Heal Your Gut by Going Grain Free

Guest: Dr. David Perlmutter

The purpose of this presentation is to convey
information. It is not intended to diagnose, treat, or
cure your condition or to be a substitute for advice
from your physician or other healthcare
professional.
Dr. Axe: All right, everybody. Hey, welcome here.
We've got a fantastic interview today with Dr.
David Perlmutter. Dr. Perlmutter is the author of the New York Times
bestselling books Grain Brain and Brain Maker. He is a fellow of the American
College of Nutrition. And you'll see him all over the media. He's been featured
on Dr. Oz and many other TV shows. And he's a neurologist. And really excited
to have him here with us today. Dr. Perlmutter, welcome here to the interview.
Dr. Perlmutter: Well, I am delighted to be here, Josh. Thank you for having
me.
Dr. Axe: Thanks. Well, I know we're going to talk today about the gut-brain
connection, something that I know that you've written extensively about. And I
think a lot of things when people think of gut health, they tend to think, well,
that's kind of where it ends. If I've got a gut problem, I might have some gas,
bloating, or a more serious issue like inflammatory bowel disease.
But they think it stops there. I know we're going to talk about that today. But
right before we jump in there, I'd love to hear about what you got you involved
because, again, your training is on the brain. What got you involved with both
the brain but as well as how that's connected to the gut?
Dr. Perlmutter: In a word I would say frustration. I've been practicing
medicine for thirty-five years and most of that time as a brain specialist, as a
2016 Axe Wellness, LLC. All rights reserved.

neurologist. And really it was a hugely frustrating endeavor at least for the
first ten years of my practice. I was actually in practice with two other really
good neurologists, good guys. But we really had nothing to offer patients. It
was a situation of diagnosis and adios, meaning you do the very best to make
a diagnosis, come up with a name for it. And then there was so little to offer
our patients with Alzheimer's or autism or Lou Gehrig's disease, even major
depression.
So I have been really dedicating the rest of that time, the past fifteen years at
least, even twenty years, to trying to figure out what else is out there. And it
turns out that one of our most powerful leverage points as it relates to brain
health isn't in the brain. It's in the gut. And that was just published by Dr.
Hippocrates a couple thousand years ago. So we have to pay attention to that.
So we're now really getting our arms around the notion that what we choose to
do in terms of nutrition and how that reflects what goes on in the gut plays a
very pivotal role in determining not just the brain's functionality right now,
moment to moment, but a person's long-term risk for brain degenerative
disease like Alzheimer's, Parkinsons, multiple sclerosis and so many more.
It does begin in the gut. And the idea of only looking at the brain is myopic. It
is unfortunately how some physicians still want to practice, but I think what
you're seeing, Josh, is more and more people are opening up and looking at
other areas, other avenues, and recognizing that the body really functions as a
very integrated machine where parts definitely are involved with other parts.
And we really have to look at the body and take a step back and celebrate the
way that the brain dances with the gut, vice versa. And when you do that, the
very empowering part of that story is it then opens up the world to you in
terms of being able to take advantage of that new science and then institute
programs that can work based upon this new understanding to lead to better
brain health and better brain function.
2016 Axe Wellness, LLC. All rights reserved.

Dr. Axe: Well, I know that you've got some excellent programs that you've
referred to in your book such as Grain Brain and Brain Maker that, again, I
know you've gotten so many good reviews on this. I know I've seen your PBS
special really referring to your programs.
And if anybody's interested in learning more about Dr. Perlmutter's programs,
I encourage you to check out his website during the interview now or after at
DrPerlmutter.com. You can learn about the programs on there. And I know
that you've referred to this thing, this microbiome, I know it's something that
you and I both referred to a lot in our writings. But I think it's new to a lot of
people. Can you explain a little bit more about what the microbiome is?
Dr. Perlmutter: Well, the gut is anything but sterile. It's an environment that
is absolutely loaded with bacteria, as well as viruses and yeast and all types of
organisms. And we refer collectively to these organisms as well as their DNA in
the term "micro", meaning small, "biome". There's this whole universe of
organisms living within each and every one of us.
And we've known about that for quite some time, but what we haven't really
appreciated is the extent to which our health, the health of us as a host, is
influenced by the health of this hundred trillion bacteria, for example.
You know that 90% of the peer-reviewed literature dealing with the
microbiome has just been published in the past five years. And I give you that
statistic just so that you get a sense as to how much of this information is
really brand new.
And we're right at the very nascent stage of understanding this incredibly
powerful role of these bacteria in terms of affecting our metabolic parameters,
extracting nutrients from our food, determining set point of inflammation,
affecting immunity, dealing with creating various chemicals that have an effect
on the brain's metabolism, and even the creation of what are called
2016 Axe Wellness, LLC. All rights reserved.

