Dr David Perlmutter: Grain Brain, Eating Fat Makes You Smart, and Why (Brain) Size Matters

Dr. David Perlmutter is a board-certified neurologist and the author of the terrifically titled #1 New York Times bestseller, Grain Brain: The Surprising Truth about Wheat, Carbs, and Sugar, Your Brain’s Silent Killers.

Dr. Perlmutter is going to tell you 2 things you can do right now to actually regrow your own brain cells. Pretty cool.

On the show we chat about:

• The surprising reason you should be eating more cholesterol.
• How eating fat makes you smart.
• The brain-building effects of musical training.
• The 2 things you can do right now to literally regrow your brain.
• And much more…

Alright, let’s go hang out with Dr David Perlmutter.

 
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Dr. David Perlmutter: Regrowing Brain Cells & Changing Your Genetic Expression

Abel: I’m so excited you’re here, and I’m even more excited about the guitar behind you.  

Right before this call we were talking about what kind of music each one of us plays and I think after we hang up this call, we’re going to jam for bit.

Your book, Grain Brain, is brilliant. A lot of my listeners have actually asked for you by name. And they’re just like, “When is he going to come on the show?” So I’m really glad, thank you so much for taking the time, I know you’re busy.

I’m delighted, absolutely.

Abel: Let’s talk about how there’s tremendous power in what you have to say and in the sense that you can literally change the way that your brain works, based upon what you eat.

So can you just riff on that a little bit?

The brain is a very energy-dependent organ.

25% of all your basal energy expenditure when you’re at rest is consumed by this highly metabolic organ called your brain. And that’s actually a good thing.

I think as we get started, we should ask, what is the fuel that we’re using to power the brain?

We all grew up with this notion in healthcare that the brain loves glucose and requires glucose to be powered for its energy demand.

And the reality is, nothing is further from the truth.

The brain actually thrives when it is shifted to burning fat, a process called keto adaptation, and it works beautifully. To the extent that even now, in Alzheimer’s disease, it’s primarily an energy utilization deficiency disease.

In the United States, the FDA has approved a medical food which basically fills in the gaps, powers the brain with ketones, with fats, and that’s available now by prescription.

So it looks like the pharmaceutical industry has jumped on board in finally recognizing that the brain really is powered beautifully, far more efficiently, and with a reduced rate of free radical production when it utilizes primarily fat as a fuel source, as opposed to burning carbohydrates and specifically glucose.

The idea that the brain requires glucose, meaning that we require carbohydrate in our diet, is really felonious.

Abel: There seems to be a growing acceptance for that fact, especially in certain circles. When did that really start to come out in the literature?

Well, in the literature probably at least 15 years ago. By researchers like Dr. Mark Mattson and others, who have recognized that in fact fat is a super fuel for the brain.

Fat is super fuel for the brain. @davidperlmutter Share on X

Things like beta-hydroxybutyrate, which is formed through the process of beta oxidation of fatty acids in the liver, provides an incredibly powerful fuel source for the brain.

To the extent that the brain functions far more efficiently and even allows its mitochondria to replicate new and better mitochondria to share the load of energy production. It is really an exciting new paradigm, again, in the past decade or so.

But beyond that, when you’re on this type of diet, a ketogenic diet, some other very important things happen.

Beyond just allowing the mitochondria to produce energy, ATP molecules, more efficiently, this ketogenic diet leads to what we call mitochondrial biogenesis, meaning the growth of new mitochondria

And who couldn’t use more mitochondria to carry the load?

But in addition, we now understand that we’ve really got to nurture our mitochondria.

The mitochondria, aside from their role in energy purveyance for the brain cells, actually function to dictate, in some regard, the function of the nuclear DNA. Not the mitochondrial DNA, but the mitochondria influence of the expression of the DNA found in the cells’ nucleus.

And specifically the mitochondria are involved in the activity of the DNA that dictates, frankly, whether the cell will live or die.

When the mitochondria are healthy, then the cell does not undergo a process called apoptosis.

When mitochondria are challenged and there is deficiency of energy production, then the mitochondria signal the genome to produce certain enzymes, ultimately activating a pathway using what are called the caspase enzymes. And that tells the cell that it needs to commit suicide, basically, it leads to cell death.

And you really don’t want to have cell death happening in your brain, losing brain cells.

Lord knows, going through our teens and our 20’s, we did enough to kill our brain cells that we don’t need to keep doing that.

Fortunately, we can grow back new brain cells, which brings me to another point and that is, when you’re ketotic and producing that environment, it also activates the genes that code for the production of brain-derived neurotrophic factor or BDNF.

And I’d really like your viewers and listeners to look up BDNF. That is really like growth hormone for the brain. It strengthens neurons, it makes them resilient, it makes them resistant to damage.

