What Sugar Really Does To Your Brain

Do you know what sugar really does to your brain?

Returning to Fat-Burning Man this week is Dr. David Perlmutter, neurologist and author whose groundbreaking books include Brain Maker and The Grain Brain Whole Life Plan.

Dr. Perlmutter is a board-certified neurologist and fellow of the American College of Nutrition specializing in preventative medicine. He has contributed extensively to medical literature, with publications in the Journal of Neurosurgery, Journal of Applied Nutrition, and Archives of Neurology.

You may have seen him on Oprah, Larry King, Dr. Oz, or the Today Show. I’ve been told he never leaves home without fresh avocados and sockeye salmon in the can. He even plays a mean guitar, ladies and gentlemen!

Coming up on the show, you’ll learn:

• How food changes your genetic code
• The effect of food on Alzheimer’s disease
• The science of gratitude and health
• What sugar does to your brain
• And what to do every day to maintain health as you age

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David Perlmutter: From Cutting-Edge To Mainstream

Abel: Some of your ideas might seem a bit “out there,” especially at first. But all of a sudden, science and research is catching up with your work, and you’re getting a lot of traction. Why do you think that is?

Well, that was the goal. You don’t want to write a book about the status quo; you definitely have to push the envelope. And if you’re right, then that will help to move the ball down the field.

Ronald Reagan said the term “status quo” is a Latin word for the mess we’re in, and I agree with that. We’ve got to improve things.

Back when Grain Brain was written, we came out with these “preposterous” ideas that humans would be better off if we cut back on our carbs and sugar and maybe avoided gluten.

And look where we are now. The US dietary guidelines came out and said, as a matter of fact, the biggest threats to our health from a dietary perspective are sugar and carbs, not fat anymore—not even saturated fat anymore. Boy, who knew that?

The next book, Brain Maker, was an early experience in what was going on relating our gut bacteria to our health, and people raised their eyebrows when that book came out as well. And now, if you look at all the research dealing with the microbiome, every day there are 10 new powerful articles that are coming out.

So you’re right, I do try to be a little bit prescient in what I look at, but ultimately the goal is to explore these things in such a way that they will lead to people getting information they can then adopt, and make lifestyle changes that can leverage this leading-edge science, and then turn their lives around and really change their health destiny.

Abel: Even the government is coming around, as it turns out. But the thing that surprised me about that is, when the government does a complete 180 on something like “fat being bad for you,” you might see it in the news for a week or so, and then it fizzles out, and most people don’t wind up hearing about it. It takes a lot of time to kind of undo that damage that’s been done.

No question. This is a terrible pun, but those ideas are ingrained in people. And the fat phobia that really entered our mentality three decades ago, now we’ve learned, based upon a really powerful study appearing in the Journal of the American Medical Association, that the forces behind the vilification of fat were brought to bear by the sugar industry in the late 1960s, trying to find a scapegoat so sugar and carbs would be looked upon as being good for us, and they chose fat. That was front-page New York Times. And I think that move, with its effect on shifting the broad-stroke dietary choices in Western countries, not just America, probably had more effect in terms of mortality than World War I and World War II combined. Because that type of diet paves the way for chronic degenerative conditions: Alzheimer’s, coronary artery disease, cancer, diabetes—which the World Health Organization now ranks as the number one cause of death on the planet.

That’s what that little move by the sugar industry actually ended up doing. And it’s for people like ourselves, these days, to do our very best to right that wrong, light the single candle, not curse the darkness, and really indicate that, by the way, the diet we’ve been eating for over two million years has worked and continues to work, and we’re not going to scientize our food and make us better.

We’ve got to understand that our food choices are interacting at an intimate level with our genome.

That’s been going on a long time. Food is more than macronutrients of fat, carbohydrates, and protein, and the micronutrients of vitamins and minerals. Food is information, and as such, is intimately interacting with our genome moment to moment, causing changes in gene expression, a science that we term “epigenetics.” And these could be detrimental changes toward our health, which we are seeing based on the standard American diet. Or we can amplify health and turn on pathways that reduce inflammation, that augment antioxidant production and enhance detoxification, based on that powerful medium of information called food.

