loud snoring, and he blamed our new mattress. We got this amazing Intellibed mattress. It's the best in the world. I can fall sleep in one position, wake up eight hours later in the same position. I just was like solid sleep in that position because you don't have to roll around. I love the Intellibed. In fact. I interviewed the founder, the creator of Intellibed. It's really neat how much science goes into it.

My husband was blaming the Intellibed. Then he got really serious and cracked down, and he lost about 15 pounds or so, and all of a sudden his snoring went away. He also did some stuff with his diet to decrease inflammation. He did some fasting. Immediately, almost overnight, the snoring went away. It's not like he had fat around his neck, it wasn't like anything was pushing, but it was something about decreasing inflammation, losing a few pounds, and all of a sudden his snoring stopped, and he started sleeping better. Of course, then I started sleeping better. It was really interesting to see how some little changes—it all affects each other. Everything affects each other.

[00:51:39] Dr. David Perlmutter: That's right. We can take advantage of your statement that everything affects each other in a positive way. Everything affects each other also in a negative way. Eat crappy food, gain weight. Sleep poorly, make worse food choices. Again, don't exercise, you won't want to get outside, you're going to binge-watch, and all these things, and spend more time on social media. We can use feed-forward cycles to our advantage or to our disadvantage. It just depends on really finding, as we've talked about, an on-ramp that works for each individual.

It might be sleep, it might be exercise, it might be keeping a gratitude journal, it might be nature exposure—powerfully effective in reducing cortisol, reducing inflammation. That's what we need today. We need to offset our risks for chronic degenerative conditions, and that will help us in terms of our outcome if we should contract COVID-19. Look who's involved with this in terms of bad outcome. I'm sorry to say but it's people who have unfortunately made poor lifestyle choices that manifest as these chronic degenerative conditions, and that will also cause manifestation of a bad outcome as it relates to COVID-19 infection.

[00:53:06] Ashley James: In the grocery stores I like to go to, there's a few of them. I like to go to one's a local co-op here that has all organic, and then there's another one at Whole Foods. There are different grocery stores I go to, and I kind of do my little circuit to get different things from different ones depending on what I'm out of. I noticed that at all the grocery stores in my area, everyone I've gone to, the baking section is empty. It's completely emptied out. In my local Facebook groups, people are saying, “Who bought all the baker's yeast? I'm trying to make this.”

I'm seeing on Facebook all my local friends are baking like crazy. They're all of a sudden baking and eating muffins and cakes. It was just on and on and on and they're also drinking a lot of alcohol. I don't know if you noticed that, but on Facebook, everyone's celebrating at home with their alcohol. I'm thinking to myself. “You are worried about getting an infection—getting the virus—and you're consuming exactly what your body needs to have the worst outcome in case you did get it.” Alcohol, and sugar, and flour are the worst things we could be consuming right now.

[00:54:24] Dr. David Perlmutter: There are two reasons for this. First is obviously pragmatic thought that these are non-perishable, so that's why people buy flour and non-perishables, and then end up baking and doing all the things with them. I think more to your point, these are so-called comfort foods. During times of stress, people tend to gravitate toward—it's why they're called comfort foods. Because you're satisfying your amygdala-based behavior, you're releasing dopamine, and you're satisfying the craving in the short run.

This is the time where you need to double down on all the right recommendations as it relates to the foods that you're consuming and your other lifestyle choices because you desperately need a good functioning immune system, a balanced immune system that can rein in inflammation, for example, that can be so devastating with this infection. Now is the time when all of those lifestyle issues that we've all been talking about for such a long time need to be implemented to the highest degree possible.

It's not like we're cashing in our chips right now. If you do, you're going to gain weight, you're not going to sleep as well, your immune system is going to become dysregulated, and as such, you're going to increase your chances for a bad outcome should you be infected by this virus. That said, it's been predicted that's somewhere between 60%-80% of people globally are going to catch this virus at some point.

