How Brain Inflammation Affects Your Mental Health and Decision-Making | Dr. Austin Perlmutter

Dr. Perlmutter: [00:00:00] Brain inflammation has been for a couple of decades now associated with poor mental health, and in particular, what we see is that systemic inflammation, correlates with a higher risk for developing depression. The microbes on your food change your microbiome, which then the gut brain connection by way of the microbiome is a major influence on the brain's immune system.

Dr. Brighten: I think sometimes people don't recognize that there's issues with cognitive health. When they think about, The brain is struggling, they think about severe depression, they think about Alzheimer's, like the extremes. I want to talk about the symptoms that are the early warning signs that we need to tend to our cognitive health.

Narrator 1: Dr. Austin Perlmutter 

Narrator 2: is a board certified internal medicine physician and New York Times best selling author. 

Narrator 1: A visionary in the field of brain and body health and known for tackling the biological roots of mental and physical stuckness. 

Narrator 2: His groundbreaking work on how environmental factors shape our cognitive and emotional well being has reached [00:01:00] millions through media outlets like PBS, Rolling Stone, and NPR.

As Managing Director of Big Bold Health, 

Narrator 1: Dr. Perlmutter is leading the charge in food as medicine innovations, including cutting edge research on how plant nutrients impact human aging through epigenetics. 

Dr. Perlmutter: The brain's immune system is tasked with understanding what's happening in the outside environment.

When I look at What is going to influence the brain's immune system? The first thing I think about is. 

Dr. Brighten: In your book Brainwash, you talk about the negative impact of social media. A lot of people wake up and they scroll. First thing, I want to talk about why that's a problem and how maybe we could have a more ideal morning for brain health.

Dr. Perlmutter: If I had my hand on the switch and I could get rid of social media, I would pull that switch. And the reason for it is I think that. 

Dr. Brighten: Welcome back to the Dr. Brighten Show. I'm your host, Dr. Jolene Brighten. I'm board certified in naturopathic endocrinology, a nutrition scientist, a certified sex counselor, and a [00:02:00] certified menopause specialist.

As always, I'm bringing you the latest, most up to date information to help you take charge of your health and take back your hormones. If you enjoy this kind of information, I invite you to visit my website, DrBrighten. com, where I have a ton of free resources for you, including a newsletter that brings you some of the best information, including updates on this podcast.

Now, as always, this information is brought to you cost free. And because of that, I have to say thank you to my sponsors for making this possible. It's my aim to make sure that you can have all the tools and resources in your hands, and that we end the gatekeeping. And in order to do that, I do have to get support for this podcast.

Thank you so much for being here. I know your time is so valuable and so important, and it's not lost on me that you're sharing it with me right now. Don't forget to subscribe, leave a comment, or share this with a friend because it helps this podcast get out to everyone who needs it. All right, let's dive [00:03:00] in.

Dr. Austin Perlmutter, welcome to the show. 

Dr. Perlmutter: Thank you for having me. 

Dr. Brighten: Oh yeah. We actually had a good time yesterday. I kind of wish we caught some of that conversation. We were hanging out, speaking at a conference. You just came from the conference, actually. 

Dr. Perlmutter: Yeah, direct, direct to the podcast. 

Dr. Brighten: Yesterday I did a podcast and then I went like direct to speak at the conference.

Dr. Perlmutter: That's good. Keeps your brain on track. ongoing focus ideas flowing and you make new connections. 

Dr. Brighten: Totally. Well, that's what we're going to talk about today. We're going to talk all about brain health. And so I actually had this question later on for you, but you just said make new connections. So talk to us about neuroplasticity.

What is that? 

Dr. Perlmutter: Yeah, I think there are a couple of ideas in medicine that are so profound when they're understood that they just change the way you interact with the world. And neuroplasticity is one of those. The basic idea is That despite what you might hear, your brain is changing moment to moment, every second of the day.

Dr. Brighten: And 

Dr. Perlmutter: the way this change happens is looked at in different domains, but most of what it's talking about is changes in the strength and number [00:04:00] of the connections between neurons. And that functionally means that you are becoming a different person with every second of every day, that the you that's you is not yesterday's you.

It's not tomorrow's you. What that means is incredible liability. Because it means that with every moment you could be wiring your brain for worse outcomes and incredible Opportunity and potential because you can take control over that and wire your brain for better outcomes But I want to go back to something I just said there because I don't think the gravity of this really hits everyone until I say it a couple times You are not the you you were yesterday.

Mm 

Dr. Brighten: hmm. 

Dr. Perlmutter: And tomorrow's you will be different the cells in your body are different will be replaced. Not all of them, but there is an incredible cellular turnover throughout your body. And within your brain, even though it's not the actual cells that are being replaced, The wiring of those cells is what undergirds things like your mental health, your cognitive health, what you feel in a given day.

So, so much of [00:05:00] my energy is kind of spent helping people to understand that they can direct the ship of their life if they start to take agency over that neuroplastic process, that brain wiring, as opposed to, unfortunately, what most people do, which is let the world around them wire their brains for whatever's happening, which leads us to kind of disaster.

Dr. Brighten: Yeah. Uh, I don't know if you're a Marvel fan, but I'm a Marvel fan. And as I'm sitting here, I'm like, with great power comes great responsibility. Right. So, uh, it can feel kind of ominous of like every single thing that I do in my day is impacting me and me making the right choices. So we're going to get in today about how to make positive choices, how to overcome even the environment that we're in.

But for people listening right now, I think sometimes people don't recognize that there's issues with cognitive health, with, like, when they, when they think about the brain is struggling, they think about severe depression, they think about Alzheimer's, like the extreme. I want to talk about the symptoms that are the early warning signs that we need [00:06:00] to tend to our cognitive health.

Dr. Perlmutter: Yeah, I think you mentioned something that is it's maybe the biggest problem with the way we look at health care Which is you only have a real problem when there's something for a doctor to diagnose when there's a prescription that goes alongside the diagnosis 

Dr. Brighten: Yeah, 

Dr. Perlmutter: and the way that health care is set up In the United States, in particular, is algorithm based.

And so you wait until a person hits a certain threshold of severity, and then they get into an algorithm as it relates to brain health conditions. That algorithm begins when a person qualifies for a DSM diagnostics. Uh, so meaning they have to be hitting the criteria for major depression or generalized anxiety.

In the case of cognitive issues, it's saying, well, you might have some cognitive problems, but you don't have. 

Dr. Brighten: Yeah. 

Dr. Perlmutter: Right? Or even if you have mild cognitive impairment, which we could talk about in a moment, it's, there's nothing necessarily to do about it. And even if you do have dementia, there's not really that much to do about it.