So it’s really a different way of looking at our food, and that even doesn’t begin to touch the notion of food as information for the 100 trillion organisms living within us. They eat what we eat; they make products and metabolize, and that significantly influences our health. So there are a lot of ways that food has really got to be looked upon as much more encompassing in terms of a health-related issue than simply breaking it down to fat, carbs, and protein.

The Power Of Intermittent Fasting

Abel: It gets even more interesting. You recommend an intermittent fasting strategy that might surprise some people—intermittent fasting—and not just the short-term 16-8 fasts like I do, but also 72-hour fasts once a quarter. Tell us more about your take on intermittent fasting.

Fasting is a powerful epigenetic event. @DavidPerlmutter Click To Tweet

In other words, when you have stopped eating, when you’ve cut your calories, you activate some very powerful life-sustaining, life-enhancing gene pathways that code for the very chemicals I talked about. Increased production of antioxidants, increased production of a chemical called BDNF—brain-derived neurotrophic factor—which gives you the growth of new brain cells, and that is by fasting. I really think it is a powerful event for allowing your brain to work better, turning on powerful immune systems.

But also from another perspective, I think fasting is a great way to reconnect with gratitude. Because when you break your fast and you have that meal, you experience gratitude; it runs through your body, the gratitude you have for the food that we have, and the life, and the health that we have. And that’s a good thing on multiple levels. If for purposes of our discussion today, we want to look at it from a health benefit perspective, gratitude in scientific experiments has been shown to change activation of various brain regions, which ultimately code for a healthier brain.

There is intrinsic merit in experiencing and expressing gratitude.

So that’s yet another wonderful benefit of saying, “Today, I’m not going to eat.” The other thing it connects you with is the sense of what is called “hunger.” And I say it that way because most people have not experienced hunger in many, many years. And it’s really an interesting thing to make a connection back to that sense of being hungry, because the answer to being hungry is to actually eat. Who knew?

I think by reestablishing connection with a sense of hunger, we reestablish our ability to know when we’ve eaten enough—satiety, and really listening to our bodies. So it’s really on multiple levels, I think, a great choice.

Now, three days of fasting might be really aggressive for many people, and I understand that. So I am suggesting that maybe on the other side of the scale, a couple of days a week, you just skip breakfast, and don’t eat until the middle of the day. That is a bit of a fast, a 12- to 16-hour fast depending on when you had dinner the night before. But even that will start to stimulate those genes that are life-sustaining.

Abel: I can vouch for the fact that when I started fasting as a practice, my body and mental state started to change, and it was very noticeable. You mentioned that food is information, but also the “lack of food” is information. Exercise is information as well. It seems like your body is always adapting to something, but most of us are adapting to the status quo… and that’s a problem.

Yes. And fasting activates areas of the brain that ultimately define us as being human, like an area… I don’t mean to be too technical, but the prefrontal cortex, where we make a stronger connection through what is called the anterior cingulate, to that part of the brain that defines us as humans, when we fast.

As such, it’s interesting that all major religious practices incorporate a fast as a way of reconnecting with God, whether it’s the fast of Ramadan, or the fast of Yom Kippur, or Jesus fasting for 40 days prior to his public ministry. What an incredible benefit of fasting, and that is: it makes you connect with whatever you choose to believe. So this is a nondenominational plea on my part, believe me.

Abel: There could be red flags for before you start fasting for some people; not everyone wants to just jump right in to involved intermittent fasting. So the idea that you try to push out breakfast to noon once or twice a week is a great way to get started.

I also find that it’s easy to get carried away with anything, so it’s important to be aware of that.

I think you’re a lot like I am in that regard. You probably way overdo it, if you’re like me… If 10 is good, well then, 100 has got to be better.

Abel: Well, you have to find the edges so you can make your way back to the sweet spot.

I think you bring up a good point, and I would like to just amplify that. People should certainly check with their healthcare providers prior to engaging in any type of fast. And the other thing is based on their medications, or underlying medical conditions. Certainly, diabetics would like to know how they’re going to go about that.

But I think in breaking the fast, it is really important to focus on not breaking the fast with a carbohydrate-rich meal. This pretty much will offset the benefits by doing that. If you can break your fast, whether it’s just having that lunchtime meal, or after a day or two with something that’s pretty well based on deriving calories from fat, healthy fat, then it starts to shift your body to a place of relying on fat as a calorie source, as opposed to continually accepting carbohydrates as a fuel. And as such, it will stabilize energy; it’ll help with weight loss by eating more fat. Who knew?