[00:56:08] Ashley James: Right now, right now, your book is so relevant. Brain Wash is so relevant. In fact, all your books are so relevant because you're teaching us how to support the body's ability to mount a healthy defense, and to also, if and when we do have the infection, we could be one of the people that are asymptomatic. That the body is so healthy it moves through the infection, fights it, and mounts a response, and we don't have to be hospitalized. Those who weakened their body by not getting enough for sort of sleep, by eating a diet that causes inflammation, that tears down the body instead of builds it up, by not getting out in nature, not exercising gratitude, or not meditating, not taking the time to actively de-stress.

If we don't do that and instead we stress ourselves out, don't get enough sleep, inflame our body with a poor diet, and stay in the amygdala response, we are guaranteeing we will have poor outcomes. You've really painted this picture. As you've been talking about the prefrontal cortex and the amygdala, as they relate to our decision-making, I'm reminded of the old cartoons that I used to watch. The Looney Tunes cartoons where there'd be a little flying devil with a pitchfork—a little red devil on one shoulder—and there would be a little angel with a harp and wings on the other shoulder all dressed in white.

They would each try to get the cartoon character to do something good, or do something about it. It's almost like spiritual warfare at this point. We have to think about every decision we make we are either giving in to that devil on our shoulder, that amygdala that wants the instant gratification, that wants us to fail and be sick in the future, or we're taking a step back, we're reflecting, we're taking sides with the angel on our shoulder, and we're building a better stronger body for our future.

We can, even though we might not be getting the instant gratification of the instant dopamine by eating that doughnut and staying up late bingeing on Netflix right now, the dopamine we could achieve through meditation, and gratitude, and nature, and starting to enjoy nurturing our body with delicious nutritious whole foods and also having really restorative straight sleep, that gives us dopamine too. But it's not this roller coaster of highs and lows. It's this constant even keel joy that we could fill our life with if we followed the prefrontal cortex path instead of the amygdala path.

So I love this picture you're painting. I would rather have this nice smooth ride down the river of joy of prefrontal cortex rather than the highs and lows of the very short-lived life of the amygdala because we will shorten our life if we do follow the amygdala. Your painting this picture very well, and that you're giving us the tools that we can take home with us, and we can implement. We start with one thing so that we can build our strength.

Talking a bit more about diet because I've come up against this resistance with people when it comes to going gluten-free or grain-free when cutting out barley, wheat, rye, and oats for example. Many people I've talked to say, “Well, I was tested and I don't need to avoid those grains because I am not allergic to them.” Other people say, “Well, I went gluten-free for a month and I didn't notice anything, so I'm not allergic to it. I don't have to do it.” What would you say to those people who don't believe, or they think either those grains are healthy for them, or they don't believe that they're excluded. That only a certain percentage, only celiac people need to avoid it, they don't, and you see that everyone needs to avoid it for better health.


Photo by Wesual Click on Unsplash

[01:00:15] Dr. David Perlmutter: It's a good point. The actual risk of so-called wheat allergy as an allergic reaction is pretty low. Certainly, celiac disease is extremely infrequent in our population, though there are some genetic determinants. Ultimately a small bowel biopsy is done to confirm that diagnosis, but it's somewhere south of 3%-4% of the population, that's for sure. Celiac disease is not what we are talking about. Wheat allergy is not what we were talking about. We're talking about some fundamental events that occur when we consume alpha-gliadin—a protein found in wheat, barley, and rye—it's a component of gluten. How that leads to an increase in gut permeability or leakiness, and this may occur in all people.

Who has what is called non-celiac gluten sensitivity? Don't know the answer to that in terms of percentages, but it's perhaps 30%-50% of the population. Meaning that there are observable manifestations, symptoms that are generated when this group of individuals ends up consuming a product that contains gluten. That said, I think the best recommendation is that we go off of these products. There's nothing wonderfully salubrious about the gluten-free aisle in the gluten in the grocery store. That is where you'll find highly-processed, ultra-processed carbs, highly-refined grains of other sorts that will spike the blood sugar that will wreak havoc with the gut.