We'll put you on some prescriptions, but everything is biased to believe that [00:07:00] the healthcare should start when the disease is so blatant. that it gets to the diagnostic criteria. Now we've moved into a world in which preventive medicine has taken, I don't want to say center stage, but it's taken an adjacent stage where at least people are talking about it, especially around something like heart health, cardiovascular health.

Uh, we've heard you should go walk or exercise because it helps to prevent heart disease. What we don't talk about. The other one is preventing cognitive decline. What we don't talk about is preventing the development of mental health conditions before you wind up in the doctor's office. And so in the spectrum of understanding, uh, you have a disease on one end, which is let's say Alzheimer's dementia.

Dr. Brighten: Yes. 

Dr. Perlmutter: And you have a person with a perfectly functioning brain on the other end, which is arguably nobody. Yeah, 

Dr. Brighten: I was like, who's this person? That person does not exist. 

Dr. Perlmutter: then you have everyone in between where there's so much that we can do. And instead we wait until it's so bad that you have to see a doctor.[00:08:00] 

So let's talk a little bit about the extremes and then we'll kind of work our way back to understanding some of the things we should all be paying attention to. 

Dr. Brighten: Okay. 

Dr. Perlmutter: I've personally had two people in my family, both grandfathers who have died with and from Alzheimer's disease. And anybody who's out there who has seen, interacted with people in their family and their friend circle, seen dementia realizes how Yeah.

And I don't mean just because that person's having trouble thinking. I mean because of the ripple effects it has on everyone around them. Caregivers, friends, family who are looking to interact with this person they care about and watching them slip away in real time. The person physically is there, but the person you know is gone.

It is so challenging. And so, If that's the extreme end, then we work, uh, well, I guess it's statistics wise, 60 million people around the world right now with Alzheimer's about 150 million by the year 2050, a one in three chance of developing Alzheimer's by the time you hit 85. This is enough to make people like me and hopefully people like most [00:09:00] of those listening.

care about it for themselves. 

Dr. Brighten: How many of those are women? 

Dr. Perlmutter: Right, so Alzheimer's predominantly affects women. About two thirds of people are women. And it's really important because of many of the things that you talk about, there's some very fascinating interactions between hormones, the immune system, brain energetics that might predispose to it.

There's also variables around stress and how women experience life that may also predispose to higher risk of Alzheimer's disease. And so our goal for all of us listening should be. Not to get to the point where the diagnosis has happened, granted, there are things a person can do once they get to the point of diagnosis, but your best chance of preventing dementia and the best thing you can do about dementia is to take steps right now.

So then let's work one step backwards, which would be mild cognitive impairment. So these are people who have. Uh, some overt symptoms of cognitive dysfunction. They have memory issues, they have trouble, uh, doing some of the things that they used to do, but they haven't quite reached the threshold of a diagnosis of Alzheimer's.

Technically, a diagnosis of Alzheimer's [00:10:00] requires a sample of amyloid and requires you to get into the brain. we're talking about postmortem analysis. Yes! 

Dr. Brighten: We're talking taking a piece of your brain. Nobody wants that. You 

Dr. Perlmutter: don't really want to do in almost any scenario unless you really need to know, I think that the best example would be infectious versus malignant.

That's where samples become important. But for Alzheimer's disease, it's very, very rarely done. unless it's 

Dr. Brighten: postmortem. 

Dr. Perlmutter: So MCI mild cognitive impairment is a huge issue too. And some statistics would say it's about one in three people after age 85, similar to Alzheimer's. The interesting thing there is if you have MCI, you have about a one in three chance of developing Alzheimer's in the next five years, and about a one in three chance of getting sick.

of going back to normal 

Dr. Brighten: cognition, 

Dr. Perlmutter: which speaks to the fact that there are things that we can and should be doing that are lifestyle in nature, many of them that can influence our cognition, make it better. So it's not like you start having cognitive decline, you're done, there's nothing that can be done.

Right. And then if you were to take it one step further, and I think [00:11:00] this is the really fascinating thing, Understanding that our cognition fluctuates moment to moment each day. So we've all had scenarios where we don't feel our sharpest and other times where we maybe feel very sharp. Cognition fluctuates over time.

What's very interesting to see though is that many of the predisposing pathophysiology that may cause somebody to develop Alzheimer's in their 80s can actually take effect as early as our 30s and even earlier. Same as 

Dr. Brighten: osteoporosis, cardiovascular disease. Exactly. It's, it's kind of unfair though that like before like your life really puts you in check, right?

Like you've already solidified your bone health, you've already like laid down the paths for these things. But as you talk about and you're a proponent of, there are are so many things we can do lifestyle wise now to really start to backtrack on that. The brain has that potential, but I kind of, I derailed your train in that.

So let's go back to what you were saying about taking that step back and what's happening in our [00:12:00] thirties and forties. 

Dr. Perlmutter: Yeah. Again, we're talking about a continuum here and I think that we have a tendency to wait until it is so obvious before we care about anything. I mean, Thank you. We know pretty clearly that excessive alcohol consumption is damaging to basically every aspect of health.

It's a carcinogen. We also understand it predisposes to basically a condition called alcohol related dementia. I mean, this is a textbook condition, but also predisposes to Alzheimer's disease, also predisposes to mental health conditions. Yet, In college age people, it's completely normalized to binge drink.

There are a number of reasons why this is the case. Can you 

Dr. Brighten: define binge drinking? 

Dr. Perlmutter: Yeah, so it's drinking a number of beverages of alcohol in a very short amount of time. And so, uh, I think textbook definitions will vary depending on male versus female, how many drinks in one sitting. But some characteristics would be things like having a significant hangover, blacking out, browning out.

These are things that, at least for me in my college years, were considered cool and normal. Yeah. It's important to [00:13:00] recognize the brain is not fully mature in most people's college years. So, myelination, which is basically the covering of our neurons, doesn't end until our 30s. And the prefrontal cortex in general, which is the part of the brain that controls higher level thinking, is still developing into our 20s.

So, the brain isn't fully mature. quite ready necessarily to be incredibly thoughtful to make these well reasoned decisions. The issue is that as we progress past and into our 30s and into our 40s, what sets in is chronic metabolic immune and endocrine dysfunction. And these are well established risk factors for the development of basically every major chronic disease.

Absolutely. But we may not experience it to the extent that we say we have to do something different about it. And so, you know, I think this is a scenario in which you have to ask, why does a person change their behavior at all? And something I just spoke about on stage is this idea that many doctors, many people in general believe that the only issue, the [00:14:00] only block between a person and Being a healthy person and being an unhealthy person is that they need a doctor to sit there across from them and say, you need to start exercising.

Yeah. You need to stop going to fast food. But that is just the information that matters. Yeah. And I think the reality is you have to have some sort of pain, psychological pain that tells you, I need to do something different. And so that could be a family member. It could be a friend who's suffering from a preventable health condition.

