How to Make Your Brain “Move” Better with Dr. David Perlmutter

– The MOVEMENT Movement with Steven Sashen Episode 095 with Dr. David Perlmutter

Dr. David Perlmutter is a Board-Certified Neurologist and five-time New York Times bestselling author. He serves on the Board of Directors and is a Fellow of the American College of Nutrition.

Dr. Perlmutter received his M.D. degree from the University of Miami School of Medicine where he was awarded the Leonard G. Rowntree Research Award. He serves as a member of the Editorial Board for the Journal of Alzheimer’s Disease and has published extensively in peer-reviewed scientific journals including Archives of Neurology, Neurosurgery, and The Journal of Applied Nutrition. In addition, he is a frequent lecturer at symposia sponsored by institutions such as the World Bank and IMF, Columbia University, Scripps Institute, New York University, and Harvard University, and serves as an Associate Professor at the University of Miami Miller School of Medicine.

His books have been published in 32 languages and include the #1 New York Times bestseller Grain Brain, The Surprising Truth About Wheat, Carbs and Sugar, with over 1 million copies in print. Other New York Times bestsellers include Brain Maker, The Grain Brain CookbookThe Grain Brain Whole Life Plan, and Brain Wash, co-written with Austin Perlmutter, M.D. He is the editor of The Microbiome and the Brain authored by top experts in the field and published in December 2019 by CRC Press. His latest book, Drop Acid, focuses on the pivotal role of uric acid in metabolic diseases, and will be published in February 2022.

Dr. Perlmutter has been interviewed on many nationally syndicated television programs including 20/20, Larry King Live, CNN, Fox News, Fox and Friends, The Today Show, Oprah, The Dr. Oz ShowThe CBS Early Show, and CBS This Morning.

Listen to this episode of The MOVEMENT Movement with Dr. David Perlmutter about making your brain “move” better.

Here are some of the beneficial topics covered on this week’s show:

  • How making quick decisions is impulsive and dictated by the amygdala.
  • Why all people are hardwired to seek out sugar and we shouldn’t listen to our bodies.
  • How people should be breaking their fasts with meals high in salad greens.
  • Why people’s BMI is not a good measurement of obesity or health.
  • How important the bacteria in the gut is and why it needs to be nourished properly. 

Connect with Dr. Perlmutter:

Guest Contact Info
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@davidperlmutter

Instagram
@davidperlmutter

Facebook
facebook.com/DavePerlmutterMD


Links Mentioned:
drperlmutter.com

Connect with Steven:

Website

Xeroshoes.com

Jointhemovementmovement.com

Twitter
@XeroShoes

Instagram
@xeroshoes

Facebook
facebook.com/xeroshoes

Steven Sashen:

Just waiting for it to start. So you know you’re supposed to exercise, do whatever you need to do to be fit and healthy. And of course, the big question is, how does diet impact that? How does diet even impact the ways you make decisions about what you might want to eat and what you might want to do?

Well, we’re going to dive into that today with a special guest on this episode of The MOVEMENT Movement, the podcast for people who want to know the truth about what it takes to have a happy, healthy, strong body. Typically, starting feet first, but we’re going to move up a couple of feet and talk about some gut things today.

Because you know feet are your foundation. And what we talk about here on this podcast is all the mythology, the propaganda, sometimes the lies you’ve been told about what it takes to run or walk or hike or play or do anything that you like to do and do that enjoyably and efficiently. Did I say enjoyably? That’s a trick question. I know I did.

Because, look, if you’re not having fun, do something different till you are. Life is way too short to make yourself more stressed out by trying to get less stress.

I am Steven Sashen, CEO XeroShoes.com, your host of The MOVEMENT Movement, the podcast. We call it that because we’re creating a movement that involves you, it’s really simple, it doesn’t cost anything or even take your time, about natural movement, where we’re helping people rediscover how using your body naturally is the better, obvious, healthy choice the way we currently think about natural food.

And so, the way you’re involved in that is simple, go join us at www.JoinTheMovementMovement.com. You’ll find all the previous episodes, all the ways to interact with the podcast, all the ways, places you can like and share and give us a thumbs-up, and all those things that you know to do to help spread the word that’s creating the movement.

In short, if you want to be part of the tribe, please subscribe. So let us jump in. Dr. David Perlmutter, it is a pleasure to see you again. It’s been way too long. First of all, hello. And for the few number of people who don’t know who you are, tell them who you are and what you do.

Dr. David Perlmutter:

Gee whiz. Well, I’m a grateful father and a husband, first and foremost. And secondly, I’m a neurologist. I’ve written a few books along the way. I practice a type of approach to medicine that’s much more patient-centric and preventive than I think typically you’d find.

And I do a lot of work in terms of outreach to people, giving information that can help them, like you do, live a healthier, happier life.

Steven Sashen:

Now, you were being a little… What’s the word? Not disingenuous. You were being a little coy when you said, “I’ve written a few books.” Because your books have done exceptionally well. Can you mention what those are so people can go, “Oh, right, that guy.”

Dr. David Perlmutter:

So, I’ve written five New York Times Best Sellers, one is Grain Brain, Grain Brain Cookbook revised, Brain Wash, Brain Maker, which dealt with the relationship between what goes on in the gut and the brain.

And most recently, as I mentioned, Brain Wash, a book that I actually co-wrote with our son, a medical doctor, and it deals with the influence on decision-making based upon our lifestyle choices, how we get to choose what we do each day, what goes into that decision-making, and which part of the brain is really brought online to make our decisions.

Are they short-sighted, self-centered, or are they more long-view and involve how my behavior and choices may affect other people?

Steven Sashen:

Well, we’re going to dive deeply into that. And, of course, I’m going to preface this conversation by asking, does the book get into one of my all-time favorite topics, namely free will?

Dr. David Perlmutter:

Well, the whole free will versus determinism is an interesting question, but-

Steven Sashen:

I would argue that’s a slightly false dichotomy, but nonetheless, yes.

Dr. David Perlmutter:

Yeah. It looks at our behavior and it looks at what goes into making decisions. Are we making decisions based upon what I want right now for myself, which is fairly impulsive and really dictated by the activity of a specific brain anatomical loci, the area is called the amygdala.