What we want to do is really start to re-emphasize what humans have eaten for almost our entire existence, and that is vegetables. If you choose to be someone who consumes animal products, untainted animal products if that is, again, your choice. It’s not just the gluten part of the story though, it's the refinement of the carbohydrates, the effect that has on blood sugar, how that amplifies inflammation, how that degrades our effectiveness in terms of our immune response, how it leads to things like insulin resistance and other aspects of metabolic syndrome.

It’s a much bigger picture. As we go through that from Grain Brain to the microbiome in Brain Maker and now to Brain Wash, how then this affects the wiring of our brains, and our decision-making, and how that takes us to the current time of what will our response be to infection, which is likely going to happen to most of us—if not all of us—with this COVID-19 based upon the dietary choices that we thought were important over the years. It's really very interesting that in a sense, this COVID-19 is selecting out individuals for the worst response based upon more amygdala-based decision making as it relates to lifestyle choices. 

Our world is conspiring to lock us into our amygdala based upon the foods that we are eating, the fact that we think we need to stay up late at night to accomplish various things, the negative aggressive fear invoking nature of our social media experiences and news exposure. The world is a fearful place and this becomes a way of stoking the fires of our amygdala, which makes us make more choices that are not going to be in our favor.

Our mission this time around in writing Brain Wash is to give the tools to decouple this, to get us away from amygdala-based decision making and re-establish connection to the prefrontal cortex to offset what we described in the book as disconnection syndrome. It’s fascinating for Austin and me to observe that Brain Wash has now been picked up by 18 country, 18 languages around the world. It was just published here in America because I think people are getting this message that at the cornerstone of what's going on here is our decision-making. Because it's our decision-making that leads to these chronic degenerative conditions that leads to bad outcome. 

That's how we're reading into why do 18 languages, why does Brain Wash coming out of 18 languages around the world? Because people finally get the fact that decision making is really important today more so probably than ever before in the history of humankind.

[01:05:26] Ashley James: That there's a direct link between diet and how we function in life. Because I think a lot of people walk around, going through the drive-thru not seeing that there is a connection. There's a big disconnect between what we put in our mouth and everything else in our life. That it could actually not only affect our health—our physical health—but it could affect how you do your taxes. It could affect how you treat your spouse. It can affect your behavior.

[01:05:53] Dr. David Perlmutter: Disconnection syndrome. We were very surprised early on in January this year, when Brain Wash came out, that it became such a big seller in England in the financial community. We did not predict that. We did not see that coming, but decision-making in terms of investments either is impulsive buy and sell because, “Oh, I feel this is going to be a good thing. I'm going to make money,” or take a deep breath, what's going to work here by looking at data, and let's be an investor for the long-term. That's a prefrontal cortex. So we didn't see that coming. It was really quite an interesting surprise.

[01:06:36] Ashley James: That's so cool because you're reaching people who've never really thought about enhancing their diet or their lifestyle, enhancing their health for their decision-making for their brain. So you're reaching people who don't normally look into the health space, which is really neat. Now, when you are researching to write this book, as you were writing it with your son, what changed in your life? How did this book change you?

[01:07:02] Dr. David Perlmutter: Yet another great question. I think it did a number of things to me in a very positive way. It certainly helped to reconnect me even at a deeper level to my co-author, who happens to be our son, so that was an interesting thing that happened. In fact, we just was with him this morning and his girlfriend. They've done everything right. They quarantined 14 days, and then came to visit, which was totally acceptable. 

It also really transcended for me though the level of our messaging. Writing a book like Grain Brain saying, “Eat this, don't eat that. It'll be good for you.” Other books that I've written, other books that my colleagues have written about various diets and their lifestyle choices that we were working on something that was at a higher order. Whereby, “Yeah, it's great to read all these terrific books, and watch these programs, and attend these summits, and learn all this information, but guess what, all the books are useless to you if you don't implement what they're talking about.”