It could be in yourself. You realize, I can't do this. play the sports I used to. Um, I'm having trouble going up the stairs. I'm not thinking as clearly. There's pain is derived from that. And then you think about making the change. But the best opportunity for people to make the change to prevent that from happening is before they experience that pain to the extent that something is really going wrong.

So, That's why so much of my work has been focused on helping people understand the immune, the metabolic, the neuroplastic kind of underliers, underlying variables for brain health and tethering it to [00:15:00] things they care about. Because in the early years of a person's life, and I use that a little bit broad, it's, it's not necessarily preventing dementia, you know, unless you've had a friend or a family member with dementia, that may not be top of mind, but you are thinking about how can I do on this test at school?

How can I think clearer there? How can I. Um, how can I show up in the world in a way that is more authentic where I'm more emotionally regulated? And these are all a direct outcome of brain state. 

Dr. Brighten: Mm hmm. 

Dr. Perlmutter: So for anybody who's out there listening, who's asking this question, well, maybe this isn't relevant to me, I would say, find what is relevant to you, whatever it is in your life, and then ask yourself, what needs to happen for that to be successful?

Eventually you will get to the same outcome, which is, you need to have a brain that is on your team. Mm hmm. So whether it's not feeling anxious, not feeling depressed, whether it's thinking clear, whether it's preventing dementia. These are all direct outcomes of how your brain is wired. And the important thing, which I'll say time and time again, [00:16:00] we have agency over that wiring.

And if you don't take agency over that wiring, you are by and large going to have to accept the base rates of these diseases. And I'm not trying to say that all cases of dementia are preventable with a couple of quick hacks. And I'm not trying to say that mental health conditions are preventable with a couple of quick hacks, but we know That applied lifestyle change can significantly decrease a person's risk for developing these conditions.

And that ranges from depression, to anxious symptoms, to cognitive decline. 

Dr. Brighten: So, 

Dr. Perlmutter: there are so many things that we can and should be doing, not to take away from the fact that these are complicated issues, but we need to bring more attention to the idea that each day you get to vote, Thousands of times for a healthy or an unhealthy brain and I think for most people again It's just taking on some of the ownership 

Dr. Brighten: as to 

Dr. Perlmutter: what those votes are going to be 

Dr. Brighten: Someone in their 30s 40s 50s right now listening to this They likely have an [00:17:00] idea of what depression and anxiety looks like but as you talk about cognitive decline Not everybody has a grasp of that, and some things are normalized.

We're told it's completely normal to lose your keys on a daily basis. So what are some signs that people should really pause and, and take notice, take account of what is going on? 

Dr. Perlmutter: So there are a number of signs of, I guess, what leads to MCI and subsequently Alzheimer's disease. One of the more common ones is like memory lapses.

Um, the keys is a good example. Forgetting names, you find you're not as sharp when you're doing your work, so you're having trouble keeping up. 

Dr. Brighten: Um, 

Dr. Perlmutter: You may be forgetting names. And again, all of these things are things that can be part of a normal day. A great example here is the effects of stress. So everyone listening has experienced some degree of psychological stress and maybe has had the, the effect of stress experienced in real time 

Dr. Brighten: where 

Dr. Perlmutter: they Made a mistake, forgot something, felt frazzled.

I think what's important for people to understand is that your brain is constantly trying to [00:18:00] optimize to keep you alive. 

Dr. Brighten: And 

Dr. Perlmutter: so that comes at the expense of a lot of things, including happiness, including remembering the names of these people who just introduced themselves to you. Your brain's trying to prioritize resources to what it thinks is important.

is most important. 

Dr. Brighten: Mm hmm. 

Dr. Perlmutter: What's really interesting though is as this progresses, as it becomes more common, uh, and so you feel like you're having consistent memory issues, either your spouse, your, your partner, or somebody who cares about you, will eventually bring you into the doctor's office and say, hey, I'm worried about them.

And that feels like, I VA for a while. That was the more common outcome would be the spouse saying, hey, something's wrong. And they say, oh, I'm fine. Or it's you start noticing it in yourself. Um, you know, a lot of the work that you've done, you probably know very well that certain things that fluctuate hormones being a great example, fluctuate alongside symptoms of cognition, uh, decision making.

Mental state. And I think that's important to understand because so many of these [00:19:00] things are kind of part and parcel of what it is to live. Mood does fluctuate each day. Cognition does fluctuate each day. But if you find that there is a trend where you see a significant change, and especially if the people around you who often are very kind and will say, no, no, no, you're fine.

But if they can start noticing things, that's when it's reasonable to pay attention. 

Dr. Brighten: Now, 

Dr. Perlmutter: rates of dementia, the biggest risk factor for dementia is age. So the older you get, as I mentioned, one in three over age 85 will have dementia, the most common form being Alzheimer's disease. These rates, you know, there are certain cases of people who will develop dementia in early years.

There's early onset dementia. So I think the bottom line is, if you notice a pattern of changes in cognition, Take it seriously, 

Dr. Brighten: you know, 

Dr. Perlmutter: just like a person would say, well, I'm having a little bit of chest pain, but it's probably nothing 

Dr. Brighten: Yeah, 

Dr. Perlmutter: you have to start prioritizing the milder symptoms because again our best chance at intervention Is right now.

Dr. Brighten: Not 

Dr. Perlmutter: tomorrow and certainly not decades from now. So [00:20:00] any cognitive changes are worthy of our, uh, spending a little bit of time to figure out whether there's some sort of a tether. It could be sleep deprivation. It could be stress. It could be, you know, depending on who you are, where you live. Uh, a nutrient deficiency could be B12 or some other issue.

But if you're not able to address it pretty quickly on your own, I would say go see somebody about it. Because if you can start to get a better sense as to whether that is something substantial, that's when lifestyle modification can have the biggest role in preventing things from getting any worse and improving things.

Dr. Brighten: Who can people go see early on? I think that's always the biggest question. I think his providers were always like, yeah, You should talk to your doctor, but we know that some of the things you're talking about, the doctor will pass off as normal. And as you explained at the top of this with your algorithm.

Some of them are trained and it's very ingrained in them to wait until there's a prescription and a diagnosis to be made. 

Dr. Perlmutter: I think it's a, it's a very good question. So there are certain neurologists who practice kind of more integrative modalities who will use protocols that allow [00:21:00] for, uh, cognoscopy is the terminology.

Uh, some of these tests you can even do online and basically get a sense as to how is your cognition. So that's a way that people can kind of get a, a general sense beyond this So, I think it is a little bit tricky. So if you go to a primary care provider and you say you're worried about some of your cognitive issues and they say, well, are you stressed?

And you say, yes. And they say, well, what else is there to say? 

Dr. Brighten: Yeah. 

Dr. Perlmutter: Um, there are tests, which you know, the mini mental status and the mocha tests, which, uh, have received some popularity in the United States because certain candidates have decided to do them or not. But these are cognition. And I think, even though they're superficial, they are a way to start the process.

