Luke Storey: Austin and David, welcome to the show, guys.
Austin Perlmutter: Delighted.
David Perlmutter: Thanks for having us.
Luke Storey: Yeah, dude. So, this is my—dudes, this is my first time having a father-son duo on the show. So, I'm super excited and I want to start off with just, what inspired you guys to do a book together and actually start working together?
Austin Perlmutter: Well, I was finishing up my medical residency at the time. I'm an internal medicine doctor. And in essence, I was realizing that so much of what was going on with patient care was an issue where patients weren't able to follow through on recommendations, where we'd have these wonderful conversations, and at the end of the day, patients really struggled to follow through and make those lifestyle changes. And my father and I talk about things all the time, and this is one of the big conversations we had
We understood that people were getting the information, but it wasn't sticking. And so, we had a series of really phenomenal conversations around this, and he had already had some ideas about a new book. And in essence, over the course of several months, this idea came together, which was, we need to start making better decisions as it pertains to our health outcomes, as it pertains to our happiness outcomes
And we started looking into the research on decision making and on how decisions lead to these outcomes, and realized that there was so much great data that could change people's outcomes if they were able to make better decisions. And I think from there, the book just became an amazing labor of love for the both of us to be able to have this phenomenal relationship where we were able to talk about this science, but also provide this message that I believe both of us think is so empowering and it will be so important to so many people.
Luke Storey: That was a really good job.
David Perlmutter: And that’s what I feel in my heart when I hear that.
Luke Storey: My gosh.
David Perlmutter: That's great.
Luke Storey: Amazing.
David Perlmutter: But also brings up some great points, ands, you know, it's very frustrating as healthcare providers to do whatever we do to learn as much information as we can. You know, you'd go to the conferences, you read the journals, you go to medical school. And then, your one-on-one with the patient, you're saying, Hey, “I've learned all this great stuff. You've got to make these lifestyle changes, and here's what you should do.” But, you know, 60%, 70% of the time, that doesn't happen.
And Austin said, that's really frustrating. So, we wanted to look at not what are the decisions that you should make. Well, eat less refined carbohydrate, maybe exercise more, not what are those decisions, but the decision-making process at the beginning. So, you know, the people are reading countless books about eating this right way or time-restricted eating, eating these foods, exercising, et cetera. There are wonderful books out there, but they're useless to everybody unless they implement what the book is talking about for crying out loud.
So, we wanted to take it to the higher order. How do we decide what to do and what we won't do? And what we learned is that there are really two important areas of the brain that we focused on. One area is called the amygdala, and one area is called the prefrontal cortex. Now, for your listeners and viewers, I don't want to make it sound too complicated, but those are the two areas that we're going to talk about. And the amygdala-
Luke Storey: Is the amygdala the one that gets activated when you thought you left your cellphone in an Uber?
David Perlmutter: Actually, so there was a—so just for your listeners, I thought I left my cell phone in the Uber and immediately, my amygdala was activated, sort of the fear, panic, whatever. And then, it was a very good lesson for me right then. I decided to bring the adult back into the room and hopefully activated my prefrontal cortex and said, deep breath, let's just think about the future and how we're going to make this happen, as opposed to—and it's a very good point, so that exactly is what happened.
But what we're realizing is as far as decision making goes, this prefrontal cortex that we have as a gift of being human to such a large prefrontal cortex allows us to make decisions that we think through that are based on thinking about the future consequences of that decision, as opposed to acting from the amygdala, which is impulsive, “I'm going to drink this soda right now. I'm going to stay up really late”, I'm thinking about myself as opposed to, “Maybe I should be more careful with what I eat. I should get some exercise”, you name it.
And we'll talk about all these lifestyle choices, but it's getting to the heart of our decision making and what we've learned that was really mind blowing is the fact that the more we make crappy decisions, the more those decisions are not based on what we really know is good for us. The worst, our decision making becomes and we're locked in. It's a feedback, positive feedback. That's right. Without inhibition?
Luke Storey: I can totally see that.
David Perlmutter: The good news, the argument there is we can enter spurs, better decisions, and then reroute that all to have better outcomes. And we'll talk about that, too.
Luke Storey: Cool, man. Wow.
David Perlmutter: We have a big agenda here.
Luke Storey: Yeah. This is exciting. And it-
David Perlmutter: With plenty of coffee on board. So-
Luke Storey: It’s in—yeah, shout out to our buddies at ZenBunni, the amazing biodynamic coffee that these two are sipping. I already had mine. It's quite strong. I already had my cup earlier. So, I've had my cup for the day, but yeah. So, before we—God, there's so many different directions I want to go with this because I think you guys are onto something so groundbreaking here, and as people will have realized by the time this episode airs that I'm really spending 2020 with a great deal of focus on brain health, and especially as it pertains to consciousness and making better decisions and having deeper, more healthy relationships with self and others, et cetera.
So, I definitely want to get into the nitty gritty of that, but I do want to just back up a little bit because Grain Brain is my most recent audio book of yours that I listened to. And so, there were so many things in there that I was kind of familiar with and just went along with, but it was—it really took the fun out of like having a doughnut cheat day. You know what I mean? Because I do much better on like a, you know, moderate-protein, high-fat, low-carb, low-sugar diet. I just feel better generally. I don't get too deep into the science, but I just know when I go off the rails that there's going to be a price to pay. So, for those that are unfamiliar with that seminal work, I just want to run through and just kind of skim over some of the basic points, especially as they pertain to fallacies that are held by people publicly because of misinformation that's been presented. So, starting out, for example-
David Perlmutter: Is this the lightning round here?
Luke Storey: We're going to start kind of with the lightning round because I just want to do a recap kind of some of your prior work because I think there's just so many nuggets in there that are really valuable to people, especially who are still thinking, for example, fat makes you fat, you know, that kind of thing. So, tell us a little bit about kind of the low-fat craze and how that came to be and why that is erroneous when it comes to health and specifically brain health.
David Perlmutter: Well, the low-fat craze was really—I think, hit its peak around 18 years ago, and I think was promulgated by the whole cholesterol, saturated fat myth that I think was also promulgated by the desire for companies to sell drugs that would target that. I mean, beyond targeting cholesterol with various medications, including the statins, there were actually drugs that were developed to target dietary fat, so you could eat what—you may not, you're too young, you may not know this, but there was a drug out called Olestra that actually would bind dietary fat so you wouldn't absorb it because absorbing fat would be the worst thing you could do. And people would take this drug, eat fatty foods, and then have that fat be excreted. Well, it didn't work out. Can you imagine excreting all of your dietary fat through your stool?
Luke Storey: Wow
David Perlmutter: So, people were, what can I say, to be politically correct, they were soiling themselves with their dietary fat that they were now not absorbing. Here's the point about that that is so misguided, to target a macronutrient, fat, in this case, that humans have been consuming for as long as we could say, there have been humans and then some, you know, is that a million years or longer, makes no sense from a historical perspective. Fat, you know, has twice the calorie density as carbohydrates and protein.
So, it's always been a wonderful source of calories for humans, has never been, you know, out of our diets. We desperately need fat, not just as a caloric source, but fat being a vehicle by which we absorb fat-soluble vitamins, for example, A, D, E, M and K. Fat being a building block for the cell membranes, for the major building block for your brain. And by the way, cholesterol being an important building block for the brain as well. Separate conversation. So, this notion that dietary fat was somehow related to cardiovascular disease really took off and was oddly enough, we now know, propagated by the sugar industry.
So, the sugar industry insinuated itself into medical research and publication in the late 1960s. And this was only recently revealed in the journal of the American Medical Association, and then recapitulated in The New York Times that they were influencing what doctors were saying about dietary fat, that if they could get more people to freak out about dietary fat and hook dietary fat to risk for cardiovascular disease, that people would restrict fat and would, by default, start eating more carbs and sugar.
And that's exactly what happened. And if you look at when that messaging took place and rates of obesity and diabetes lines up perfectly, that as soon as people stopped eating dietary fat and ate more and more refined sugar, rates of diabetes, as you would now expect, and rates of obesity once skyrocketed. And at the same time, when we recognized the relationship between those diseases and cardiovascular disease and Alzheimer's and other degenerative conditions, everything followed in lockstep with that mismessaging that we got from our supposedly respected publications, which was infused by industry.
So, it's not a pleasant story, but I think vis-a-vis our new book, Brain Wash, it's a great demonstration as to how our choices can be influenced for the benefit of others, not necessarily for our benefit. And one of the things we would focus on today is how aggressive the efforts are to influence our choices today, that not only is there this incredible effort in our digital experience to make us feel inadequate in one way or another, we're not rich enough, handsome enough, tall enough, thin enough, or whatever it may be, but here is—if you feel that way, and we're going to make you feel that way, here's the quick fix, here's the button to click to get the thing that's going to ostensibly offset that, you know. And-
Luke Storey: Right. Well said.
David Perlmutter: That feeds us into catering to this part of the brain that we described in the book, the amygdala, the instant satisfaction, the impulsivity, and the more you do that through what we're going to talk about neuro-plasticity, the harder is the wiring to that area of the brain, the more you see the world in a fear-based model and the more impulsive you are, the more narcissistic you are, the less empathetic, the less compassionate, the less desirous you are of connecting to other people and the less likely you are to consider the long-term consequences of today's choices.
Luke Storey: Austin, can you break down in a summarized way why eating fat doesn't make you fat. When I eat like a spoonful of ghee and someone's in my house, they'll look at me in shock going, “You're going to get fat”, like people, I think, they think that when you ingest fat that it just sticks to your body and becomes the fat of your body.
Austin Perlmutter: Well, I think this is such a great conversation and as you well know, the science of nutrition isn't necessarily incorporated into medical learning very well. And so, when you hear these messages in, I guess, the lay public, the media, it's so simple to think that calories in equals calories out and fat, as my dad mentioned, is high in calories. So, you'd think that if you eat more fat, you will become fat, but it really doesn't give the body nearly enough credit. If you consider the body as this incredibly integrated system where every part of it is talking to every other part of it.
And then, I mean, that again is the scientific understanding we have of the body, and yet, then we say, well, calories in equals calories out, it's that simple. It isn't. As it turns out, the body is far more complex than that, and it removes all of the influence of things that we know about, specifically things like insulin, which changed signaling throughout the body and determine whether our nutrients will be packaged in fat cells or used to remodel, rebuild, and re-energize our bodies. So, the really important takeaway point here is that it turns out eating dietary fat doesn't really translate into fat gain.
With that said, eating simple dietary carbohydrates seems to do that more so. The reason is that strongly activates insulin, and insulin is basically a signal that tells the body to store fat. It tells the body, we need to hold on to this because that winter is coming up, whether or not it actually does, who knows, but we need to store this extra fat reserve. And it doesn't mean that the fat itself is being converted into the fat, what it instead means is that the carbohydrates are signaling for the body to conserve fuel in fat cells. So, I think that—I'm not sure if you want to add anything to that.
David Perlmutter: No. I mean, what you're saying is spot on, and that is that we have to look at our food beyond the macronutrients, fat, protein, and carbohydrates, and look upon our food as information. Food is information. What Austin talked about is that consuming simple carbs like sugar is information. It's telling your body that winter's coming. When did the fruit ripen? It ripens in the fall, right? And so, you're eating sugar for this one time of the year and as, again, Austin said it stimulates the production of insulin.
Insulin says, make fat and store fat. Why? Because winter is coming. So, we all have a sweet tooth because it was a powerful survival mechanism. And now, as we talk about in Brain Wash, that survival mechanism is hacked by people infusing sugar into our food that more than 60% of the 1.2 million foods sold in our grocery stores has added sweetener to make it more appealing, so we can't stop. It's catering to that primitive and life-sustaining desire to eat sweet cause it did keep us alive, those who had the sweet tooth stored the fat and survived the winter.
Those who have—who are catering to the sweet tooth now will be less likely to survive because of gained weight. And interestingly, you know, it's been said, “Well, we gain weight because we eat too much. We make fat because we eat too much.” Gary Taubes has an interesting way of looking at that. We understand that our body fat signal has a role to play in our signaling for our appetite and for inflammation, but our body fat sends signals to eat more. It affects a hormone, for example, called ghrelin. And so, our body fat wants to make more body fat. So, as Gary Taubes said, “We're not fat because we overeat. We overeat because we're getting fat.”
Luke Storey: Oh, interesting.