We realized that we were dealing with a higher order overriding plan that could help people engage in whatever goal they wanted to achieve. Be it weight-loss, be it better health, be it being more financially sound, and having talked about that recently. It was a bit transcendent, and beyond that, it certainly helped me reaffirm why I do what I do in terms of day-to-day lifestyle choices, and really double down on so many of the things that I think are important. Double down on the value of meditation, of exercise, of eating low carb, of intermittent fasting. All the things that we think are very important. Now, with the recognition that this is affecting my brain wiring, not just helping me have a better insulin response. I think that was very enlightening.

[01:09:18] Ashley James: I love it. I love that you got even closer to your son who also chose to be an MD. Did he choose to become an MD because of you?

[01:09:27] Dr. David Perlmutter: Who knows? Did I choose to become an MD because of my father? I don't know, but it's given us so much common ground. We relate on so many other levels as well in the things we like to do together. We got to go fishing recently, which was quite wonderful. We've always enjoyed that. We looked at each other a couple years ago in a conversation and said, “You know, it's the decision-making where our efforts are breaking down. It's not that we don't know a lot of stuff, and it's not that we don't teach a lot of stuff, it's the patients and their decision making. That's what we need to write a book about.” That began our research, and that was the manifestation of Brain Wash.

[01:10:10] Ashley James: I love it. I'm a trainer and Master Practitioner trainer of neuro-linguistic programming (NLP). NLP is all about how what in our brain is affecting our results in life, and decision-making is at the root of it. I love that you're laying this out with all the science. It’s brilliant. Because our mood, even just your mood, if you're sitting there and you're feeling down, people think that they're a victim of their mood. If you wake up on the wrong side of the bed, “Oh, well the whole day is ruined.” 

You're in a mood because our mood directly affects how we're going to behave. Whether I'm going to go do the dishes, or whether I'm just going to sit in front of the TV. If I'm going to go for that walk and make something healthy to eat, or if I'm just going to order takeout. We become victims of our mood. If we're in a mood, we're probably in the amygdala. There's a way, like in NLP, we learn how to immediately change our mood. You are laying out these steps. If you someone were to go meditate, do a gratitude journal, walk around the block, get some exercise out in nature. Make sure you're resting, go take a nap, but there are so many things we can do, what we call in NLP, a break state, and we can choose to activate a different mood. We can get out of a bad mood. From a mood where we're excited, and joy, and happiness, then we're able to more easily connect with the prefrontal cortex, we're able to more easily make adult-based decisions, and then our results in life come from that.

Catching ourselves when we're in a bad mood and going, “Okay, I'm not a victim of this mood. I'm not going to let this mood control me. I'm not going to let the amygdala, which is like this four-year-old terrorist in my brain, try to control me. I am going to switch over, and I'm going to do something right now. One thing I can do, one thing. What can I do right now to switch over from this bad mood into the prefrontal cortex? Picking one thing from your book Brain Wash. I love it. What do you eat? You sort of alluded to eating a whole food plant-based diet, and then you said, “If you want to eat animal products, then make sure they're clean.” Are you whole food plant-based? How do you eat? What's on your plate every day?

[01:12:33] Dr. David Perlmutter: Let me go back to Brain Wash for just a moment. We wanted to be as inclusive as possible as it relates to food. What we called for in Brain Wash was OMD, One Meal a Day, being entirely plant-based. Fully recognizing that in and of itself, that was a lot to ask. But for environmental considerations and health considerations, just to get people more into the mindset of the idea of plant-based. I think it’s ultimately better for people to engage in a more plant-based diet. Understand I said more, I didn't say complete. I know plenty of people engage a fully plant-based diet, but not everyone does that, and I want to be as inclusive as possible.

I am on a mostly plant-based diet. I do consume eggs, pretty much every day, and we eat a lot of wild fish. I allow those things. I think they're good for us. I mean, for my family based upon how we respond and based upon our genetic profiles, as we've seen. We try to put out in Brain Wash the most inclusive but good recommendations that we could.

[01:13:57] Ashley James: Based on science, based on results. You're seeing that more whole plants, more vegetables. What about legumes? Grains, you talk about not eating grains, but what about whole grains? What about legumes? What about potatoes or sweet potatoes?