And perhaps most importantly, BDNF triggers the brain to actually grow new brain cells, a process called neurogenesis.

Beyond that, the ketogenic diet reduces the production of inflammatory mediators, with the recognition that inflammation is really the cornerstone of some of our most dreaded neurologic conditions including Alzheimer’s, multiple sclerosis, Parkinson’s, etcetera.

The shift of nutrition of the brain away from a carbohydrate-based protocol to one that embraces the beauty of fat is really a revolutionary new paradigm.

It's only the type of diet humans have been eating for a couple of million years, so it's really brand new. Share on X

Abel: Ha! That’s so interesting.

That’s the short answer to your question.

The Diet-Change Conspiracy: Why we Switched from Fat to Carbs

Abel: So the way that I understand it then, is we’ve been following the advice that we need to eat lots of glucose to fuel our brains, which is the exact opposite of what we should’ve been doing all along.

Here we are, from 99.9% of our time on this planet, we’ve been on a gluten-free, low-carb, high-fat diet. And now all of a sudden since 1992, the government says we should all be cutting out fat and eating more carbs.

Who gave us that information? It really came from the US Department of Agriculture whose job it is to sell more grain and corn, where high fructose corn syrup comes from. It’s been the death of us since 1992.

Ten years later, the rates of diabetes in America went up three-fold when we cut out fat and substituted these ridiculous carbohydrates for the healthful, wonderful fats that we have been consuming for a couple of million years. Now we’re going to do better because the US Department of Agriculture tells us so?

And then we see what the health consequences are.

And the reason I stress the diabetes part, is because when you become a type 2 diabetic, which is diet-induced diabetes, you’ve doubled your risk for becoming an Alzheimer’s patient, a disease for which there is no treatment.

Becoming an Alzheimer’s patient, then, being related to diabetes, being related to your diet, therefore draws this connection between the food that you eat and risk for becoming demented. And that’s a very powerful connection.

When you’ become a type two diabetic you’ve doubled your risk for getting Alzheimer’s. Share on X

How to Eat a Fat-Adapted Diet

Abel: When people hear about this, it’s one thing to understand it intellectually, but what does it look like?

Could you follow the path of someone who eats in a fat-adapted state over the course of their lifetime, compared to someone who eats basically, fueling their brain with carbs over the course of their lifetime?

If you want to see what it looks like to fuel your brain with carbs, or fuel your entire body with carbohydrates, you have to go no further than your nearest airport.

So the next time you take a trip and you’re waiting for your flight, just watch the people passing by and they always seem to pass by under a sign that says, “Terminal” at the airport.

And that to me really just characterizes so well Americans in awful condition, awful shape. The physiology of Americans is absolutely dreadful.

We’re being crippled economically by the healthcare dollars that are being expended for the diseases that are caused by our maladaptive dietary choices, that are coming from what we are being told to eat.

There’s this big debate right now about the healthcare initiative, the Affordable Care Act.

And the reality is that, as far as being a healthcare initiative, it has absolutely nothing to do with health. It’s all about what to do when people get sick.

Will they have insurance that will cover their illnesses and their hospitalizations, etcetera?

Now, that’s very honorable and very meaningful, but the point is, it does nothing to keep you healthy in the first place.

And that starts with the food that you eat, and the idea that your food can influence your health, that’s brand new as well. That was just published by Dr. Hippocrates just 2,000 years ago.

In the PBS special, I mentioned before we did this interview, that I’ve been going around the country doing a PBS special.

And I start off that special with a picture of my dog, and people are going, “Is this random? Where did this come from?”

And I explain that our dog was sick. He was losing his fur, we took him to the vet. And the first question that she asked us was, “What are you feeding your dog?”

And we responded, no big deal. And I was thinking two things…

Number one, if that was the first question your doctor were to ask you, you’d be surprised.

Number two, you’d be probably offended, “I just want you to give me a prescription for something so I can go on.”

And the other thing is we totally think that’s cool with respect to our pets. The first question the vet says, “What are you feeding your animal?” We answer because obviously it’s very, very important.

Why is it not important for you and me?

Abel: Isn’t that such an interesting disconnect?

And a similar thing happens when people will go out and walk their dog, but they won’t go outside at all if they don’t have a dog.

Right.

And we have tried to scientize our food, as if science is going to somehow make it better.

That infant formula will somehow be better than breast milk. That dietary supplements are somehow going to take the place of what we would normally have gotten from food.

And the reality is, that’s just absolute fantasy.

Your food matters more than anything you can do with respect to your health, moment to moment.

And your food is hugely influential in changing, for the better hopefully, the way that your genes express themselves.