Generally speaking, a good primary care doctor will take a cognitive decline concern seriously and should at least administer some of that testing. There's lab work that every doctor should do to look at potential causes of cognition that are, or cognitive decline that are not necessarily something like Alzheimer's.

So, uh, in certain places, syphilis in certain [00:22:00] places, vitamin B12 deficiency. And I think that's, that's very important, but eventually. I do think you're kind of moving towards either primary care providers who are trained in tenets of kind of integrative neurology, integrative neurologists, of which there are some.

And I also think that psychiatrists are increasingly recognizing the role and the overlap between cognition and mental state because mm-hmm . They're not, uh, somehow unrelated processes. Yeah. It's kind of this idea that has been pervasive, which is you can have a mental health condition like depression, and then you can have a cognitive health issue like Alzheimer's disease, and they occur in different places.

One is an issue with the mind, and the other is an issue with the brain, as though they weren't occurring co localized, right? So I would say that there is increasingly kind of a trend towards integrative psychiatry that looks at some of these characteristics that maybe are more cognitive, but that also relate to psychiatric state.

Because for example, to mention [00:23:00] depression, have a lot of overlap. For example, depression predisposes to a much higher rate of depression. of developing, uh, dementia, and maybe most important, many of the conditions and kind of altered immune metabolic endocrine system, uh, effects in the body are the same risk factors for both.

So for example, type two diabetes is a significant risk factor for both dementia and for depression. So it's shared pathways there. At some point, we will start doing screening for these conditions based on people's risk Uh, underlying metabolic immune dysfunction. I don't think we're there yet, but I think it's inevitable because if we agree that some of these conditions, these chronic conditions and even preconditions are major risk factors for these cognitive conditions, these mental health conditions, then we then could intervene on those conditions as kind of a cornerstone.

of preventing those outcomes. So I'm not sure if I would completely answer the question. [00:24:00] I think the point would be, no, I think you gave us 

Dr. Brighten: a list of like places to start, which is what we needed. 

Dr. Perlmutter: It is. It's also, I think it is simultaneously growing in terms of the number of people who are invested in testing people's cognition prior to their being ready for a diagnosis.

But I think, you know, The main point I would make would be, if you are concerned about your cognitive condition, you should be able to ask your doctor for cognitive testing. 

Dr. Brighten: Yeah. And I 

Dr. Perlmutter: think it is completely reasonable, as you might say, hey, I'm really worried about my mental health, to expect to have some testing done to see whether there is a potential for something that should be done.

taken seriously and potentially intervened upon. 

Dr. Brighten: Mm hmm. I want to get more into talking about the metabolic component, talking more about, you know, the immune health. But I think the best place to start is where so many people really started paying attention to cognitive changes. And that was the pandemic.

And you are uniquely positioned to speak about this [00:25:00] because you were involved in research regarding COVID, the immune system interaction, what was happening with inflammation in the body, and how that was affecting the brain. Can you speak to that research? I 

Dr. Perlmutter: appreciate you bringing that up. Um, so I, like most people during the pandemic, noticed that there were these widespread effects on mental health.

Uh, and cognition, but certainly mental health. I feel like nobody was in a good mental health place. 

Dr. Brighten: No, I mean, you isolate humans and, and, and then no one gave us a playbook to the pandemic. So like, literally no one knew what they were doing, including the experts. We were all figuring it out together and that.

I mean, just the unknown creates so much disease. Correct. There was 

Dr. Perlmutter: fear, there was stress, there was distrust, and all of these things combined with the fact that you've taken away access to the things that bring people joy. Yeah. It's kind of a recipe for disaster. The, the interesting thing to me about The pandemic.

And the reason I wrote this review paper was because there were kind of two schools of thinking around it. And I feel like in some ways, they're both [00:26:00] true. So one school of thinking was the virus is the worst thing ever. And any manner of mitigation strategy is worthwhile. So, you know, take away interaction with humans, take away opportunities to go outside and all that stuff.

It's worth it because the virus is a

The other school of thought was that we went way too far on some of these restrictions. They weren't evidence based. 

Dr. Brighten: And 

Dr. Perlmutter: that the impact of the taking people away from interaction and exercise and healthy food was, was really significant. And so people had different kind of beliefs in terms of what they thought was the bigger threat.

But what I saw was nobody was in a good mental state, whether you were a conventional doctor on the front lines, or whether you were somebody who was questioning the validity of some of what was being said. 

Dr. Brighten: Well, and you weren't even allowed to question, which became very hard for us to deal with. And you in science where we're like, but we're supposed to ask questions as kind of science.

And [00:27:00] so it was like, you were not supposed to question those who were in the conspiracy theorists like camp and you weren't supposed to question those who were in the expert camp, and I think that also led to people being like, I don't know who to trust or what to think anymore either. 

Dr. Perlmutter: I think we're still seeing the ripple effects of of that outcome and I agree with you I think it was a really challenging time to just have discourse.

Dr. Brighten: Mm hmm, 

Dr. Perlmutter: but the the idea here being that Whether it was because a person became infected with the virus, or because a person did not have opportunities to eat healthy food, interact with humans, exercise, uh, get good sleep, the convergent pathway that I thought was so important was to understand that brain inflammation.

Has been for a couple of decades now associated with worse mental health. And in particular, what we see is that systemic inflammation correlates with a higher risk for developing depression. So there's fascinating research that's been done showing that when you take healthy participants, um, volunteers and you [00:28:00] inject them with a molecule called LPS.

or endotoxin, which is basically a piece of a bacterium that it creates inflammation and that correlates with feelings of depression, social withdrawal, which is absolutely fascinating because, you know, many people have for a long time considered depression as a serotonin problem. A paper came out a couple of years ago debunking that idea.

But then the question is, well, Why do we feel bad and one of the main drivers appears to be inflammation in our bodies that changes into inflammation in our brains? 

Dr. Brighten: Yeah, 

Dr. Perlmutter: so the the hypothesis was And I think it's been pretty well supported since then, that whether it was because we had an infection, or because we were socially withdrawn, or because, which was true, people started eating a lot of processed foods.

Dr. Brighten: Mm 

Dr. Perlmutter: hmm. Um. Comfort foods. Comfort foods. Right? Comfort foods. You 

Dr. Brighten: can't really judge people for being like, I can't connect to a human. So now I'm going to do what biology tells me, which is connect to another source of [00:29:00] pleasure, like something that's going to make me feel comforted. Right. 

Dr. Perlmutter: All the coping mechanisms and the, the watching, you know, Netflix and Tiger King on repeat.

It was 

Dr. Brighten: Tiger King. I forgot about Tiger King. I couldn't get through it. I'm like, I feel like I'm the only person who was like, I watched it. I'm not 

Dr. Perlmutter: going to make a recommendation one way or the other, 

Dr. Brighten: it 

Dr. Perlmutter: was kind of a, you had to be there. 