Or am I looking at a lot more data? Am I looking at not only what is the decision but how will the decision affect me and others today and in the future? And not just other people, but the planet that we live on.

And that is really subserved by another part of the brain called the prefrontal cortex, kind of our gift as human beings that we have this prefrontal cortex. Yes, other animals have prefrontal cortices, like chimpanzees, maybe at 17%. But it’s one-third of our entire cerebral cortex represented by this area, that is really the adult in the room.

It’s really the area that allows us to override the child in the room. It allows us to make decisions that are forward-thinking and empathetic and compassionate.

So there’s so much that conspires against having that run the show these days, that takes us away from making good decisions and really disconnects us from good decision-making, a term that we’ve called disconnection syndrome, whereby the adult is not in the room anymore, the child’s in charge; and the decisions are based upon what I want now, what I want for me, my future, and the world be damned.

And we really are doing everything we can in this book to give people the tools to reconnect to that part of the brain to virtually and certainly functionally bring the adult back into the room for better decision-making.

Steven Sashen:

It’s so interesting because if we think about human beings from an evolutionary/biological perspective, we aren’t wired for a lot of the kind of decisions that we’re trying to make. Or I’ll say it slightly differently, it seems to me that there’s so much happening pre prefrontal cortex that argues with that, that is arguably, in certain ways, more powerful.

And the prefrontal cortex just hasn’t gotten smart enough in many ways. I think about… Oh, I just blanked on this name. Daniel Gilbert at Harvard, who wrote a book that you know.

People ask me what books changed my life, that one. I don’t know if it changed it, but it certainly shaped it dramatically, which is we’re constantly trying to figure out what we need to do to be happy or not unhappy in the future. We’re horrible at figuring that out. We’re even worse at remembering how horrible we are at it.

And then, of course, we think we’re magic and special because if we met a million people who got the thing that we thought would make us happy and found out they’re no happier than we are, we’d still go, “Yeah, but if I got it… I know all those people who won the lottery aren’t any happier now, but if I won the lottery…”

So, this gap between these two different parts of our brain is so interesting. And I’m just intrigued by the fact that there is this argument still that one side hasn’t won. The prefrontal cortex certainly has not usurped all the other brain mechanisms and functions. I can’t think of…

It’s a Thursday, and Thursdays my brain doesn’t work. So anyway, I find the whole evolutionary biological perspective on this really interesting rather than it just being personal. A lot of us think that what’s going on in our mind is some personal issue we’re failing, without recognizing the millions of years that led to where we are right now.

Dr. David Perlmutter:

Well, there is a place for discussion of this evolutionary environmental mismatch that I think is what you’re describing and across multiple platforms, certainly across the platform of nutrition and how our nutrition influences or is interpreted by our DNA.

It certainly influences DNA expression moment-to-moment, as do all of our lifestyle choices. But I think nowhere could there be a bigger evolutionary environmental mismatch than in that level of information, which is what food is.

We can deconstruct it in terms of macronutrients/micronutrients, but ultimately, it is informing our bodies as to the nature of our environment. And we lose sight of that. And unfortunately, it’s a very important descriptor of our food because as so doing, it changes our gene expression to be more adapted to the environment that it reads.

So, this is the information, DNA modifies its expression. It doesn’t modify the code at all. It modifies the-

Steven Sashen:

The expression.

Dr. David Perlmutter:

… The expression, The methylation patterns if you will, that control gene expression. So that said, we live in a very different world, not just in terms of foods as an environmental call it an insult to our experience, but a challenge to our evolutionary gift, our DNA.

But some of these things, to take it another step, are being hacked into in terms of our self-manipulation, what happens to us in the modern world. Let me give you a couple of examples. First-

Steven Sashen:

You read my mind.

Dr. David Perlmutter:

Yeah. The hack that is taking place, we are all hard-driven to seek out sugar.

Steven Sashen:

Right.

Dr. David Perlmutter:

It is a very powerful survival mechanism whereby our bodies will then convert sugar or activate pathways via both fructose and glucose input to form more fat. Fructose making us insulin resistant and ultimately raising our insulin levels. And glucose, of course, raising insulin immediately.

And insulin is a powerful signal that winter is coming, that we are going to now be challenged by periods of caloric scarcity and therefore, we better start making and storing fat, so we’ll get through.

Those mechanisms prove to be powerful survival mechanisms. Those of our ancestors who, in fact, made more fat and had so many mechanisms in place that many of which began around 18 million years ago, and our primate ancestors would be the ones who would have survived during the times, the Middle Miocene period when there was not as much food availability, and passed those genes onto us.

Now, those genes have been called a variety of things. Dr. James Neel in 1961 called it the Thrifty Gene, whereby we as humans are trying to be thrifty. So we have a genetic predisposition for packing on the pounds whenever we get specific types of calories like sugar because it’s a signal, again, it’s hacking into our hard drive, that we should be making and storing fat, and we do so for the winter that never comes.

We have caloric abundance, sugar abundance 365 days a year, so we’re always preparing, packing on the pounds for the winter that never comes. And the hack is what happens in the 60-70% of the foods on grocery store shelves that have added sweetener, generally fructose, generally derived from high-fructose corn syrup.

Why? Because that tells our brain stem that we need that food, we like sweet, because it’s primitive programming of our deepest drive and decision-making apparatus. So we like sweet, who doesn’t like sweet? Yours truly included.

Steven Sashen:

Isn’t it a great irony that the prefrontal cortex, the thing that’s supposed to help us make good decisions, led us to the decision that is a horrible decision of eating more and more of the stuff that isn’t good for us?

Because at a time, it was good for us because finding calories was difficult. So there’s a certain irony in that.

Dr. David Perlmutter:

In a way, you’re right, but it’s not the prefrontal cortex that, these days, is sweet foods.

Steven Sashen:

That’s driving that. 

Dr. David Perlmutter:

It is a more primitive sweet-tooth drive coming for more primitive brain centers. The beauty of the system is such that the prefrontal cortex allows us to leverage current data that indicates to our consciousness that sugar and sweetened foods are a health threat, and therefore, the adult in the room overrides this more primitive desire to have sweet, and we make better decisions.