neurotransmitters themselves. Chemicals like dopamine and serotonin are

affected really quite dramatically by the bacteria that live within us.
So even as it relates, for example, to depression, we now understand that
there is a role for the happy chemical serotonin in depression, hence all the
drugs that are designed to increase serotonin availability in the brain. We call
those SSRIs.
But, look, 90% of the serotonin in your body is made in your gut so the notion
that hey, we'll give a brain drug and increase serotonin there for depression
really misses the mark when 90%+ of that chemical comes from the gut. And
when we understand that when we change the balance of the gut bacteria, it
has a dramatic effect on our metabolism, on our blood sugar, on our risk for
obesity, on our risk, for example, of becoming a type II diabetic.
Why is that intriguing for me? It's intriguing because type II diabetes is
associated with doubling a person's risk for developing Alzheimers disease.
Now, Alzheimers is a disease for which we have no treatment, none
whatsoever. And yet we now see this strong correlation in terms of risk with
becoming a type II diabetic. Type II diabetes is correlated with our diet,
obviously, and also with change in the gut bacteria.
So when you take a step back and look at how powerful and how related gut
bacteria are to some of our most worrisome conditions, you really want to
think about what it is we're doing in our day-to-day lives that threaten the
health of the gut bacteria, that increase the overgrowth of potentially bacteria,
and then beyond that, as I talked about in Brain Maker, what can we do to
rehab.
What can we do to press the reset button, if you will, on the microbiome and
pave the way for letting good bacteria flourish, keeping bad bacteria at bay or
in check, and really in so doing, paving the way for us to be healthy and
specifically have better brain function?
2016 Axe Wellness, LLC. All rights reserved.

Dr. Axe: Well, I know we're going to get into that in just a minute. I'm excited
for you to talk about some of the dietary things, the supplements that people
need to follow.
But how far reaching is this? Let's talk about some of the symptoms, some of
the side effects, of an unhealthy microbiome and gut issues. What are maybe
five or ten of the most common symptoms or conditions that people experience
as a result of an unhealthy microbiome?
Dr. Perlmutter: Well, that's an excellent question because as you may know
there are various tests that people are now trying to popularize that will give
you some inferential information related to the state of your microbiome.
I think we're really kind of also in our infancy in terms of understanding the
implications of what those stool tests of your gut bacteria have to tell you. I
mean, certainly they're accurate in terms of what they reveal in terms of the
gut bacteria, but the question is what is a healthy result versus a non-healthy
result. And beyond that, of course, what do you do to fix it?
So I think the question is really excellent that looks at it from the illness side
of the spectrum. What are the kinds of things going on in your body or your
history that may make you suspicious that your gut bacteria have been
affected or traumatized?
And I would say many factors should be looked at. First of which would
certainly be your method of birth. How were you born? We know that there are
obvious changes in the microbiome that are seen in kids born by C-section. If
you're born by cesarean, you don't pass through the birth canal. You don't
obtain this microbial baptism where you gain healthy bacteria by passing
through the birth canal that are there specifically to inoculate the newborn.
We know that the consequences of cesarean section include increased risk for
things like autism, ADHD, type I or autoimmune diabetes, celiac disease, and
2016 Axe Wellness, LLC. All rights reserved.

even becoming obese as an adult- all associated with being born by C-section.
Having lots of antibiotics as a child clearly damages the microbiome. One of
the questions we use would be did you have your tonsils out? Another one,
did you have ear tubes placed when you were little? That's an indication that
a) your immune system was likely compromised as a child, and b) likely if you
were involved in conventional medical care, you prior to having the ear tubes
or the tonsils and adenoids removed, you probably were hit with a few courses
of antibiotics, oftentimes much more than a few courses.
Now, do you have an autoimmune condition like lupus, rheumatoid arthritis,
celiac disease, type I diabetes, multiple sclerosis? Are you more than twenty
pounds overweight? Do you suffer from depression? Are you gluten sensitive?
Are you a type I diabetic? Are you a type II diabetic? These are all indications,
again, that your immunity and your medical treatment in the past may have
set you up for changes in your gut bacteria.
Do you take nonsteroid anti-inflammatory drugs? Do you take acid-blocking
drugs called PPIs (proton pump inhibitors) that you can buy over-the-counter?
And are you a person who might take an antibiotic every maybe one to two
years for who knows what- colds or sniffles? This is obviously an indication of
over usage of antibiotics likely although you should check with your doctor.
But each of these points that I raise or questions that I raise we actually have
in Brain Maker on page seventeen. It's a checklist about your lifestyle choices,
maybe not your choices but choices that were made for you. Obviously you
had no role to play in getting antibiotics as a child or how you were born.
But I raise the questions because you know what? Many of the readers are
trying to decide whether they should have their child born vaginally or
through C-section. But I like the fact that we have that information for
parents-to-be so that the discussion that they can have, for example, with
their obstetrician will go a little bit further than simply how long will my scar
be if I have a C-section.
2016 Axe Wellness, LLC. All rights reserved.