Back when I was in medical school, we were told that our DNA was hardwired and it pretty well described who and what we would be, and it was a one-way street. DNA to protein to physiology, basically.

We now understand quite readily that the genes that we contain, our genome, our book of life, is influenced moment to moment by our specific lifestyle choices, most importantly food.

The food that we choose to consume dramatically modifies our gene expression.

And more than 70% of our genes that have a role to play in health and longevity are under our direct control based upon our food and lifestyle choices including exercise, and sleep, and the emotional experiences that we choose to experience or not.

Abel: So what we do about this?

Because my story, and a lot of my listeners are familiar with this, but when I went into the doctor in my early 20s, I was rapidly gaining weight, getting high blood pressure, my thyroid was crapping out and I had a lot of issues that were just completely unacceptable for someone who was my age.

And looking to be healthy too, right?

Abel: Oh, yes, I was trying with all of my heart to be healthy.

And it was really interesting because the things that I was doing, following my doctor’s advice to be healthy, were in fact the things that were making me sick in a lot of these cases.

The word “doctor” doesn’t mean healer. The word “doctor” actually means teacher, and that’s the mission here. The mission is to get out.

As I wrote in Grain Brain, that book is the essence of the most well-respected peer-reviewed journal citations that are available as we have this conversation.

It’s not to say, “Well, we should all be on a paleo diet because that’s what our genome evolved to accept.”

That’s great, that’s one absolute important leg of the stool.

The second leg of the three-legged stool is that’s where current science is in terms of its recommendation.

And the third leg of that stool for me is, what do I see in my clinical practice every single day in terms of making these changes in people’s science, and then seeing the results.

Seeing things like various illnesses and problems that have been affecting people for 10, 20, 30 years suddenly go away with nothing more than a simple dietary change.

The other metric I use is social media. People go to my Facebook site and are writing these incredible stories of success.

They’re cognitively improved, memory is better, that their joint pain is going away, their skin is improved, and by the way, losing 20, 30 pounds and not even trying, based upon finally giving back to your body what it has been so desperate for all of these years.

Abel: I think a lot of people can relate to being in that position, where they go into the doctor, things are falling apart, they’re expecting a prescription.

I remember, when I was there, it was basically this conversation that went something like, “Well, I’m running 30-plus miles a week. I’m eating almost zero dietary cholesterol. I’m basically starving myself.”

And they would say, “Well, if you’re putting on weight, your blood pressure’s getting worse, your heart’s getting worse, all of these numbers are bad, you’re not doing it enough. You need to do more running. You need to eat less fat. You need to eat more carbs, more whole grains.”

And it took literally my house burning down for me to re-evaluate my whole situation and what advice I was taking.

But it occurred to me that that’s absolute lunacy, what I was doing. And the fact that basically every time I went in there, there was another prescription or two that I was supposed to be filling out.

It just breaks your heart, as a physician, to see what is the play of that recommendation.

And what is really heart-wrenching is it’s still being told to patients.

They’re being told, “You’ve just got to cut your dietary fat and keep cutting your dietary fat”.

I think Dr Dean Ornish is a wonderful man, done some great work, but his diet doesn’t make sense. In fact, there was a head-to-head comparison. There was a study published in the Journal of the American Medical Association called the A to Z study that was published in 2007.

The A stood for Atkins, T for Traditional, O for Ornish, and Z was Zone. Basically, the big outliers here were the Atkins diet on one side being very low carb and high fat, and the Ornish program on the other side being very low fat and high in carb.

And this was an interventional trial in women.

And it demonstrated that, in fact, those women eating more fat lost more weight, had a better lipid profile across the board, lower triglycerides, better ratios.

And this was also confirmed in the New England Journal of Medicine in July of 2008, in a trial called Weight Loss with a Low Carbohydrate Mediterranean or Low-fat Diet.

Across the board, who lost the most weight? Those people eating the most fat.

Who kept off the most weight? Those people eating the most fat.

Who had better insulin response? Who had better control of blood pressure? The people eating the most fat.

Who actually had better lipid profiles across the board? Who had lower what’s called C-reactive protein, lower markers of inflammation that relate not just to heart attack risk but also to Alzheimer’s risk? Those people ate high levels of fat and low levels of carbohydrates.

In April of this year, published in the same journal, the New England Journal of Medicine, was a comparison interventional trial looking at the standard American diet compared to the Mediterranean diet compared to the third group, which was the Mediterranean diet with a lot more fat added.

And the endpoints of the trial, it’s actually very interesting, were one of three endpoints. Either you had a stroke, a heart attack, or you were dead. And those are the endpoints.

And what was published in the spring of 2013 was the fact that they had to stop the trial because the people eating the most fat had an incredible 30% reduction of the endpoints of stroke, heart attack or death.