[01:14:15] Dr. David Perlmutter: The grains that we objected to are the ones you had mentioned early on: wheat, oats, and barley, and rye as well, of course, but oats are on the on the list where they can go either way. It really depends on where they are milled. If they're milled in a gluten containing factory, then I wouldn't include them. But not processed oats I think can be eaten along with other grains, which by definition are seeds of grass, so that would include some wild rice. Other things like amaranth and quinoa. We're not necessarily talking about by definition grain, but I think there's a place for these as part of a whole food kind of diet. 

Here you are talking to the Grain Brain author, and I'm saying that plates should be mostly colorful above ground vegetables. Frankly, I've been saying that since day one. When Grain Brain came out so many years ago, “So this is this Atkins all over again. Dr. Perlmutter wants to eat bacon, and short ribs, and that's all we're going to eat.” Anything but. I think a diet, my personal opinion, is that a diet that's based on mostly meat—a so-called carnivorous diet—that's getting some attention these days, my feeling is—and I'm entitled to that—that's not necessarily going to be a healthful diet for most people. Might there be somebody, who based upon his or her genetic polymorphism, that might be a good diet for? I guess so, but I think having spent so much time involved in understanding the role of our gut bacteria in terms of our health and disease resistance, to create a diet that is most appropriate for our gut bacteria is important. That means a diet that's high in dietary fiber, which nurtures our gut microbes, our gut bacteria. 

There is no fiber in any animal product whatsoever—zero. So a diet that's focused just on animal products isn't going to give your gut bacteria what they need, and therefore, I think that one should be concerned about a purely carnivorous diet. I think for me, legumes are acceptable if they are cooked. I eat legumes. We do eat a lot of dal, which is lentils. We've been doing that for many, many years after I studied Ayurvedic medicine. I think it's a very calming dietary approach. Coupled with a carbohydrate can be a good source of protein. I don't necessarily spend a lot of time worrying about lectins per se, but that said, our legumes are cooked.

[01:17:26] Ashley James: Awesome. Very cool. You mentioned that some oats, like gluten-free oats, could be okay. What about gliadin in oats, which is a protein similar to gluten? I've heard that could be the reason why we should avoid oats.

[01:17:42] Dr. David Perlmutter: I don't think that it's a big issue to worry about in oats. We don't really use much oats, but my wife does make oat milk and almond milk that we use in coffee. I just think from all that I've looked at in terms of oats that are certified gluten-free, I don't see that as a problem.

[01:18:08] Ashley James: Very good. I love that you say, “Fill your plate with a variety of colorful vegetables that grow above ground,” and then you can have the other things too, but make sure the majority of that plate is filled with a variety of colorful fruit vegetables. What you talked about genetic testing with yourself with some others, polymorphisms was mentioned, how important is it for us as individuals to get genetically tested, to speak with a functional medicine doctor? Is that something we should do? Is it really important to know, or if we ate the way you've outlined in your book, we should be good?

[01:18:50] Dr. David Perlmutter: I think in an ideal world it would be very, very helpful for each of us to know what our genetics are, what are the polymorphisms that we carry. I think it's exceedingly valuable to know this information that what we might be at risk for, and more importantly, how we can offset that risk based upon this knowledge by making certain more aggressive lifestyle changes and interventions, changes in our diets, our supplement regimen, etc. based upon our uniqueness. This is the cornerstone of personalized medicine. I think understanding our genome, and perhaps even our microbiome, are extremely valuable. 

I have done several of these studies, and have had my genetics interpreted by several algorithms, and have learned quite a bit about myself that I would never have known about risk for certain things, and about changes that I can make, whether it's using a methylated b-vitamin or higher levels of vitamin D because I have polymorphisms for vitamin D receptors. My risk for inflammation. A higher risk for melanoma, for example, therefore going to the dermatologist with more regularity. All kinds of things good to know because knowledge is power. As it relates to knowing your genetics and your risks, this is exceedingly empowering. 