Dr. Brighten: But it was a, had you be there, you had to be there moment in our society.

It was 

Dr. Perlmutter: point being though, we started to take on a lot of unhealthy habits. It's kind of what happens to humans when you take away their healthy opportunities. And all of these things are by their very nature of what they do to their bodies correlated with higher levels of inflammation in part through metabolic reprogramming.

So the idea here is. regardless of how you get there. The central pathway is elevated inflammation in the brain, increasing feelings of disconnection from others, increasing feelings of depression. Um, and if we can kind of embrace that, I feel like all of a sudden [00:30:00] there's a topic that we can all agree to converse on because At the end of the day, and I know there's a little, it's a little bit contentious, but at the end of the day, my feeling is the only thing that actually matters is brain health, that everything else is a surrogate, right?

Whether it's, it's blood pressure or a one C these things only matter because if they aren't regulated, it decreases your enjoyment of life. It decreases your brain health. So I'd love to see. kind of a convergence around the idea that brain health is the primary outcome. And then it opens up the door to conversations about, well, what influences it for the better or for the worse?

In COVID, it was tough because everyone had an agenda of some sort. But now what we're seeing in the context of long COVID is a lot of the inflammatory changes in the brain are actually correlating with people's cognitive symptoms, with people's mental health symptoms. And There's still a lot of research to be done, but point here being that what happens in the immune system, especially [00:31:00] in the brain 

Dr. Brighten: is 

Dr. Perlmutter: fundamental to how much we enjoy.

our day to day on earth. We need to be thinking about this and taking it more seriously. It's not just about, um, fighting off the bacteria because we don't want to get, um, you know, an upper respiratory virus or a bacterial infection. It's, it's about trying to understand how the body works and how the immune system works.

And in particular within the brain. 

Dr. Brighten: So the interesting thing, and I'll, I'm just going to share this because whenever I bring up Um, we should, we should be critical of how the pandemic was approached. Not from the like, shame on us for not knowing better from the, what do we do in the future? How do we approach things differently?

What can we learn from this? But whenever I bring up being critical of any part about the pandemic. People rush to be like, you forgot people died of COVID. You forgot all of this and you conveniently think like this never happened. So I got COVID at the beginning of 2020. I thought like everybody else, if I don't have metabolic disease, [00:32:00] if I don't have, you know, cardiovascular issues, I'll be fine.

I spent four months on oxygen. I was not in fact fine. The hospital was like, Yeah, you have COVID. We don't know what to do about it. We can send you in with oxygen because you can't keep your oxygen levels up. But like, literally said to my husband, She'll make it in two weeks or she won't. But we have nothing for her because this is the start of the pandemic.

I then developed long COVID. But here's the thing. I could not saturate. I could not keep my oxygen saturation levels up. I never had a cough. I never had a fever. But I did have trigeminal neuralgia, migraines, wandering pains shooting through my body. There were moments where I, you know, there was brain fog, but there were definitely moments of, uh, having extreme nightmares of actually waking up and having moments where I was like, And this was when it was like at the, at the peak of things of like, what's reality, what's not right now.

Like I just dreamt this. Yeah. Everything was neurological. And I was told then by like the, [00:33:00] the, the people on the internet, the so called, you know, there were doctors out there that, uh, you know, were like, you're malingering, you're making it up. And I actually joined a Facebook group. Like I've never joined a Facebook 80, 000 people dealing with long COVID.

So bring this on. just for anybody who's like, Oh, she's being skeptical. She like, I literally was writing a will in my bed and like making peace with like my children. Like I did not know what was going to happen, but all of my symptoms were neurological, neurological. So that's why I was like so excited to like talk to you about this because I want to talk more.

Cause it's not just COVID there's other viruses. By the way, I'm obviously recovered now, like I had POTS, I had all kinds of stuff, but a lot of mitochondrial support is what I'll say to people. Um, and then I don't recommend this as a treatment, but once I entered the second trimester of my pregnancy, all of my symptoms went away, which is to say, everything about immune health and the nervous system.

Uh, wait, people won't know [00:34:00] why because you shift into a state of th2 dominant. So it's a different aspect of the immune system. So just to wrap that up, I got videos on this, but I want to talk to you about brain inflammation beyond just viral of what else can be causing brain inflammation that maybe people aren't aware of.

Dr. Perlmutter: I'm gonna, maybe it's a bad idea, but I'm gonna go back into your story here for a second. Yeah, yeah, no, no. Because I think it is, it is such a I'm always 

Dr. Brighten: just like, I don't want to center myself. You're the guest, but I did Not, not at all. Just want to share that. Well, but 

Dr. Perlmutter: I think this is, You know, to be frank, this is the conversation that is missing and it's a conversation where yes, metabolic dysfunction, immune dysfunction, all of these things can predispose a person to worse outcomes from anything, including if a person gets COVID and let's be honest, there are still things we don't fully understand.

Yeah. I think one of the liabilities of certain conversations is that we try to present ourselves as having all the solutions. Mm hmm. And I think we have to perpetually be learning about the new evidence and COVID is an amazing example of it. It caught everybody off [00:35:00] guard. Nobody really knew what was driving it and what would potentially help.

As much as certain people want to say I had the solution all along. 

Dr. Brighten: Oh, I know. 

Dr. Perlmutter: We're still, we're still learning about it. Now, it doesn't discount the fact that for people with pre existing metabolic dysfunction, immune dysfunction, things were generally much worse. For people with pre existing, um, systemic issues in the way that they managed Outside dangers of which COVID is one.

They had much higher risk of death and disability, and that's true. And there is some variable here, which is we don't know all of the information. So to your point here, and the way that you experienced this, there are so many people that I know who I've spoken to in these Facebook groups who are just trying to figure out answers.

I think one of the biggest problems is when people will say something like. You're making it up. Yeah. And they're 

Dr. Brighten: especially when they're credentialed. 

Dr. Perlmutter: Well, right. Because it dismisses it out of hand. Yeah. 

Dr. Brighten: And because there is this power dynamic of this [00:36:00] is the expert gaslighting me. And then you start to question yourself 

Dr. Perlmutter: there.

There is, as I'm sure, you know, very well, a really terrible track record of doctors of medical experts saying that if I can't the reason for your symptoms. The issue is that you have a psychological issue and because as we already discussed, psychology occurs in the mind. That's an issue with your own stuff.

It's not biology. It's because you just have a problem. Historically, that's been a lot more female who have been targeted with this type of mentality. We see this in conditions like multiple chemical sensitivity, which is you're making up your issues with being in these buildings. And If we could just be honest about it, if you're having a negative experience that's happening in the body, in biology, now we may not be 100 percent certain what the pathway is that's connecting things together, but just because you can't observe it in a lab doesn't mean it isn't real.