That’s what it’s all about, it’s better decision-making based upon letting that adult in the room say, “I know you want the jelly doughnut for breakfast, but we’re going to have a couple of scrambled eggs or a salad or whatever it may be.”

Whatever that prefrontal cortex is able to garner from learning, that’s been incorporated into higher cortical function to allow for making a more appropriate decision that leads, ultimately, to a long-term outcome of better health.

It’s the long game that the prefrontal cortex is playing, as opposed to the short game that the amygdala, for example, is playing, that “I want that jelly doughnut today. The rest of everything be damned. It’s what I want, I’m going to have it.”

Steven Sashen:

Well, you know anyone who makes the decision of salad for breakfast has other problems that we’ll have to deal with, that’s just…

Dr. David Perlmutter:

I’m not sure it’s a problem. Somebody said that you don’t have… At breakfast, you have cereal or you have toast and eggs, but you can have whatever you want. And that breakfast can be 3:00 in the afternoon, right?

Steven Sashen:

True.

Dr. David Perlmutter:

Breakfast is breaking your fast. And so having a salad at noon or 3:00 in the afternoon, well, that seems okay, that’s something grandma wouldn’t object to.

Steven Sashen:

Well, admittedly, when I make a smoothie for breakfast, it has more spinach than any salad I’ve ever eaten.

Dr. David Perlmutter:

Right. There you go.

Steven Sashen:

Yeah. There you go. You’ll appreciate this, I was taking a walk with a friend of mine who was saying, “I’m just trying to get healthier. I just need to listen to what my body wants to eat.” And I just started… I literally fell on the ground and started laughing.

I said, “I know what your body wants to eat. It wants to eat candy and ice cream and french fries. You just have this idea that you could do this thing called listening to your body, that would allow you to eat things that you think will make it change its shape into one that you find more acceptable, but that ain’t the way it’s going to go.”

Dr. David Perlmutter:

No. And there’s a lot of sound bites that are involved there. It’s these colloquialisms that say, “Well, just listen to your body.” No.

Steven Sashen:

Right.

Dr. David Perlmutter:

Your body wants fat, salt, and sugar.

Steven Sashen:

Right.

Dr. David Perlmutter:

And that’s what has led to our ability to survive. The consumption of salt helped in the day to keep our blood pressures up when we were dehydrated.

Steven Sashen:

Right.

Dr. David Perlmutter:

The presence of fat is a fundamental building block for the cell membrane of every cell in our bodies, and a key component, 70% of the dry weight of your brain is fat.

Steven Sashen:

Yeah.

Dr. David Perlmutter:

And sugar, through the mechanisms I just described, lets your body survive during times of caloric scarcity. So we’re hardwired to love salt, fat, and sugar. But then again, when we are confronted by this environmental evolutionary mismatch, that was the diet in the day that allowed us to survive, now it’s putting people in their graves.

Steven Sashen:

How much of eating those things or other things that you might mention is actually then, in this vicious cycle, impairing the decision-making process and making it hard to get the adult to have a reasonable voice in the conversation?

Dr. David Perlmutter:

It’s a very good question. It’s going to take a little bit of unpacking.

Steven Sashen:

Go for it.

Dr. David Perlmutter:

The adult in the room, the prefrontal cortex exerts control, top-down control, over the amygdala, reigns it in, and allows for more thoughtful decision-making about my exercise, the foods I eat, how much sleep I get, do I get out of nature? Am I going to engage stress versus am I going to exercise, meditate, engage in stress-relieving activities, eat the right foods?

So, the issue is that we need this top-down control. There’s a connection that’s so incredibly valuable, an anatomically defined connection between this prefrontal cortex and the amygdala, it’s called the anterior cingulate.

And we threaten the connectivity between the prefrontal cortex, allowing the adult to remain in the room, by the process or the mechanism of inflammation. So inflammation disconnects, leads to what we call, in Brain Wash, disconnection syndrome.

So, when we’re disconnected, then our decision-making goes to pot and we just do whatever we want, whenever we want, without thought as to what the repercussions are going to be.

So if we focus on then inflammation, then you do realize that a diet that, for example, fans the flame of inflammation, which is actually a redundant statement because fanning the flame of inflammation, inflammation comes from the Latin [foreign language 00:16:44] meaning “On fire.”

Steven Sashen:

Right.

Dr. David Perlmutter:

So, anything that leads to increased inflammation is further going to segregate the prefrontal cortex from the amygdala and lead to further bad decision-making, which does what? Leads to higher levels of inflammation.

When you eat the wrong foods, when you don’t get the right amount of exercise, when you stay up too late and don’t have enough restorative sleep, all of these things conspire to ramp up the inflammation level in your body. You can measure that by looking at C-reactive protein.

And you see that inflammation’s augmented and decision-making fails. We go back to the amygdala, we make impulsive, self-centered decisions that make that disconnection even worse. So it’s incredibly valuable then to look at what are the on-ramps for better decision-making.

And more times than not, those on-ramps really focus on getting to the root of inflammation, leading to a decrease in inflammation to allow then reconnection to the better decision-maker, bringing the adult back in the room.

Steven Sashen:

I’ll never forget, I met Joy Hirsch, who was a doctor who was the first person to put someone’s head in an fMRI. And the research that she did at Columbia, she was showing how information comes up into the midbrain to the prefrontal cortex and with a negative inhibition loop back to the midbrain.

So, this is like the literal physical mechanism for what you’re describing, of exerting some control. I’m curious though… Anyway, that’s just an aside that you gave me a flashback to her conversation about that.

So other than measuring C-reactive protein levels, which people can do with a blood test, what are the other signs of inflammation so that someone can know if that’s what’s going on? And then let’s dive into the foods that are corrective or causative for inflammation.

Dr. David Perlmutter:

Sure. Well, there is a very powerful tool that has just become available to people for bio-hacking, to determine how inflamed their bodies are, and it’s called a tape measure. You take a tape measure, you put it around your waist, and if that number is large, you’re riddled with inflammation.

Steven Sashen:

Define large, because obviously, someone who’s this big versus someone who’s this big…

Dr. David Perlmutter:

Yeah. So to be more specific about it, then we might look at something like the body mass index, which then takes into account-

Steven Sashen:

Well, BDMI is so out of whack because it says that I’m obese.