When babies are born by C-section, again, it provides them a different set of
bacteria that builds their microbiome. They obtain bacteria from the operating
room and from whatever might be on the surgeon's gown as opposed to being
enriched and inoculated with a more appropriate microbiome from the birth
canal.
Dr. Axe: Wow. I know that in reading a lot of the medical journals and seeing
how many species of bacteria that a lot of us are missing, it's incredible. I
think you've probably saw the recent research or information on the
Yanomami tribe that they looked at and how they had 40% more microbial
diversity.
In looking at that and you working with I know thousands of patients over the
years, and I know you mentioned a few, and you talked about C-sections and
antibiotics, what are some of the other things maybe surprising or some of the
foods that people could eat that could actually decimate or cause issues with
microbes in the gut from a diet standpoint?
Dr. Perlmutter: Let me go back, though, to your comment, and then I'll
answer your question, the comment about the diversity of organisms in people
living in rural environments, specifically those in sub-Saharan Africa. And one
of the big studies, of course, is this study that was carried out in Burkina
Faso where they did genetic analysis of the bacteria of the stool in children
living in sub-Saharan Africa in Burkina Faso and compared that with children
in Europe, in Western Europe, age match same age.
And they found an incredible difference in the diversity, that those kids living
in a rural environment had a much more robust diversity in terms of the sheer
number of species as you well characterized of bacteria living within them and
the metabolites of those species found in the guts were also significantly
different.
One of the main metabolites that gut bacteria make are called short chain
2016 Axe Wellness, LLC. All rights reserved.

fatty acids. And we saw a significant difference in the short chain fatty acid
array of those three fatty acids in comparing the children in Burkina Faso
with those living in Western Europe.
So then to answer to your question, which would play, of course, upon that
would be then what are some of the things we're doing? And I mentioned the
nonsteroid anti-inflammatory drugs. I mentioned the proton pump inhibitors
as medications. But really I think the biggest issues that affect the diversity
and the health of the gut bacteria are our food choices.
And I think the most devastating issues in our food would be things like the
amount of sugar in the diet, as well as the amount of other things like
artificial sweeteners that are so commonly introduced into the Western diet
these days.
So sugar directly is traumatic to the gut bacteria and changes the array,
creates a gut bacterial array or diversity profile that does tend to favor obesity
and favors even metabolic changes that will set the stage for type II diabetes.
But beyond that, people seem today to think, well, therefore if I'm not going to
be eating sugar, I should opt for artificially sweetened foods, artificially
sweetened beverages.
And it turns out that we've known for several years that the risk for obesity
and the risk for type II diabetes is actually higher in those people drinking the
diet drinks in comparison to those drinking the sugar sweetened drinks. Now
that may sound really counterintuitive, and at first blush it is.
Over the past few years, we've been trying to explain that by noticing how
aspartame affects our appetite. And we know that aspartame, at least in
laboratory animals, has some effects in the brain in the appetite center, in the
hypothalamus.
But now a new study came out of Israel that pointed the finger back to the
2016 Axe Wellness, LLC. All rights reserved.

microbiome showing that the changes that happened in the microbiome when
we consume artificial sweeteners is the type of change that increases our risk
for obesity and type II diabetes. So again it's not nice to fool mother nature.
When we're challenging our gut bacteria with poisons like this, sugar or the
artificial sweeteners, and I'm calling them poison, it has a significant effect on
many downstream issues that relate to how the microbiome influences our
health.
Dr. Axe: Wow. There are such a cascade of events can happen too with eating
a certain type of food. I'd love for you to describe a little bit about what goes on
in the body. We've all heard of so many times millions of books at this point
probably people are referencing gluten. People are referencing certain types of
casein and things.
When somebody consumes gluten and sugar, what is the entire process of
how it's from when you put it in your mouth to happens in your gut to that
could even, something happening in your gut, could then affect your blood
stream and brain? How does that work?
Dr. Perlmutter: Well, the biggest issue that relates to problems with the brain
is a mechanism that's called inflammation. Inflammation is a cornerstone
player in autism, Alzheimers, now we know even in depression. And for your
viewers, if they wanted to Google the word "depression" and the word
"inflammation," the number of journal citations that will come up is really
quite astounding. Who knew that depression is an inflammatory disorder? But
so is Parkinsons and so is multiple sclerosis.
So the process of inflammation really needs to be looked upon as playing a
pivotal role in brain disorders. It's hard to imagine. You consider inflammation
as this redness that appears when you get a mosquito bite or the
inflammation in the joint that an arthritic person might have. But front and
center that's what's going on in Alzheimers. That's what's going on in autism.
2016 Axe Wellness, LLC. All rights reserved.

