Dr. Perlmutter sitting on a bench

What should you eat to optimize your brain’s ability to function? Dr. David Perlmutter suggests that there are many lifestyle changes we can make today to preserve our mental capacity into the future. You might be surprised that one of the first, even for people who do NOT have celiac disease, is avoiding dietary gluten as well as sugar and other foods that raise blood sugar and make insulin spike.

What kind of diet should we follow to reduce inflammation throughout the body, and especially in the nervous system? Has cholesterol been falsely demonized?

In the book Grain Brain, Dr. Perlmutter argues that a low-carbohydrate, high-fat diet promotes brain health and can help stave off depression and ADHD as well as dementia. How do medications harm the brain? How can we balance exercise, sleep and diet to optimize brain function?

This Week’s Guest:

David Perlmutter, MD, is the President of the Perlmutter Health Center in Naples, Florida, and the co-founder and president of The Perlmutter Brain Foundation. He is a board-certified neurologist and a Fellow of the American College of Nutrition. His book is Grain Brain: The Surprising Truth About Wheat, Carbs, and Sugar–Your Brain’s Silent Killers. His website is www.drperlmutter.com. The photo of Dr. Perlmutter was taken by Ed Chappell.

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Air Date:December 14, 2013

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  1. LINDA

    My Personal Clinical Trial has continued since Jan. 14. I knew I was in control, what did I have to lose? I could stop at any time if I found it too difficult and saw no benefit. The changes that have come, were totally unexpected.
    *Brain Fog Lifted, gone, for the first time in decades, as did low level depression, what I call flat.
    *No more waking with that awful feeling in my gut and brain-depression.
    *Realized no more free floating anxiety and hamster on a wheel worry, self talk, that went on and on and that kept me from sleep.
    *Sleep changes, NEVER SAW THIS ONE COMING. A life long night owl, all my adult life, sleep problems, bedtime avoided because of fear of worry racing brain talk. Late to wake, awful feeling in my gut.
    *Found myself sleepy 9:30-10:30pm-waking 5am-6:30am, fully rested. Unheard of!
    When I stray from diet, the symptoms return, Ketostix verifies that I have strayed, and when I go back on diet, Ketostix 40, it works better than any pill usage than I have found.
    I am better again.
    Everyone is different. I was motivated my a family history of Alzheimers, other frightening health problems. I can understand why people with no health problems would find aversions to this. This simply was my Clinical Trial on Myself.

  2. BobK

    I’ve put this comment to many sources who advocate certain types of restrictive diets and never get an answer. I look back at my grand parents who were coal miners. They ate fat, bread, home grown vegatables, drank whole milk (quart or so), half dozen eggs, etc. every day. Follow dinner up with a shot of whiskey and a beer and maybe some smokes. Never did I hear of anyone in that town having heart problems. Black lung? Yes. However, these people were healthy and as Dr. Perlmutter says these people died of natural causes and not some disease like we do today. My mother’s cholesterol was 292 and lived to be 92 and not on a single med. She used butter and sugar in her daily cooking and baking. Bottom line was these people ate fat and lots of it with no apparent harm to the body organs. On the other side of the coin I knew several people who were on no meat diets or strict vegan diets who had heart attacks or died at early ages.
    Have to say that today it seems like there are many, many more medical problems then ever before so the only real change in life has been what we eat. The doctor makes a good case and backed by many valid studies. So what’s the harm in following his recommendations?

  3. LINDA

    Age 70, knew nothing of Chron’s, Leaky Gut, gluten, never had problems. But when I began to experience fecal leakage, yikes, I was scared. (Having said, I love bread more than cake, the idea of no gluten was like a horror show.)
    When I listened to Dr Perlmutter’s pod cast, found his site drperlmutter.com, read, explored, listened to videos and began to educate myself, decided to do My Own Clinical Trail even before I got his book. (17 pages of scientific references) I, overweight, was Not my Goal, low level depression, sleep problems, fiery pain, numbness, tingling, and swelling in feet and legs
    Dec, fast, then no sugar, no gluten, 2TBS coconut oil in coffee, (continuing salmon, talapia, olive oil, salads, avocados and more.)
    Result for Me: Within 3 days leaky gut gone, hunger gone, no sugar, my body being fueled by good fats, energy there. Then sleep changes, waking early-5am-7, to bed 9:30pm or so.
    Today, though weight not my goal, rather gut and mental clarity, brain fog, I have lost 20 pounds and feel more alert and alive than in a long long while.
    Argue, discuss what you will, carbs, wheat, modified wheat…I am no scientist and it is beyond me.
    All I know is that it worked for me. And it took being absolutely terrified for me to try it!