Dr. David Perlmutter:

It is. But I would say, probably the most valuable, by far and away, index would be something called the waist-to-hip ratio.

Steven Sashen:

Okay.

Dr. David Perlmutter:

Because it doesn’t just look at how big your belly is but looks at where you’re storing your fat. The truth of the matter is that if you have a big butt but a smaller waist, you’re, to some degree, protected against the inflammation that I described.

So, it’s really about this central abdominal obesity or adiposity that really makes us realize it’s not just being fat or being heavy, it’s the distribution, i.e., the type of fat that has such an important role to play in augmenting inflammation.

If you want to be looking at blood work, looking at C-reactive protein is certainly available. There other markers like Tumor Necrosis Factor Alpha, Interleukin-1-beta, Interleukin 6, Interleukin 10.

But a lot of doctors aren’t perhaps familiar with those cytokine measurements and may prefer to offer up other tests that they are familiar with, like a fasting blood sugar or a hemoglobin A1C. So if your hemoglobin A1C is six or above, for example, that is a surrogate marker for the increase in inflammation in that person’s body. It really begins at around 5.8 when inflammation is starting to increase.

Now, why is that? Well, not only is it a surrogate marker, but it’s a marker of insulin resistance, which is associated with increased blood sugar, which translates to elevated inflammation. And beyond that, this process of glycating proteins, meaning that the sugar in your bloodstream attaches to proteins, which is what the A1C measures, this is a specific protein called hemoglobin. That’s the protein in your red blood cells that carries oxygen.

In this case, the sugar binding to the hemoglobin in your red blood cells is what is measured. And it’s sort of looked upon as representing an average of your blood sugar over the previous 90 days.

Everybody gets their A1C measured. Why? Because we all see the commercials on TV where diabetic people – actually, they’re actors – are saying, “I’m going to get my A1C below seven and I’m taking XYZ drug.”

The goal should not be to get your A1C below seven. The goal should be to restore insulin sensitivity. And if you want to get your A1C to a normal level, I’d say let’s start at 5.2, if you really want to know what’s optimal, not just what is common, meaning what is normal. Basically, what is normal is what is common.

Steven Sashen:

Right.

Dr. David Perlmutter:

The so-called ideal range then is a couple of standard deviations on either side of that normal value. Well, normal, if it’s average, is way out of control. We want ideal, we want what’s the optimal blood sugar measurement? What’s the optimal A1C? What’s the optimal C-reactive protein if we’re talking specifically about inflammation?

But having said that, when we glycate our proteins, again, that’s what’s measured in the A1C, it changes what our proteins… How they fold, what they look like in three dimensions. And suddenly, the immune system says, “Hmm, I’m not so familiar. It kind of reminds me of a guy I used to know named hemoglobin, but I don’t know, with all that sugar and the way it’s changed, I’m not sure that that’s necessarily friend, it might be foe.”

And now the immune system starts to get ramped up because that A1C and all the rest of the proteins in the body that don’t look quite normal, begin to challenge the immune system. And what happens? You upregulate inflammation.

So that is a mechanism whereby having a higher blood sugar translates to increased inflammation. So we’re talking about surrogate markers, whether it’s getting on the scale, measuring your belly size, having your fasting blood sugar measurement, looking at your A1C, or to be more specific, the high-sensitivity C-reactive protein.

All of these things tell us that inflammation is either where it needs to be, or it’s been turned on. When inflammation is turned on, it segregates that prefrontal cortex from being able to fully influence and reign in the impulsivity of this amygdala and we make crappy decisions.

Steven Sashen:

I noticed something a couple… First of all, thank you. That was awesome. It gave me a flashback to arguments that I had with some of the people in the paleo community where I…

Well, first of all, in the early days of the paleo, one of the big secrets was how high many people’s C-reactive protein levels were. They didn’t want to talk about that. That was hidden something.

But there were some people who were arguing that my fasting glucose was a little high. And I said, “I wonder how much of this is idiosyncratic and genetically determined, since I’m a sprinter, which is a whole different world than other kinds of human beings.”

But more I said, “But FYI, I actually had a glucose tolerance test in a hospital, and they pumped me full of 150 grams full of glucose and of course, my blood sugar went up, then they gave me less than half a unit of insulin. And within 10 minutes, I was down at 30 and I tapped out.”

And they said, “We haven’t had anyone in here who is as insulin-sensitive as you are.” And so it was an interesting thing where my resting glucose was… It wasn’t high, but it was higher than what some people in that community thought was ideal. But my glucose tolerance or my insulin sensitivity was also extraordinarily high.

And this, I think, is related to the phenomenon of being a power athlete, of someone who’s tapping at ATP storage very quickly and doesn’t do any endurance things at all. And so I’m always just curious about what those ranges are that are still healthy ranges but are dealing with idiosyncratic differences.

Dr. David Perlmutter:

Well, I think that it’s a little bit myopic to be focusing on what is a person’s fasting blood sugar, and certainly their A1C.

Steven Sashen:

Yeah.

Dr. David Perlmutter:

I think the A1C is… I’m going to say almost meaningless. I mean, it’s just so overplayed, because simple, it’s a tool that doctors use, and you don’t really have to put a lot of thought into it. They’re managing the numbers. And everyone, as you say, is different.

But I would say that you described a profound sensitivity to insulin, which is what we want. We want to be very insulin-sensitive. And I think the best way to look at this is to look at two ways of looking at blood sugar.

First of all, what is the total excursion that it goes through when you eat a high-carbohydrate meal and then you compare that to what you are fasting in the morning? That number shouldn’t be a lot. If it’s somewhere, the low is, let’s say, 85 to 90 and the high is 110, maybe 120, you’re going to be in the good range there.

The other thing to look at is what is the total area under the curve? In other words, if you could draw out a line of your blood sugar over a 24-hour period, seeing its dips, seeing its highs, you really want to look at the area under the curve.

That’s what really is valuable moving forward in terms of being able to prognosticate the relationship of this metric to future health risk or good health. So where I’m going with this is the value of continuous glucose monitoring.

Steven Sashen:

Right.