We now fully understand that one of the major contributors to inflammation

in humans is what goes in the bowel, and specifically the leakiness or the
permeability of the bowel lining itself. Recognize that what keeps out bowel
contents from getting into the blood stream is a layer one cell thick. That's the
entire gatekeeper.
And these cells are juxtaposed or held together by cement that generally keeps
the bowel from allowing those things to get from the bowel into the blood
stream. Well, many things can escape from the bowel, get into the blood
stream, and immediately amp up this process called inflammation and
challenge our immune system.
Now, many things will disturb the gut lining and make it leaky. And among
those most importantly are changes in the array or the complexion of the gut
bacteria. When you induce changes in the gut bacteria, when you bombard
your body with antibiotics or eat a diet that's high in sugar, you change the
appearance of those bacteria, the relationships that they have, and you reduce
the ability of some of those bacteria to maintain the gut lining.
That's their job. That's what lactobacillus plantarum, lactobacillus
rhamnosus, it's one of the things that these species do. But when you affect
them, when you hit them with antibiotics or the nonsteroid antiinflammatories, we've known for a long time that NSAIDS, medicines like
ibuprofen, lead to gut leakiness. And that's a drug designed to reduce
inflammation. Think about that. And at the same time, it increases
inflammation by virtue of the fact that it increases the leakiness of the gut.
Who knew? What a perfect storm.
But that said, we now understand through the work of Alessio Fasano from
Harvard that gluten, because it contains another protein called gliadin, can
actually lead to increased leakiness or permeability of the gut by activation of
a cascade pathway that utilizes a chemical called zonulin. Zonulin when it's
activated leads to deconstruction of the tight junctions that hold cells
2016 Axe Wellness, LLC. All rights reserved.

10

together. And therefore becomes associated with leakiness that leads to

inflammation and that is the cornerstone of bad things like Alzheimers,
coronary artery disease, diabetes type II, obesity, and even cancer.
So when we talk about the integrity of the gut, the importance of maintaining
that gut integrity, understand that throws a wide net and really gets back to
your original question with me, why in the world would I be interested as a
neurologist in gut-related issues?
And I'm hoping we're connecting some really important dots here because this
is really leading edge and very, very exciting because it opens up the door for
being able to reduce inflammation by targeting the gut and that will affect the
brain.
Dr. Axe: It's amazing. And I loved how you circled back around on that and
really explained the process because I think as so many of our listeners are
hearing right now that their conditions are not a direct result of the diagnosis
they were given.
For instance, so many people today with autoimmune disease, if you mention
things like Hashimoto's thyroiditis, so many people would think, well, I've got
to treat my thyroid. That's the problem. Because you're saying no, it's a much
more specific problem that can start with your microbiome and with your gut,
these different areas of the body.
And I just think it's an important thing to consider is that so much of
medicine today has become about treating the specific organ where the
symptoms in play, but not treating the root cause. And that's something that
I've really respected about you is you've really took head on and said, You
know what? We're going to figure out what the root cause is and treat that
instead.
Dr. Perlmutter: It's true. And there is a simple lab test that you can get called
2016 Axe Wellness, LLC. All rights reserved.

11

LPS (lipopolysaccharide). And I don't mean to be too technical for your

viewers, but the point is LPS lives in the gut. It's part of the lining of the cell
membrane of many of the bacteria that live there. And that's where it belongs.
But when you measure LPS in the blood stream or antibodies against LPS in
the bloodstream, that's an indication of two things. That the gut is leaky and
that inflammation has been turned on. And in Brain Maker, you'll see graphs
showing high levels of LPS in people with Alzheimers, Lou Gehrig's disease,
autism, and as I mentioned before major depression, indicating that we've got
change our focus from the brain to the gut.
And then we have the chance at really finding out what's going on as a causal
mechanism, not just treating symptoms as you well mentioned. And to me it's
paying attention to the fire, not just the smoke. When psoriasis, for example,
is treated with skin creams, that's a really gross example of being at the end of
a line of a very long cascade events that finally manifests itself in the skin.
Now, I think that skin treatments and even immunomodulation therapies that
are popular now for something like psoriasis are helpful in reducing
symptoms. I'm all in favor of that, but I'm more in favor of putting the fire out.
So if you measure LPS, for example, in psoriasis, Hashimoto's thyroiditis, type
I diabetes, Parkinsons, Alzheimers, ALS, even frequently in autism you will
see that it is elevated.
And again it's telling us there's something going on in the gut, and you need to
pay attention to that. These ideas about treating rheumatoid arthritis by
injecting the joint miss the cause of the disease, and I submit to you today
that it's a gut-related disorder. And it takes some getting used to. This is a
different paradigm.
But like I tell my patients, I'm going to tell you right now that you may think
that in the morning you look to the east that the sun rises in the east and
then it moves straight up during noon time, and then the sun moves to the
2016 Axe Wellness, LLC. All rights reserved.