Fat really is perhaps the most powerfully effective fuel from which you can power your brain. So, we’re trying to push the body to a low level of what is called ketosis, and a great way to get jump-started is to engage a fast.

Abel: Ketosis is a hotter and hotter term these days. The word “ketosis” itself freaks out a lot of people. But most people don’t realize that when they wake up in the morning, especially after a somewhat extended fast or if they had early dinner, they’re in a form of mild ketosis. Ketosis, for the human body, is in fact a very recognizable and normal state.

That’s right. And I think you’re probably quoting Gary Taubes when you say that, and you recognize that humans have been in a low state of ketosis as long as we’ve been here. Why? Because we never had carbs.

We weren’t walking through orange groves and picking cartons of orange juice off the tree; they didn’t exist. Our diet was really based upon fat and protein. And fat was a coveted food, because it’s so dense in calories and clearly has other benefits in terms of how it reduces inflammation.

That said, this state of ketosis is one in which our bodies are starting to mobilize fat from our fat storage, in the formation of what are called free fatty acids. They are processed in the liver, undergo a process called beta oxidation, and then these other fats, called ketones are produced—acetoacetate, acetone, and beta-hydroxybutyrate. And I think that most of the attention has been on beta-hydroxybutyrate, which classically is actually not a ketone. There is one for you: by IUPAC definition, beta-hydroxybutyrate is not a ketone, but that’ll be the bonus question on the exam.

When we power our bodies with this beta-hydroxybutyrate, it’s far more efficient. It produces what are called ATP molecules—the currency of energy, if you will—much more efficiently, with less production of damaging free radicals. But more importantly, when we are burning fat as a fuel source, we have a well-regulated steady state of energy provision throughout the course of our day. As opposed to when we start our day with a short stack of pancakes with some syrup on it. The store is going to tell you it’s maple syrup, but you can be sure it’s not—it’s corn syrup with a coloring—and then maybe a glass of orange of juice for yet another 36 grams of carbs. Then our insulin levels skyrocket to deal with that elevation of blood sugar, and as such, insulin comes up, and the next thing you know, your blood sugar is plummeting, and you feel crummy by 10 o’clock in the morning, and you’re seeking out more sugar and carbs. More coffee; a cheese danish at midmorning.

What happens is, ultimately, this insulin activity does more than just deal with blood sugar. Insulin has two major effects, or three, in human physiology. It deals with sugar, by packing it into the cells; it deals with protein synthesis; but most important for our conversation is, insulin is your body’s signal that winter is coming.

Insulin tells your body to make and store fat by activating various enzyme pathways. So the more these insulin surges occur, the fatter you are going to become.

This was a life-sustaining mechanism that allowed us to store calories in the late summer or early fall, when we had a few ripened berries that we would find, and we would store body fat, and we made it through the winter.

Why do you think the bear, for example, is able to make so much body fat? It’s because it’s eating berries all day long, foraging for berries and animal protein as well, and doubles its body fat prior to hibernation. So it was a survival mechanism, and it explains a couple of things. It explains why everybody, including you and I, has a sweet tooth. Can’t deny it.

But it also really very handily explains this incredible epidemic of overweight and obesity that we are seeing, because people are succumbing to the sweet tooth 365 days a year, for a winter that never comes. We also know now, based upon work that’s actually been done in bears, looking at their microbiome, their gut bacteria in the summer, when they’re adding weight, versus the winter when they’re hibernating and they’re using fat they’ve stored to power their bodies through hibernation.

There are dramatic changes in the gut bacteria that correlate with either the weight-gaining state and making fat, or the weight-losing state when you are burning fat as a fuel source. So these are other ideas that I think are really relevant as they relate to this notion of the health benefits of being in a low-grade ketosis, and there are even more that people may not be aware of.

Healing Your Microbiome: The Gut-Brain Connection

Abel: This all seems like we’re getting back to honoring nature’s laws, something humans have ignored for a generation or two.