They had to stop the trial because it wasn’t fair to the people participating in the trial who were on the other two diets.

They said, “Look, these results are so astounding, here’s what the results are. Those eating the most fat are improving, doing so much better. We can’t ethically continue this study.”

So that’s the science.

And whether people’s mainstream doctors want to embrace it or not, people tend to be down on what they’re not up on.

And again, this is where our current level of science is in the field of nutritional influences on whole body health, and specifically as it relates to brain health.

In the Journal of Alzheimer’s Disease, in January of 2012, there was a fascinating report published by the Mayo Clinic, very well-respected, and they determined that those individuals consuming a high carb diet had about an 89% increase for developing dementia; those elderly individuals eating the most fat had a 44% reduction in becoming demented.

Abel: Wow!

Those having the highest consumption of the dreaded saturated fat had about a 35% reduction in becoming demented.

So, when we recognize that saturated fat and total fat is so desperately important for the brain, it really turns upside down, literally, these recommendations that we’ve been hearing for so long.

Recommendations that were really codified in 1992 in terms of governmental recommendations followed two years later by the American Heart Association and the American Diabetes Association telling us, “Cut out the fat and eat more carbs.”

And the word “bogus” is not a scientific term, but to me, that’s what comes to mind.

Because it’s not, number one, what we’ve ever done historically, and that matters, and number two, it’s not what the science is recommending.

And these are the references that I’ve just quoted to you. This is our most well-respected literature that’s telling us, “Eat more fat and cut down on the brain-damaging, heart-damaging, immune-damaging, cancer-risk-increasing carbohydrates.”

Abel: You’re so eloquent and you know your stuff. Why don’t people know this?

I hear this so often for people who don’t really drink our Kool-Aid, who say, “Well there’s no science that supports it, or I haven’t seen science that supports a low-carb diet, Paleo diet, ancestral diet, high-fat diet or anything else like that. That’s not what the science says.”

How can they get away with saying that?

Oh, you can say whatever you want.

Abel: I guess that’s true.

My book is on Amazon and there are comments also on Amazon and people say exactly that. “Oh, the brain needs glucose, and the science is clear that you should be on low-fat diet.”

Well, that’s not what the science says. And this is the most well-respected peer reviewed literature telling us that this matters a whole heck of a lot.

A wonderful article appeared in the New England Journal of Medicine on August 8th, 2013, if you want to have people look it up, and it was a measurement of individuals who came into the study.

They measured their fasting blood sugar. They followed them over a number of years to determine who became demented.

“What’s your fasting blood sugar? Who became demented?”

They found a perfect correlation between fasting blood sugar and risk for dementia.

The higher the fasting blood sugar, the greater your risk for dementia. @DavidPerlmutter Share on X

But what was astounding was the fact that there was already a substantial increased risk of dementia even at blood sugar levels of 105 and 110…

Where your doctor is going to say, “Hey that’s totally fine, don’t worry about it. You’re not diabetic.”

So these were blood sugar levels way below the diabetes range that are already correlated with risk for developing dementia.

So I think that we have to ask ourselves, “What is not normal in terms of what we tell our patients and strive for what is normal? What is ideal? What is the best recommendation that we can make to our patients, and that has absolutely nothing to do with a blood sugar of 100 to 105, 110?”

That isn’t good enough. While that is normal, normal means average. That’s nowhere near ideal. We’ve got to drive the blood sugar lower.

Two months ago in October, in the Journal of Neurology, put out by the American Academy of Neurology, that’s the most well-respected neurology journal perhaps on the planet, was a fascinating article that demonstrated right off the bat, memory function is directly related to blood sugar levels.

In other words, your memory function declines as your blood sugar rises. And these are low levels, again, 105, 110.

And your memory center, your hippocampus shrinks in direct proportion to your blood sugar, even at 105.

Now, let me just go on because I want to finish right here.

Abel: I’m having so much fun right now.

A lot of people measure their average blood sugar by looking at a blood test called A1C, or hemoglobin A1C.

If you’re diabetic, obviously you have your A1C measured every three or four months because your doctor will tell you that’s an average blood sugar measurement, and indeed it is.

But we’ve got to understand that there is a direct correlation between that A1C level and the annual rate at which your brain will shrink. The higher the A1C, the more rapidly your brain shrinks.

And you can talk about other body parts, but when it comes to your brain, size does matter.

You don't want your brain to shrink. @DavidPerlmutterMD Share on X

And therefore, you’ve got to control your A1C, the binding of sugar to this protein hemoglobin.

And whether you have diabetes or not, any doctor can order this A1C level. In my book, Grain Brain, on page 117, is a very interesting graph that demonstrates this exact correlation between the degree of annual brain shrinkage and your A1C.