12

west at the end of the day. I'm going to tell you that's not true. In reality, the
earth is spinning, and the sun isn't moving. It looks like it's rising in the east
and setting in the west.
And people then they say, Oh, yeah, I remember that now. And it's again it's
a new paradigm. And once you embrace that there's no going back, once you
realize that these fringe ideas that people have been talking about for a long
time are now gaining incredible traction.
So viewers can Google, for example, something like "rheumatoid arthritis" and
the letters "LPS." Or "multiple sclerosis and LPS," "Parkinsons and LPS,"
"autism and LPS." And these journal citations are going to come up, and you'll
realize that there are a lot of people in a lot of institutions doing some
incredible work.
Brain Maker has forty-seven pages of references, and every mention of these
ideas is referenced by really good information. So it's a paradigm shift. Again,
getting back to how we started this interview, it takes a little getting used to.
For me, as a brain specialist. But now that it's happened, gosh, there's so
much good to be done.
Dr. Axe: Yeah, I know the results you're seeing are amazing as per if
somebody picks up Grain Brain or Brain Maker and starts reading the great
success stories of your patients, I know that they'll get to see that for
themselves.
Let's start talking about the diet and some of the things that we can do to fix it
now that we know that a lot of these diseases begin in the gut. And we've
really got to nurture our gut back to health. What are some of the most
important foods that you recommend that people need to start eating right
away to start repairing their gut?
Dr. Perlmutter: People need to start eating right away, huh? I'm all for that!
2016 Axe Wellness, LLC. All rights reserved.

13

It's actually lunchtime right now. You're talking to me.

But that said, again, I'll get there in a moment. But the first R is remove,
meaning let's remove the sugars. Let's remove the artificial sweeteners. Let's
remove the chlorinated water. Let's remove the medications and this perverse
over usage of antibiotics that even the Journal of the American Medical
Association and the Lancet are warning people like myself, physicians, about
because it's just getting out of hand. Clearly there's a time and a place for
antibiotics, but I think we all agree that that's a medication class that is
extremely overused.
Once we remove, then we replace. And we replace the good bacteria in the gut
in various ways. First, I like to focus on what are called the probiotic foods,
fermented foods. Foods that are undergoing fermentation are things like
kimchi and the popular drink now kombucha, cultured yogurt, sauerkraut,
fermented vegetables, fermented eggs, fermented fish.
The idea of fermentation in terms of creating a food that will last a long time
has gone back at least 7,000 years. And prior to that, this isn't going to sound
very savory, but people would eat food that was already fermenting because it
wasn't refrigerated and wasn't preserved, and that's how we ate. That's how
we've been eating for a couple of million years.
Turns out that those foods are teeming with good bacteria. That's why I
recommend foods like kimchee and kombucha and fermenting your own
vegetables because they've got wonderful levels of bifido bacteria and others
that are good for recolonizing the gut with the right type of bacteria.
Now, beyond that, in the vein of probiotics there are certainly better and better
probiotic nutritional supplements that you can buy at the health food store.
More and more we're seeing probiotics with better technology as it relates to
creating products that will survive through the stomach acid or even let's get
started with how it gets to the store in the first place so that even in the
2016 Axe Wellness, LLC. All rights reserved.

14

package these bacteria are still alive. Then when they are consumed
throughout the time of their shelf life, they continue to supply you with
adequate numbers of viable bacteria. Then these bacteria are encapsulated in
such a way that they'll make it through the stomach acid and go on to
colonize the gut.
So we want to find products that in fact have good technology and have a
pretty wide array of species and have a high CFU count. What does that
mean? When you see the ten billion, twenty billion, fifty billion, ninety billion
bacteria, that's given in what are called CFUs (colony-forming units) that we
hope will still be viable when you buy the product.
Now, we want to nurture our bacterial friends. Understanding that we call
these bacteria commensal meaning "co" means with, "mensa," eat. They eat
what we eat. And I want to just stay there for one brief moment because I'd
like the viewers of this video to understand that we should look upon our food
not just in terms of its nutrient content, the amount of fat, calories,
carbohydrates, micronutrients, vitamins and minerals, but look upon our food
in terms of nurturing the gut bacteria.
We call them commensals because they eat what we eat. They share the table
with us. Every bit of food that we eat goes on to be looked at and processed by
our gut bacteria for good or bad. When we eat foods high in sugars and
artificial sweeteners as I've mentioned, we don't favor the overgrowth of good
bacteria. We tend to damp that down and allow bacteria species that are less
favorable to flourish. And that sets us up for problems.
On the other hand, when we eat what are called prebiotic fiber, not just fiber
but a specific type of fiber called prebiotic fiber, that's the type of fiber that by
definition will nurture the gut bacteria and lead to health benefits. So one
popular prebiotic fiber is inulin. And inulin-rich foods are things like
radicchio, Jerusalem artichoke, dandelion greens, asparagus, onions, leeks,
garlic.
2016 Axe Wellness, LLC. All rights reserved.