David Perlmutter: It’s an interesting way of looking at it that are fat. And years gone by, in my day, when I was your age, fat was a storage depot of calories, end of story, right? And now, we know that fat is an organ, fat is secreting chemicals that are involved in inflammation, we call them adipo, like fat kinds or cytokines. Fat is involved in playing as if affecting the endocannabinoid system, which we can talk about, but it's also very much controlling our appetite. So, if there's a lot more going on with fat, then it's simply being a cosmetic issue, has huge, huge health implications.
Luke Storey: Let me just-
David Perlmutter: One more thing that comes to mind because we recently just reviewed a study that compares body mass index, a measurement that has to do with your height and weight, a relationship, and the ability to postpone, to make decisions that are more looking at long-term outcome versus being impulsive. And it demonstrates that a body mass index has a very important role to play in allowing us either to access the prefrontal cortex and make better decisions or at higher levels of body mass index, locking us into that part of the brain, the amygdala, which is impulsive. So, the more we gain weight, the less likely we are, again, another feed-forward cycle, to make better decisions. So, now, we've covered two things, inflammation makes it worse and body fat makes it worse.
Luke Storey: That’s so interesting. That feedback loop is really, really trippy.
David Perlmutter: Feedback loop.
Luke Storey: Yeah. So, there's definitely a play on that.
David Perlmutter: The title for another book, perhaps, I'm just saying. Royalty over here.
Austin Perlmutter: I would say one more thing to that end.
David Perlmutter: Yeah.
Austin Perlmutter: The way that I'm reframing this is our adipocytes, our fat cells, they have their own agenda. They want to continue to survive. And how do they do this? They send messages to our brain, which is keep us alive. Eat the foods that are going to keep us going. It's a crazy thing when you think about it that way, but this is what the science is telling us.
David Perlmutter: Isn't that amazing? I mean, the thing is that we know cancer cells do the same thing. Cancer cells say they're going to inhibit those body functions that would have broken them down. They increase angiogenesis or the growth of blood vessels. They're doing everything they can to survive, and as Austin said, the same thing with fat cells. They just—they want to be around—they make you cater to them.
Luke Storey: Wow. That's so fascinating. We're being run by our bodies without even knowing it.
David Perlmutter: Yeah, but that's what we're doing, we're calling attention to it. That's job one.
Luke Storey: Right.
David Perlmutter: Raising awareness as to what your lack of sleep is doing, as to what your digital experience is doing, as to what your sedentarity is doing and what your diet is doing, what your lack of nature expulsion are doing to you. So, that said, now, we go to phase two, then what do you do about it? But we'll talk about that later.
Luke Storey: As we kind of move out of the fat piece, I think it would be really useful for people to understand the differences. You mentioned inflammation, of course, which is kind of a cornerstone of your work, and I'm assuming the work you guys are doing together. I think that many people still don't understand the differences between something like a grass-fed ghee, butter, coconut oil, uncooked olive oil, fats, good, and correct me if I'm wrong, bad to just put it in sort of a dietary duality here being like all of these seed oils. And I know when you go in a store like whole foods, I call it kennel foods because it's like you go to the salad bar and everything's just canola oil or so many products that are like in the health food store will say like vegetable oil or safflower, sunflower, all of these oils. And maybe you could just speak to kind of the differences between the various fats that are in our food system.
Austin Perlmutter: So, I'll speak to one point you just made, which I think is so important. You have these three macro nutrients being protein, fats, and carbohydrates. And it's easy to say that it's a simple solution. Do a little more of this, a little less of this. But as you mentioned, the nuance is so key and it's understanding that we now know trans fats are bad for us. They stimulate inflammation in the body, but Omega-3 fats, which is a polyunsaturated fat, is good for us.
And are we capable of holding this in our heads and understanding that fat isn't universally bad or good? I think we are. It's important to have some level of nuance with these things. And so, the messaging in Brain Wash is to understand that our dietary choices should be based around a simple core-unifying idea, which is what are we doing to lower inflammation in our body? And conversely, what are we doing that we may be unaware of that is increasing inflammation in our body?
So, from that lens, then we can reevaluate our macronutrients. We can look at carbohydrates and say, well, do some carbohydrates increase inflammation in the body while others decrease inflammation in the body? And the answer is yes. So, certain types of carbohydrates, meaning your refined carbohydrates, where all of the good fiber has been stripped away, those increase inflammation in our bodies. But good carbohydrates, meaning high in fiber, meaning things that humans haven't messed with that much, things like you find in vegetables, these are good for the body.
Similarly, I think that thinking about how much has a protein been processed, meaning, is that an animal that's been raised in a lot where it's been fed lots of antibiotics, lots of hormones, and been fed things that perhaps that animal wouldn't have eaten in the wild? That is a processed food. And these are proteins that then also, as the refined carbs, increase inflammation. A wild game, on the other hand, is something that may not increase inflammation and actually have anti-inflammatory properties.
Talking about, for example, salmon, farm-raised versus wild-caught salmon, and the different inflammatory profiles you see with those macronutrient contents contained within. And then, finally, to talk about fats. And again, I mentioned trans fats being something that we know increases inflammation, but as you said, vegetable fats and seed fats, things that have been highly processed. I would just come back to this message again, which is how much has the food been processed? Because that correlates quite strongly with how much it might be inflammatory.
So, appreciating that our monounsaturated fats, things like what you find in olive oil and avocado and nuts and the polyunsaturated fats, which, again, bring us back to the Omega-3s. These are things that are very good for us, are low in inflammation, actually are anti-inflammatory, as opposed to a lot of what you can find, as you mentioned, in the salad bar, where they're seemingly trying to produce a healthy product, but then you read through the ingredients, and honestly, my girlfriend and I were just talking about this two days ago, you want to believe that you go to a healthy restaurant and you look at the ingredients and it's going to be all the things that you know are good for you.
And then, you read in and there's added sugar and there's canola oil, and these are things that are, I want to emphasize this, inflammatory. And so, yes, inflammation matters because it correlates strongly with diseases like diabetes and Alzheimer's disease, but inflammation because it is going to compromise our decision making. And if you have that happening, you will continue to make those decisions to eat those inflammatory foods because your decision making is compromised. Such an important point. This is a feed-forward cycle where eating inflammatory foods compromises your decision making, leading you to eating more pro-inflammatory foods. So, we've got to put a stop to this cycle, and that's what Brain Wash is all about.
David Perlmutter: I mean, there's a couple of things that Austin said, that I hadn't heard before, that I'm going to remember, and that is—no, really good. I mean, we talk about processed foods, you know, I'm thinking in a package, in a box, 10 ingredients, that's a processed food, right? But you talked about processed foods as you’re referring to a meat, for example, get fed antibiotics and hormones as well as range—rather a non-wild fish, farm-raised fish as processed foods. I like that. I mean, I want to talk about that moving forward because they are processed. That's not how those foods would be in their natural environment. And point well-taken about the health food store. I mean, if we buy into this idea that it's a health food store, first question is, what are the other food stores selling if it's not a health food store?
Luke Storey: I've talked about that so many times.
David Perlmutter: Yeah.
Luke Storey: So, we have this differential between what we call organic food, and then conventional food, and I've always thought that was so backwards because truly, conventional food is food that has not been altered or messed with. It's just grown. Ideally, like the most conventional would be a wild food, right? Secondarily, food that's grown without pesticides. But now, we have this special category called organic food, that's that weird food over there. And then, conventional or normal food is food that's literally sprayed with poison that's meant to kill stuff. You know, it's just crazy.
David Perlmutter: You know, Luke, when I lecture sometimes, I like to set the audience up, and then hit them with a punchline, one of them is I say, “Gosh, you know, nowadays, it's so wonderful because we can go anywhere—there's organic food wherever we go. You know, back when my father was young, you know, how hard it was for him to find organic food?” And the audience is thinking, I said, “It wasn't hard at all because all the food was organic.” That was before the 1950s, in ‘40s when we started poisoning our food. You know, what does—think about that. I mean, Gregory Bateson, anthropologist said that mankind is the only animal who will befoul his own nest. And we're seeing the consequences of that not just in human health, but in terms of health of the planet.
And, you know, that's the big picture that at the end of the day, the existential part of Brain Wash that when we finally got to that point was—you know, made us take a moment and sit back and realize that we had unleashed the genie here, that if, in fact, this westernized diet, you know, the high-inflammatory-type diet, if it's becoming global, and it is, and it's globalizing now, this pre-packaged type of quick food, which is highly inflammatory, and if inflammation, as we now know, is disconnecting people from the prefrontal cortex and locking them into the amygdala, which is the us versus them part of the brain, then this global change in diet has these existential implications of fostering this fear and this us versus them mentality across the globe.
Luke Storey: Wow, that's interesting. And it's trippy that the play on our inherent cravings for calorically dense foods and, you know, fats and sugars, like that's the very thing that is being targeted because it's the most profitable, right? And the thing that locks us into that craving, but also then, as you're saying, instigates that more base level of interfacing with others. It's really interesting.
David Perlmutter: It’s true. I mean, it is-
Luke Storey: Which of course then is a loop of making us more disconnected and unhappy. It makes us want to go eat those foods more. It’s crazy.
David Perlmutter: Well, you know, we talk about, give us 10 days, we just want you—and you in particular, all right? We're challenging you. The 10-day challenge here.
Luke Storey: I'm up for it, depending on what it is.
David Perlmutter: You've already agreed, so we throw anything at you at this point. But, you know, 10 days of paying attention to how much time you're spending online, being mindful about your online experience, by being mindful about making changes, do you get a restorative sleep, enough sleep that you do spend some time in nature that you are careful in terms of what you're eating, that you are dedicating time to meditation on a daily basis, and, you know, doing all of the components of the program because it's enough.
Even if you just do a few of these things to help that decision making very quickly to allow you then to embrace what's going on. You know, most of this battle is getting the information, realizing, what in the heck has happened to me? How have I been taken advantage of in terms of my decision making? So, that's all we're looking to do. You know, we're looking to just change that a little bit, give people just a little bit more traction because, you know, so many people are suffering because they've got the information, but we are providing the bridge between information and action.
Luke Storey: Let's go into the sugar piece a bit because I think like fats, many people just give a blanket categorization to sugars, right? But there's all sorts of different sources of sugar. Do they affect the brain differently? In other words, if we have like a really crappy sugar, which to me would be the bottom of the scale, maybe corn syrup, right? Speaking of refined, and then perhaps coconut sugar or something like that, or monk fruit extract. Give us like a breakdown.
Austin Perlmutter: I love it.
David Perlmutter: Go ahead, Austin. I'll let you handle this one. You might not like his answer.
Luke Storey: You guys are like tag team here. What I want to know is like, if you could break down sort of a simple hierarchy of like, if you have to put something sweet in your food, you know, Stevia, monk fruit extract, xylitol, whatever, down to like the bottom of the barrel, worst sugars.
David Perlmutter: We’re not talking about sugars then, we’re talking about sweeteners.
Luke Storey: Well, let's expand it to sweeteners, yes.
David Perlmutter: Okay, good.
Luke Storey: But you could perhaps tee it up by saying, you know, sugar in general is bad for your brain because of X, Y, and Z.
David Perlmutter: It's a great question, and this does harken back even to the Grain Brain days. And where people would tell me, you know, “No, we don't use sugar. We only use organic honey made from bees that are on an ashram and meditate three times a day, and therefore, it's got to be good for me or, you know, organic maple syrup. I mean, that sounds great or coconut or whatever the sugar is, it's sugar. You can dress, go ballistic on the pig, it's sugar, right? And your body doesn't know that it came from a package from the best health food store around, it's labeled organic, and it was on sale. It doesn't matter.
Sugar, you know, there are types of sugar. There's glucose and fructose, as you were alluding to, that affect the body differently, but they each, you know, have their detriments. Whereby, fructose, by definition, doesn't affect insulin pathways, it does lead to what we call fatty—nonalcoholic fatty liver disease, and has a huge effect on other aspects of our health that are not good for us. So, you know, what I do my best to do is to get people away from catering to their sweet tooth all the time.
The more we cater to the sweet tooth by saying, “Okay, I’m not having sugar, I'm having Stevia or using monk fruit, whatever it may be, the more then we activate that pathway, and the more that becomes indelible. If you want to use a little Stevia or monk fruit, then have at it, but any of the sugars, I love this one, in recognition of the dangerous aspects of fructose, the highest fructose-containing sweetener out there is this thing called agave nectar. Now, how could that be bad? It's called nectar for crying out loud.