That’s right. You said earlier that just recently we’ve done a 180—it was your words—in terms of the foods that people are eating. And we’ve done a 180 from having previously done the 180!

So 30 years ago or longer, we were not as bad; we’re eating pretty much along the lines of what we had been eating. Then we did the 180 based upon this notion that fat is terrible. And now we’re doing the other 180, and completing the circle, going back to honoring the natural wild human diet.

Now this is what the Paleo movement is all about; it’s honoring that relationship between food as information and our genome being instructed by that extrinsic environmental influence called food. So this has worked, and it’s worked for a couple of million years. We’ve seen it not work when you look around, and you walk through an airport and see a fair cross-section of America, what people are looking like, and it’s scary for sure.

But again, rather than curse the darkness, light the candle. And here’s what the candle’s going to tell you, and that is getting back to the diet of our ancestors as our salvation. It’s our key to health, not only from a macronutrient perspective in terms of carbs, fat, protein, and micronutrients, but also from the notion of reconnecting to our genes in a positive way.

Then, from the notion of nurturing our gut bacteria that then makes so many metabolic products that have a huge effect on our mood, on our neurotransmitters, our appetite, our levels of immune function and inflammation—so many parameters are mediated by the health of our gut bacteria. Who knew? It’s a bit of a revelation.

How Much Protein Should We Eat?

Abel: It’s beautiful. This is your third time on Fat-Burning Man, and it’s incredible what’s happened since the first, in terms of popular opinion, what people are even entertaining as legitimate ideas now in health and fitness. One example of that, for better or worse, is “Paleo.” The Paleo movement started out very small and niche-y with early adopters, and I think you and I were both in those circles years ago – and we still are – but the movement has expanded enormously.

But now people new to what they think is“Paleo” might be stopping at a fast food restaurant and instead of getting the buns, they’re getting three burger patties… But that is a far cry from what “Paleo” should be, what you recommend, and what I recommend. And on the protein side, that’s where most people get a bit carried away, especially when they first find something like Paleo.

Could you talk about your take on how much protein we should be eating a day?

You bring up a very good point; neither you nor I, nor other advocates, are recommending going literally hog-wild and pounding the plate with protein.

Getting away from this crazy notion of a food pyramid, let’s see what your plate looks like. It’s mostly filled with colorful, nutrient-dense vegetables. Vegetables, fiber-rich vegetables to nurture your gut bacteria, and that’s what we’re just beginning to understand about prebiotic fiber found in these vegetables. Some fat in the form of an oil, butter, olive oil, coconut oil, ghee. And a protein. We specify that this is going to be grass-fed beef, this is going to be wild fish, or pasture-raised chickens.

A lot of people comment in trying to refute what we talk about, by saying, well, look at Dr. Campbell’s work, The China Study, and ask, “Well, what do you think of that?” And I will tell you that I think that was a magnificent work, and his conclusions regarding eating meat at all in terms of cardiovascular disease and colon cancer are exactly on target. Now that may be surprising that I would say that, because we’re saying go ahead and eat meat.

But there’s a far cry between what we are recommending and the type of meat eaten by the people who were looked at in his statistical analysis. By and large, the type of meat that people eat today is powerfully life-threatening, and so that is where his statistics come from, and I think he’s right.

When you’re eating grain-fed, GMO, or glyphosate-sprayed grain given to animals, as well as antibiotics to change their microbiome, this is poison.

You don’t want to eat that cow’s meat, or lamb, or whatever it is, because it will lead to problems just as Dr. Campbell described. So I think when you take a step back and look at this information more specifically, it starts to make sense. Now again, we’re not—and I’m sure you’re not—recommending to people to go and order a plateful of beef, and that’s what your dinner should be. It wouldn’t be the worst thing for you to have the beef or the pork, whatever it is, relegated to being the side dish or even the condiment. That’s what cultures have done traditionally.

So I think we’ve really got to back down and recognize that we’re deriving calories from fat, and to a lesser extent from protein, and to even lesser extent from the carbohydrates that we’re consuming.

First, what we do understand is if you’re going to be eating too much protein, and you are hoping to get in ketosis, it’s not going to work. Because what your body is going to activate is a process called gluco, meaning sugar, neo—new—genesis; meaning your body’s going to make new sugar out of the amino acids that are now so readily available, because you’re eating too much protein (gluconeogenesis).