I know that it is a bit elitist, especially in these times, to be having this conversation because clearly, people are not going to go out and get these tests as readily. But for the most part, these are things that may be able to be sent in the mail from a practitioner to a patient, and then forward it on to a laboratory, and then allow a virtual interaction with the treating physician to go through what it means. Therefore give a patient an individual some very valuable information.

[01:20:51] Ashley James: Right. Also, there's going to come a time where we're all integrated back into society, and the virus isn't an issue anymore. We can just keep this information in our pocket for when it is easier to get this testing. I like that you have thought of a way that we could do it now. There is a way we could mail it in. There is a way we could have a virtual conversation. How does your son Austin or yourself see clients or patients? How would we go about finding the right practitioner to have this genetic testing done? 

I'd like to see a holistic approach, so the practitioner doesn't go, “Oh, well you need to get extra mammograms because you might get breast cancer more because of your genetics.” Not that standpoint, but the, “Oh, because of your genetics, you definitely want to eat even more antioxidants. Or here's the things you could do to prevent disease so that we cannot have the epigenetic changes occur by having a bad diet, for example.” So a holistic doctor that looks at the functional medicine to support the person and their lifestyle choices, which is what your book teaches us. Is there a website where we can search for a practitioner?

[01:22:22] Dr. David Perlmutter: Sure. I would say first, though, you do want to have a practitioner who might consider mainstream interventions be it CAT scans, MRI, or mammography for example. You want to have access to good technology at the same time that you have access to this good nutritional information, lifestyle modification, supplementation, etc. I think a great place to start would be ifm.org. That's the Institute for Functional Medicine. You can search that by zip code, by area, and determine who's practicing in your vicinity, and then interview or at least visit their website. Determine if they do in fact employ genetic testing, if that's where your interest lies.

[01:23:16] Ashley James: Yes. To clarify, I didn't mean never have the mainstream medical approach, that kind of prevention where they're screening for things, but unfortunately, I know some people who got genetic testing and their doctor said, “Well, we need to do a double mastectomy and remove your uterus. Do a whole hysterectomy to prevent cancer.” She was in her early 30s and this is their approach. They see, “Oh, your genetics show that you may be more at risk, so we're going to remove all these parts of your body.” Rather than, “We’re going to screen you more, we're going to get you on a really healthy lifestyle to help you prevent it.” Unfortunately, some doctors are taking the approach of screening and going in not in a holistic direction where they’re helping their patient create a whole lifestyle of health. 

Of course, if someone went to IFM, they'd be finding a functional medicine practitioner or functional medicine doctor that looks at the body as a whole, which is what we want.

[01:24:29] Dr. David Perlmutter: That's right. I would say that it would be very unlikely that a mainstream doctor would really be in a position to even offer up this type of genetic testing much less for counseling. Certainly, as it might relate to I think what you were inferring there the BRCA2 gene, for example, that might lead to hysterectomy, oophorectomy, and mastectomy. That is something that might be prompted by that type of physician who took care of this individual sister, or mother, or who knows what, but I think by and large by its nature, that physicians who are using genetic widespread screening and interpretation are generally more integrative/functional.

[1:25:24] Ashley James: Excellent. I do have one final question about grains because I think that this is one you've been asked a lot, and you have such a great answer. There are grains in the Bible. We’ve been eating grains for thousands of years. Why now go grain-free? Haven't we always eaten grains?

[01:25:41] Dr. David Perlmutter: Give us this day our daily bread. I would ask you, when was the Bible written? When was it written? I don't know. I mean it was written about 2,000 years ago, right? That probably represents less than one-quarter of 1% of our time on this planet when we weren't eating daily bread. Our genome undergoes changes that are significant. It takes about 70,000 years for a significant genomic change to impart itself, and our genome is refined by our environment by environmental pressures like the foods to which we have access over time. 

This just happened. Let's go even 14,000 years ago when agriculture was developed. This happened in the blink of an eye, just happened. We’ve not had time to genetically adapt. So, that's the explanation. We haven't always had bread. We haven't always had grains. We have almost always had none of this.