Luke Storey: Right.
David Perlmutter: And it's in the health food store. When you buy—get a tea or coffee, it's right there because at the health food store, it's agave nectar. I mean, it's not sugar, no, it's nectar, the drink of the gods, right? Ambrosia was the food of the Gods, it’s got to be good for me.
Luke Storey: When they showed the cacti in the photo too, and you're like, that doesn't look sweet, that can't be bad for me.
David Perlmutter: Yeah. And, so, I just think it's the messaging. And the messaging is that if that sugar—I hate to make these all-encompassing statements, but all sugar is bad. You know, that's pretty dramatic, but we should avoid all sugars. And even beyond that, this notion of refined carbohydrates, it's not that all grains are bad. Do you want to have some organic rice, a serving of that with a meal? Have at it. You know, rice is, by definition, a grain. It's the seed of a grass. Yes. Have some, if you can find some, a non-GMO organic corn, which, good luck with that, but if you can, have a little bit of it, why not? I mean, popcorn, by and large, is organic. Who knew? Or at least non-GMO. So, if you want-
Luke Storey: I've heard that, that the GMO kernels don't pop well or something.
David Perlmutter: The colonels, no, but the generals do. And the-
Luke Storey: That’s great.
David Perlmutter: But anyhow, that's true. So, there's a snack for you, some organic popcorn, which you can buy.
Luke Storey: Right.
David Perlmutter: And by definition, is that a grain? You bet. Then there are the sort of, you know, the quasi-grains that are out there, that might be good in moderation, but recognition that these are a good source or bad source of carbohydrate if you're watching your carbs. So, you know, you were getting at something earlier and that is how our sweet tooth was an entry point for the hacking people, to get into our sweet tooth and manipulate our choices. And Austin brought up a very good point that he brought into the book about how humans, you know, being social animals is an entry point as well. You should tell us about that.
Austin Perlmutter: I think that the two fundamental hacks, one being our natural desire for sweet and the other being our natural desire to exist in a tribe, to be accepted by the people around us are probably the biggest things that we bring up in the book when it comes to easy-to-understand hacks into our brains. We mentioned the sugar hack. The idea that humans are part of a tribe, that we rely on each other, it's something that has been pretty well-understood, and it makes sense.
Back in the day, you needed somebody to have watched your back in case that saber-toothed tiger was coming up behind you, but these days it's being unfortunately manipulated to make us buy into these systems where we think we are developing friends. And sometimes, we're not really. We think we're participating in this social network, that we are on social media and therefore, by definition, we are becoming more social, we're becoming more integrated, more connected. And it doesn't mean that that isn't happening, but every time we go onto these social networks, we are exposing ourselves to mental manipulation.
And if you're keeping up with the news, which I don't always recommend, actually, you'll see there are so many stories that substantiate this claim. Your attention is being sold when you go online and your, your eyes are being directed towards targeted media that can very easily polarize us. And this is a big concern because what it means is if we're spending our time in these echo chambers of partisan thought on social media, we're actually becoming less disconnected. We’re becoming more polarized against the people of the opposing political party or even the opposing sports team.
Luke Storey: Right. Or the keto, paleo, you know, carnivore-
Austin Perlmutter: Dichotomy
Luke Storey: Within the health industry, there's a lot of that, too, which was funny to see it because it goes in cycles. You can see it kind of every 10 years, you know, there's camps that switched sides and all that.
Austin Perlmutter: Listen, it's really nice to believe that all of a sudden, we've got all the answers and this is the solution, it's this diet or that diet. But if you look back at history, it's very unlikely that we've got it all figured out. And if we can appreciate that and think to ourselves, everyone else out there is just doing the best that they can. There's so much more to relate. And this is the central message of our book, is that we need to cultivate empathy. People who have higher levels of empathy have higher levels of wellbeing.
They have better relationships. These are essential things. You want to be in a good relationship with your partner, you need to have empathy. And that means effective empathy, yes, but also cognitive empathy, being able to understand what they may be thinking. When we put ourselves into these social media chambers of believing that now, we have all the answers and everyone else is bad, we can't bring that online. And we can't understand that these are other people doing the best they can, trying to make sense of this really intense and crazy world, and then we can't relate to them.
So, it's something I was thinking about the other day. If you look at political divides and how they've been expanding over the last 10 or so years, people are more politically divided than they ever have been before. That means that we are being distanced from our neighbors. We are doubling down on our political ideologies and this split, you know, for one reason or another seems to be something people want to hold onto, but there is so much that we have in common. There's so much more we have in common with our neighbors than these specific concerns that we have.
If we're capable of getting together, having dinner with them and bringing our empathy online, we can learn so much and improve the quality of our lives. So, empathy is key. On the other hand, we worry that some of these social media mechanisms are instead fostering the opposite of empathy. And what would that be? Well, that's narcissism. And there are a number of number of studies that show that people have become more narcissistic in the last several decades. And unfortunately, narcissism is linked with a variety of pathological outcomes.
One of the more interesting pieces is that people with narcissism have problems with their cortisol regulation. And so, why does that matter? Well, cortisol is the stress hormone. Cortisol and stress in general distance us from the part of our brain that's able to make good decisions. And it activates the part of our brain, the amygdala that keeps us locked into making these impulsive, irrational, and emotionally reactive decisions. So, let's walk that through a little bit slower.
Narcissism is linked with problems with cortisol regulation. Higher levels of cortisol take our prefrontal cortex, our thoughtful part of our brain offline. So, you can see how there are many mechanisms through which over-reliance on social media, and again, not saying social media is bad, but doing it the wrong way can have significant impact across a variety of very important parts of our lives and our brain health.
Luke Storey: There was a really interesting correlation there, I think, and you guys tell me if I'm wrong here, but when you're looking at the human desire for community and to be a member of a tribe and to be accepted because that's how we're wired to, you know, form bonds that unify us together for safety, right? And then, social media, in its most positive intent, would be a way that we can keep that connection going despite of distance and lack of physical proximity. However, and in addition, because the social media—I think the brain mechanism there that's driving us back is dopamine, right?
And so, we feel the sense of connection from likes and comments and bonds and follows and unfollows and swipes and all that, but in an interpersonal, like going back, you know, hunter-gatherer days, interpersonal relationships would have been buffered dopamine when you get excited, right? “Oh, I saw that. You know, he came back from the hunt. I thought he might've been dead.” But then, there's also oxytocin because there's human touch, right?
And I make this correlation to social media because of something I learned from John Gray in regard to pornography and why it's so damaging to the brain because you have these insane dopamine spikes. But when you're with a real human, you have high dopamine, but it gets tempered by the oxytocin that's created throughout the human bond. So, do you think there's a correlation between the addictive nature of social media and the dopamine spikes that we're getting and the lack of true connection that might temper that and make it less addictive? Like I don't have to hug my friend 10 times when I see him, but I'll refresh my phone 10 times.
David Perlmutter: Well, I think the whole online experience, even beyond social media, is addictive because it is really designed for immediate gratification across a big spectrum, whether it's gratification to buy certain things, gratification by the number of likes that you've gotten, a gratification that your political party is the right political party. Why so? Because that's the site that you are on, whether you're a Republican or Democrat or Liberal or Conservative, you're going to gravitate to those areas of the internet that are fostering your belief system, so it entrenches you deeper and deeper. And that is contrary to what the prefrontal cortex is all about. The prefrontal cortex is that part of your brain that allows you to engage the perspective of another person. And that's really very important. Maybe the world is flat. I don't think it is, but maybe it is. If you believe that it is, I want to visit that a little bit because that's how we make progress. We don’t-
Luke Storey: Flat earthers are my favorite Twitter follows because they make some very compelling points. Sometimes, I’m like, wow, they’ve got-
David Perlmutter: They’re valuable to listen to.
Luke Storey: Yeah.
David Perlmutter: Because if we dig in our heels, even if it's an eye for an eye, tooth for tooth, we're all going to be, have no teeth and be blind ultimately, right? So, I have to be okay. I may not embrace what you're saying, but as Austin said, this idea of cognitive empathy, to be able to see things through your eyes, to walk a mile in your shoes and see what it's like because one area that I've been criticized for over the years, and I am grateful for it, is, there was a magazine, put a really scathing article about Dr. Perlmutter a few years back saying, “Oh, he first told us we should be on a low-fat diet 20 years ago, and now, listen to him.”
And that it changed my messaging. You know, I did change my messaging and I'm going to tell all of your viewers and listeners, I will likely continue to change my messaging. It's what you want me to do. You want me to stay up with the literature and do the very best I can to speak from the heart and tell you what I've learned and that's going to change. And one of the ways I learn and ultimately change is by listening to the opinions of other people, whether they are similar to mine or different. If I constantly only listened to people of the same opinion as I do, I won't make any progress, i.e., vis-a-vis our conversation.
If I'm only on those social media sites that are in line with my ideology, I won't experience diversity. I won't experience what the rest of the world may be thinking, and therefore, I don't have the opportunity to change my groundwork, my frame of reference, my ideology, which is so important. You know, we, as humans, have only two huge attributes that differentiates us from other animals. We have an opposable thumb and we have the ability to question. And when you lock in to ideology, you abandon the ladder and you cannot make progress if you don't question what's going on around you.
Luke Storey: I think you two should run for president and vice president.
David Perlmutter: Then, he’d be president. You know, people say to me-
Luke Storey: I thought we’re just talking about why bread's bad for you, we’re getting deeply philosophical here. This is amazing.
David Perlmutter: That’s why this book is—when I think—when we both think about it, it's, you feel it, you feel it in your heart, you get chills. I mean, you know it, it tends to override some of our longstanding beliefs, and that's really a good thing. You know, you would say the sun rises in the East and it sets in the West. Well, you know what, it doesn't. It doesn't rise in the East. The earth is turning. The sun is just—it's not flying across the sky in its golden chariot. You know, we—you know, suddenly, you say, my gosh, that's a different perspective. I'd like to embrace that.
Luke Storey: When it comes to inflammation and-
David Perlmutter: We’re only in your second question on five pages. I hope you got-
Luke Storey: Yeah. No, I got a lot. I got a lot. We got plenty of data, plenty of data room. When it comes to inflammation, and, you know, obviously, we spent a little bit of time just touching on, you know, the high sugar, refined carbohydrates, bad fats, all of that stuff that contribute to inflammation, I'm specifically interested in inflammation as it affects the brain. And how—in addition to some of the poor decision making and the feedback loops that we're kind of talking about there, what about very specific things like depression and anxiety and ADD and autism spectrum and things like that?
I know that in some of your work, you've indicated you've seen remarkable turnarounds from people with some of those issues just for making these changes, which essentially, we're just eliminating or decreasing the amount of inflammation based on lifestyle and diet. You know, what does it do—if I'm prone to depression and I wake up every day and I'm just eating donuts all day, like what's happening to me and why am I not going to get better?
Austin Perlmutter: The story behind inflammation and the brain is something that is in constant evolution. It's been expanding so rapidly in the last 10 or so years. But for me, the first, I guess, concept that there might be this relationship here is in seeing patients in the hospital. And when you see patients in the hospital, especially when they're in the critical care unit, the ICU, these are people who are very sick. And you often see that their thinking is off. And I don't mean just a little off, it's really off.
So, ICU delirium is a very common condition. And researchers have looked into why does this happen. And what they found is these states of significant sickness, you would, as you would expect, have high levels of inflammation. And they can actually see that this inflammation makes its way into the brain. And so, there's this idea that this sickness-type behavior is something that is driven by inflammation. Now, that's just a general model for how thinking the brain and inflammation might be connected, in addition to all the work that you've done linking Alzheimer's as an inflammatory condition.
But the next step was to be—to say, does inflammation cause changes in our thinking? And specifically, as it relates to depression. Well, when they were looking at people treated for hepatitis, they would give them interferon. And one of the most common side effects of interferon is depression, depression-type behaviors. So, scientists said, “Well, maybe there's a link here.” They took this a step further by actually injecting people with things that induce inflammation, which sounds like a lot of fun, right?
But what they've done is they've given people either vaccinations, typhoid vaccination, which induces inflammation or endotoxin, which is a technical term for a part of a bacteria that reliably increases inflammation. And what they found is in these cases, people display symptoms of depression. They have the depression phenotype, meaning they outwardly express that they are withdrawn from other people, that their mood is not as good, the traditional diagnostic criteria for depression.