So there are various formulas to calculate how much protein you need, which is about 0.8 grams of protein per kilogram of ideal body weight. It’s a simple formula (that comes out to about 50-100 grams of protein a day for most people). If you’re weight training, you probably need a little more. If you’re recovering from an injury and you’re lying in a hospital bed all day, maybe you need a little bit less. But I think by and large people are eating too much protein, and I’m grateful for you giving me the opportunity to make that point about what our programs talk about.

It is not about loading up with meat day in and day out. It is not what some people consider to be the Atkins program, where you’re just focused on any kind of meat. You mentioned going to get fast food and getting three meat patties—not that at all. It’s restricting, and being very selective about those choices that you make.

Abel: So the takeaway point is we should be getting better meat, the highest quality meat you can find and afford, and just eat less of it. And then bumping up the veggies, and bumping up the good fats.

That’s right. And I believe in these days of significant stress to our bodies, based upon our changed environment, and our toxic environment, that there is even a place for supplementation of various types, whether it’s probiotics, prebiotic fiber, magnesium, vitamin D, DHA.

I think that in an ideal world, which would be probably greater than 10,000 years ago, those things might not have been necessary. We wouldn’t need vitamin D if we were all outside, no clothes on, walking around in the sunshine all day long. Well, that’s not what we do.

So, we need magnesium, because these vegetables that we are eating are devoid of magnesium now, because where will they get it from? The soil doesn’t contain many trace minerals anymore, and magnesium is critically important, perhaps one of the most important minerals that we can get. DHA that you get from krill oil or fish oil is so fundamentally important for the brain, and I think there is now great science indicating that both prebiotic fibers supplementation, and even taking a really powerful probiotic, makes sense. And mostly because of its ability to reduce that powerful mechanism that underlies all of our chronic degenerative conditions, and that is inflammation.

Abel: Let’s raise the stakes a little bit, because people might be thinking, “Maybe I should lose a few pounds…” But no, you could actually lose your brain; you could lose who you are. You could lose your life.

That’s right. And that is the purpose, really, of my new book. Grain Brain and Brain Maker really were more focused on the why. What is the science behind why we say little carbs and higher fat? What is the science that begins to connect us to the health of our microbiome? And the new book is much more about how. How do you implement now? What do you do with this information in terms of your choices for exercise, diet, how you sleep, how you express gratitude? Medications that you might reconsider taking once you understand what they are doing to you, supplements that are, in my opinion, important for you based upon what our needs are.

But it’s much more about that; it’s about how you really do this day in and day out. And written from my perspective, as a now 61-year-old individual, who is at risk for every disease like everybody else, and probably at increased risk for Alzheimer’s, because my father died of that disease.

I wrote this book more from my perspective about, “Hey! What is it like to live this life, where you know you’re not likely going to get Alzheimer’s, though you may have inherited an increased risk? How do you offset a genetic predisposition by making lifestyle changes?”

It’s a different perspective this time around. And I just recorded a new public television program that’ll air pretty soon, and it is really kind of focused on this as well. It’s really me just being as transparent as I can: here I am, judge me if you wish. This is what I’ve learned, this is how I do it, and what my experiences have been that have really kind of enhanced my dedication to this program.

Abel: What are early warnings signs of mental dysfunction so you can nip these health issues in the bud?

People call these events “senior moments,” to make light of them. It’s going to lead people—I know this is why you asked the question—to not take them as seriously. But when you’re having to run the list of your children’s names until you finally got the right one, and stop on that name, and that may include the dog. Going into a room and not remembering why you did so. Maybe, I guess, it’s acceptable to from time to time forget the WiFi code if you haven’t ever reset and it’s about 15 characters long. I guess we can let that one go.

But certainly things more importantly, like getting lost, forgetting where you keep putting things, and it’s getting worse; these are all not to be laughed at and looked upon as being “senior moments.”

The big elephant in the room here that we haven’t mentioned, of course, is that these are harbingers for dementia. And the most common form of dementia is senile dementia of the Alzheimer’s type, so Alzheimer’s disease. Are you at risk for that? Well, if you live to be age 85, your risk is 50/50. That becomes epidemic. The 85-year-old and older group is the largest group in terms of the expansion or increase in our population; they’re growing much more quickly than other age groups. So it’s a huge issue.