15

These are foods that contain a lot of inulin. And absolutely when you eat those
foods, your gut bacteria are so thrilled to see that stuff coming down the tube.
They're just excited as can be, and they are going to reward you. They're going
to say, Look, what you gave me, all right, I'm going to give you vitamins. I'm
going to give you reduction of inflammation, balancing of your immune
system. And that's what you get in return for giving your friends, your
symbiants that live within you, what they need to flourish.
Dr. Axe: Wow. I love it. I was just picturing how excited you and I would be for
lunch right now, similar to our gut microbes. Foods are obviously critical. And
you mentioned probiotic-rich foods. You mentioned prebiotic-rich foods, which
is something I think a lot people skip over and those forms of soluble fiber.
Let's also talk about a little bit with supplements. You mentioned probiotic
supplements. Are there any other supplements you recommend to patients?
Dr. Perlmutter: Well, I do. I would say in an ideal world it would be nice if we
didn't have to have supplements. Our world is less than ideal. And our
lifestyle is clearly less than what it used to be. Obviously in days gone by we
would spend a lot more time out of doors and we wouldn't be wearing clothes.
Now, to be clear, I'm not suggesting we all run outside naked all day for a
number of reasons that are obvious.
But that said, in that we're not outside without clothing, we're not going to be
making as much vitamin D as would be ideal. So I think it's important to
consider taking a vitamin D supplement. And obviously the best thing to do is
to have your physician monitor your vitamin D level, recognizing that at least
here in America, our units in terms of normal are between 30-100.
With that said, 31 doesn't mean that you're home free, everything's great. So
rather than just being in the normal range, I think it's important to look at
being in the optimal range, so keeping your level around 80 or 90 is what I
would target. You might need 5,000 units of D3 a day or even 10,000 units of
D3 a day or 50,000 units a week, something like that, to get your vitamin D
2016 Axe Wellness, LLC. All rights reserved.

16

level up. It's critically important. Vitamin D activates more than 930 genes in
humans, most of which are actually also in the brain.
I like an antioxidant detoxicant called alpha lipoic acid. In Europe it's called
phytic acid. I think it's a terrific supplement. It's a very powerful antioxidant
that is both fat soluble and water soluble, meaning it will get probably
everywhere in the body. It helps to regenerate other antioxidants like
glutathione, and it's also important as a chelating agent. It will help bind
certain metals and help your body rid itself of toxic metals.
In Europe people use alpha lipoic acid in the treatment of diabetic
neuropathy. Here in America if you'll watch television, you'll see that drugs are
used not to treat the neuropathy (if you watch carefully) but only to treat the
symptoms, to treat the smoke. But that ignores the fire. The alpha lipoic acid
protocols treat the neuropathy. They help the nerve get better and hence the
pain then falls by the wayside down the line.
I also like a specific omega three that's called DHA (decosahexaenoic acid).
Now, you'll find DHA in fish oil, in a much less extent but in krill oil, in other
marine oils, and also of algae derivation. It's derived from algae. That's how
some of the products in the health food store are made. That's the form that's
found in many baby formulas that you can buy at the grocery store. DHA is a
critical player for the brain. It's a fundamental component of cell membranes.
It is also important as it activates genes that reduce inflammation. I've talked
about why that's important earlier.
And finally we know that DHA activates a gene pathway that turns on the
brain's production of something called BDNF. I know I'm throwing a lot of
initials but suffice it to say that DHA turns on production of BDNF and that
allows your brain, enhances your brain's ability to grow new brain cells in the
brain's memory center. Pretty cool.
So when Martha Clare Morris at Rush University publishes journal articles
2016 Axe Wellness, LLC. All rights reserved.

17

that show significantly lower risk of dementia in those individuals/people/

humans with higher levels of DHA, we have to take notice of that. And that's
why I think it's really reasonable to have 800, 900, or 1,000 milligrams of DHA
a day. Now, you can get that from having wild salmon every day or eating a lot
of fatty seafood. On the other hand, there are some wonderful, highly purified
fish oil products on the market today that you can get and have. Take several
capsules so you get 800-1,000 milligrams of DHA daily.
Dr. Axe: Great advice, Dr. Perlmutter. A lot of good information there on
something that I think that a lot of people some of us know some people aren't
as well aware and how they work. Ive got just two more questions for you.
One would be lifestyle factors, emotional stress, exercise, anything else. What
role do they play and what maybe recommendations do you have for both
viewers and patients on things they need to do lifestyle wise for their gut?
Dr. Perlmutter: Well, understand that these days I make no distinction
between actual patients and people who read my books, people who are
watching this video right now. Why? Because the word "doctor" means
teacher. It's what I do in my clinic. It's what I'm doing right now.
So to answer the question after that preamble, one of the most underrated but
critically important lifestyle issues is aerobic exercise. Publishing in the
journal Proceedings of the National Academy of Science, Dr. Erickson at the
University of Pittsburgh about three years ago showed that aerobic exercise
actually increases the amount of BDNF. I just talked about that in terms of
DHA. It actually increases the amount of this chemical that causes brain cells
to grow in the brain's memory center.
And he took a large group of individuals, half of them over a two-year period,
were given a twenty-minute aerobic program to perform every day. The other
group kind of did whatever they want. They were fairly sedentary. These were
adults. And what he found after two years, and the group (it wasn't just Dr.
Erickson), was that when they measured the size of the brain's memory center
2016 Axe Wellness, LLC. All rights reserved.