  4. Eliezer

    I think that Dr Perlmutter as well as many other medical professionals do not define the term carbohydrates. There is a big difference between a sweet potato and a piece of cake. I eat a high carbohydrate diet and because of it lost 40 pounds. I eat mostly unprocessed vegetables, fruits, legumes and some grains. I think that he will have to explain why Asians (up until recently) ate almost entirely carbohydrates and there was little or no heart disease, cancer or dementia. In fact if you look at the Rice Diet which was run by Duke University starting around 1940 people with blood pressures of over 200 were fed a high carbohydrate diet consisting of white rice and a few fruits and vegetables and many would see their high blood pressure normalize. Okinawa has the greatest longevity and they eat a very high carbohydrate diet. So he will need to specifically explain why over one billion people eat a high carbohydrate diet and are much healthier than the people in the western world

  5. TR

    I am a Nutritionist by profession and I think that Dr. Perlmutter may be onto something here in regards to excess carbs in the diet causing inflammation of neurons and subsequent degradation of those neurons and brain function from chronic inflammation or some such mechanism.
    At the same time, I don’t believe he has teased out the difference between excessive carb intake and a balanced intake in his research. I think this is a direction he needs to take in his future studies. Certainly, the archaeological record supports the notion that humans have included carbs in their diet for a very long time whether by chewing on roots or eating fruits.
    We are adapted to having carbs in our diet. However, an excess of anything is not good. So, I agree that there may be neural degradation from excess carbs in the diet but I do not agree that that means to completely eliminate carbs from our diet. Even meat has a small amount of glucose in it. Carbs cannot be eliminated from the human diet. Its just not possible and not reasonable to recommend.

  6. Eliezer

    Dr Perlmutter referred to studies at Harvard which indicated that all people to some extent may have inflammation from gluten. Can a reference to this study be posted please. I have done a search and have not come up with any such study. There is information posted on the Harvard public health website that in some people there is inflammation but nothing regarding all people possibly having inflammation.

  7. kl

    thank you for an interesting presentation. it is understandable that our bodies’ evolution does not respond to our technology’s advances. i.e. the hybridization of wheat to increase gluten content or the elimination of micro-organisms in our gut (through mycin drugs developed in the 50’s). the latter corresponds to a notable and parallel increase in auto-immune disorders. we all can improve our health by being more mindful, chewing and enjoying. we’ve invited the thought that we’re so busy providing for our bodies (hurrying) that we overlook the fundamentals.

  8. ror

    The diet Perlmutter recommends is extremely restricted. For instance, he recommends eating eggs for breakfast almost every morning. Missing from his diet also are beans and lentils, food highly touted in Eat to Live, another best-selling diet book, and by other prominent nutritionists. Perlmutter holds out what may turn out to be false hope for future sufferers of Alzheimer’s Disease. Until studies are done, we will not know if his diet recommendations will lessen the incidence of Alzheimer’s.
    However, the link between Type 2 Diabetes and Alzheimer’s is one worth noting. That alone makes trying aspects of his diet worth trying.

  9. Priscilla

    I love the People’s Pharmacy but it does seem like they’re really pushing doctors who advocate for much more meat and saturated fat. How about put some doctors on who go the other way and let us hear what they have to say? Besides the doctors mentioned in DR’s comment, how about Dr. Joel Fuhrman, who advocates for very limited grains, all of them whole, with somewhat less limited starchy vegetables, but still much lower than many veg promoting doctors. His push is to get the bulk of your food from vegetables, beans, fruits, nuts and seeds so as to get the most bang from your buck nutritionally. It’s not a high carb, low fat diet, nor a low carb, high protein, high fat diet. It’s a high nutrient diet with plenty of protein, fat, carbs, and fiber. I would really love for the People’s Pharmacy to investigate some other approaches than what it seems like they’ve been featuring lately.
    People’s Pharmacy response: Keep listening. We will continue to schedule interviews with dietary experts. Dr. Perlmutter had been requested by many listeners.

  10. Don Burton

    I found the interview very interesting. I in absolutely no way credentialed enough to make any comments as to the accuracy of his statements. I was able to take away a sense that he has done a goodly amount of homework on the subject. A couple of things he said I believe could have used some calcification to prevent confusion. Such as the OJ comparison to a Can of Pop and the Length of time man kind has been eating grains.
    I think many of us would do well to limit our consumption of the object he was most concerned about and vary our diets to include a wider range of food types.
    As one person pointed out, our food sources are really being contaminated by all types of pollutants. Too many of them Agricultural based. It’s to bad that Profit is the top priority rather than good quality food.