There are 5.4 million Americans who already have been given the diagnosis, and about 47 million people worldwide. And this is by and large a preventable disease.

Just so there’s no misunderstanding, Alzheimer’s is by and large preventable. @DavidPerlmutter Click To Tweet

Moreover, it is a disease for which we have no meaningful treatment at all whatsoever, Abel James, as we have this conversation. We read all the literature and the news about all of this new discovery, and this company is making this drug and they hope it’s going to work. That hasn’t happened, and it’s not going to happen any time soon.

John Kennedy said, “The time to fix the roof is when the sun is shining.” And I think now we understand, for example, that simple aerobic exercise powerfully augments the growth of new brain cells, and in a study recently published at UCLA, has been shown to be associated with a 50% reduced risk for Alzheimer’s. That means you’ve got to go out and buy a very expensive piece of equipment called a pair of sneakers. And that is your medicine; that is now demonstrated to be associated with a 50% reduced risk for a disease for which there is no treatment.

The other really important thing to consider is that if you become a type 2 diabetic, you have likely quadrupled your risk for Alzheimer’s.

So all the talk about diabetes is interesting; it goes along with the obesity conversation, changes in the microbiome, etcetera. But the answer is not to treat your blood sugar by taking a medication. That may happen. But the answer to our discussion is to prevent diabetes in the first place, because type 2 diabetes is by and large a choice. It is a lifestyle choice, meaning that if you become a type 2 diabetic, it is based upon your lifestyle choices. You have chosen to quadruple your risk for Alzheimer’s disease.

Now I don’t want to sound mean and aggressive, but I’m the guy who receives these patients now who are having the very complaints that you’ve just mentioned. And truthfully, there are things we can do, but if we can keep people healthy cognitively at the beginning, it’s going to go a long way. It’s been estimated that there may be as many as a 100 million Americans that are pre-diabetic, and that’s a very large statistic, meaning that’s almost a third of our population. It’s scary. But my concern is, of course, that it relates to renal disease and coronary artery disease. Cancer as well, but also Alzheimer’s. So we’ve got to pay strict attention to that.

How To Prevent “Aging Diseases”

Abel: And we need to remind ourselves of that, because there’s such a temptation to be afraid of sharks, and other silly concepts that are more in tune with with our primal instincts. But those looming, dark fears of something that might happen later on in life, they’re hard to conceptualize for most people. Is there anything else you can do, or people can do at home who are listening right now, to connect those dots? To make sure that when the rubber meets the road, when you’re making your plate, when you’re putting on your sneakers, you’re doing the right thing?

Well, let me just emphasize, then, one more point, and that is if you live to be age 85, you flip a coin to determine if that’s going to be you or not. If you end up in the doctor’s office and you say to her or him, “I’m not as sharp as I used to be, my memory is failing,” there is nothing that can be done for you at that point in mainstream medicine. I wish there were. I would have used medicines with my father had they been available. They are not even available now.

So the plea is that it’s coming, we’re all getting older, and our risk for these issues is increasing. And so prevention is the ultimate principle of wisdom.

To cure a disease after it has manifested is like digging a well when one feels thirsty, or forging weapons when the war has already begun.

That comes to us from the Neijing, the Yellow Emperor, 400 BC. So that’s ancient wisdom, that we’ve got to emphasize prevention in keeping people healthy right now. And it even goes beyond reducing our risk for these potentially devastating conditions. It also speaks to the notion of enhancing brain function today, making your brain work better and sharper, and more efficiently, so we can be more successful at whatever it is we want to do.

No matter what you do in life, you’ve got to have a pretty sharp computer upstairs, or you won’t be as productive and effective. No matter what job you have, if your brain’s working better, or even beyond your job, however you choose to enjoy your life. If you can enhance your RAM capacity of your laptop in your brain, then life is going to be a better place for you, better experience for you. And at the same time you’re going to reduce your risk for Alzheimer’s, which is such a devastating situation, and not just for the patient.

Frankly, the patient is probably the least affected in terms of who gets involved with this emotionally. I’ve been there. It’s the family, it’s the loved ones who are just devastated. And then they want to know… Day in and day out they ask me, “Doc, I don’t want to end up like Mom or Dad. What should I be doing?”