So, this has led to, in the last several years, this phenomenal understanding that depression can actually be caused by inflammation. And again, something that I really never learned when I was in my medical training, we learned about these things as a serotonin deficiency, let's say. You have a neurotransmitter imbalance, but it never really got to the root of why is it that some people experience depression and other people do not, even when they're in the same environment, have the same things going on around them.
And maybe a part of that is how much inflammation they're experiencing. So, depression is a condition that is incredibly common, unfortunately, too common. And it's something that is around 300 million people worldwide are experiencing depression at any given moment. It's a huge problem. But we should also think about depression, not just from the problems it creates in our social function, but it is a change in our thinking patterns. It is the change in the way that we see and approach the world.
So, the next piece of this then was to say, okay, depression, inflammation, changing our thinking, what about how inflammation might change our decisions, specifically our decisions? And that's actually research that's only been published in the last year or so, where they look at how inflammatory tendency is, meaning, how likely your body is to have inflammation if exposed to something that induces inflammation? How likely you are to have short-term decision making if you have higher levels of inflammation in the body? And as it turns out, people who have higher levels of inflammatory markers are prone to being present-oriented.
And that's impulsive with their thinking, that they're more likely to take $10 today than $100 in a week. And that is such a fundamentally important message because it means that inflammation, even short-term inflammation, biases our thinking, such that we favor short-term outcomes. Such a fundamental mechanism for us because that means by influencing our levels of inflammation, whether that's through diet or even going out into nature for a little bit, we can change our decision making to favor these well-reasoned long-term outcomes that are so essential if we want to live lives of happiness, if we want to live lives of lasting health.
David Perlmutter: Wow. Well said.
Luke Storey: You have a smart kid here, man.
David Perlmutter: I can see you're taking it in.
Luke Storey: I think we're both impressed. I'm like, damn, wow, you're very, very articulate. Thank you for that. And then, what about inflammation as it pertains to brain fog. I think this is something that many of us, including myself, from time to time, really struggle with of just that feeling like, God, I know I'm smarter than this, but there's like this gauze over my eyes. And I get a lot of feedback from people that that's one of their main complaints is that, how often is that related to-
David Perlmutter: Well, I think as it relates to brain fog, there are so many things that have to line up for your brain to work well. And that said, if there's any missing piece of that puzzle, whether it's having adequate fuel, the presence of inflammation, compounding factors, toxins, et cetera, lack of sleep, everything's got to line up so that we can do this interview right now, so we can be present and focused and be able to retrieve information. So, it isn't a wonder to me that—I mean, it's a wonder to me that, you know, so many people can function as well as they do when you think of all the entry points that can compromise thinking.
Just one other point I wanted to add as Austin was talking is interesting that depression is associated with a slightly higher body temperature. Again, indicating that it's a sickness type of response. It's an inflammatory type of response. But getting back to what I’m just saying, this notion of brain fog. So, brain fog is characterized as a characteristic of an infection, raising body temperature with the presence of these inflammatory mediators and those inflammatory mediators actually can antagonize or make less functional the receptors for various parts of our neurochemistry.
So, actually, in affecting how the chemistry works that has to do with nerve transmission, beyond that, we know that inflammation through a specific pathway called the kynurenic acid pathway, which is, some of your geeks will look that one up, but, boy, they may know about it already, is the pathway by which your body manufacturers serotonin out of tryptophan. And when there's inflammation present, tryptophan is deviated away from the production of serotonin to make some equal quinolinic acid, which actually antagonizes how nerves work. It actually threatens nerve conduction.
So, that's a very powerful relationship then between inflammation and interrupted nerve function. So, you know, when people eat the crappy food or don't get a good night's sleep, which affects your thinking, cognitive function from other perspectives that we’ll hopefully jump into or any of a number of issues, or even when you're sick and have a fever and you're fighting some kind of infection, why you experienced brain fog, why people with chronic Lyme disease, for example. One of the main things they complain of is that their thinking is fogged, that they can't put their thoughts together.
It's because of these direct toxic effects of this quinolinic acid produced because of the shunting away from serotonin with the utilization of the amino acid, tryptophan. So, there's some pretty well-described biochemistry that addresses your question quite specifically that we can now hang our hats on. You know, will that answer be different in three years when we come back to your place here and do another interview? Hopefully, it will be because that'll mean we're learning new things.
Luke Storey: I just wonder how many people have been, you know, mistakenly prescribed psychiatric medication that could have a number of different adverse side effects when it's kind of going after the wrong issue, right? Like I interviewed a woman named Dr. Kelly Brogan a couple times, and she's a formerly trained psychiatrist and basically just puts people on a paleo diet and cures them of all this stuff and gets them off medication. You know, it's just crazy. You hear her stories and you can't even believe that they're true half the time.
David Perlmutter: Well, Dr. Brogan's new book really does focus on the global mismanagement of depression. And she is spot on. And interestingly, after her book was published, and it's so unfortunate that this happened, there was this amazing publication that really put a nail in the coffin of the utility of these SSRI medications that are prescribed so aggressively around the world for major depressive disorder. So, you know, she's really quite on target with the idea that yes, there is some utility to exercise as a therapeutic intervention for depression and dietary change.
I mean, there's wonderful Rhonda Patrick podcast that talks about, can exercise be used as a therapeutic as it relates to depression? I'm not saying, and no one would say that, yes, this is the cure for depression. But let's take a step back. A depression is not a Prozac, Paxil, a Celexa deficiency. It is this notion of, well, you don't have enough serotonin, so you're depressed, therefore, we’ll inhibit the enzyme that breaks down serotonin, have more serotonin and the world will be a better place. It just isn't so.
If it were, then these patients would, by and large, get dramatically better when they're taking the medication. The truth of the matter is the difference between placebo effect, which I'm not discounting, and the effectiveness of these SSRI medications is minimal. So, I would say, why don't we just give them sugar pills and tell them they're going to help, but I don't want them to get sugar. So, if we got some other inert substance in there, maybe, should I say hallucinogens? I don't know. I know that's where we're going next.
Luke Storey: Yeah. Did you cheat and look at my notes?
David Perlmutter: Realized that after the interview, no. But having said that, I think that, you know, what Austin was saying earlier that we have to take a step back and look at where we are today, at the time of this interview, mechanistically, in terms of what's going on with depression. And when we do that, we realize we can begin to target the cause, not the manifestation. We can look at the fire, not the smoke. And it's so interesting when I use that metaphor because fire in Latin is inflammare. That's where inflammation comes from. And in a very real sense, that's what we're targeting, inflammation.
The cornerstone of not just depression, but coronary heart disease, diabetes, cancer, Alzheimer's is inflammation. And now, inflammation in Brain Wash is the cornerstone mechanism of disconnection syndrome. What is disconnecting us from that part of the brain? It is our gift as human, the part of the brain that allows us to be planning for the future, to be compassionate towards each other, to be compassionate towards the planet, that's what we're trying to reestablish connection to. And I'm sorry I ended a sentence in a preposition. My fourth-grade English teacher is still looking at me and saying, “Don't end a sentence in a preposition.” So-
Luke Storey: I think would have never noticed. That's a lesson for me. So, that's a great segue then into—I'd like to kind of get into some of the anatomy of the brain, A, but before doing so, perhaps stepping back from the inflammation issue, dietary and lifestyle choices that we make as they pertain to things like depression, anxiety, other disorders of that type, how much of it is perhaps just, you know, unresolved trauma and more of the psycho-spiritual angle. You know, in other words, it's like I could be eating very clean, anti-inflammatory diet, exercising, human connection, all that stuff. And if I've never looked at, you know, childhood trauma and things that I experienced, those could manifest as something like depression or anxiety or other disorders. Where does that kind of fit in there to you guys?
Austin Perlmutter: This is a really important point that you bring up. And part of the way that we've studied trauma is through the question of stress or the discussion of stress. There was a 2018 paper where researchers from both Penn and MIT looked at these children aged four to seven and they pulled their parents to find out had these children had significant childhood traumas, things like divorce or a significant illness. And what they found is that the more childhood trauma these kids had, the less the connection between the prefrontal cortex and the amygdala.
The connection pattern had been disrupted seemingly by that trauma. And that disconnection was linked to higher levels of aggressive behavior. So, what does this mean when it comes to maybe adults? Well, we know that stress seems to do this in adulthood as well. There have been a series of really fascinating studies coming out of a Yale researcher named Amy Arnsten that demonstrate how stress, and, again, we can use traumas, but stress, it compromises the pathway, the connection between the part of your brain that gives you the ability to calm yourself down and the amygdala that holds on to that fear, that holds on to that trauma, that reactivates these patterns that bring you into this scared state.
So, when it comes to early life traumas, we're not exactly sure how much long-term interventions in adulthood change what happened early on, but what we do know is that you can change what is happening in the present. And as it pertains to chronic stress, that means that lowering chronic stress, lowering these sources of chronic stress in your life is probably one of the most significant things that you can do to get yourself out of this loop where you're constantly reacting from this emotionally reactive perspective, from this impulsive perspective.
And when we get into the neuroanatomy of this, it'll make this a little bit more clear, but your point is very well-taken, which is what is trauma doing to our brain and what can we do to lower this trauma that children are having early on in life? And that's obviously a much bigger conversation, but I think it is essential to the bigger picture of how do we get people to have happier, more enjoyable lives. And one of the ways is addressing sources of childhood trauma. And then, as we age, to have interventions for adults to help them to manage perhaps what had happened earlier on in life, but more specifically to decrease sources of modern-day unnecessary stress that disables our connection to the prefrontal cortex.
David Perlmutter: And, you know, along those lines of what Austin just said, we have the ability then to reconnect to the prefrontal cortex and distance ourselves from this aggressive connection to the amygdala that, as he pointed out, is fostered by early-life trauma. I mean, there's no going back, but the Dalai Lama said, “The brain we develop reflects the life we lead.” So, it means that our moment-to-moment choices in terms of what we pay attention to has a role to play in how our brains are then rewired moving forward. We call that neuroplasticity.
So, if we choose to concentrate on those lifestyle choices that are helping us connect to better parts of the brain, we can distance ourselves and that those connections related to early-life trauma can wither on the vine because they've not been nurtured. We can nurture connection to the peripheral cortex by engaging in acts of empathy, by allowing our bodies to nurture the whole notion of neuro-plasticity. How do we do that? We increase our body's ability to make new pathways and connections by increasing the production of a particular chemical called brain drive neurotrophic factor or BDNF.
How do we do that? We do that with exercise. That is the miracle growth that allows these connections to happen. So, we set the stage for this neuroplasticity that happened by exercising, by consuming DHA, by whole coffee, food extract, turmeric, various ways. And then, we take advantage of that fertile soil by engaging in acts of gratitude, expressing our gratitude, acts of empathy, not just for each other, but empathy for your future self. That's another person, the Luke who's going to sit in this chair in 10 years, you can be empathetic towards that person and do right by that person based upon the choices you decide to leverage today.
Luke Storey: Wow. Fascinating. Yeah. The neuroplasticity piece to me is something I'm extremely fascinated with now because it's—even in my life—I'm 49, in my lifetime, it's like the brain you got and the injuries that, you know, you took on as a kid, that's just you and you're going to be an alcoholic and die a miserable death, you know what I mean? It’s like—and now, we're realizing that there are ways in which we can actually kind of build a new brain. And I think that's just so exciting.
So, it's my current obsession of like looking into every known modality to help facilitate that. I recently, last week, interviewed Dr. Daniel Amen down in orange County, and he took some scans of my brain. He said, “Your brain's in really bad shape. You know, eat fish oil, do hyperbaric oxygen”, et cetera. And I was like, “Well, yeah, but what about the neuroplasticity? Like how do I get that moving?” And he's like, “All right, you're ready for this? You're going to have to play a sport.” I was like, “I hate sports.” And he said, “You got to play table tennis every day.”
David Perlmutter: Exactly. I really keep challenging Dan and his wife to play ping pong because he's really into it. In fact, the last time I was with him was out here in California. And at that time, we were remodeling our garage and I was so happy to tell him, BTW, we've got—as you know, Austin, we put the table tennis, and based on what he said, and it's really true because clearly, it’s hand-eye, but I'm not sure for neuroplasticity, I think we're looking, with all due respect, and Dan's a very close friend, we really want—if we're going to amplify that, we really want more aerobic and some resistance exercise to have it, if you're looking at the raw upregulation of BDNF.