18

on a MRI scan that the hippocampus (the brain's memory center) in the group
exercising had increased in size by about 2% compared to where it was at
base line. In the non-exercisers, the hippocampus actually shrunk. Memory
functional actually improved in the exercisers. And it declined in the nonexercisers. Blood values of BDNF increased in the exercisers and had no
significant change in the non-exercisers.
Now, this is breathtaking information because there is no pharmaceutical
agent known to man that can lead to improvement in memory. And what Dr.
Erikson demonstrated was aerobic exercise in people at risk for dementia,
meaning that they are adults, was able to reduce their risk of cognitive decline
and amplify the size of their brain's memory center while it increased BDNF
level, just by slapping on your sneakers and going for a brisk walk. You don't
have to buy anything else special.
There's no prescription that your doctor's going to need to give you. There's
nothing involving health insurance here. It's getting a pair of sneakers and
jumping on the treadmill, stationary bike, or in the pool (maybe without your
sneakers). But whatever you want to do, if you can aerobically exercise in
some form, get your heart rate up, that changes your gene expression to code
for a chemical that will help you reduce your risk of memory decline. Who
knew?
You mentioned a couple of other lifestyle issues. And I would indicate that
sleep is also very underrated as it relates to the brain. When we sleep, we
allow changes to happen in a part of the brain called the glymphatic system.
Now, perhaps many of your viewers have heard of the lymphatic system. And
the lymphatic system is sort of a circulatory system in the body, but not
related directly to the heart that tends to clear debris from the tissues, the
detritus or the garbage that tissues generate, and allows us to get rid of it.
Well, we now have recently discovered in the brain there is something called
the glymphatic system that actually does the same thing as it relates to brain
2016 Axe Wellness, LLC. All rights reserved.

19

cells and the time that this system is activated is during sleep. So we've
known that there's a dramatic increased risk for Alzheimers, for example, in
individuals with sleep apnea or other nocturnal interruptions and now we
believe that one of the factors may well be because they're not clearing out the
garbage. They're not taking out the garbage, and it's accumulating.
Certainly the lack of REM sleep has other implications and people with sleep
apnea have oxygen levels that go down. Certainly that's not going to be a good
thing for your brain either. But we're really focusing lately on this glymphatic
system in terms of its effect upon the brain.
The other thing you did mention was stress. Now, it turns out that stress at
low levels might actually be good for the brain. Stress involves activating
what's called the HPA axis. What in the heck is that? That's the hypothalamic
pituitary adrenal axis. It means the brain when it is stressed or perceives
stress sends a signal to the adrenal gland to make cortisol.
Now, as mentioned, at low levels cortisol actually enhances memory. It's why a
low level of emotionality or stress during an event allows us to remember that
event because it's important. If it caused us to have some emotionality
associated with it, probably it was important and something we would need to
remember. But when cortisol levels are sky high or chronically elevated or in
other words elevated over a long period of time, that level of elevation of
cortisol turns out to be damaging to the brain's memory center called the
hippocampus.
And this was really elegantly demonstrated in the work of a Dr. Robert
Sapolsky in California, written a couple of books demonstrating in primates
how chronically stressed primates will have ulcerations in their
gastrointestinal systems and also drop out of neurons, less brain cells in their
memory center.
So we know that there's an increased risk of Alzheimers in PTSD individuals
2016 Axe Wellness, LLC. All rights reserved.

20

and individuals who have been traumatized significantly when they were
young. Individuals under chronic stress have higher risk for Alzheimers.
Experiencing divorce, experiencing the death of a spouse is a profound stress
and associated with increased risk of developing dementia.
So these are things to avoid. Do your best to avoid stress. Get out of stressful
situations. When people say harmful things about you or attack you in
various ways, it's best to take a deep breath and move on as opposed to
engaging. Our natural desire is to engage. People who do things that are mean
to us, who cut us off in traffic, who cut us off in line at a place or who are
rude to us, it's really time to bring in the Zen master a little bit and take a
deep breath and move on.
Similarly, it's important to understand that we are exposed to a threatening
situations when we watch the evening news. We are inculcated with this
notion that the world is a horrible place and that around every corner is going
to be a terrorist waiting to do something awful to us. When we continue to
bombard ourselves with that type of information, we're raising cortisol and
we're damaging our brain. It's that simple.
So maybe turn the TV off, especially during meals. Or be selective about what
you watch. Sure, there are terrible things going on in the world. And I don't
think it's reasonable to bury your head in the sand, but to have the network
news on 24/7 and bombard yourself with that information is not healthy.
I was giving a lecture recently in New York, and it was about the effect of
stress on the brain. And I was talking about there's a researcher named Dr.
Andrew Newberg who has demonstrated that meditation is associated actually
with regrowth of cells in the brain's memory center and also shown how stress
affects the brain.
And as I was getting ready to get in the taxi to go to the venue to where I was
giving this talk, I went from my room to the elevator and even in the elevator
2016 Axe Wellness, LLC. All rights reserved.

