00:47 – Pre-intro/Summary
2:12 – Introducing Dr. Perlmutter
3:34 – How has the science behind Grain Brain progressed
8:45 – Health care crisis and important things to focus on
17:50 – How the view of dietary fat has changed in the past 5 years
21:41 – Dr. Perlmutter’s visit with Nestle
25:24 – Why ketogenic diets have become so popular
28:48 – Alzheimer’s ineffective medications
31:08 – Statin drugs increasing diabetes risk
33:58 – Comparing diabetes treatment with medications vs ketogenic diet
34:23 – Diet template and paleo
38:54 – Plants able to change gut bacteria genes
42:15 – Connection
43:28 – Fasting
51:20 – Muscle loss and fasting
57:40 – Things to be aware of and how to thrive on keto
59:49 – Predictions for the next 5 years
1:04:15 – Where you can find Dr. Perlmutter
(Link to plant RNA research paper talked about https://www.drperlmutter.com/study/plant-derived-exosomal-micrornas-shape-the-gut-microbiota/)
YouTube: The Empowering Neurologist
Book: Grain Brain (Revised and Updated)
Download a copy of the transcript here (PDF)
Paleo Solution – 417
Robb: Hey, folks, Robb Wolf here. Super, super cool podcast today. Dr. David Perlmutter, one of my very dear friends and just such a cool guy. He had his first publication in the journal Neurology at the age of 19. The guy is absolutely brilliant. He has a fascinating career because he went from a very kind of mainstream, orthodox, high-carb, low-fat kind of orientation. And then over the course of time, looking at the literature, working with patients on a variety of neurological issues, the guy has circled around to kind of a low-carb, ketogenic leaning, Paleo-friendly type of approach, very aware of immunogenic foods, aware of the importance of finding the proper glycemic load for individuals.
He was on the podcast quite a while back, Episode 200, and that’s fantastic if you want to check that out. This episode is looking at his updated Grain Brain book, which has been out for five years. We covered a ton of different topic: intermittent fasting, autophagy, the pluses and minuses of ketosis, the healthcare system. We just covered a lot of ground. Love this guy. Really, really a good friend and I think you guys will enjoy this one a lot.
Dr. Perlmutter, how are you?
David: Well, I don’t think I could be better. If I was any better, I’d be Robb Wolf.
Robb: Oh, man. Well, you would be less good-looking because you’re much more handsome than I am at a minimum.
David: We’ll see about that.
Robb: Well, just a huge honor to have you back on the show. I’m not sure if you’re aware of this, but when you appeared on Episode 200, I believe, of the Paleo Solution Podcast, that has gone on to be in probably the top four to six most popular shows that we’ve ever done.
David: Well, that makes me feel very, very good.
Robb: Yeah, yeah. I mean the love and adulation that one receives when mentioning on Instagram that I was going to chat with you this day, it was pretty amazing. Like you have a lot of folks that just absolutely love you, are so appreciative of your work, and I am definitely at the top of that list.
David: Well, I have a big smile on my face right now, just so you know. To hear that, it’s so encouraging to continue doing what we do because, frankly, the work is seeing the science as best and interpreting it as best we can and then making that available for everybody to utilize. That’s the job. It’s been what I’ve been doing for I guess 40 years now, and to hear that people are appreciating it makes me feel encouraged to continue working.
Robb: Well, it’s a very fascinating time because as problematic as I think some of social media and the internet can be, there’s also a really cool opportunity to share ideas, put out these ideas, have people tinker with them. Like so much of what I’ve observed in this kind of ancestral health space, like the past couple of randomized control trials looking at the autoimmune Paleo diet, that happened as an outgrowth of anecdotal collaboration that provided enough noise that some folks in the legitimate academic circles said okay, well, we can probably justify at least doing a pilot study around this and a feasibility study.