Luke Storey: So, if we're priming the brain through, you know, different forms of exercise, movement, et cetera, hand-eye coordination, and we're priming it for neuro-plasticity, where we want to get in there and do some work and kind of rewire things and make neurons, new ones fire together and wire together in positive ways that are going to reflect a positive outcome, once we've sort of set the stage and we've lowered inflammation and we're good to go, and the brain's like, all right, tell me what to do, what are some modalities, like something like EMDR comes to mind or psychedelics or all sorts of things that are kind of, you know, becoming popular now to actually start to change the way that your brain operates?
David Perlmutter: Well, I think that if you're, again, creating that fertile ground, then to take advantage of neuroplasticity, then you engage in those activities that you want your brain to be adept at doing. And that means doing your best to connect to other people, to try to look at new things and see things through different perspectives. Now, can that be augmented and bypassed through the use of psychedelics? You know, that's certainly a conversation that we could have, but I think for the general population, at least where we are today in terms of accessibility to these modalities, the broad message would be yes, enhance your neuroplasticity by physical exercise. Maybe use a little turmeric in your cooking, take some DHA, take some fish oil, and then do good things. Do things that you think are where you want your brain to go, not necessarily where you might see your brain today, but, Austin, you probably-
Austin Perlmutter: Well, I was just going to say that your brain's going to get good at whatever you're doing. So, if you are practicing a sport, it will get better at letting you do this sport. If you're becoming good at becoming stressed, your brain is going to be good at being stressed. If you're constantly watching stressful news, your brain's going to set itself up so it does the best job possible at being as stressed as possible. Then the question becomes, what is it that you are putting into your brain? Because your brain is going to reflect what you put into it.
So, in theory, that means let's look at all these things in my life that I would like to improve. And those are going to be different for individual people. What we do in Brain Wash is provide a package which allows people to then have the ability to choose the things they want, and then stick to them. But you may be somebody who really enjoys getting coffee with friends. That should be what you focus on and really double down on making that happen. If you keep doing it, that will become a pattern in your brain. As opposed to, your pattern is every Thursday night eating a pint of Ben & Jerry's.
Now, Ben & Jerry’s is delicious, don't get me wrong, but if you continuously are setting yourself up for that, that will be what your brain expects. It will be good at remembering that and reminding you every time Thursday, 5:00 PM rolls around, this is what we do. The key then becomes how do you break out of that cycle so that you can decide what are the things I want to be doing. And that requires what are called executive functions. Executive functions are a core manifestation of the ability of the prefrontal cortex. This is things like allowing you to block out things that might, I guess, cause you to be impulsive. This is cognitive flexibility. This is attentional control. These are so key in allowing us to make good decisions.
In Brain Wash, we talk about the things that have been shown in studies to improve executive functions, which when implemented, will give you the opportunity to make those decisions. What are the things in my life I want to be doing more and less of? But you can't just force yourself to say, I want to do more of this and expect that that will stick. The way I describe this is, imagine you were sitting at a table, there's a donut and an apple in front of you. You'd like to think you can just force yourself to eat the apple. That doesn't work. That donut is delicious.
So, you need to design a brain that says, actually, you know what, I'm better off not eating that donut. And the way to do that is sequentially adding in these factors like nature exposure, like meditation, like time spent with other people that build your brain up to that point. This is what is so important. You need to design a brain that lets you make the good decisions in the first place. And then, you can have whatever it is that you like to do, that you would like to do more of, those things will fall into place.
Luke Storey: That really explains a lot about addiction recovery and that—you know, because that's part of my story. Thankfully, I’m on the recovered side of it. But it's like you take a junkie off the street or an alcoholic out of the bar and you don't change anything about their life except just put them in a position of abstinence, whether that'd be forced or maybe they just have a stroke of good luck for a while and have some willpower or grace. But if their circumstances and way of thinking and relating to the world does not change dramatically, they're going to go back into the default mode of using that coping mechanism.
David Perlmutter: Well, what do we do with the people who make the very worst decisions? People who make really bad decisions, ultimately, we put them in jail. And what happens in jail? They're cut off from nature. They're cut off from good food, they may not get good sleep. And so, they're in an environment that does-
Luke Storey: Okay. So, I'm going to do another slate for sound in three, two, one. Austin, what do you have to say about how this might fit into the addiction model? I think your dad brings up a great point with, you know, sending people that make bad decisions to prison as it pertains to things like alcoholism and drug addiction. What's your take on that? And what are some, perhaps, a direction that we could go to help people that are suffering from those afflictions?
Austin Perlmutter: Well, we're now understanding that addiction is a problem with the prefrontal cortex, that addiction conditions are where we're not able to make those good decisions that come from that top-down, prefrontal control. Again, addictions are so linked to poor decisions. And we know now that we can do things to support better decision making, but putting people into jail, let's say, cutting them off from their social support, these are not things that anyone would say are good for helping our brains to make better decisions.
Ideally, we would have a model where we supported people with the types of things we're describing in our book, give them access to social support, to good food, to nature, to good quality sleep. These are the things that improve decision making. And by the way, sleep problems have been linked to basically every type of psychopathology that we know of. And if we want to support a brain that thinks things through but also is in a healthy state because there is such a significant overlap between poor mental states and addictive behaviors, we really need to be thinking about all of the things in the middle you that creates the best environment for good decision making.
Bottom line here, putting people away for a certain amount of time doesn't seem to be in the best interest of improving their decision making other than just having them be more scared of making bad decisions in the long run. And we know fear is an amygdala-based mechanism. That fear is a stress and amygdala response, which again keeps us emotionally reactive and from making good decisions. So, it really doesn't make sense.
Luke Storey: So, this is—you know, being in an environment like that is perpetuating this limbic system trauma loop, right? So, you're a kid who has perhaps experienced trauma, your coping mechanism has been to adopt various addictions, to kind of self-medicate, self-soothe. That becomes pathological to the point where now, you don't have the power to stop. So, you start making poor decisions and you get incarcerated, and now, you're put back into a system that's going to further perpetuate that same limbic system response. It's crazy. I don't know what the solution is exactly. I mean, I feel grateful that I was able to get out and I'm, you know, doing everything possible to ensure that I never go back, not to prison, but just in active addiction.
David Perlmutter: Well, you know, having heard you say that, what do you think tipped you over and allowed you to finally break the cycle?
Luke Storey: Well, object hopelessness to the point of being beaten into at least some degree of humility and open-mindedness to be willing to consider that there is some higher power in existence in the universe, and that if I could surrender my will to that power, that perhaps it could help me when I couldn't help myself. So, it took like the cognizant awareness that like, wow, no matter how hard I try, I can't break out of this. And that took a lot of training until I finally admitted defeat. And then, literally, like what happened for me, it sounds like it can even be true, but I literally just checked myself into a rehab, asked them what to do, you know, the next day because I was going to wake up with no drugs. And they said, “Well, you just have to pray.” You know, I was like, “Pray? I didn't grow up with religion or spirituality or anything.” That was very foreign to me.
David Perlmutter: So, what does prayer do. It's a rhetorical question. I'll tell you what it does.
Luke Storey: Yeah, please do.
David Perlmutter: There's a wonderful book, How God Can Change Your Brain, written by a Dr. Andrew Newberg.
Luke Storey: Oh, we've got to put that in the show notes.
David Perlmutter: And it's a terrific book. And what Dr. Newberg demonstrates is that prayer is one of the most powerful things that we can do to connect to the prefrontal cortex, that prayer literally brings decision making back online. It connects us—it's powerful in terms of reconnection. So, what you do when you pray is, you're lighting up the prefrontal cortex and you're finally letting the amygdala calm down. So, finally, you're bringing the adult back into the room. Now, you can call the adult by any specific name if you want, if it's a directed type of prayer, give that a name, but what you're doing from, as you were asking about the neuroanatomy or more specifically the neurophysiology, here's, you're bringing back the decision making part to make better decisions. How God Can Change Your Brain by Dr. Andrew Newberg.
Luke Storey: Wow, that's fascinating.
David Perlmutter: University of Pennsylvania.
Luke Storey: I guess you could take that in one of two ways, that I mean, it could be kind of a God placebo thing where you're altering the chemistry of your brain just by believing that there is something to believe in.
David Perlmutter: And you know what? I don't care.
Luke Storey: Me either.
David Perlmutter: I really don't care because you're sitting here right now because that happened.
Luke Storey: Yeah.
David Perlmutter: So, you know, I'm all in.
Luke Storey: Yeah, I am too. I mean, to me, I think it's both. It's both. It's-
David Perlmutter: Yeah, I like talking to my colleagues and we'll say something about whatever, diet, nutrition, lifestyle change, and they'll say, “Oh, that's just the placebo effect.” Who cares? You got your response, didn't you? That patient's experiencing less depression, less anxiety, making better choices. I don't care if it's placebo effect, works for me.
Luke Storey: Right. So, getting into then the different parts of our brain here and how they work, I think it's a great way to kind of segue into that. So, if one is experiencing what we call in our common vernacular now being triggered, right? Like so, you know, someone bumps into my car or, you know, a fight with your significant other, whatever, and you're having this overreaction that is completely inappropriate to the situation that's going on and is more likely due to something that you've experienced in the past, as I understand it, that that memory then would have—you know, you got bullied, say, as a kid and your amygdala got hurt or imprinted with that.
And now, girlfriend, husband, whomever, is making a comment to you and you experienced that as that bullying again, and now, you're reacting as you were on the school yard with those bullies, you know, giving you a snuggie or whatever the hell they were doing, right? And so, inserting then that prayer then, and it having given you the ability to calm down or get back into the free kind of frontal cortex and out of the amygdala, how much of that can we like self-direct and self-regulate once we have a knowledge of how that works? And is that playing with neuroplasticity or is that a different-
David Perlmutter: It absolutely is. And let me tell you two things that come to mind. First of all, what's happening when you have that experience is, you're activating what's called an engram. You're all of a sudden lighting up a certain pattern of response and behavior based upon the previous experience. And here is a wonderful example of people activating an engram, watch somebody walking on the street, talking on their cell phone, and what are they doing? They're using their hands.
They're not FaceTiming holding their phone up to their ear, are they? They're talking and they're saying, “Oh, it was way over there and I was—I'll be home at 5:00”, whatever it is. So, they're activating an engram that is based on previous conversations with people when using your hands to describe something was effective, like I'm doing with you right now, but people do this on the phone, it happens. It's like scratching your dog's belly. And what will it do? Its leg will start to move, we all know, because you're activating that engram.
Similarly, I was in—and I talked about this in Brain Wash, I was in a Costco and we were in line and my wife had forgotten something and went to the back to find whatever while we're still in line to get that thing. And when she returned, and I feel it right now, the guy behind us in line had a hissy fit, and I don't mind that he had the hissy fit, but he started to verbally abuse my wife. And my amygdala lit up. I mean, and I felt it and I just almost lost it. We've all been there, right?
Luke Storey: Yeah.
David Perlmutter: And luckily, as I—and I talk about this in the book. I brought the adult back into the room and didn't do anything that I shouldn't have. Took the deep breath and, you know, what is it? You count to 10. What are you instructed to do? I didn't do anything specific except for take a deep breath and walked away from it. But that's the neuroplasticity that you can take advantage of. The ability to, again, rein in that impulsive reaction and make a better decision, not that the amygdala-based decisions are bad always because they are not.
And I want to make this point that the amygdala allows for us to make a sudden immediate response when oftentimes, it's bad when we have to fire off a tweet because somebody did wink, looked at us funny or says something on television or whatever, but when we're, let's say, backing out of our driveway, and there's a kid on a tricycle that you see in the rear-view mirror, you're not going to think, well, prefrontal cortex, maybe I ought to just take my foot off the gas right now, put it on the brake and-
Luke Storey: That’s right.
David Perlmutter: Because then, if I do that, the long-term outcome will be that this kid's going to—not get run over by the car and grew up to be—you know, what happens is you make—bam, foot on the brake, done, story over, kid’s fine, right? That's the upside of the amygdala. So, you know, vis-à-vis, our conversation from today, we don't want to, you know, castigate, the amygdala fully, nor do we want to say that inflammation is necessarily all bad. It's all about what's appropriate and what is ultimately the best for us.