But what is so compelling is that even at an A1C level of 5.8 where your doctor is going to say, “Hey, that’s totally in the normal range,” you’re already in the second highest category for shrinkage of your brain.

Abel: Wow.

And again, that was published in the Journal of Neurology, one of the most well-respected peer-reviewed medical journals dealing with brain disease.

So there’s no quick fix for this.

There’s no drug to fix your brain shrinkage, or to bring you back your cognitive function when you’re starting to become forgetful. You walk into a room, you don’t remember why, you can’t find your keys, you don’t remember your Wi-Fi code and your [birthday] and your children, or your parents, that would be worse.

But the point is, we kind of laugh those events off as being senior moments and being acceptable, and the reality is, they are very serious. These events are harbingers to upcoming full-blown dementia.

So it’s not to be taken lightly. These things are reversible.

You can grow back new brain cells in the brain’s memory center called the hippocampus, and those techniques are non-pharmaceutical.

And I’m sure we’ll talk about that at some point.

Abel: Can we talk about it right now?

Okay.

Abel: Because it’s very clear that we’re all, or most of us anyway, especially in America and countries that like like America—we’re in trouble.

So this is the graph that correlates annual brain shrinkage to the hemoglobin A1C.

That’s a laboratory study that every doctor can perform, and this came from the Journal of Neurology. I put it in my book Grain Brain because that’s where we are in terms of current science.

But here’s what’s so darn empowering: You can reverse that process and you can grow back your hippocampus.

You can regenerate your memory function by growing back the cells in your hippocampus. @davidperlmuttermd Share on X

A process called neurogenesis, which is occurring in you and me right this moment.

If you’re 80 years of age or 90 years of age, it’s still happening. And you can enhance that process of the regrowth of brain cells by getting aerobic exercise and taking a nutritional supplement that has in it the Omega-3 called DHA.

To be clear, I didn’t say DHEA, I’m talking about DHA, docosahexaenoic acid. And if you choose not to take it as a supplement, then you’ll eat wild fish, fatty fish, not farm-raised, and that triggers your DNA to make a chemical that will then turn on the growth of brain cells.

And that’s pretty darn exciting.

Does Eating Fish Make You Smarter?

Abel: So does that make you smarter? What does that do?

I’m not sure… We have to define “smart”.

Abel: Right.

What has been demonstrated in a study from the University of Pittsburgh, what to do is actually regrow the hippocampus.

Three things were studied in the one particular study that I mentioned.

1. Number one was it increased the level of brain-derived neurotrophic factor, which is the growth hormone for the brain. This is just from exercise, by the way.
2. Number two, it improved memory function in one year.
3. And number three, it led to an increased size of the hippocampus as measured on a special type of MRI scan.

These individuals who participated in the trial, they had a brain MRI scan at the beginning of the trial.

One group was told to stretch each day, the other group was given aerobic exercise.

The group that stretched, I’m not saying there’s anything wrong with yoga and stretching, it’s wonderful, but the group that did not do aerobics and simply stretched had a decline in memory function, had shrinkage of their brain’s memory center, which is kind of typical.

As opposed to the group that did the aerobics, in which memory function actually improved, and the hippocampus increased in size.

We’re all under this notion that we get our 100 billion brain cells—or whatever that finite number of brain cells is—by the time we are 18 or 19, and that from that point on, it’s a…

Abel: That wasn’t my peak.

Yeah, and then every time you drink a beer, well that’s 20,000 brain cells and you’re just on the skids.

Reality is, you don’t have to accept that. You can turn that around and grow back new brain cells.

So you can expand your memory function and actually strengthen your brain’s memory center, the hippocampus, by taking some DHA and exercising aerobically.

Who knew?

I think that’s very, very empowering.

And again, that’s the mission here, that’s your mission. And that’s why we’re doing this, simply to give out this information.

There’s nothing proprietary about what it is that I’m saying. No one owns it. The knowledge isn’t quite ubiquitous.

You asked why nobody talks about this, because it’s precisely for that reason that no one can own it, no one can put a patent on it, therefore, it’s not going to be advertised on the evening news.

Abel: I was just talking to someone about this in an interview earlier today about how, if you could put fasting in a pill, it would sell like hotcakes, it would take over the world.

And some of the things that fasting does for human physiology is actually available to us. We know that certain nutritional supplements do in fact activate certain gene pathways that are similar to what are activated when we fast.

Things like turmeric and resveratrol, DHA and aerobic exercise mimic the effect of fasting in terms of the mitochondrial response and in terms of acting epigenetically, in other words, modifying gene expression.

Abel: It’s so cool but it’s quite a quandary when it comes to getting your message out there, because if you follow the money… Not many people are going to be throwing loads of money at something that says, “Consume no products and you’ll do better.”