Abel: There’s another piece of all this that you experienced firsthand, and that’s stress, the lifestyle factor everyone wants to glaze over. Stress and sleep are huge wins if you can dial them in, but it takes effort and discipline to keep your eye on the ball.

Stress: You might be thinking about that a bit differently now than in years past, because you’re not only type A, but you’re also a doctor and a super high achiever. You want to help the world, and constantly work as hard as you can. But being truly healthy means tapping the brakes every once in awhile too.

Yeah, and I guess I am type A. You said that, don’t think I didn’t hear it, but I guess I am.

You’re right, stress is a major factor. Especially long-term, ongoing stress changes the gut bacteria, increases permeability of the gut lining leading to increased inflammation. And that elevated cortisol is very damaging to your brain’s memory center. I generally live a very low-stress life; I’m real careful with myself. But at times things occur that you can’t necessarily control. And as I talked about in the book, I had to deal with the loss of a friend over about a 12-hour period; he had a sudden hemorrhage in his brain. And during those 12 hours, while I was waiting for all the family members to arrive in the intensive care unit, I was the neurologist. I was not the best friend.

This is a man who married my wife and me. He was the godfather of our daughter, a very, very close individual to us. And to have to extubate him, take him off life support at midnight, and then explain to the family that he had gone, it was very, very tough for me. As a doctor I was able to do that for years and years, but this was a different scenario.

So following that event, the next day I did not feel well. That night, I felt very, very sick, probably sicker than I’ve ever felt in my life, and in every way, top and bottom. So the next day, I got a phone call from his wife, saying, “Can you collect up some pictures and video of Uncle Mike?” That’s what we called him. For a memorial service.

I went on the computer, and I booted up a video of our band playing. We were doing a benefit concert, and there he was singing. And I saw that, and I had to lie down on the couch, and my wife came in and I must have looked a sight, as they say. And she said, “I’m going to take you to the hospital,” which, don’t ever say that to me, because I will never, ever go to a hospital. I had a fish hook in the back of my head, and I said, “I’ll get it out with a pair of needle-nose pliers.” Anyway, she said, “I’m taking you to the hospital,” and I said, “No, you’re not.” And she thought I was being stubborn. I said, “You need to call an ambulance right now.”

That’s how I felt, and that’s not who I am. And the ambulance picked me up, and I had a heart rate of over 180 in atrial fibrillation. And they blasted me with medicines in the intensive care unit and they couldn’t break it, and they’re charging up the paddles to shock my heart back into rhythm. And I’m a healthy guy; it was a bit of a shock what stress can do to you.

But I have to admit that after everybody had left the ICU, and I was just one-on-one with the nurse and he was explaining his life, I felt this sudden wave of gratitude to this person, a complete stranger, just for the care that he was rendering for me. I had this love for him. And at that moment this wave passed over me, and my heart rhythm immediately converted right back to normal rhythm, but the rate was still a little bit elevated. And throughout the course of the night my rate got lower and lower, and I started to say, “My heart rate’s going pretty low; you’ve got to get easier on that medication, because I’m a runner.” And finally I dozed off, and when I woke up I looked over at the monitor, and I had flatlined. I had no heartbeat, which is kind of a strange place to be. And I closed my eyes, thinking I had to be dreaming, but I looked over at the monitor again and again, no heartbeat. So I said, “Well, I guess this is when I’m supposed to float over the bed,” and all these things.

But actually what I did was, I traced the EKG leads and found that one had popped off my chest. I connected it back up, and of course my heartbeat was fine. Then I had a full workup, stress echo; they took me up to 180 on the treadmill, and the guy said, “Oh my gosh, you’re like 16 years old.” So I was fine.

Again, this book—that story is in my new book, because I think it’s really important. As you and I discussed before we went on to record this today, people recognize that it’s one thing to stand on high and give advice, but it’s certainly quite another to be transparent, and be on the same side as everybody else. And that’s what this is about, that I’m learning as much as I can, and then sharing as much as I can, from the perspective of being on the same side of this as everybody else. I think it feels really good for me to be speaking in this way.