Luke Storey: And isn't the difference between having a healthy, functional mind and a dysfunctional mind and as a result of personality your ability to know thyself and to know that you're safe now, the kid's gone by, and so, now, your amygdala can settle back down? Just—you know, it's like when you watch an animal in the wild, like you startle a deer and they freak out and run away, and then 10 seconds later, they're over there just nibbling on grass like nothing ever happened, but you cut me off in traffic or you insult me on social media, that amygdala fires up, I'm full of adrenaline and cortisol and now, I can't stop it. Now, it's like I've become addicted to that.
David Perlmutter: Again, what the Dalai Lama said, you know, what we choose to do—or how we choose to form our brains reflects the life we lead. And that will then influence your perspective moving forward. If you're constantly enhancing your connection to the amygdala, you'll ultimately won't ever shut off. I mean, somebody cuts you off in traffic, you're pissed, and you carry that for the rest of the day, and it never ends. Then you watch the news, oh, that politician said this and oh, my neighbor didn't cut the hedge, and you just go—you know, everything's rump.
Luke Storey: Do you think that it's possible that some people are in a low-level amygdala activation, ongoing, and that could lead to things like, you know, acute chemical sensitivity and EMF sensitivity and things like this of this nature, where you're in kind of a low-grade fight or flight nervous system response all the time without it necessarily manifesting inner temper tantrum, but you're just kind of like always on edge?
Austin Perlmutter: Well, this is actually what chronic stress seems to do, back to this idea of what is it the amygdala does in our brain, I think of it—well, it is a threat response system. It's an alarm system in our brain. And that alarm system can be set to a different level of sensitivity depending on your life experiences. And depending on what you do to modulate that level of sensitivity, that alarm system can be blaring every five minutes, waking you up from sleep, going off every time somebody cuts you off in traffic, or it can be relatively less sensitive, and that means that you're not too bothered if somebody was to shove you.
So, the question would be then, what is it that promotes that alarm system being more active more of the time, being too sensitive, let's say? And it seems that one of the key factors in that is that chronic stress. It is how you are responding to the world around you. Things that increase chronic stress could be anything from watching stressful news, could be stressful relationships, could be a stressful job, but these things all come together to increase, literally increase the neurons, the connections and the neurons in the amygdala to make it the part that governs more of your day-to-day life.
Simultaneously, we know that the connection between the prefrontal cortex and the amygdala, as we said, is really critical to this. So, coming back to that, let's say, alarm mechanism, the analogy that I like is the one I was telling you about last night, dad, but this whole, you have a child in a bedroom who is worried about the monsters under the bed. He’s convinced there are monsters under the bed. That child is not getting any sleep. That child is going to be petrified throughout the night.
That's when the prefrontal cortex, the adult can come into the room and say, “Hey, let's take a look. There's nothing there. We all good?” And the kid says, “We're all good”, and everyone gets a good night's sleep. So, it's both these two things. It's one, bringing down the sensitivity, the over-activation of the amygdala, and then the other is fostering a stronger connection between the prefrontal cortex and the amygdala. And how do you do these things? Well, it's things like meditation.
It's things like getting enough sleep. It's things that by virtue of lowering our stress, for example, getting out into nature for 20 minutes once a week, which has been shown to lower levels of the stress hormone, cortisol, even in urban settings. These are things that we can start doing to lower that amygdala reactivity and making us less likely to jump up every time there's a scary noise on the TV or to, again, be concerned every time somebody cuts in front of us in traffic, which I imagined living in LA would be a major benefit.
Luke Storey: That's when I knew I was starting to make spiritual progress, is when I became a chill driver.
Austin Perlmutter: Yeah.
Luke Storey: You know, there's a certain threshold where I just, everyone drive however you want, and I'm just having a great time and everyone else is like, “God, the traffic.” You know what I said, “I don't know what you're talking about. I’m having a wonderful time, you know.
Austin Perlmutter: Well, you bring up spirituality, and meditation is one of the most powerful tools that we have to dampen down that emotional reactivity of the amygdala and to connect those two parts of the brain. So, it could be a spiritual journey, it could be more of a secular journey, but that's why we're so big on mindfulness and meditation. These are practices that help to calm everything down, such that you're not immediately reacting to every concerning stimulus around you, which, given the context of our modern lives, can be a lot of potential problems.
Luke Storey: And that was the input that changed that for me actually, specifically was really getting serious about meditation. In terms of neuroplasticity and specifically neurogenesis, like growing new neurons that weren't there before, have either of you seen any compelling research that would indicate micro or macro-dosing things like psilocybin, LSD, et cetera, would have any benefit toward that end? Because I asked some pretty smart people this. And sometimes, they're like, “Oh yeah, I have the studies”, and dah, dah, dah. I asked Amen about this, he's like, “Oh, no. Drugs give you brain damage. I would never do any of that.” I was like, “Wow. It seems like there's a lot of proponents for it.”
David Perlmutter: Well, I'd say that we're probably a little bit more liberal-minded than Dan in this particular area, and we'd be delighted to—Dan’s—again, I've mentioned before, a good friend, but we have different views, I think, on this. And I think that, you know, there's certainly developing literature. I wouldn't go as far as to say that it's robust as yet, but there is ongoing research developing ledger that indicates even some really powerful effects of the use of psilocybin and-
Luke Storey: MDMA.
David Perlmutter: ... and MDMA as well in terms of, dare I say, jump-starting this whole approach in terms of making connections to the bigger picture, enhancing access to those parts of the brain that allow then, you know, different perspectives. So, I think we're—you know, unfortunately, until quite recently, that research was extremely difficult to be available to researchers because the material was very unavailable. But now, we're seeing that it's seeing a resurgence.
Now, you know, at the risk of having any of your listeners or viewers think that—well, therefore, they're going to, you know, get some mushrooms and take care of the problems, I think that's shortsighted and narrow-minded. I think that, you know, what we're seeing are studies carried out by professionals in a clinical setting that are having significantly positive results as it relates to depression and PTSD, I mean, in particular. I mean, many of your viewers and listeners, I'm sure, are aware of that literature. So, I think this is an evolving story that we need to watch very closely because I think there's, from the looks of it, some very potentially powerful therapeutic benefits to be seen moving forward.
Luke Storey: Do you have anything on that?
Austin Perlmutter: I think I'd echo those sentiments. When you look at where research is for psilocybin and MDMA, I would say when it comes to MDMA, looking at how that may suppress amygdala function, increase oxytocin and increase the functional connectivity between the amygdala and the prefrontal cortex, that integration, that kind of makes sense in the context of what are we using this for right now. And we're using it for PTSD, which is very much an amygdala disease. So, I won't comment any further on that at this time, but I think that there is a lot of potential for exploration in this realm. And of course, would advocate for continued scientific exploration in these different medicines.
David Perlmutter: And let me just comment on just the notion of how we can affect the amygdala, 2008 study that looked at using a mindfulness program in people who rated themselves fairly high in terms of stress, but were otherwise healthy. And the study demonstrated, number one, that over the eight-week program, their ratings on stress declined dramatically. And number two, as these individuals were imaged using sophisticated MRI studies, the density of the amygdala was significantly reduced in correlation with their degree of stress reduction as brought on by the meditation program.
So, it changes your brain. Getting back to what we talked about, Andrew Newberg's book, it changes your brain. Getting back to the quote for the Dalai Lama, so we can restructure, we could rebuild, we can rewire our brains. That is pretty darn empowering. From my perspective, you know, again, in my age, back in medical school in the day, we were told that your brain never grew new neurons, that was, no chance of that. Every beer you had was 80,000 neurons, that was what we were told anyway.
Luke Storey: That was part of the just say no movement, too. I remember when I was in junior high, it was like, you know, if you smoke weed, it fries the brain cells that never come back and this kind of stuff, you know.
David Perlmutter: Right. And you're finished and you're going to have chromosomal damage, too. But-
Luke Storey: Yeah, that was part of the propaganda.
David Perlmutter: Oh, I know.
Luke Storey: They used to say that it would make us male teens grow boobs if you smoked pot. There were like posters in doctor's offices and stuff.
David Perlmutter: I can’t look at the mirror.
Austin Perlmutter: Who came up with that?
David Perlmutter: So far, so good. So, no, but that's it. I mean, we were told we never grew new neurons. And, you know, the other thing is that our DNA, our genes were locked in a glass case and they determined everything about you. And now, we recognize, as matter of fact, we do grow new neurons. And number two, that every one of our lifestyle choices influences our gene expression moment-to-moment. And that can be worrisome or it can be empowering. This whole field of epigenetics, looking at how we can make certain choices to amplify gene expression or suppress gene expression, wow, we hold the keys to the kingdom in our hands.
Luke Storey: That's exciting.
Austin Perlmutter: I would absolutely echo that. My feeling is that we can be the conscious architects of our brains, and that is an unbelievable ability that we can't forsake. This is—it's essential. It is the key to our ability to realize lives that are the lives we want them to be, but we have to take back the keys to our brains. We have to start making the decisions that set up our brains for the lives that we want. And we can't outsource that to other people who may or may not actually have our best interests at heart.
David Perlmutter: That is fundamentally why we wrote the book because we've realized, and I think that your audience is quite aware of the fact that there are these powerful efforts to take that away from us, that our decision making is being sold to the highest bidder whenever we're online or even in public, that there are these, you know, obvious efforts to take our decision making away from us. A, be aware of it. That's what part one of our book is about, is being aware of these efforts. And B then, how do we regain control? How do we put ourselves back in charge of our decision making?
Luke Storey: When it comes to having some, you know, license over how our brain operates and activating different parts of it and down-regulating other parts of it, where does the pineal gland play into this for either of you? You know, I've been, you know, rather new agey for a long time and I've done a lot of kundalini yoga and psychedelics and plant medicines and all that kind of stuff. And from that standpoint, the pineal gland is, you know, the third eye and your—where spiritual perception comes from and things like that.
But then, you have a guy like Joe Dispenza who's not doing any drugs or any funny business, and is having, you essentially do these kinds of yogic practices and activate these metabolites of different types of melatonin coming from your pineal gland, and people are having these psychedelic experiences just by breathing and moving their body and whatnot. So, I'm very fascinated with that particular part of the brain right now.
David Perlmutter: So, I think that, we can get some information from a couple of sources. First, as far as Joe Dispenza goes, you know, he was one of the early pioneers in sort of this whole field, you know, writing books about how our actions are effective in changing our brains. And, you know, really, was one of the early ones to let us know that we can, as Austin said, be architects of our future brains. So, you know, kudos to him for being that trailblazer. What do we know about people who have had their pineal glands removed?
You know, typically, these people who have developed what's called a pinealoma, and therefore, as part of—you know, they have surgery that splits the hemispheres of the brain from the back, goes in and grabs the pineal gland. You know, their clinical manifestations I think are unusual. There is some dysregulation of sleep. There is, as you mentioned, you know, some, issues that relate to production of melanin, and certainly, melatonin, as well, I think has a downstream effect. But I don't know that necessarily—and I could be wrong, but necessarily, there are ways then on the other side of the coin of being able to necessarily up-regulate or enhance the action of the pineal.
I don't know. I mean, I think that dates back to, you know, some spiritual practices that have looked at that part of the brain and their concentration, but is it really the effect of changing the action of the pineal gland? I'm not sure. What we do know is that the pineal does seem to play a role in immune function, and that a lowered level of pineal activity that may happen when we are dyssynchronous with day and night cycling, maybe involved in some of the ways that our immune—would be then dysregulated by virtue of our lack of being in sync with, you know, chronobiology.
Luke Storey: There's also, you know, in the more new age circles, this concept that the pineal gland gets calcified due to the fluoridation of the water, et cetera. And this, again, is not something I've ever seen any proof for, but I did ask someone who's cut open a lot of brains, Dr. Jack Cruz, about that. And I said, “Is that really true? I mean, you open brains up.” He's like, “Oh, yeah, absolutely. Everyone's brains are—or that part of the brain is calcified”, but he described it not like a hard plaque, like the calcium on your sink, but sort of a sludge that is prevalent there and more so on people that are from countries where most of the water's fluoridated and they've been drinking fluoridated water. Do you think there's any correlation to that?
David Perlmutter: I think there may be some correlation, but it doesn't beget causation. And I would further tell you that even in the very early days of x-ray when there were the beginnings of x-raying the brain, and even beyond that, doing more sophisticated testing, like pneumoencephalogram, in older people, the pineal gland calcifies. Now, on CAT scan, when that became a thing, originally called an EMI scan, E-M-I, because it was developed by the Electronic Music Incorporated, EMI, actually.