  11. Esme

    Variety is important as Kathleen pointed out. Again, if people would reduce or eliminate the amount of processed foods from their diets, many would see interesting improvements in health. Make whole grains a small side, not the focus or shining star of meals. It is also important to realize carbohydrates don’t have to come from grains–vegetables and fruits are great sources when consumed at reasonable amounts.

  12. Kathleen

    I am a doctor and I also have a bachelors in food science and human nutrition and dietetics. I agree that whole grains provide many necessary nutrients for our bodies, but the problem is that America are consuming the wrong types of grains and way too much of the same grains. Variety is the spice of life.
    We can get enough carbs from fruit, vegs, whole wheat berries, oats, barley, corn and other whole grains. However, people tend to eat too much refined and processed foods (we have been brainwashed by the big food corporations and it is killing us and our children) into our daily meal plans as being good for us: breads, cakes, pies and sweets on a daily basis.
    These were treats in a time when most people worked hard for their “daily bread” because there was not an abundance of many varieties of food. We have changed by adding these foods into our diets as a daily staple that is readily available on every corner and block in the big cities and towns of our country.
    Another leading problem, (America is paving the way and in the lead) is that people do not exercise to support the need for the large amounts of carbs they are consuming. Dietitians are pushing too many carbs at populations who do not need them, especially diabetics and obese individuals. If they are not exercising, then these people cannot substantiate the need for the excessive carbs in their diet. Most people could stand to go through the complicated process of breaking down fat for energy.

  13. Dorothy S.

    Thanks for mentioning Dr. Graveline again. Please have him on again soon. My one-hospital town continues to prescribe statins like they were going out of style.
    The end of my father’s life was ruined by statin induced cognitive impairment. You never hear that particular possible side effect mentioned by cardiologists. Thanks, Dorothy

  14. Meaton

    I too found Dr. Perlmutter’s nutritional examples misleading.
    Drinking a freshly squeezed glass of orange juice in the morning is NOT the same as having a can of Soda. He passed over the nutritional benefits of fresh fruits and whole grains (vitamins, fiber etc.) to serve his own narrow focus on carbs. That’s like saying buying your own home is bad because you have to pay a mortgage. It’s all in the cost/benefit balance!

  15. DR

    Except for reducing the amount of sugars we consume, Dr. Perlmutter’s advice is completely at odds with the advice of a growing community of MDs and researchers advocating a plant strong, low fat diet, with the elimination of animal fat and dairy products. They have seemingly overwhelming evidence that such a diet sharply reduces the risk of heart disease, cancer and type 2 diabetes.
    The documentary, Forks Over Knives, features some of these experts — MDs like John McDougall, Caldwell Esselstyn and Dean Ornish and PhDs like Colin Campbell. Forks Over Knives has been favorably commented on by Sanjay Gupta, MD, and Dr. Oz. There is a virtual flood of additional books and documentaries that all advocate a plant strong, low fat diet, and sharply reducing animal protein and dairy products.
    My personal experience with a plant strong diet (90% vegan) has been a 30 lb weight loss, a lowering of my sugar and cholesterol levels, and the elimination of hypertension medications. Were I to follow Dr. Perlmutter’s advice I am certain all of my progress over the last 5 years would be reversed. I look forward to Peoples Pharmacy every week. But the Graedons owe their listeners additional programing aimed at reducing the confusion introduced by their interview with Dr. Perlmutter!