And I think that it's so problematic because then people feel, well, I can't turn to conventional medicine [00:37:00] because they don't believe that what I'm having happen, which is a real thing in my body. is something that we can do anything about and they just say, well, get along with your life. Yeah, long COVID is a perfect example of this.

I think we've started to see that we haven't started to see the medical research has been clear that long COVID is a real condition that now we're starting to understand what's happening. And so one of the drivers and some of the research here suggests that. Obviously there's a brain component. So neurological symptoms are very common in the context of long COVID.

It's actually one of the most common symptoms. 

Dr. Brighten: Everything we know now, and I want to say this. It's for everybody listening. If it wasn't for the Facebook group with 80, 000 plus people, if it wasn't the hundreds of thousands of women who said, no, I got the vaccine and my period changed, they wouldn't have researched it.

They wouldn't have looked into it. And so I just want people to understand it's by sharing your story. That doctors and researchers [00:38:00] actually know where to look. Because in the beginning it was like, no, no, no, this is a lung issue. Maybe it's a vascular issue, but neurological? And then it was becoming very clear.

from people sharing their stories and advocating for themselves. 

Dr. Perlmutter: And an underlying theme to all of this is the belief that at any point we have things fully figured out. I think it's incredibly dangerous and it becomes increasingly dangerous at higher levels of power 

Dr. Brighten: because 

Dr. Perlmutter: when you, you're kind of obligated to say you have things figured out.

In the United States in particular, we have a system in which we call out politicians for flip flopping. Yeah. If you change a position, It's a liability. 

Dr. Brighten: Yeah. And 

Dr. Perlmutter: the reality is I want people who change their opinion based on new data, whether that's my doctor or my president or my, uh, local elected official or my friends or my partner, that is what it means to be human is to have the ability to be thoughtful, to reflect on the new data and then to update and make a better decision, have a better outlook on On the [00:39:00] problem based on that data.

And so I think we have all these examples of where that is a problem, but the, the fundamental concept is. Nobody has all of the answers. And I am always more willing to trust the people who can admit that as opposed to those who will say, I have it fully figured out. And if you just come to me, I will solve every aspect of your problem at this stage.

Dr. Brighten: And that is really a red flag. I would say in looking for practitioners, you, you see that kind of behavior a little bit more often, I would say among unlicensed healthcare. Uh, professionals, people who are, are, they really want to help, but we'll see this often in women's health as people who are like, if you come to me, I can cure your endometriosis.

If you come to me, I can eliminate your PCOS. And we, we just, and I think we sometimes, like, as, as somebody who has some of these conditions really, we want to find that solution and believe that the body can completely reverse things. And, and I think you [00:40:00] always have to be cautious. That's one thing I tell people to like screen.

If, if your provider is unwilling to listen to new information, if they think they have it all figured out, I am like, You, I always want to invite people the opportunity to change their mind, but there has to be also a willingness to own up to the fact that like, you know, just as I said endometriosis, we used to say it was retrograde menstruation.

We were wrong in medicine and we can say that and say, now that we have new information, this is what we're working off 

Dr. Perlmutter: of. You're not hysterical because of a wandering uterus. 

Dr. Brighten: Yes. It turns out your uterus does not take a monthly trip to your brain. Yeah. 

Dr. Perlmutter: Yeah, I totally agree with you. I think we don't have to get into this in too deep a level of detail, but I think it is an interesting time to be in health.

I mean, to be in anything because there is the opportunity for anybody to have a perspective. And honestly, people who, Uh, have not had to go through standard credentialing and through standard education, are far more likely and [00:41:00] willing, uh, to take the chances to just say something for the pure sake of generating attention.

Mm hmm. And so, it is This is so 

Dr. Brighten: true. This is like the social media, like, in a nutshell, right? Right. 

Dr. Perlmutter: But, I mean, it's It's, it's also true that because modern medicine has failed so many people, there are a lot of people out there looking for solutions. Some of those solutions are valid and many of those solutions are simply trying to capitalize on the fact that you have an incredibly vulnerable population who are at their wits end and modern medicine has failed.

And so it is a complex landscape. There are things that are. Excellent. I think that there are a lot of things that are very true things that are very false and a lot of things in between where I think you can get stuck. I love that we have democratized the sharing of medical information and then there are so many citizen scientists out there who are learning about whatever it might be.

You know, the gut brain connection. I'm talking about the vagus nerve on social media. Yeah. I think it's amazing because it's, they're committing to learning. They're oftentimes sharing really relevant and interesting information. And maybe most importantly, when you bring in a [00:42:00] community of people who care about science in one way, shape, or form that I think elevates the whole conversation.

Dr. Brighten: Yeah, 

Dr. Perlmutter: and doctors in general are not the best at making science appealing to the general public. Mm hmm. Nor 

Dr. Brighten: are they necessarily the best at understanding the nuances that go behind research. 

Dr. Perlmutter: Correct. I think all of that is true. I think despite the fact that Many people want to see doctors as capable of owning the entire landscape of health.

There just isn't enough space in the brain. There certainly isn't enough bandwidth and training to do all of that. You know, it's not like you take a course in how to convey information to the general public on stages and on social media. Yeah, I have kind of branched into that space, but I think it is a a A fraught environment, if you are somebody who doesn't know the material trying to find a true solution, go on Tik Tok, you're going to learn about 18 solutions to every probable issue in the world, and there's no regulation in terms of saying, okay, well, this person can't say this because somebody's going [00:43:00] to come after them because there's nothing to come after.

So all of this is to say nuance is important, but also expertise is still important, despite the fact that there's been a push against expertise and towards the belief that because a person Doesn't. doesn't have training or doesn't have, uh, the exposures to those things that therefore they're right simply because of the absence.

Dr. Brighten: Yeah. No, it's really true. And I, I think this, you know, so a lot of times we'll see doctors say like, Oh, did you do your own research? And I'm like, most women struggling with infertility know a lot more than the average doctor about fertility because. they are so invested. Most women struggling with endometriosis know a lot more than the average doctor because that is their life.

They have lived it. They're so invested. And I think, you know, we have an, so, and, and to say that there are experts who are doctors who absolutely know so much about these, but to understand that just because someone doesn't have credentials doesn't [00:44:00] mean they don't have expertise in their body or understanding about it.

It's not that like. research can't be read. Like, you don't have to have credentials to begin understanding that. There are, I mean, Cornell and other institutions put out courses for the public to be able to start to learn this. So, I think it's that intersection that's really powerful. And as you were saying, like people sharing on TikTok, we have now seen because of women sharing their stories about IUDs and the pain that gynecologists in the United States are facing.