Luke Storey: Oh, really?
David Perlmutter: Actually. So, we can thank the Beatles for CAT scans.
Luke Storey: No way.
David Perlmutter: Yes, we can. In the day when these things were actually shot onto a Polaroid film, and we opened the Polaroid film and there was the image of the brain, we’re going to look at that and go, “We're looking into the brain, amazing.” And looking at that center dot that was white between the hemispheres, so that would be calcification of pineal gland. And I don't know. I mean, I don't—I can't say that I'm aware of that fluoridation of water is causing that because again, we've seen that in really old x-rays of the brain as well.
Luke Storey: Oh, before that would have been common practice. Interesting.
David Perlmutter: Well, fluoridation, you know, became really widespread, I think, in the 1950s and certainly, in the 1960s when they were looking to find some way of utilizing the fluoride that was generated as a byproduct of creating industrial agricultural chemicals. And they're saying, “Oh, we have this fluoride, what should we do? And somebody said, “Well, let's just put it in the water because it will make everybody's teeth stronger.” So, there you go.
Luke Storey: Oh, the folly of man. And then, you know, I'm sure you—well, you may or may not be aware of, the more conspiratorial side of the fluoridation of the water and that it tends to make people more dim and dulled down and manageable as a populace. So, there are those that say that it's been put into place by the powers to be for that purpose, and that those powers would never drink that water in their own home or give it to their own kids.
David Perlmutter: Right now, my prefrontal cortex is saying, don’t comment.
Luke Storey: Don't comment. Well, that's the beauty of me being the wacky host is I get to comment and you guys can play it safe, you know. Sometimes, I played devil's advocate and people go along and sometimes, they don't. So, we'll leave that one there. I wanted to ask about, what role does cerebellum has in all of this because it seems to be a part of the brain that's largely ignored? And I recently interviewed a gentleman, which his show will have come out, Wynford Dore, and he developed a program called ZING performance.
And he helps adults and children with learning disabilities and autism and all sorts of things by developing these sort of—yeah, I don't want to call them games, but using neuroplasticity essentially through an interface on your computer to activate the cerebellum and get it going again. And he believes that this is kind of a missing link that's often overlooked. Where do you—what role does that part of the brain play? And how can we, you know, bring it back online?
David Perlmutter: Well, I think the cerebellum is certainly very amenable—I wonder if amenable came from Dan Amen, that's a play on his name, amenable. There you go, Dan. To the notion of neuroplasticity, not just in the folia or the part of the cerebellum itself, but in its connections to other motor areas, in coordination areas and sensory areas in the parietal cortex in coordinating movement. So, I think that there is plenty of room for validating interventions that are designed for enhancing motor activity based on this whole notion of neuroplasticity as it relates to the cerebellum.
It's really a beautiful part of the brain. Cerebellum means little brain, but when you look at the cerebellum, when you slice it, in a cadaveric specimen, it's called the arbor vitae, the tree of life because you should see this beautiful tree of the cortex then, sort of looks like cauliflower, which I think really reminds me of a brain or cerebellum. So, it's really a—I don't know how this is going to sound on your podcast, but it's really a beautiful part of the brain to dissect if you—if that's-
Luke Storey: If that’s your thing.
David Perlmutter: So, in my earlier life, it was my thing. I spent a year dissecting human brains as in my different lifetime, but it was—we were writing a book at the time on what's called microsurgical anatomy of the brain, where the operating microscope had just been developed by a company called ZEISS in Switzerland, allowing neurosurgeons to do much more technical work in the brain than they had ever been able to do, but they didn't have a roadmap.
So, our lab decided that we would create that roadmap, and we started taking parts of the brain, and looking at them under the microscope and mapping them, which was kind of cool, but I would say that as I was—when I began the project, I was a junior in college, and on my first day on the job, I remember I went to get the brain to start my work and they said, “Oh, the brains are down in the morgue.” I was at a hospital and I said, “Okay, that makes sense, in the morgue.” I went down to the morgue with my cart. And I went in and walked into the morgue and what was in the morgue, a bunch of dead bodies.
And I walked in there and I said to the diener, the diener is the man who takes care of the morgue, “I'm here for the brains. Could you give them to me now, so I can do my studies?” And he said, “The brains are in the head.” And I said, “Okay. Got you. And I said, “Okay. So, where can I get those brains?” And he handed me a craftsman saw, like you used to cut the—it is a rough time. That you used to cut the limbs off of a tree in your backyard. Well, next thing you know, I'm sawing away. I wasn't opening the skull because I didn't know, but we were going to do that upstairs. The purpose of the craft—why am I telling you this story?
Luke Storey: I love this story. Please don't stop. It’s amazing.
David Perlmutter: The purpose, so it was to actually cut the head off, so I'm sawing away.
Luke Storey: Oh, my God, dude.
David Perlmutter: Oh, my gosh. And so, it's crazy story. So, I cut—why am I telling you this?
Luke Storey: Because it's an amazing story. Are you kidding me? You should open all podcast interviews with this story.
David Perlmutter: Oh, my gosh. I’ve never told this on a pod—anyway, I cut off three heads. And it was—and I was a good—you know, I was very much a freshman at this experience because I remember the first one I did, I was sawing across the neck and the head was no, it was now going back and forth. And I'm thinking, why am I doing this? Because I've got to do this study. And so, I took the heads finally, which were surprisingly heavy. I never realized how heavy they were, put them in a big garbage bag, put them on the cart and wheel them, I was in the basement of the hospital, to the elevator.
I’m in the elevator and getting ready to go up to the lab, which was on the fourth floor, but just as I was ready—as the doors were closing, a young woman was going by with a cart of laboratory rats, and the cart was in the basement of the hospital. They were grates. There wasn't a floor. It was great so that they could hose it down, and her cart had gotten stuck with the wheels in the grates. So, being the gallant individual that I—she was really cute. Anyway, she got these rats, she looked—and was wearing—anyway, so I ran out to help her leaving the cart with the heads behind in the elevator, which then was the same elevator that goes to the lobby of the hospital and up to the waiting rooms and all of that. Oh, my gosh.
So, the doors closed behind me. And I dived at the last second and stick my arm into the door, the doors opened. I mean, can you imagine what would've happened had I not been able to keep those doors from closing and that cart? Oh, what a moment. But anyway, it took me a while to settle down from that one. And anyway, so then we, of course, learned how to extricate the brains from the heads. And I began my research and it was really fascinating to be pursuing the micro-surgical anatomy of the human brain in a way that had never been done before and to then create this roadmap that is used to this day. I mean, I can tell, because people still cite the references from our work that people are using for that anatomy. So, that was early on, I guess it was 19-
Luke Storey: Yes. 19?
David Perlmutter: Years of age.
Luke Storey: Oh, you were 19.
David Perlmutter: Yeah.
Luke Storey: I was waiting for 1975, no. Oh, you were 19 doing that?
David Perlmutter: I was 19.
Luke Storey: Oh, that’s crazy.
David Perlmutter: Nineteen, yeah.
Luke Storey: Wow. Austin, are you stoked med school has come a long way in its sophistication or has it?
Austin Perlmutter: I haven't had to cut off any heads in the most recent past. Medical school has made changes. And one of the things that I'm still quite bothered by though is the rampant rates of burnout and depression and anxiety, and even suicide in medical students and residents and in practicing physicians. So, while there have been some incredible advancements as far as the curriculum and the knowledge base that people are bestowed, there's still so far to go as far as the things that we're talking about right now that are essential to, I don’t know, happiness.
We know that people who have time to sleep, who are able to spend time with their friends and family, who get outside, who are able to exercise, do better. They have more enjoyable lives. And yet, those things are all taken away from medical trainees, which doesn't really make a lot of sense to me because at the end of the day, I believe that as providers, we're trying to help patients optimize for happiness, for lives of happiness, as much joy, purpose, meaning, and, yes, health for as long as possible.
And so, there's this strange hypocrisy where we don't allow medical trainees themselves to experience those things, where we take away all the things that we know are associated with living lives of joy. So, that's, I guess, a separate topic, but something that I feel strongly about, which is why if we say these things are important, are we not letting the people who are supposed to be the strongest advocates for this to have the lives where they get to enjoy health and happiness?
Luke Storey: Amazing. I think that's a great statement to make. And those of you running universities listening, please take heed.
David Perlmutter: And, you know, and beyond just the statement that Austin makes right now, he's done a lot of writing in that area, a lot of outreach because it's—you know, he's targeting those very people who are, you know, the front line of defense for the population seeking happiness and seeking reconnection. So, yeah. Good on you, man.
Luke Storey: Absolutely. The last thing I want to cover with you guys, and then we'll get out of here is the importance of sleep. What happens to our brains when our sleep is crap?
Austin Perlmutter: I can start with that. In the last hundred years, we've made tremendous strides in understanding what sleep does for the body, but still, we live in a society where it's seen as a badge of honor to operate on four hours of sleep. I would say medical residency is the best example of that. Specifically, these high intensity surgical residencies where it's, “Oh, well, I only had two hours of sleep last night, but I'm still here in the hospital seeing patients.” Okay, why are we so excited about that? We know that sleep is associated with worse decision making, for example, which is exactly what you want in somebody who is operating on you.
So, what does sleep do for the brain? Well, it does a number of different things. Let's begin with a little background. Sleep is associated with better overall health. People who get more sleep have lower rates of developing all sorts of diseases. Those diseases go from heart disease, and then all the way up to Alzheimer's disease. We see that not getting enough sleep is associated with higher rates of developing Alzheimer's disease. Okay. So, that's long-term brain health. We know that getting more sleep may be protective against developing this degenerative brain disease.
What I think is more interesting is what is it doing in the short run? What happens when we skip a few nights of good sleep in favor of watching extra couple hours of Netflix, which is something that, yes, I've been doing in the past as well? When we don't get enough sleep, we become more emotionally reactive. We become less able to make these measured decisions. We become less able to suppress poor choices. And so, that means a whole bunch of different things. That means that when we're interfacing with friends, family, coworkers, trying to land a business deal, we're more likely to snap at that other person.
We're more likely to feel like they are trying to get us as opposed to working with us on our team. And that damages our social interaction. Great. Obviously, not something we want. Sleep deficit is associated with behaviors of loneliness. What does that mean? Well, loneliness is an epidemic in the United States. A recent survey showed that 47% of people feel like they are experiencing being alone in a given week. So, what does sleep deficit do to loneliness?
Well, in a study by Matthew Walker, who is a provider, he is a sleep doctor who wrote a book called Why We Sleep, which we highly recommend, he showed that people who are sleep-deprived don't want to be as close to other people physically, and that people who were sleep-deprived and people who had a good night's sleep go into this room, and then the researcher would approach these people and they'd say, “Tell me when it gets uncomfortable”, people who were sleep-deprived said that they were uncomfortable at significantly larger distance than the people who had gotten enough sleep. Moreover, people who were sleep-deprived could be—when an outside group of people looked at people who were sleep-deprived, they felt lonelier looking at these people who were sleep-deprived. So, it shows that sleep deprivation may induce a loneliness contagion, a contagious loneliness. Okay. So, these are just a couple of the things.
Luke Storey: Dude, wow.
Austin Perlmutter: Not to mention sleep deprivation.
Luke Storey: I love when people say not to mention, then go ahead and mention it.
Austin Perlmutter: There are other things.
Luke Storey: Please mention all of them.
Austin Perlmutter: Well, it goes without saying, let me say it, as if we needed more reasons to get good sleep, people who don't get enough sleep tend to eat more calories of poor caloric—or I should say poor-quality than people who get enough sleep. Somewhere in the ballpark of 300, 350 calories in a day. They don't spend any more calories. It's not like they then go offset it with exercise. They just eat more calories. And those tend to be calories that are not great for us. So, these are things like unhealthy fats and carbohydrates. When they put them on a buffet table, that's what they tended to pick. Let's keep going. What does sleep deficit do to your decision making?
Well, there is research showing that people become a bit more impulsive. And why might this be happening? Well, sleep functionally disables the connection between the prefrontal cortex and the amygdala. In just one night of sleep deprivation, there is a 60% increased activation in the amygdala and two nights of sleep deprivation. There is a decreased connection between the amygdala and the prefrontal cortex. So, the implications of not getting enough sleep is so much beyond what we already probably know, which is I don't feel as good, I feel a little bit more snappy at other people, I feel a little bit less focused.