Abel: We’re all in this together. And at some point we need all hands on deck. I think we’re getting to that point.

If you could clarify a little bit, the moment that something changed… It sounds like when you were talking to the person who was attending to you in the hospital, you were able to let go of something. All of us have gone through tragedy, trauma, or grief. Are there any words of wisdom as a practitioner and patient you could offer to help others get out of that state?

Well, just to go back to that moment of letting go. Many people, including my wife, have told me that what I was letting go of at that moment, was letting go of Mike, and letting him go, that I had held onto him: “My best friend—I will do anything to keep you, and keep you safe.” And I needed to let go of him. The whole family was processing the fact that he had died, and I was acting as the neurologist, going through the steps that I should go through. And I had not processed the fact that he had gone.

That may well have been what happened to me at about 9:30 that night, that I finally relinquished holding on to my best friend, and letting it go. Then the manifestation was my heart rate saying, “Okay, we’re back to where we used to be. You did what you needed to do.”

So I think that it’s maybe a lesson for others. That’s why I put it in my book; I’m hoping it’s a lesson for others. About letting go of things that are so difficult for us, and moving on, with love in our hearts that we did the best we could, in whatever the situation was, whether it’s a marital relationship, or something that we did that wasn’t what we wanted to have done. Let it go, and realize that we’re all human, and move forward. It was a very good lesson for me.

So again, I write this book now from the perspective of the lessons I’ve learned, but the lessons that I continue to learn day in and day out, being human, looked at through the lens of the science that formed the backbone of my previous books. People get that, they understand… the low-carb, the gluten, the microbiome, the importance of healthy fats, what good bacteria do for us.

Alright, now we look at that information, and we leverage it into a plan. But that plan also includes exercise, it includes sleep, and it includes the powerful effects on your health of expressing gratitude. Gratitude is not looked upon as being something you would find in a health-related or a medical book. But hey, that’s who I am now, and that’s why we included it, because it’s really one of the four pillars, in my opinion.

Abel: I want to make sure that we mention one beautiful thing that I found in your book, Dr. Perlmutter. You called it “morning quotes” that you read with your wife. Could you explain that practice, why you do it, and maybe share a quote that stands out to you recently?

Sure. We, in the morning, have a reading. Oftentimes it’s a much more lengthy inspirational reading, from all kinds of sources. And again, this is nondenominational. It might be from the Bible, it might be from Helen Keller, it might be from Steve Martin; it’s as diverse as can be. And then we like to look at a sentence or two from people that then we will deal with, or ruminate over during the course of the day, and whether it deals with gratitude, or kindness, or acceptance. That’s why I actually included that in the book as well.

Obviously there’s a section on exercise. And then I went to a gym, Equinox Gym in New York, and recorded myself doing those exercises and posted them online, showing you, hey, there I am doing the best I can. I am not competing in the Olympics; neither are you, or you might be. But this is how I do it. This is how I think is an important way to do a situp, to strengthen your upper body, your legs, etcetera. So, it’s really all about what I found works for me, and is working for me. Hopefully in three years, when Abel James has me back on the show, we will again see what dedication to these principles has done for me, and then your viewers can feel whether that is right for them or not.

Abel: Well, Dr. Perlmutter, you do terrific work. I was very much encouraged reading your new book, because it’s right on point. I think it’s what people need to read right now. So could you tell the folks who are listening a little bit more about your work and where to find you?

The new book is called The Grain Brain Whole Life Plan. I also post every day on Facebook.

We have a very, very robust website, which is highly searchable, with the actual full PDF articles of many of the scientific studies that we quote. And we have focus areas for things like autism and Alzheimer’s. In these areas, we’ve collected the various videos that I’ve done, interviews, as well as blogs I’ve written, as well as research papers. So it’s all about information. It’s there for everybody.

Spend a lot of time on the site, get as much as information as you want. My blogs are free for anyone to use and copy; do whatever you want with them. It works for me, that’s the mission here.

Public television, I found, is a great avenue for me in terms of being able to spend an hour with people, or longer, and get my message out. That’s where you’ll find me. And of course, Abel James always does a great job, so thank you for that.

You can also find Dr. Perlmutter on Twitter @DavidPerlmutter and Instagram @davidperlmutter.

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