21

was still the news. So the only break, I turned it off in my room, but the only
break you get is when you're in the taxi I thought, right? So you're getting the
TV in the elevator. Yet get down and you get in the cab, and there it is in the
back seat looking at you. It doesn't end. So, hey, news is something that can
be monetized, but the point is it's really somewhat harmful. Keep that in
mind.
So exercise. Maybe get yourself involved in meditation. Stop exposing yourself
to such negativity. That creates cortisol. That's bad for your brain. A diet
that's low in sugar and carbs that's high in prebiotic fiber and probiotic,
fermented foods- these are keys that are going to really pave the way for
health.
And in my profession, finally we have actionable ideas as they relate to brain
health. We've always thought of brain disease as something that just happens.
Oh, well, live your life, come what may. We'll give a pill. There is no pill. And
lifestyle choices like you've been so kind to allow me to enumerate have a huge
role to play in keeping your brain healthy.
Dr. Axe: Well, Dr. Perlmutter, this has been great. And I know that one of the
things I can appreciate about you as well is you've really taken, I mean these
matters are complex, but you've done a great job of really simply explaining
how it works, breaking it down, giving us easy, actionable steps.
My last question for you is this: What does your diet look like on a regular
basis? What did you have for breakfast? What are you going to go have for
lunch right now? For dinner? What are just an example of a breakfast, lunch,
dinner, and maybe even a dessert that people could try?
Dr. Perlmutter: Truth be known, I've been missing a lot of breakfast lately
because I'm not hungry in the morning. And it isn't written in stone
somewhere that you have to have breakfast or something horrible is going to
happen. It doesn't work that way. Breakfast is when you break your fast,
2016 Axe Wellness, LLC. All rights reserved.

22

hence the name obviously. And the longer you have that fast, I think the
better it is for you.
Dinner for me is a dinner that's got a lot of fat in it in terms of olive oil on top
of my vegetables. It's a mostly vegetarian, high-fiber, colorful vegetable above
ground vegetables. If there's meat, it could be grass-fed beef, free range
chicken, but mostly wild fish I'm very fond of. And I always try to add in some
fermented food with that. I like to have as a side dish either kimchi or
sauerkraut.
And as I mentioned, I put a lot of olive oil on my food, and I think that's one of
the reasons that I'm not hungry when I wake up in the morning. When you
have fat and you train your body, you shift your physiology to be fat-burning
as opposed to carb-burning all the time, your hunger level goes way down.
And truth be knownand I'm not advocating this for your viewers right now,
especially the diabeticsbut a lot of times I won't eat lunch either. And I'll just
have dinner. But if I do have lunch, it would be a salad again with some
prebiotic food, prebiotic fiber, probiotic fermented foods.
When I do have breakfast, and it's not that uncommon. I do have breakfast
from time to time, I like eggs. I think eggs are an incredibly wonderful food. I
will do an omelet with dandelion greens and kale. What I find it best is to cook
the dandelion greens, saut them first, then make the omelet and then put
them on the inside. Then when I serve the omelet of course I'm covering it with
lots and lots of fat in the form of extra virgin organic olive oil. That's fat. That's
where you get good fat.
I think a cup of coffee is reasonable. I have one each morning. I drink a lot of
this new beverage that just came out called water. Who knew? And I'm a big
fan of kombucha. So it works for me. It's working for my patients. It's working
for so many of the people who've read Grain Brain. They're now reading Brain
Maker. It's interesting because the recommendations in Grain Brain about
2016 Axe Wellness, LLC. All rights reserved.

23

gluten and certainly what it was focused on is eating much less sugar and
lower carbohydrates, eating lots of vegetables that were high in fiber. That
whole approach was so validated now through the lens of the microbiome as
we talk about in Brain Maker.
So there was very little change. In fact, I don't think there was any change in
the diet except with the addition now of even more prebiotic fiber and the
fermented foods. So we've narrowed in on how and what to eat. Now we know
why you do it because it's nurturing your friends who want you to be healthy
and happy because that keeps them alive. And I'm talking about the hundred
trillion bacteria living within your gut.
Dr. Axe: Well, excellent advice, Dr. Perlmutter, and I think that's a great
picture of what an ideal diet looks like for retraining and boosting our
microbiome health.
I want to encourage everybody check out Dr. Perlmutter's website. Again, it's
just DrPerlmutter.com. Also you can find his book on Amazon.com, Brain
Maker. And if you really want to dig deeper in learning about everything that
Dr. Perlmutter talked about.
If you want to find some great examples and healthy recipes of what he
recommends and meal plans and other suggestions, again, check out the book
Brain Maker. It's been on the New York Times bestseller list, again, for weeks
and weeks and weeks. It's been there for a reason because it is an incredible
book, well written.
He breaks things down easily and gives you recommendations that you can
actually use, love, and enjoy. He's not telling you to eat sticks and grass. He's
telling you to eat things that are flavorful, tastes great, and easy
recommendations. So Dr. Perlmutter, thanks for being our doctor and teacher
today. I know it's something everybody's loved.
2016 Axe Wellness, LLC. All rights reserved.

24

Dr. Perlmutter: Well, I do appreciate the opportunity. So again, thanks for

having me.
Dr. Axe: Great. Hey, all right, thanks everybody. Thanks, Dr. Perlmutter. Have
a great day.

2016 Axe Wellness, LLC. All rights reserved.

25