The message here is: Give your genome what it has always gotten. @davidperlmuttermd Share on X

Abel, your genome, my genome has not really changed in about 50,000 to 70,000 years, and suddenly… The only thing that has changed are the epigenetic factors, how we influence the expression of our DNA, and that has changed a whole heck of a lot.

And there’s no mystery why for the first time in history, our children’s generation’s longevity is less than ours.

For the first time in history, we’ve now reached the top of the curve, and now longevity predicted for our children is going to be less than ours.

And that’s a very, very scary proposition, and to me, it says that we’ve really done a disservice to the next generation by not giving them what they’ve desperately needed.

Abel: It’s heartbreaking. But I think to your point earlier, it’s not hopeless. You can reverse a lot of the problems.

The mission here is, “Let’s light a single candle, and draw to that single candle those who are interested, as opposed to cursing the darkness.”

I must say, from time to time you have to curse the darkness a little bit in terms of what people are told to eat and these governmental recommendations about how people should choose their foods. It’s wrong.

It always reminds me of the movie, “The Poseidon Adventure”. Remember the cruise ship flips over, and then Gene Hackman and his pals tell everybody, “No, we’ve got to go up to get to the top of the boat, which is…” Now, it was the bottom of the boat, because then that’s where they’re going to rescue them. And Gene Hackman is a minister and he’s telling everybody, “You’re going the wrong way. Please come this way. This is your way to salvation.”

I mean there’s a bit of a religious overtone there obviously, but these people say, “No, my doctor said to cut back on dietary fats,” and they go straight to the bottom and they perish.

That’s a bit of a drama there, but I think it really serves to very well characterize my sense as to what is happening to people who do not get this message and are maintaining a diet that is so maladaptive to our genome.

Abel: Can we talk about that in a little more specificity? Because I get a lot of questions asking, “Are you advocating to be in ketosis all of the time? Or are you saying we should be fat-adapted or keto-adapted and not necessarily in ketosis?”

Keto-adapted, fat-adapted is really the extreme of what I’m talking about. And I think in an ideal situation, that’s a terrific place to be.

Now, I fully recognize that most of the individuals who are following the program we outline in Grain Brain, are not going to be that fully adapted to the program.

You can measure your degree of ketosis by buying a product called Keto sticks; it’s not a prescription, it’s basically a stick, and you put a drop of urine on it, then you measure it against a scale to determine how much your body is burning fat.

So you get to a low level of ketosis, which is a wonderful place to be. It’s really, as Gary Taubes has told us in Why We Get Fat, that’s in his book and what to do about it, it’s really what he believes is kind of the nature of humans. It was also spoken about in Nora Gedgaudas‘s book called Primal Body, Primal Mind.

Abel: Great book. Gary and Nora have both been on the show in past months.

And they’re speaking the truth. And again, they both talk about this low level of ketosis which really should be considered a normal situation for humans.

If you don’t eat after dinner and go to sleep, when you wake up in the morning, you do have a small degree of ketosis already. It’s a great place to be.

And with our patients, I still practice medicine all the time, five days a week, seeing patients all day long.

Abel: Five days a week, wow.

Well that’s what I do when I’m not doing this with you.

Abel: Right, when you’re not writing #1 New York Times bestsellers, it’s what you do.

I do that on the weekends. Thank goodness for coffee.

But that said, the idea that this mild level of ketosis is physiologic, and when people begin to experience that, they get back to a cognitive state, a clarity state mentally, that they haven’t experienced for decades.

Because all of a sudden they’re powering their brain with ketones and less carbohydrate and they experience clarity once again. And for many, it’s absolutely an epiphany.

Abel: So would you describe it more as binary or a sliding scale?

Well, I always say that halfway measures work half way.

In an ideal world, it would be binary, and to explain, Abel, for the viewers, meaning all or none, basically, zero or one in the code.

But I would say that no one’s going to be perfect, you and I, I’m sure, included. But the more of this that you follow, the less carbohydrates that you consume, the more you favor eating higher good-fat foods like eggs, for example, and grass-fed beef, but mostly concentrating on vegetables.

This isn’t a strongly meat-based program, what I’m advocating. Include meat when you can get grass-fed beef, free-range poultry, or wild fish that hasn’t been farm-raised. But by and large those are considered the side dishes. Those are not the main.

The big story on the plate are lots of wonderful above ground vegetables, kale, broccoli, the cruciferous vegetables, spinach, all of those wonderful colorful vegetables should fill the plate. And the animal protein part of that is the garnish, not the main event.

We go to a restaurant, they say, “You’re going to have the fish or are you going to have the chicken or the steak? Which one?”

I’m going to have a plate full of vegetables and maybe I’ll have a piece of one of those three choices on the side.