Finally starting to shift to after pain management. And so I just say all of this because I think it is not an either or conversation. I think we need both. And, you know, I, I know exactly what you're talking about the push against credentials just because my handle has a big D little R in front of it. I will, I, my favorites are when people say, like, I will put a post up about birth control, and I have literally had people say, like, you're just another pharma shill, like, you should read this book beyond the pill because it'll open your eyes, and I'm like, do you know who the author is?

[00:45:00] It's me. It's me. But just because there's big D, little R in front of my name, people are like, you're the bad guy. You are the bad guy. So I think we really need to find that common ground, but I do want to steer the conversation back to sources of inflammation. You and I talked yesterday like a ton, and I was like, this podcast is going to be like here and there, and it's going to be fantastic, but my job is to just bring it back.

So viruses definitely can cause brain inflammation. What else do we see as common causes? 

Dr. Perlmutter: Right. Great. I mean, viruses is a very interesting topic. EBV, HSV, correlations with neurodegenerative diseases, autoimmune diseases. So we'll just put that aside, but yes, that's an important one. When I look at what is going to influence the brain's immune system, the first thing I think about is it's basically any input that the brain receives has the opportunity to have that effect.

So that means thinking about where are you collecting data from the outside world? And so if we're just going to go kind of top to bottom, The eyes and the ears are the principal conduits for psychological stress in the brain. Chronic [00:46:00] stress is correlated with chronic inflammation. Now the pathways that get you there are a little bit complicated and it involves receptors and resistance and changes there.

But, The more important thing for people to understand is that when your immune system detects a threat, it revs up, it gets to a place of becoming prepared to fight off danger. And stress is by its very nature, a danger signal. So when the immune system within the brain, which is called the brain's microglial cells, they're about 15 percent of all the cells in your brain detect that there is a threat in the form of chronic stress, they kind of migrate towards a more chronically pro inflammatory state.

This has a number of implications. We can talk about what inflammation can actually lead to as it relates to neurocircuitry, uh, as it relates to some of the changes in terms of how, uh, we process data. But point number one would be chronic stress. And here I'm thinking about the data coming in through your eyes and through your ears.

So think about. The social [00:47:00] media that you're consuming, think about the news that you're consuming. Think about some of the conversations that you're having with people. This is a potent instigator of inflammation throughout the body, and it's believed to bias the brain's immune system towards inflammation as well.

Dr. Brighten: Mm hmm. 

Dr. Perlmutter: We can go through and talk about some of the steps for each of these, or I can just kind of keep going through some of the additional variables. Maybe we'll talk about some of the variables. We'll talk about what you can actually do about it. 

Dr. Brighten: Of course. We're definitely on a dog solutions friend that is coming.

Dr. Perlmutter: So chronic stress in through the eyes, in through the, uh, the ears. I'd say we start there. Then we go to the mouth. So obviously you're taking in a lot of data each day, uh, in terms of the food that we eat. And so who knows how many trillions quadrillions of food molecules a person eats, but typical person, you know, is consuming a couple of meals a day.

And it's not just about the nutrients in that food. We could talk about this for a while, but in terms of things that influence the brain, it's, One, the core building blocks. So your brain is made out of the food that you eat 

Dr. Brighten: and 

Dr. Perlmutter: depending on what are 

Dr. Brighten: you saying? Nutrition [00:48:00] matters. 

Dr. Perlmutter: It's a funny thing, right?

Because it's somehow the brain is separate from the body. Okay. What's the brain made of? Uh, I guess it comes from the atoms, the elements in your food. Okay, so there is an effect there. 

Dr. Brighten: Okay. Okay, yes, fine. 

Dr. Perlmutter: But so, so the quality of the building blocks in what you eat, and really we're talking about I'd say fats and proteins being the most important, are going to have a impact on how your brain functions and your brain's immune system.

People here will go to talking about omega 3 fats as a good example. Omega 3 fats are disproportionately represented in the brain. The brain is, if you took out the water by weight, mostly fat, and it's the highest concentration of these omega 3 fats, specifically DHA 

Dr. Brighten: and EPA. 

Dr. Perlmutter: Necessary for a number of things, membrane fluidity and the like.

But they're also incredibly involved in immune regulation. And so DHA, EPA can subsequently be processed into molecules called resolving mediators, 

Dr. Brighten: which 

Dr. Perlmutter: are very active in regulating the immune system. Omega 3s regulate microglial cells within the [00:49:00] brain. So structurally and functionally, the kind of.

Fats and proteins, I would say are going to have an impact on brain structure and function. 

Dr. Brighten: Right. But I'm not gonna let you move on carbohydrates. 

Dr. Perlmutter: Yeah. Yeah. So carbs are a little bit different because they don't, even though there is this glyco and so there's individual carbs that do play roles there, I would say the more important thing for people to understand is that carbohydrates probably have the most immediate impact on systemic metabolism.

Mm-hmm . There's still a lot of debate as to sugar and drivers of diabetes, but I think it is clear that a person consuming a diet high in dietary sugar, and I want to be clear here, we're talking about a difference between sugar in your brain and sugar in your food because your brain needs sugar to function.

Uh, as much as people like to say, Oh, well, it's terrible for the brain. Actually, your brain is running on sugar right now, unless you have been fasting for a month or doing something extreme, 

Dr. Brighten: please don't, 

Dr. Perlmutter: you have to basically push ketosis to about a month or longer to get to [00:50:00] the 60 percent threshold of your neurons running on ketones, unless you're taking a really extreme kind of exogenous ketone regimen.

So the brain is mostly running on glucose. But the sugar, the carbohydrates in our diet, specifically the added sugars and specifically the added sugars in beverages. 

Dr. Brighten: And when we say added sugars, this is not fruit. This is what's on the label that they're putting additionally into your food. Which is a 

Dr. Perlmutter: great thing.

You can look at the actual Nutrition Facts panel and see if there are added sugars in your food. Basically, nobody needs added sugars. No, 

Dr. Brighten: we don't. They're just pleasurable. 

Dr. Perlmutter: Yeah. They, they taste good. Yeah. And that's why they're there. In America, it's somewhere around 70 percent of foods and beverages, based on data from UNC, have added sweeteners of one form or another.

But the biggest villain, in terms of consensus, is alcohol. beverages. Because you're basically saying how far can we get from a food in which sugar exists naturally. And so if you start with a fruit, there's sugar in there, fine. But it's got fiber and it's bound up in a matrix. Now you say, okay, well it's a, uh, fruit [00:51:00] juice.

You've taken away all of the things that blunt the glycemic response. That helped program your brain and body to versatility, and you're basically just getting a load of sugar. So to kind of bring this back to the point, I think added sugar, particularly in the context of sugar sweetened beverages is one of the biggest villains as it relates to systemic inflammation, mostly by way of what it does to metabolic programming.

And also that transfers into high risk for brain neuroinflammatory conditions, depression, dementia, uh, as well as a host of other issues. So I would say. As we're looking at carbohydrates, yes, your brain needs carbohydrates. It doesn't necessarily mean you have to consume them in your diet, your brain, or your body is able to synthesize, uh, glucose.