Dr. David Perlmutter:

Which is available to anybody. Wearing a patch that measures your blood sugar, it actually doesn’t measure your blood sugar, it measures the sugar in what’s called the interstitial fluid, the fluid between the cells. And then through an algorithm, it computes, basically, for your smartphone, your blood sugar, and it’s deadly accurate.

Steven Sashen:

It’s a miracle.

Dr. David Perlmutter:

And it gives you immediate feedback in terms of your activities, be they dietary, exercise, sleep, you name it, and how that affects your blood sugar, which is exceedingly valuable information.

This is available to anybody. By and large, it’s been only prescribed, until quite recently, for diabetics. But gosh, who wouldn’t want to know their blood sugar response? I wear a CGM. I think the feedback I’m getting moment-to-moment is invaluable.

I know my pulse rate, I know my pulse ox if I want to, I know how I slept last night using an Oura Ring. This is all really very helpful for me to cultivate what is the best program for Dr. David Perlmutter? Steven Sashen might want to know what’s best for him.

You apparently are exquisitely sensitive to insulin. You learn that by undergoing a fairly sophisticated test. I’d say moving forward-

Steven Sashen:

Crazy test.

Dr. David Perlmutter:

… A continuous glucose monitor will tell you that in the privacy of your own home, day in and day out, will record all this information for you on your smartphone, where you can put in the information about your diet, your exercise that day, and learn the relationships for you in particular.

Steven Sashen:

I want to dive into the food things, but this conversation just reminded me of one of the things that I hadn’t thought about in ages, which is what happened after I got the test.

So literally, so they give me the insulin, my blood sugar starts dropping like crazy, and when it got to about 30-35 is when I tapped out. But the thing that was most interesting, for the next week, I was insatiably hungry. I could not eat enough.

And it was fascinating watching my brain work, where I knew I didn’t need the food, but I could not have been hungrier and could not have been less able to stop myself from eating.

Dr. David Perlmutter:

Well, insulin plays a role in hunger, as does leptin. And so what you’re saying is that perhaps insulin was no longer serving you in terms of indicating satiety, don’t know.

Steven Sashen:

It was less about the satiety and more about the desire, more about the… What we’re talking about is just literally, just the urge to eat something; sugar, if I could do it, or anything sweet if I could do it.

I went through like half a gallon of orange juice immediately at the hospital. And I don’t even drink juice. I’m a water guy. That’s all I really care about. But again, just the phenomenon…

Let me take this in a weird direction. A couple of years ago, I started noticing that the way my desire for food happens, in a moment-to-moment level, that’s not the word I’m looking for, moment-to-moment process, is an image will pop into my mind, out of nowhere, of some food.

And if I don’t pay attention, I’m walking towards getting that food without thinking, without blinking. And if I do pay attention, sometimes I can stop that, sometimes I’d go with it, sometimes there’s an argument. But it is a very palpable process of something popping, an idea popping into my mind, and then my body basically following or some variation of arguing with it, that could not be more out of my control, but really interesting to watch.

Dr. David Perlmutter:

Well, what’s going on in your brain is that your amygdala, your impulsivity center is saying, “I want…” Fill in the blank.

Steven Sashen:

Something. Yeah.

Dr. David Perlmutter:

“I need a banana right now, and I’m going to seek it out.” There you go. See? Impulsivity. Whereas prefrontal cortex is going to say, “I had a really good breakfast. I really don’t need to eat now.” “I want that banana right now, damn it. I’m going to…” “No, you’re not. You’ll have a very nice lunch or dinner, whatever it may be, take a chill pill and we’re going to be just fine.”

And it’s about bringing a level of control back in. One of the powerful motivators to eat is not the level of blood sugar per se, although it is, but the rate of fall. And for people who are hyperinsulinemic, as perhaps you may have been at the time of that test, the rate of fall is dramatic.

And they have a high-carb breakfast at home, a short stack of pancakes with some syrup on top and maybe a muffin on the side, whatever it is. It’s breathtaking to watch when you see people what they order for breakfast.

But what does that do? Blood sugar skyrockets, and subsequently, insulin skyrockets. And in some people, insulin passes the mark, and then the blood sugar will fall. What happens then at 10:00 in the morning is you’re in a situation where your blood sugar is falling and, just like you said, you got to have something and you need to have it right now.

And it’s why, in the middle of the morning, people are busting out the bagel or the muffin or whatever somebody may have brought into the office or something like that. Because they’re going from blood sugar peak to blood sugar fall, back and forth all day.

And again, that is why we want to look at the area under the curve, to get a sense as to where a person is, as supposed to spot-checking a blood sugar along the way and say, “Oh, your blood sugar is fine.”

Because when we happen to look at the video, the one still image that we took out, shows that it was okay. So it’s why continuous glucose monitoring is really good. And it also really, I think, validates the notion of fat as a fuel source being like burning the slow candle as opposed to throwing gasoline on the flame, and it happens quickly then it’s done and then you got nothing in the tank.

And so many people experience that. What do they do? They choose high refined carbohydrates in the middle of the morning because they’re crashing, and then they bump it up with a couple of shots of caffeine. And lo and behold, that’ll last until 12:00 or 1:00.

Steven Sashen:

So, we’ve been tempting people’s appetite by talking about all these delicious high-carb things while simultaneously saying that these are not necessarily good for what your brain needs to do to achieve optimal long-term health.

Let’s move into the things that people could be eating instead, that can actually get the adult back in the room, get the prefrontal cortex back online, making better long-term decisions.

Dr. David Perlmutter:

Well, first let’s set the table for better decision-making. And what I mean by that is let’s avoid what we just talked about, let’s avoid the peaks and valleys as it relates to blood sugar. Because when you’re crashing towards that valley, you’re not going to make a good decision.

Steven Sashen:

Right.

Dr. David Perlmutter:

If there’s something in the refrigerator that will get your sugar back up, you’re not saying that to yourself, “Oh, I need something to raise my blood sugar because it’s falling so precipitously.” You’re saying, “Man, that donut looks great, I’m all-in.” There’s no prefrontal cortex involved in that decision, I can promise you.

Steven Sashen:

Right.

