Brain Health Begins in Your Gut

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"Food matters," says David Perlmutter, a neurologist and author of the popular book Grain Brain. In this interview he explains why you may want to give up gluten and why it's so hard to do.


By David Perlmutter

Omega: You've been in the medical field for more than 35 years and your father has Alzheimer’s disease. What advances would you like to see in the medical community in coming years?

David: Unfortunately, medicine is still, for the most part, practiced with a reductionist mentality. Basically, doctors have become specialized and even super-specialized, looking at specific body parts as if they existed on their own. Moving forward, it is clear that a more holistic view of the body as an integrated being is clearly going to offer a specific advantage as it relates to dealing with some of our most pernicious medical issues. Holistic medicine is far more than a trend, it is a return to and appreciation of the human body as an integrated whole.

Omega: Your book Grain Brain starts with the idea that “to cure disease after it has appeared is like digging a well when one feels thirsty.” That's a pretty poignant statement for the power of prevention. What are some of the ways we are “digging wells” in our current medical system?

David: No doubt, the most obvious inadequacy of our current medical system is its almost complete avoidance of any discussion related to nutrition. Hippocrates was right. Food matters. And now that we understand the pivotal role of the human microbiome, the 100 trillion organisms that live upon us and within us, in terms of regulating our most fundamental metabolic processes, the discussion of nutrition is taken to a much higher level of importance.

Omega: Can you talk about some of the research that links the health of the brain with the health of our stomachs?

David: The explosion of research connecting the brain and the gut is truly breathtaking to behold. We now understand that the organisms living within the gut, for example, play a pivotal role in regulating the process of inflammation. As it turns out, inflammation is the cornerstone of our most dreaded brain conditions, including Alzheimer's disease, autism, Parkinson's disease, multiple sclerosis, as well as other issues like coronary artery disease, cancer, and diabetes. Even depression is now looked upon as being an inflammatory disorder, and as such, relates back to the health of the gut bacteria. Who knew that more than 90 percent of the so-called neurotransmitters are actually manufactured in the gut? I'm talking about things like serotonin and dopamine, which are the targets of aggressive pharmaceutical manipulation. So attention to the gut takes on a new level of importance as we design programs to help the brain become more functional and resistant to disease.

Omega: You call gluten “a silent germ.” Can you explain why it's bad for you?

David: Gluten, a protein found in wheat, barley, and rye, contains as one of its components, another protein called gliadin. Research at Harvard has now demonstrated that gliadin induces increased permeability of the gut lining. And it is this increased permeability that amplifies inflammation in our bodies. Inflammation is critically important across a wide spectrum of disease processes, not just those involving the brain. The inflammation induced by increased gut permeability is systemic, meaning it involves the human body in its entirety. We called gluten the “silent germ” because, in general, people consuming gluten-containing foods are unaware of the damage that is unfolding.

Omega: Why is it so hard to give up grains? Is it physiological or psychological?

David: Grains are clearly difficult for many people to give up for several reasons. First, most foods made from grains are high in carbohydrates, and we just love our sugars and carbohydrates. In fact our desire for carbohydrates has allowed humans to survive during times of food scarcity as consumption of carbohydrates stimulates the production of body fat. Unfortunately, that mechanism remains in place today with sugar and carbohydrate consumption clearly playing a key role in our obesity epidemic. Further, wheat contains chemicals that actually stimulate the morphine receptors in the brain. So when we talk about actually being addicted to wheat for example, this mechanism makes the notion of addiction far more approachable.

Omega: Is Alzheimer’s disease actually an autoimmune disease? And if so, does that affect how we are currently treating it?

David: While the notion that Alzheimer’s disease is a manifestation of inflammation has been around for at least the past two decades, actually characterizing Alzheimer's disease as an autoimmune condition is a much newer idea. Like other autoimmune conditions, Alzheimer’s disease is more common in women. Further, recent studies have demonstrated antibodies being elevated in the brain to a particular brain lipid called ceramide. But it is interesting to consider that both regulation of our immune system as well as the level of inflammation in the human body actually takes place in the gut. So whether Alzheimer’s turns out to be a fundamentally autoimmune disease or not, we still have to emphasize what goes on in the intestines, especially as it relates to the microbiome.

Omega: Can you talk about your anti-Alzheimer’s trio and how someone could incorporate these foods into their day?

David: Three of my favorite foods include avocado, coconut oil, and grass fed beef. My mission in popularizing these foods is quite simply to reintroduce the notion that healthful fat is fundamentally critical for the human diet, and especially important as it relates to brain health.

Omega: You’re pro-coffee, but dietary research flip-flops on whether it's healthy or not. What are some of the biggest benefits and are there any risks people should be aware of?

David: It’s true, I am in favor of coffee consumption, and while this comment may seem self-serving, and it is, there’s some very good science that supports coffee consumption as it relates to the brain. For example, an international team of researchers publishing in the Journal of Alzheimer’s Disease in 2009 demonstrated that midlife coffee consumption was associated with a dramatic reduction in risk for late in life dementia. In fact, those who drank three to five cups of coffee per day demonstrated a 65 percent reduced risk for developing dementia. I can assure you that if any pharmaceutical could make that claim, it would be a blockbuster by anyone’s measure. To be sure, I believe that’s a lot of coffee. Five cups of coffee is certainly going to put somebody at risk for agitation, may aggravate an underlying heart rhythm issue, and may even elevate blood pressure. Coffee acts as a diuretic, and as such can lead to loss of important vitamins as well as minerals. I limit myself to one or occasionally two cups per day and I use organic whole milk to make my cappuccino.

Omega: What does your daily routine for staying healthy and balanced look like?

David: My family history puts me at higher risk for Alzheimer’s disease and as such I take my lifestyle choices very seriously. We do not have a cure for Alzheimer’s whatsoever, and yet we know that lifestyle choices are fundamentally critical in terms of reducing the risk for this untreatable disease. So I engage in aerobic exercise six days weekly for a minimum of 30 minutes. And this can be riding a bike, jogging, or using an elliptical machine. There are significant health advantages related to weightlifting, so I visit the gym at least four times a week. To prevent injury and to reduce pain that might otherwise keep me from exercising, I incorporate a fairly comprehensive stretching program to my regimen every single day. My diet is very rich in fermented food, as well as foods that are high in prebiotic fiber. I often do not eat breakfast and simply do very well on two meals a day. My wife and I begin each day with an inspirational reading. In addition, meditation is a very important part of our lifestyle. I write for approximately two hours each day and read for at least one or two hours as well. 

Omega: What do you think is the role of spirituality in treating patients?

David: We need three pillars upon which to stand—body, mind, and spirit. As it relates to the actual practice of medicine, guiding patients to tap in to their spiritual selves has proven to be a powerful ally in terms of healing. And I can certainly say that this is anything but new information.