That's true, but so much more is true. And I think the message would be, when you are investing in your sleep, you're investing in so many aspects of your life, but specifically in your brain function, in your thinking. So, it's not like I need to get my things done, and then maybe I'll get enough sleep tonight. If you want to, I don’t know, be a happier, healthier person or make good decisions at work, you want to land that business deal, you don't want to have an impulsive decision where you sell all your stocks based on something you heard on the radio, you need that sleep. It is going to balance you out and ensure that you're making the best decisions possible.
Luke Storey: Damn. Sleep's important to me because I just get super irritable and I'm braindead, like when I don't get sleep. So, it's something I've really worked on. And now that I'm working on it through a bunch of ways that I've talked about on the podcast, at nauseum, people I'm sure have heard all the tactics and things like that, but I mean, it just never ceases to amaze me. I got a cabinet in there of supplements. I mean, there's probably literally thousands of dollars’ worth of shit in there. And if I don't get enough sleep, I go in there, I'd take 50 things and this and that, and I feel a little better, little more functional. And the next day, I just get a good night's sleep and I don't need any of that stuff. I mean, it trumps everything in terms of performance.
David Perlmutter: You know, when you take a group of people, and I've done this, and ask them, what are the most important lifestyle choices that you think are really important for your health? Sleep is never on the top of the list, or never even mentioned as among the top couple two or three. It's always about exercise and about the food that you eat. And, you know, very rarely do people really recognize that this is—you can do it. You cannot exercise for the rest of your life, and it may affect your lifespan, to some degree.
You could stop eating for 40 days and 40 nights, and then you'll eat again. But, you know, if you don't sleep for a week, you'll probably die. So, I mean, I guess the only other thing that's more aggressive would be holding your breath. So, that's how important it is. We spend a third—we should spend one-third of our lives sleeping. We don't spend a third of our lives exercising. We don’t spend a third of our lives eating, but we spend a third of our lives doing this activity that is ubiquitous in every animal on the planet, even every animal shuts down.
And, you know, we used to think that until quite recently that this is a—that everything is shutting down during sleep and everything is, you know, going—slowing off and there's not any activity—nothing is further from the truth. Brainwaves are active. Metabolic processes are extremely active. And what we've now learned, quite recently, is that the process of cleaning the brain, the glymphatic system is activated during deep sleep as well, allowing the brain to purge itself of accumulated metabolic waste, not the least of which is amyloid protein, misfolded protein, that, again, Dr. Matthew Walker has demonstrated, you know, is something that is significantly higher, and when measured in the spinal fluid and people who've missed a night of sleep.
So, we're accumulating higher levels of this questionably toxic protein that isn't necessarily toxic. That's a part of another story, but, you know, I think as Austin said, the idea of our decision-making being threatened, that's demonstrated in study after study. And, you know, as it relates to our food choices, again, as Austin mentioned, you don't sleep well, you make bad food choices. Make bad food choices, you're going to gain weight. Gain weight, and guess what happens, you don't sleep well. So, body fat ultimately compromises your ability to get a good night's sleep. Therefore, you're just going to make continued poor food choices and you're back into yet another feed, call it what you will, feed forward cycle.
Luke Storey: Right.
David Perlmutter: So, you know, most people don't know how they are sleeping. Are they—have they been to a sleep specialist and had a polysomnogram to determine how well they sleep or have they bought an Oura Ring, for example, or other wearable device that can give them some metrics as to the length and quality of their sleep? Very important to do that, you know. And when you realize that you didn't get enough sleep and/or it's not restorative, then you begin to make lifestyle modifications like avoiding blue light exposure in the evening, reducing your caffeine consumption after a 2:00 or 3:00 PM, getting some exercise, winding down at night. All those things that we know are making the room extra dark, and maybe reducing the temperature a couple of degrees, various pointers that are helpful to really work on your hygiene, your sleep hygiene. Maybe a couple of milligrams of melatonin might be helpful for you or for somebody. It's reasonable.
Luke Storey: I was going to ask about the melatonin piece, and also shout out to Oura Ring because once I started quantifying my sleep and gamifying it and challenging myself, and even some of my nerd buddies will text each other, “I got a 94, F you”, you know. I mean, it's a really healthy competition, but like then I can track actually, oh, lasted—like two nights ago, I got really a nice percentage of deep sleep and REM sleep, but what was interesting is I had a really high HRV, it was like 59, which is pretty high for me.
And I thought, okay, what did I do last night? I took an hour-long infrared sauna in my Clearlight sauna and I did this chakra alignment, meditation, where you kind of hum and activate the different chakras. And I did that. And I was like, I hadn't eaten anything different. That's really the only thing that was kind of an uncustomary. And so, I could now look at that and go, oh, wow, maybe if I did that a few more nights, I could correlate if there's, you know-
David Perlmutter: Hey, I'm all for the N of 1, you know. It’s cool. You're right. And why Ns of 1 are important is because that's the only person who is being looked at here. And you are unique, and it may be that your sauna or whatever else you did is effective. In terms of you, you're getting immediate feedback. And ultimately, you're going to learn. You're going to look at those variables one by one and determine, hey, which one had the biggest impact on the amount of time I got deep sleep, and therefore, I was activating my glymphatic system and purging my brain, et cetera. How much time was I in REM? What was my total length of sleep? What was my sleep onset looking like? What was my heart rate variability, that you point out was a metric that you're following? These things are all very important for, we, biohackers, who want to know this stuff about ourselves.
Luke Storey: What I was going to ask was in regard to melatonin, I've heard some experts say that if you habituate yourself to taking exogenous forms of melatonin, that you're going to downregulate your body’s ability to produce it. Do you think there's any truth to that? Is that something you want to cycle and not get dependent on, or does it matter?
David Perlmutter: I would say that, by and large, if you don't have to take it, then don't. I use melatonin extremely infrequently, but I do it when across time zones, large time zones, three hours, not enough to push me to take melatonin. Personally, N of 1, I can absolutely feel melatonin when I take it in a very big way. I actually once took another actual sleeping medication on my way over to Europe and I—you know, I wasn't in psilocybin, but it was darn close. I was really out to lunch on the flight. And, you know-
Luke Storey: I’ve been there.
David Perlmutter: ... it's not like they can kick you off the plane when you're in the middle of the Atlantic. So, some people are more sensitive than others. And I find I'm pretty exquisitely sensitive even to melatonin. So, for me, one milligram seems to be plenty, but for some people, three, even five and some, even 10 milligrams melatonin is well-tolerated and does the job. But I would say that your point is well taken, and that is, wouldn't be something you'd want to do all the time. Look at those other factors, those lifestyle factors, leverage those, modify those, see what works for you. And beyond that, like the Oura Ring, get some feedback in terms of what is the quality, not just quantity of your sleep.
Luke Storey: Love it. All right, guys. Last question, you guys have taught me so much today. You've taught our listeners so much, and our viewers. By the way, this is a great YouTube video, those of you that are just listening to the podcast. Who have been three teachers or teachings that you might recommend our listeners go check out? It could be an any area of life, just something that's really informed who you are.
Austin Perlmutter: That's a great question. I want to say the default one here, which is my dad.
Luke Storey: I had a feeling.
David Perlmutter: And I was just going to say you. I was just going to say you.
Austin Perlmutter: Well, I beat you to the punch, you're going to have to find somebody else. But as you are a mentor for me, and not just the academic world, but in becoming the type of person that I want to become and working on this book project with you, it's one thing to talk about the science with somebody else who's interested in the science and after three cups of coffee, we're both really interested in the science, but to be able to explore this philosophy piece of what is it we're trying to do in life and how can we share these things we've learned with other people, it's been incredibly meaningful to me.
Other people who I'd like to credit with, at least the last several years of my journey, would be a couple of my good friends from home, and then Alan Watts’ philosophy has been of huge benefit to me more recently, in trying to just say, what are we doing in this world? What are we trying to get out of it? And what are the things that really don't matter so much that we don't have to fixate upon? I have also invested in some stoic philosophy that has been helpful in grounding me.
As far as academic people, I've been a big fan of Matthew Walker's work. We mentioned him before. He is a sleep scientist from Berkeley. And he is showing the world how critically important sleep is. And he opened up that world for me because I tried to justify the idea that sleep was some sort of a secondary activity until I started to appreciate some of the research that he's been doing. So, that would be, I'd say, my core go-to right now. I've really been thankful for people like you who have been willing to create podcasts to democratize information.
And I've absolutely loved listening to podcasts from Hidden Brain to Rhonda Patrick because it's just the spread of ideas. It creates that spark of insight that will sometimes be the reason that I want to write a blog post or just write in general to create that curiosity. And so, I guess that's just a general shout out to people like you who are willing to get out there and have opinions and research this stuff and take it out of textbooks and make it available.
Luke Storey: Amen, brother. How about you, David? Who are your three?
David Perlmutter: Well, I'm going to bend the rules as well and-
Luke Storey: Yeah, I noticed he gave 10, but I let it slide.
David Perlmutter: That's the way it goes.
Luke Storey: Hey, man, gratitude has no bounds.
David Perlmutter: I too would thank my father who I miss. I really miss more and more as years go by because his lessons become more and more meaningful as I get older. He was a highly skilled neurosurgeon, brain surgeon, but it was the compassion part that I still remember most. And so, he was and remains powerful influence. And I have the opportunity to have that influence from who came before and who came after, and that's Austin. Austin serves as a mentor for me, and has done that for many years, though you don't know it.
Based upon your life choices that I've watched, I've been so proud of, and it has caused me to modify my behavior. And this process of writing a book, you know, I've done this before and I know what it takes. And Austin, who has not written a book before, but this time around was able to refine our messaging, and as I have said before, hold my feet to the fire of making certain that everything we've said has been substantiated by a peer-reviewed literature. But beyond that, the morality part, the ethics part, I do my best, and I see how you accomplish those parts of life and it serves to inform me.
And similarly, my wife, your mom, you know, is a model for me to watch how she navigates the world and how she distances herself to get back to neurophysiology from her amygdala, and always guides us back to taking a look at things and being rational about responses. I am proud to be friends with a fellow by the name of Jeffrey Bland who really made it safe for me to come out as a neurologist in terms of being good with the challenges from the mainstream that I have endured and now, welcome because of my approach to understanding parts of the science that deal with the brain that don't necessarily resonate with mainstream neurology, that have more to do with prevention of disease and the influence of lifestyle choices.
Dr. Bland who created what's called The Institute for Functional Medicine, has created a safe place, if you will, over the past 25 years for iconoclastic disruptors, who, now, I wear that badge, you know, proudly. And I would say, like Austin said, this isn't necessarily the mentor part, but it's the gratitude part for people like yourself who recognize that the messaging is really important, that people have to hear other sides of stories, and to make these venues available to us today, to get out what little information we have, what little piece of the puzzle we might be contributing, maybe it's the corner piece or maybe, it's just one of those pieces in the middle somewhere, but allowing us to share what we've learned, right or wrong, but just to create that space. So, that's a vote of gratitude.
Luke Storey: Awesome. Wow. What a beautiful podcast episode and conversation today, guys. Thank you so much for joining me. Give us URLs, website, social media, anything you want to send people to go look at.
David Perlmutter: Well, the book is—here's the book.
Austin Perlmutter: Here you go.
Luke Storey: Let’s hold it up for our YouTube viewers. Look at it, right there, all three cameras. See, just take a peek.
David Perlmutter: The whole status on the brain.
Luke Storey: Yeah. This has like their secret manuscript notes in here, too, which is fascinating. It's neat to see like the kind of the working copy of a book by the author. So, yeah.
David Perlmutter: Website for that is brainwashbook, brainwashbook.com.
Luke Storey: Cool.
David Perlmutter: And more information at drperlmutter.com, drperlmutter.com, lots and lots of information, thousands of research articles in their full PDF form. And it's totally searchable as well. But I would say brainwashbook.com is a great place to go.
Austin Perlmutter: I have an Instagram account @austinperlmutter and a Twitter account @austinperlmd, which I am occasionally active on.
Luke Storey: Cool. Because you're taking care of your brain-
Austin Perlmutter: Trying to.
Luke Storey: ... you don't want to be addicted to social media. It's a double-edged sword of like, you know, building a career and also being mindful. Well, thanks so much for joining me, guys. I really appreciate your time today.
David Perlmutter: Awesome.
Luke Storey: All right, folks. We did it.