Dr. David Perlmutter:

And we’ve all been there. We’ve all realized that, for example, when you’re up all night, that your decision-making as it relates to food choices is terrible.

Steven Sashen:

Yeah.

Dr. David Perlmutter:

I’ve been there as a resident when we were up doing surgery all night, you know what you do the next day. What we used to do is we go to the pediatrics floor and we would eat banana and tapioca baby food. And really, it’s just super sugar, high in sugar. And we loved it. One scoop with a spoon, you have the whole jar done.

But having said that, we now see research whereby people having what you referred to before, functional MRI of the brain, when they’ve been sleep-deprived for just one night, fMRI demonstrates a 60% increased activation of the amygdala, the impulsive, non-thinking decision-maker.

And that explains why that following morning after you’ve been up all night, your decision-making is terrible, which I have to say, is a terrible place to put a doctor in. The next day, you’ve been up all night working, now you’re making rounds and you’re trying to make decisions that are literally life and death for people.

You have to wonder what goes on during residency. We all got through it, but anyway, it’s not an ideal situation.

Steven Sashen:

Yeah. That is a whole other conversation about the practitioners.

Dr. David Perlmutter:

You bet.

So, once we’ve done our best to avoid the peaks and valleys in terms of fueling the brain, the decision-maker, the longer-term play is to reduce inflammation. And the diet then, a good place to start to reduce inflammation is a diet that brings blood sugar under control for reasons that we’ve covered.

It’s a diet that nurtures the gut bacteria. That may seem like a stretch, but it turns out that the health and diversity and functionality of our gut bacteria play a front-and-center role in determining the set point of inflammation in our bodies. How so?

Well, it turns out that our gut bacteria have, among their multiple day-to-day jobs, they have to maintain the integrity of our gut lining. And there are certain species of bacteria that are adept at that, the clostridia species, for example, help to maintain the mucin lining of the gut, that is part of its permeability or lack of permeability determination.

And ultimately, many things go on to keep the gut lining healthy. But by and large, that is influenced. And in fact, the task of our gut bacteria, when we eat in such a way to nurture our gut bacteria, they can do their job and help us by keeping that one cell layer thick lining intact.

Now, when we eat in ways that threaten our gut lining or threaten our gut bacteria, by consuming chlorinated food, food that contains traces of the herbicide glyphosate, food that is high in refined carbohydrates and sugars, food that contains any number of toxic things that our food does contain these days, it threatens the balance of bacteria in the gut and therefore can lead to increased permeability, what is called a leaky gut syndrome.

Why that relates to our discussion is as follows: there are chemical constituents kept within the gut, hopefully, that should remain there. When they transgress into the systemic circulation when the gut is leaky, they augment inflammation and can do so dramatically.

One of them is a chemical called LPS, lipopolysaccharide. It is in the cell membrane of what are called gram-negative bacteria. A lot of the gut bacteria is called gram-negative. It has to do with how they’re stained with a particular type of strain called gram stain.

Steven Sashen:

Right.

Dr. David Perlmutter:

Anyway, the covering is this LPS. When that gets into the systemic circulation, man, oh man, inflammation explodes. In fact, for decades, researchers have used LPS to cause inflammation in laboratory animals and in humans as well, to see what happens in their brains.

Steven Sashen:

Systemic inflammation.

Dr. David Perlmutter:

That’s right.

Steven Sashen:

Yeah.

Dr. David Perlmutter:

So, this relates then our gut bacteria to systemic inflammation. Now, our most powerful tool to keep the gut bacteria healthy are the foods we eat.

Nurturing our gut bacteria with high fiber foods, for example, giving them what they want, lets them behave in such a way that it’s good for them being able to maintain our gut lining, which then, downstream effect, helps keep inflammation in check.

So now we’ve related the foods we eat through the gut bacteria to the gut lining to whether or not we’re going to be inflamed. When we recognize that inflammation as a mechanism is the cornerstone mechanism of what are called chronic degenerative conditions, that means things like coronary artery disease, type 2 diabetes, obesity, overweight, Alzheimer’s, these are the number one cause of death on planet earth. Not COVID, not other infectious agents.

The number one reason that we are dying on planet earth is from chronic degenerative conditions which are inflammatory.

Now we’ve related the foods we eat to the health and function of our gut bacteria, to the permeability or not of our gut lining, to inflammation, to the number one cause of death on the planet. The short circuit then relates foods to the number one cause of death on the planet.

When all those dots are connected, the foods we eat pretty much determines what we’re going to die of. And that’s pretty heady. When we recognize that the Western diet is a powerfully pro-inflammatory diet, and that the Western diet is now becoming the global diet, that really sets the stage for worsening of these chronic degenerative conditions.

And remember what I told you earlier, that inflammation severs the top-down control, the connection of the better adult in the room decision-maker from the impulsivity decision-maker, the amygdala. Inflammation keeps those things apart, and favors making a decision from the amygdala, making it impulsive and self-centered.

That’s induced by the Western, now global, diet, diet affecting the decision-making ability of virtually everyone on the planet.

Steven Sashen:

One of the things I noticed that you didn’t mention, well, let me say this a slightly different way. So what I heard you talking about is food that is… Oh, how do I want to put it? Crap, I can’t do that line of reasoning, let me do the other one.

You didn’t mention taking a probiotic with specific probiotic strains, with specific gut bacteria, etc., etc. You’re talking about the things that are inherently nurturing, independent of what someone’s gut microbiome may or may not look like, given all the various things that have gone on, which is an interesting position considering that right now, probiotics are like the belle of the ball.

Everyone’s talking about how you need to be taking probiotics and talking about the microbiome as if we know the specific way it should be for every individual, rather than giving it the foods that are inherently nurturing, wherever you might be starting from, whatever your gut microbiome looks like today versus yesterday.

Dr. David Perlmutter:

Well, I would say in an ideal world we wouldn’t need probiotics, we wouldn’t need prebiotics as a supplement. But we don’t live in an ideal world, so therefore, there’s a powerful role for good probiotic supplementation and prebiotic supplementation.

Prebiotic fiber is what nurtures our good gut bacteria, and that comes from the fiber that we eat. And we get about 10% of the fiber that we should be eating. We ought to be getting 80 grams of prebiotic fiber in our diets each day, somewhere in that neighborhood.