  16. Phil

    Lindsay, I have never ever heard of any science papers backing up your claim that carbohydrates are “the preferred fuel source for the body” or that lack of carbs would somehow “compromise muscle”. I also have no idea why you think that turning fats into ketone bodies is a “complicated process” — no science was provided for that conjecture, either. A fact-based questioner must ask: where did your claims come from???
    Our muscle cell mitochondria is clearly well-adapted to produce ketone bodies. As nutrition scientists Volek and Phinney note in their book “The Art & Science of Low-Carb Performance”, the mitochondria of our muscle cells can easily produce ketone bodies in ketogenically-adapted individuals.
    Burning ketone bodies in our nerve cells produces fewer ROS than burning glucose. It also produces more water (something we need) and less CO2 (which lowers pH and increases our ventilatory drive). I would fondly hope that these facts are covered in nutrition/physiology programs, but my experience is that few programs actually do cover the facts. Everybody “knows” that our brains can only burn glucose, but that also turns out to be wrong. From my conversations with many legacy nutritionists, it’s clear that they have failed to keep up-to-date on the science of the last decade.
    In my n=1 experimentation, I find that I have much lower stress on a LCHF diet. I sleep far better, and the dreams I have are far more vivid (and entertaining). This makes perfect sense with what I have learned from researchers Perlmutter, Phinney, Volek and others. The truth is that there is absolutely no nutritional need for wheat in our diet. There’s nothing essential that we can’t get elsewhere. The nutrients from whole grains can be had without the clear risk that gluten poses to our GI tract and our brains. I think that anyone who objectively evaluates the facts will come to the same conclusion. I think it’s a no-brainer. :)
    If you have evidence to the contrary, we’d love to hear it. Thanks!

  17. WJF

    You should be ashamed of allowing a snake-oil salesman like Dr. Perlmutter on your usually balanced program. Some of what he claims may be true, but much of it is exaggerated claims with little-to-no supporting evidence, like many of those hyping “alternative medicine.”
    It’s “alternative” because it’s not supported by experimental evidence. I’m not saying that it’s all false, but it should have to meet the same standards as FDA-approved drugs, i.e. evidence of efficacy balanced against evidence of risk.

  18. Chris S.

    This is a fascinating show. I’ve been working towards eliminating sugar completely and I barely eat bread or pasta anymore, being that I’ve been violently anti-sugar for many years at this point. And I do distinctly remember feeling “opiated” (every time) after eating a certain brand of granola cereal I used to eat; so much so, that I ceased eating it completely. Thanks for the great information.

  19. Ron DeM.

    I found the show frustrating, because after a while, it seemed like 99% of what I was hearing is ‘don’t’. Don’t take statins, don’t eat wheat, don’t drink juice… I know that some people need to validate their assertions, but if I’m driving a car, I don’t need a history of the auto industry first. The whole gluten thing has gone over the top and starts to look like another food fad, like ‘no salt, no fat, no msg, no starch’. When we’re told to eat the way we have for thousands of years, what does that mean?

  20. J David A., M.D.

    Dr. Perlmutter has some good things to say about fats and carbohydrate effects on the brain. The causes of the diabetes and dementia epidemics elude him, however. Any studies done in the last 20 years in the US are flawed by the 80% of Americans who are loaded with industrial, unmetabolizable fats, plastics, GMO products and many of the 80,000 chemicals allowed by the government.
    Most Europeans are taller, healthier, have better diets thanks to their governments and are exposed to fewer than half as many chemicals. They don’t have problems with gluten, carbs, or glucose which have been part of the diet for millenia.
    Northern India had good statistics until they switched from Ghee/butter to vegetable oil for cooking in the 70’s – now they suffer from the same problems as Americans but seem to have less protective genetics.
    Dr. Perlmutter should go and live with some of the southern Europeans where he won’t find the same effects of carbs as in the typical American who has been insulin resistant for years and is loaded with other chemicals.

  21. ingrid p. lmft

    love your program as a former nurse and now a therapist, re: today, 12/14 wonder whats left for me to eat!
    Also with all your information on the statins, have yet to hear what the cholesterol does that is good for us, maybe being good for the brain is the best news of all.

  22. Terry G

    Dr. Perlmutter mentioned TGA (transient global amnesia) in connection with statins. He credited a NASA astronaut, Dr. Duane Graveline, for identifying this side effect of statins. You can hear Dr. Graveline, Spacedoc, describe his frightening experience on The People’s Pharmacy:
    Dr. Graveline’s book is Lipitor: Thief of Memory.

  23. Lindsay

    I have a Bachelor’s Degree in Nutrition and Dietetics, and I must say, I disagree with much of what was said during this podcast. Doctor or not, I don’t believe we need to completely eliminate grains from out diet. I do believe the American diet consumes grains in excess and the quality of grains aren’t the best, but I don’t believe this warrants a complete elimination of grains.
    Grains, especially whole grains, offer a variety of vitamins and minerals, fiber, and of course a good source of Carbohydrate. Carbohydrates are the preferred fuel source for the body; it’s what helps us run and swim and find the energy to perform daily activities without compromising muscle or going through the complicated process of breaking down fat for energy. Perhaps the recommendations for grain intake should be lowered, but the complete elimination of grains is unnecessary in my opinion.

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