Why You NEED Cholesterol and Vitamin D

It brings up the notion of eggs, there’s some really new exciting research on eggs that’s just been released, and maybe your viewers are going to be the first to hear.

Eggs have been found to contain a new chemical which is a brain antioxidant.

It’s this incredibly important chemical that actually serves as the component from which your body makes vitamin D, and all the sex hormones and cortisol.

And that chemical is called cholesterol.

So this is a wonderful thing that eggs contain that is life-giving, it’s brain supportive.

Abel: Hold on a second, I thought it was heart-stopping. 😉

Not at all.

Look, every cell in the human body has made cholesterol for millions of years.

So if cholesterol is bad, then either God or Mother Nature got it wrong, or both. You could say whatever you like.

Every cell in your body is making this wonderful life-supportive chemical.

And now, in the last millisecond of our time on this planet, we’re told there’s something bad about it.

Abel: Ha! Right. Now it’s poison.

So, when I do vitamin D levels on my patients, and so often these vitamin D levels are in the gutter. Levels like 15, 17.

And you couple that with the idea that people are taking—I know this is hard to imagine—but taking medicines to get rid of the substance by which your body produces vitamin D.

In other words, statin medications to lower cholesterol. Then it’s no wonder that the vitamin D levels are so low.

Low Vitamin D being correlated to risk for Parkinson’s disease, found to be low in multiple sclerosis, found to be dramatically low in Alzheimer’s disease.

This vitamin D story is just beginning.

We were told, “Yeah, you need vitamin D to make strong, healthy bones.” End of story.

And nothing could be further from the truth.

Vitamin D isn’t even a vitamin by definition, it’s a steroid hormone and activates more than 930 genes in human physiology, most of which actually reside in the brain.

It’s powerfully anti-inflammatory, it is powerfully antioxidant and so it plays so many roles, that it’s not surprising that we see that low levels are associated with any number of issues that you can imagine.

Why is vitamin D so low?

Well, because, two reasons, it’s made from exposure to sunlight and generally most people are wearing clothing when they go out for a walk these days.

And number two, it’s made from cholesterol and everybody’s so dramatic in terms of wanting to lower their cholesterol.

Nothing is worse for human physiology.

We need cholesterol.

Those elderly individuals with the highest level of cholesterol have about a 70% risk reduction for developing dementia and about a 45% risk reduction for dying each year.

So we’ve got to rethink the cholesterol idea.

Those adults with the lowest cholesterol have a dramatic increased risk for suicide, depression, cognitive issues like memory dysfunction and dementia.

So again, we’ve got to change the narrative here.

Abel: I can personally attest that eating my doctor’s recommended diet a few years ago, I definitely experienced a lot of that.

It’s almost like an emotional feeling of emptiness.

Absolutely.

Abel: It’s a breakdown of strength, in who you are, in willpower in a lot of cases.

As soon as you switch over to eating loads of fat though, It’s hard to describe, but it’s an amazing feeling of balance. It’s almost a confidence.

No doubt. And what you’re doing is you’re getting your DNA back to where it wanted to be in the first place.

Abel: Yes. And I don’t think many people have experienced how good it can feel when you are fueling with fat. It’s shocking.

But again, the cornerstone of the things we dread the most is inflammation, and a diet that’s higher in fat and lower in carbs is the perfect diet to reduce inflammation.

Abel: You talked about vitamin D. We’ve been getting a lot of questions, especially given the season, of what an effective supplementation plan would be for most people.

What do you recommend?

Well, what I recommend is no specific dosage, because… I have a great story.

I told a woman that she needed to take 10,000 units of vitamin D a day, and her doctor said, “No, you can’t do that. That’s way too much vitamin D.”

So she came back to me and I put her on 5,000 units of vitamin D a day and she went back to her doctor and he again, an endocrinologist had a conniption.

And he said, “Look, you need to stop 5,000 units of vitamin D a day. I don’t know what Dr Perlmutter was thinking.”

And he wrote her a prescription for a pharmaceutical vitamin D once a week, 50,000 units.

And I said, “Hmm, he gave you 50,000 units a week. I gave you 5,000 units a day. Let’s do the math. 5,000 units times seven days, that’s 35,000 units.

Turns out he’s giving you more and criticizing me for giving you 5,000 units a day.”

That said, the bottom line for vitamin D is there is no magic wonderful ideal dosage. It is absolutely irrelevant.

Some people may need 15,000 units a day and some people can get by with 1,000 units a day. It depends on heredity, sunlight exposure, levels of cholesterol, a variety of factors.

And obviously body fat has a huge role to play in terms of maintaining vitamin D levels.