Steven Sashen:

Wow.

Dr. David Perlmutter:

At least we know that’s what cultures that have been studied today that are extant today are consuming. And we’re pretty well able to determine what our ancestors consumed, based on looking at what are called coproliths. Copro, poop. Lith, stones.

So, this is fossilized poop. We’re still able to tease that apart and determine what the diet was like and what their microbiomes were like by residual RNA signatures left in the fossilized poop. Who knew?

And so, what we see is that the microbiomes of our ancestors from thousands of years ago are very similar to what we find in these isolated cultures that have been studied. And so, we don’t live in an isolated culture and we have to think that we need supplements.

Well, supplements are just that, they’re to supplement the best that we can do from a dietary perspective. But even eating the very best diet that we can, I can’t imagine, and it’s quite clear that we cannot keep up with the insults that are thrown our way based on living as we do in the 21st century. We know that antibiotics, for example, that we must take from time to time, are weapons of mass microbial destruction as it relates to the gut.

That Ibuprofen, non-steroidal anti-inflammatory drugs, these acid-blocking drugs that are so commonly prescribed that you have to take every time you eat a food and it disagrees with you, or that’s what Larry the Cable Guy would have us believe.

These dramatically affect the health and diversity of our gut bacteria. So therefore, taking a good probiotic does make sense, and nurturing our bacteria with a prebiotic supplement.

And there are some that are out there that are really good that are made from things like the acacia tree and baobab, from not the sap, the gel of the acacia, so it’s sustainably doesn’t hurt the tree, and the gum as it were, and the baobab fruit that comes from the baobab tree.

These are powerful sources sustainably harvested and made into prebiotic fiber that… There are many brands out there you can go to the health food store and buy. I do that. I supplement with prebiotic fiber every day, and a probiotic, and a variety of other things because I don’t live in hunter-gatherer times and I’m not living today in a place that has very little contact with the outside world.

Steven Sashen:

If someone’s going to look for a probiotic, what should they look for or look out for?

Dr. David Perlmutter:

Well, there are a lot of factors. I think the best thing to determine is shelf stability. Do you really get what the package says?

Steven Sashen:

Right.

Dr. David Perlmutter:

So, the package will say either “10 billion units” in little letters, “At the time of manufacture.” Or going to make a guarantee of that 10 billion or 90 billion, 50 billion, whatever it may be, X number of months out, a year out, six months out. That’s what you really want to look for.

You want to look at when it was manufactured and are, they guaranteeing 50 billion colony forming units, CFUs, at the time that you’re using it? So shelf stability, arrive alive is what we’re looking for, is really very, very important.

The next thing would be that number of billion units. And I think it should be somewhere north of 20 to 30 billion units. The next thing is the diversity of the strange strains that it provides. And I think a minimum of 10, 12, 13, even better.

I think being encapsulated in a non-GMO capsule is a good thing. Looking for products that are organic, no matter what you’re buying, I think is certainly a plus.

So those are things, those are the boxes to check as it relates to getting a probiotic. Same thing with a prebiotic, but they’re not generally… I guess there are some ones that are encapsulated out there but they generally are bags of fiber.

Steven Sashen:

Right.

Dr. David Perlmutter:

… That you can consume. I like the sustainability part of the story because, as with anything, we want to be using products that aren’t going to further impact the environment, which is becoming such a central issue these days.

Steven Sashen:

Yeah.

Dr. David Perlmutter:

As you and I are having this conversation, we are seeing record-breaking temperature and drought in many areas of our country. So whatever we can do in a small way that is less impactful on the environment, I think the better.

Steven Sashen:

Yeah. I could not agree more. We’re in a place where we’re seeing the impact on a daily basis. As we were talking before we started this, it’s been hotter and drier earlier than ever before. I’ve been in Colorado 27 years, I’ve never seen it this green this early, and already starting to turn this brown this early.

I’m very curious to see what the rest of the summer looks like. Anyway, well, I want to wrap this up by asking you this one question. When you and I met a couple of years back, whenever the hell that was in Denver, you and I talked about how movement is a hugely important part of people’s health that is incredibly overlooked. When are you going to write that book, David?

Dr. David Perlmutter:

Well, actually, it’s in Brain Wash. 

Steven Sashen:

Oh, brilliant.

Dr. David Perlmutter:

And we kind of riff off the notion of sitting is the new smoking, it really is. I think nothing is more threatening to health than this sense that people have that they need to sit and do their work.

These days, with much more work being done virtually, means much more computer time, sitting on your butt. I’m sitting down to talk to you right now but a lot of my computer time is done either standing or sitting on a ball and moving around.

But it’s really critically important that people gain a reconnection with movement, even without the discussion of exercise. Just moving is so fundamental for your body in so many ways. It activates genes, it helps with balance, it helps with brain connectivity, it helps with lowering cortisol.

There’s a lot going on when you are moving, and even when you’re standing. So I think it’s overlooked. And unfortunately, with the lack of people going into the office… 42% of the time that Americans are awake, they’re in front of one screen or another, whether it’s their computer screen, TV, smartphone or tablet, whatever it may be.

That equates to about 22 years if you drew it out over an average lifetime. Most of that we would agree, for most people, is sitting down.

Steven Sashen:

Yeah.

Dr. David Perlmutter:

Or lying down in the case of the smartphone. (a) That is so threatening for reasons I just described; but (b) that’s time that you’re not doing other things, you’re not shopping for the meal that you should be preparing, you’re favoring fast food.

You’re not writing a letter to somebody. You’re not calling somebody up and communicating and reconnecting. You’re not exercising. You’re not meditating. You’re not doing the things because you are locked into this notion that you’ve got to remain on the internet because the pop-ups are so, oddly enough, interesting to you.

How come they’re so interesting to me? How do they know that I’m going to like that next YouTube video that’s queued up? Well, I think we all are quite aware as to what goes on and how we’re targeted and manipulated.

And part of what we wrote about in Brain Wash is really calling that out so people can be aware that, yeah, as a matter of fact, it is happening. Yes, it is. So much is invested by companies for their ads to pop up that are targeted for their demographic.