It’s funny, when you look back at the history of say like the Mediterranean diet, it too started with an idea basically around a couple of review papers, and then people started tinkering with it, and then more rigorous science and testing has gone on since then. But you are still at this interface, in my opinion, that is just really, really controversial. Grain Brain focused on the health risks of sugar, refined carbohydrate, gluten, different immunogenic compounds like gluten being problematic. Clearly, I’m pretty sold on that as a big vector in the modern health problems that we face. There are a lot of people out there though that are still not, but how has the science on these different topics progressed in the last five years since you first published Grain Brain?
David: Well, it’s a great place for you and me to start. I’ve been asked that question, what was right, what was wrong about Grain Brain, and I have to say that by and large what we talked about, the subtitle of Grain Brain is The Surprising Truth About Wheat, Carbs and Sugar, Your Brain’s Silent Killers. That was a bit bold, but it turns out over the ensuing five years that there’s been a high degree of validation of what we originally were contesting and that was that a high sugar, high carbohydrate diet is going to translate into a higher blood sugar, which is basically a bad thing for your brain. As we looked at the correlative studies that we talked about in the original Grain Brain showing that a higher A1c or average blood sugar correlated with a higher dementia risk, we’ve seen follow-up studies, one published in the journal Diabetologia this year, matter of fact, that correlates the A1c with cognitive decline. We’ve seen the work of Dr. Rosebud Roberts at Mayo Clinic publishing in the Journal of Alzheimer’s Disease showing that diets that are favoring carbohydrates as a primary source of calories are associated with 83% increased risk of dementia to be contrasted with the diet that’s higher in fat with a 46% lower risk of developing dementia.
Over these five years, there has been a really high degree of validation of these fundamental principles that basically having a higher blood sugar is not a good thing, that this is a diet that contradicts really 99.5% of the time we’ve been on this planet. There’s been a terrific ongoing experiment for 2.5 million years that has really proven itself quite well that a relationship to an ancestral type of diet seems to be what has allowed us to have this conversation today. I’m aware of the nuances of dietary recommendations. I mean chapter one of Wired to Eat, your book, is one size does not fit all, and indeed, I think we have to be cognizant of the fact that while we can talk about the broad stroke recommendations, which are very important because they will reach a large number of people, there is absolutely merit in being more specific for people based upon their heritage, their medications, their current body morphology, their microbiomes, their genomes, et cetera.
I think it’s been a very, very interesting and very encouraging past five years. It really has done a lot to strengthen our position, the fundamental position being that lifestyle choices affect your brain’s destiny. We start there and now we take that apart and determine exactly what the implications are of the specifics of this discussion.
Robb: Absolutely, yeah. It’s so fascinating to me and it’s frustrating at times too. There are these camps that I would characterize as being maybe a little bit more in the kind of like fitness, bodybuilding kind of orientation where they’re very calorie focused and not as food quality focused, and they tend to be remarkably dismissive of say like these immunogenic properties of foods. I’ve honestly modified my position on say like the insulin hypothesis underlying this whole story, like I’ve maybe gone a little bit more middle of the road. Clearly, insulin is important, but overall caloric load is important. I don’t argue with any of these things, but I’m perplexed by kind of the position of some of these folks when we’re facing just the diabetes crisis that Westernized societies are facing. Outlets like the Congressional Budget Office have a pretty modest projection that 15-20 years from now the US is bankrupt from diabesity-related issues, and this is before we get to neurodegenerative diseases.
Diabetes, although hard to manage, but there’s a huge suite of drugs and the person can be provided medication and trained in how to implement those use of glucometer. Although it’s a very shoddy treatment protocol in my opinion, it’s comparatively low cost compared to a massive number of people entering this neurodegenerative tsunami that we’re going to face, Parkinson’s, Alzheimer’s, dementia, in which these individuals will require 24/7 nursing care effectively. That is something that people have not even thought about.
We’re in this kind of battle, and I’m sorry I’m jabbering so much, but I’m trying to set this whole thing up so I can get your thoughts on it. But we’re in this kind of pissing match back and forth of it’s the carbs, it’s the fat, and I tend to think it’s the processed…