More body fat compromises your ability to convert sunlight into vitamin D and even store vitamin D, which seems paradoxical for a couple of reasons.

You’d think having more surface area, if your body is like a solar panel and you have more surface area exposed to the sun, you’d make more vitamin D. It doesn’t work that way.

But here’s what does matter, here is the fundamental on the vitamin D story, and that is, in recognizing that we’re all different, we should be performing blood tests to measure vitamin D levels in everybody and get people to an ideal level of vitamin D, not in the normal range.

Let me explain.

The normal range of vitamin D is between 30 and 100 nanograms per milliliter.

So many doctors will tell their patient, “Well, 30 to 100 is the normal range. So you’re at 35. That’s totally fine. I’ll see you later.”

But yeah, that’s the normal range, but the normal range is what is considered average, and normal and average are not terms that I want to use for individuals who are following our program.

I like terms like ideal or optimal.

If you want to optimize your vitamin D you’ll want to target getting it up to a level of 70 or 80, still in the acceptable normal range but well in the range of being much more what your body can really use to augment gene expression.

Vitamin D to some degree also plays a role in gene expression.

So the short answer is, there is no ideal recommended dosage.

I usually start people at 5,000 units a day, an adult, and then we work from there, go up or down following the blood test.

And that’s one of the things I covered in the PBS special, is this is how to do it.

This is what you need to be asking your doctor to check, a vitamin D level.

And it’s so compelling to me that oftentimes doctors will say, “No. You’re taking too much and I’m not going to check your levels because you’re just taking too much, and I don’t know what your other doctor was thinking.”

That’s why we have blood tests readily available in any doctor’s office to look at your vitamin D level; it’s that fundamental.

Abel: Absolutely. We’re coming up on time. We’ve been burning through this, having way too much fun.

Why Every Kid Should Learn a Musical Instrument

Abel: Well, I would be irresponsible if I didn’t ask you this, because this is something that’s very close to my heart, it’s what I studied in college, wrote my first book about it.

You’re a musician, you’ve been playing guitar since, I believe you said seven years old. What is the effect of music on the brain? I’m sure you have some opinions on that.

Well, I do. In fact, I wrote a book about that too, oddly enough.

Abel: I didn’t realize that.

It was in my book called Raise a Smarter Child by Kindergarten.

In that book I was obviously trying to give parents as much information as I could about what can they do for their children to enhance their abilities.

And it turns out that by starting children on the keyboard or any musical instrument early on in life is associated with not only better math performance, but verbal performance and reading performance, as well. Especially if children learned this abstract notion of reading music.

There’s nothing intrinsic about notes on a score, or notes on a scale, but what they learn is that a note in one position on the scale represents a particular tone, and that a note higher on the scale is another tone that’s actually higher.

So it develops early on in life the ability for what is called abstract thinking and symbolism, that a note on a piece of paper can symbolize a sound that you can then experience by touching a particular key on the piano.

Why that’s important is because there is nothing intrinsic about the difference between the number 6 and the number 19, they’re images, but they do have symbolism, they symbolize quantity and magnitude, and then that child’s able to grasp that abstract thinking early on in life.

There’s no real difference between the letter A and the letter Z in terms of, again, being scribbled on a piece of paper or on a computer screen. But their sounds and the implications for what can be formed with those abstract symbols is profound.

So I’m all over this idea of music training early in life and continuing that throughout your lifetime.

It’s really very, very important because it augments your ability to connect seemingly disparate, from a functional perspective, parts of the brain, those areas that deal with abstract thinking and visual imagery, connecting those areas to executive areas and more complex areas, and even the auditory areas.

What brain function and smartness is all about is not particularly your performance on a math test or english test, but being smart is a brain that’s fully integrated, that is fully communicative one part with the next part, with the next part, and then those concept connections being ingrained as we call an engram, as a pattern that’s then, hopefully permanently, put in the brain to use later on.

Abel: I’m having an irresponsible amount of fun right now, I really am.

But we are out of time, unfortunately, but I had to bring that up because you’re the first person, literally, I’ve interviewed who has a guitar behind you as I have a guitar behind me. love it.

Where to Find Dr. David Perlmutter

As we sign off, could you tell folks where to find you and what exciting projects you’re working on next?

You can find me in Naples, Florida but that’s probably not the answer.

Follow me on my website, which is drperlmutter.com , on Facebook as DavidPerlmutterMd, and on Twitter @davidperlmutter. Those are great resources I think if you really want to stay up to speed. We try to keep that information as fresh and refreshed as possible.

Abel: Awesome. And Grain Brain is a #1 New York Times bestseller, an incredible book. If you guys haven’t checked it out, I very much encourage you to do so.

Dr. Perlmutter, thank you so much for coming on the show, we’ll have to jam again soon.

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