[01:26:54] Ashley James: I love it. I love how you just simply put, our genetics are not designed to, our bodies not designed to eat this way because we've just started eating this way. When we look at the history of our genetics, we just started eating this new way. Especially when you look at what you eat when you go through the drive-thru. All these refined oils and, all the refined sugars, and everything our body just doesn't even know what to do with. Then we end up with a huge amount of our population obese, fatty liver disease, type 2 diabetes, and heart disease. All diseases of living in the amygdala.

[01:27:41] Dr. David Perlmutter: Living in the amygdala, and all diseases that set a person up for a bad outcome these days as it relates to this pervasive infection.

[01:27:51] Ashley James: Well, I think your book would be such a great gift now that most people are at home. We could jump on Amazon and gift your book. We could send it to our friends and our family members who could benefit from reading it. Right now, we have lots of time. We can turn off Netflix, and listen, or read. Your book’s an audio book, they could listen to it because I know my listeners like to listen to things, or they could get the Kindle edition and read it right now, or they could get the hardcover and get it shipped to them, or they could ship it, or gift it to their friends and family. 

This is the perfect time when our routine has been disrupted. I think you mentioned that. This is the perfect time to read your book, and implement these changes, and create a new routine, so when we're able to integrate back into society, and start living life again, we're not going back to the old way. We are adapting, and we're elevating, and we're evolving, and we're going to create an even better way to live. I'd love that your book would help us to do that. Of course, the links to everything that Dr. Perlmutter does is going to be in the show notes of today's podcast at learntruehealth.com

You are so kindly gifting one of our listeners your book. We're going to have a contest. It’s going to be in a Learn True Health Facebook group. All the listeners now can go in and comment under that post, and one lucky listener is going to be chosen to win your book. I'm very excited about that, but I think all of us should go and gift your book, start listening to it, or start reading it, and start implementing these changes. Whoever ends up winning it and if you've already bought the book, you could gift that physical copy to someone in your life. I'd love for you to leave us with some homework. Is there something that you'd like to tell us to go do today?

[01:29:52] Dr. David Perlmutter: Yes, I would. I'd like your listeners, if they feel so inclined, to over the next one week to everyday write down five things for which they are grateful, and just do it for one week. 

[01:30:10] Ashley James: Beautiful. You know what, that's going to be the part of the giveaway. That’s going to be in the Facebook group. Everyone's going to write down what they're grateful for, and then one person will be chosen at random. Sometimes I get my five-year-old son to come in and just point at someone in the comments and that person wins it.

[01:30:32] Dr. David Perlmutter: There you go. That’s pretty random. 

[01:30:34] Ashley James: Yeah. He likes it. The last person that won something, because I like to do giveaways in the Learn True Health Facebook group, they were very happy that they were chosen by my son. So it'll be a lot of fun. Awesome. It has been such a pleasure having you here today.

[01:30:50] Dr. David Perlmutter: Oh, it's been a wonderful pleasure for me. Thank you so very much for having me today. 

[01:30:54] Ashley James: Absolutely, please come back on the show anytime you want to come, and teach, and impart your information. We'd love to have you back.

[01:31:01] Dr. David Perlmutter: I'm delighted. Thanks again.


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Ashley James

Health Coach, Podcast Creator, Homeschooling Mom, Passionate About God & Healing

Ashley James is a Holistic Health Coach, Podcaster, Rapid Anxiety Cessation Expert, and avid Whole Food Plant-Based Home Chef. Since 2005 Ashley has worked with clients to transform their lives as a Master Practitioner and Trainer of Neuro-linguistic Programming.

Her health struggles led her to study under the world’s top holistic doctors, where she reversed her type 2 diabetes, PCOS, infertility, chronic infections, and debilitating adrenal fatigue.

In 2016, Ashley launched her podcast Learn True Health with Ashley James to spread the TRUTH about health and healing. You no longer need to suffer; your body CAN and WILL heal itself when we give it what it needs and stop what is harming it!

The Learn True Health Podcast has been celebrated as one of the top holistic health shows today because of Ashley’s passion for extracting the right information from leading experts and doctors of holistic health and Naturopathic medicine


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