Steven Sashen:

Yeah. What are you looking at me for? Why are you saying that to me? Just because we run because we’re helping to help people move. But yes, it’s an interesting thing because on the one hand, there are things that are designed to keep you engaged.

On the other hand, when people say, “Well, I don’t want ads targeted to me.” It’s like, well, no, no, you actually do want ads targeted to you. You don’t want to see things that have nothing to do with you.

The balance is… And balance, I think is a critical piece. The balance is how much time are you spending there? Again, back to the adult in the room versus the child in the room. How much is the adult saying, “Got it” and moving on, versus anything else?

And to your point also, you mentioned with movement, Dan Lieberman, I don’t know if you saw his recent research talking about sitting as the new smoking, where he was saying if you actually look at tribal cultures, they do a lot more sitting than you can imagine, but they also do a lot more moving because they don’t just sit there.

They sit, then they get up, then they move around. Then they sit, then they lie down, then they get up. So it’s a lot more movement and a lot more sitting.

Dr. David Perlmutter:

And it’s a lot more intensive in terms of what’s going on in their bodies when they’re sitting.

Steven Sashen:

Absolutely.

Dr. David Perlmutter:

Because generally, when you look at them sitting, they’re not in a chair, they’re squatting.

Steven Sashen:

They’re squatting or they’re ground and having to… Using their muscles.

Dr. David Perlmutter:

Exactly. There’s always movement involved.

Steven Sashen:

Yeah.

Dr. David Perlmutter:

Because we’re uncomfortable a little bit, so we’re always readjusting. And squatting, leg muscles are key.

Steven Sashen:

Yeah.

Dr. David Perlmutter:

If you’re talking about keeping your glucose balanced, leg muscles are fundamental. Where does glucose go? By and large, into the muscles to form glycogen. That’s what insulin does, among many, many other things.

So, this constant stressing of our leg muscles when we’re squatting down is fundamentally helpful as it relates to glucose balance. So let me leave your viewers with an acronym that we developed as it relates to the time we spend on our digital devices, and it’s called the test of T.I.M.E. T-I-M-E.

T: how much time are you going to dedicate to the activity? Okay, I’m going to spend the next 30 minutes, by the clock, going on Facebook and reconnecting with people that were in my shop class in ninth grade. Whatever it may be, right?

Steven Sashen:

It’s funny when you look up your exes and you find out you were lucky that they’re exes. That’s the point of Facebook.

Dr. David Perlmutter:

We’ll leave that for your audience to deal with. I is intentional. What am I going to do? What’s my goal here? I want to buy a new T-shirt on Amazon. Wherever I go, what’s my goal? Do you remain intentional or are you sucked away, as you mentioned before, down the rabbit hole?

M: do you remain mindful when you’re involved in this experience? Are you distracted? Are you looking around? Talking on the phone while you’re surfing the internet? Smoking a cigarette. Whatever it is that people tend to do at the same time that they should be concentrating on the task.

And finally, E: enriching. When it’s all said and done, are you net positive from the experience or are you feeling like, “Shoot, I just wasted two hours because I got taken away. I didn’t remain mindful.” So, test of T.I.M.E.

Steven Sashen:

I like it. And by the way, I don’t feel like I was spared by all of my exes, but there are a couple where I definitely dodged a bullet, so I don’t know who’s listening.

David, if people want to find out more about the work that you’ve been doing, what do you recommend they do to do that?

Dr. David Perlmutter:

My website is, oddly enough, DrPerlmutter.com, D-R Perlmutter dot-com. And my new book, which is now, in terms of information, about it, is called Drop Acid. And the URL for that is DropAcidBook.com.

And I feel compelled now with that response, Steven, from you, to explain what it’s about.

Steven Sashen:

Oh, because I’m the only one who’s had that response when you said that.

Dr. David Perlmutter:

That’s right. That’s the only reason we chose the title. And it’s all about dropping acid, which we are going to tell you is a very important and good thing to do. The acid that we are referring to is called uric acid.

Uric, U-R-I-C, is heretofore something that’s been measured at your doctor’s office in the context of gout or kidney stones. We now recognize that uric acid is the signal in your body that says, “Make fat and become insulin resistant.”

This is the mutation that took place in our ancestors, primate ancestors, 15 to 17 million years ago, allowing them to survive when they could eat things like fruit to make more body fat. We carry that legacy, that mutation, whereby we don’t have the enzyme to break down uric acid.

It accumulates in our bodies and leads to the formation, the storage of fat, raising our blood pressure, insulin resistance, and things like dyslipidemia. So this is now a central player in terms of all those powerful metabolic conditions that we’ve talked about.

So, people will not forget the name of the book, it’s on Amazon. It’s not out yet though. It’s called Drop Acid.

Steven Sashen:

Love it. Well, I’m very much looking forward to-

Dr. David Perlmutter:

Dropping acid.

Steven Sashen:

Dropping acid. Can’t even remember the title of your own book. You need some sort of food maybe, something that’s going to stimulate your brain in a positive way.

Dr. David Perlmutter:

There you go.

Steven Sashen:

I’m always looking forward to the things that you’re exploring and thank you for spending the time on this one. We’ll have to do this again when there’s more things to… Well, after Dropping Acid comes out, that’s a whole other conversation that I’m sure is going to be a blast, and I will not be the only one who’s going to be asking for your time to talk about it because that sounds totally, totally compelling.

Dr. David Perlmutter:

Well, Steven, thank you. It’s sure good to see you again. You look really healthy and that makes me happy. And I look forward to a real-time connection.

Steven Sashen:

Yeah. You and me both. Now that people are starting to do that again, we’ll do that when you’re off your boat.

Dr. David Perlmutter:

There you go.

Steven Sashen:

For everybody else, please check out Dr. Perlmutter’s work. Thank you all for being here. Again, go to www.JoinTheMovementMovement.com to find all the previous episodes, all the ways you can interact with us, all the places you can like, and share, and comment, and review, etc.

If you have any questions, if you have any recommendations, people who you think should be on the podcast and have conversations about how you can live a happier, healthier life, send those to move@jointhemovementmovement.com. And most importantly, go out, have fun, and live life feet first.

 

 

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