And also if you eat glucose in the form of kind of, uh, more complex carbohydrates, that's more than sufficient. There's really no need again, with an exception glycemic issues who maybe sometimes need to. Bring up their blood sugar due to a hypoglycemic episode. Yeah. [00:52:00] To consume CaRMS in, in the more simple forms.

So again, that scrubs and proteins at a first level, they have a lot to say as to how our brain works and the brain's immune system. 

Dr. Brighten: Mm-hmm . 

Dr. Perlmutter: Next group. Vitamins and minerals. So these are things that influence neuro transmission. Um. I should also say amino acids, going back to the proteins, influence neurotransmitter synthesis, so they're very important too.

But vitamins and minerals, I mean, very clearly if a person is deficient in certain vitamins, B vitamins being the best example, cognition drops off a ledge. So vitamin B1 deficiency in alcoholics, vitamin B12 deficiency in people with inadequate intake. Or pernicious 

Dr. Brighten: anemia. Correct, 

Dr. Perlmutter: correct. Um, have direct and strong correlations with worsened cognition.

Vitamins and minerals also modulate the immune system. Um, and so there's a lot of nuance to this, but, uh, the basic idea is that immune cells like any other cell in the body necessitate certain levels of certain vitamins and minerals in order to function adequately. And when they have low levels or Um, in some cases [00:53:00] extremely high, but mostly low levels, they're not able to do what is necessary to keep the immune system in balance.

So obviously vitamins and minerals. The other group here is everything else that's in our food. 

Dr. Brighten: And 

Dr. Perlmutter: so polyphenols, uh, which are a group of 8, 000 plus nutrients found in plants 

Dr. Brighten: that 

Dr. Perlmutter: are part of the plant's immune system, uh, we're now learning have an impact on our immune system and potentially even the brain's immune system.

Um, so. This is research that we just had accepted into, uh, Frontiers in Nutrition, um, journal looking at the fact that polyphenols influence the immune system, influence glial cells in the brain by way of epigenetic pathways. Uh, so there's, there's a lot to unpack there, but the point being, Food is packed with data that influences the brain's immune system.

And that's just the starting point of what you consume from your mouth because it turns out food also has a microbiome. 

Dr. Brighten: And 

Dr. Perlmutter: the microbes on your food change your microbiome, which then the [00:54:00] gut brain connection by way of the microbiome is a major influence on the brain's immune system. 

Dr. Brighten: Um, polyphenols run us through some of the sources of polyphenols for people, because I think that word is probably a little intimidating for some people.

They're like, this might be new. 

Dr. Perlmutter: Yeah. So if you haven't heard of polyphenols before, you're really just thinking about plant nutrients. So they're, they're non caloric. They're not vitamins, minerals, and they're not fats, carbs, and proteins. What these are, are basically. The elements within plants that they use to defend against insects, to defend against UV radiation.

Um, they're also a give plant foods, their colors. So you see a colorful carrot or a colorful spice. Those are the polyphenols that are doing that. And so again, they're part of the plant's immune system. The way that, that we talk about this at the group I work at with big bold health is that plant isn't able to escape from a threat.

You can't just pull up its roots and run away. So if a bug lands on it. It doesn't have the opportunity to swat it away, unless it's a Venus [00:55:00] flytrap or something. That's atypical. Uh, so instead what it has to do is upregulate genetic machinery to produce levels of molecules that can fend off insects or fend off viruses or fend off bacteria.

But these molecules, similar to what happens within our own GI tract, actually have an interaction with microbes in the local soil. So they're able to signal using these molecules to bring in healthy bugs, healthy bacteria, and they're able to have this. Interaction with the microbiome of the soil 

Dr. Brighten: for 

Dr. Perlmutter: a long time.

And maybe some circles still, these polyphenols in our diet were thought of as throwaway ingredients. They didn't serve a purpose. And in the last couple of decades, what we've seen is that not only do people who eat diets rich in polyphenols do better, have lower rates of dementia, lower rates of mental health conditions, but that these molecules act on pathways, including those directly related to the immune system to kind of translate over from the plant.

The signals that they were using to develop resilience. So it's kind of this [00:56:00] interspecies transfer of knowledge from plants to us. And so where do they exist within our foods? Generally speaking, colorful fruits and vegetables are going to be rich sources of polyphenols. The highest sources of polyphenols in our diet, based on the amount we consume from individual sources, are going to be coffee.

I mean, for some people, maybe even red wine, but coffee is actually the top of the list because we like coffee and because it's rich in polyphenols. And because it's 

Dr. Brighten: just awesome. Coffee is awesome. I'll go on 

Dr. Perlmutter: record saying that. 

Dr. Brighten: Yeah. Well, we spend enough time in the Pacific Northwest. It is a part 

Dr. Perlmutter: of the day.

Dr. Brighten: It is our liquid sunshine. Don't ever touch it. It 

Dr. Perlmutter: doesn't have to be caffeinated. By the way, polyphenols are still found in decaf coffee, but the most concentrated source of polyphenols by weight of food is actually spices. So spices are, Incredibly rich in polyphenols. And so I think this is one of the things that many cultures historically got, right.

Yeah. And we're not talking about salt and sugar here. We're talking about, you know, rosemary and oregano and cloves and these spices that many people maybe have kind of forgotten how to [00:57:00] use. These are incredibly concentrated sources of these nutrients. The plant that we're researching is called Himalayan tartarine buckwheat.

And the reason we're researching it is because this is a plant that, uh, Grew up on the tops of mountains. So it had to produce really really high levels of these polyphenols to survive Compared to common buckwheat or grains. And so it's super rich in rutin and quercetin, asperidin, luteolin Other polyphenols in case people are curious.

Yeah, which are we've 

Dr. Brighten: known are great for immune system regulation You know, things that we use for people who have allergies, histamine issues, and then came more of the brain research on it, which has been fascinating. 

Dr. Perlmutter: Right. It's exactly right. So, so these have been used, I mean, they've been part of many cultures for millennia, but now it's, we're starting to isolate and say, oh, well, red wine is great because of the resveratrol in it.

Or green tea is great because it has EGCG, these polyphenols that have an outsized impact on health. But I think we're still in the place of, [00:58:00] Many, uh, academic institutions around the world now recognizing these, these molecules play a role in health, but the specific pathways is where we're trying to get clearer because usually people say polyphenols are antioxidants and you want antioxidants.

So get polyphenols. I just don't think it's super accurate. I think that it's actually not the main mechanism, which is why this research is so interesting because, you know, historically can we really say that taking high doses of polyphenols or sorry, antioxidants. Yeah. And a powerful antioxidant. Not necessarily great for people.

And so I think there's a lot more natural wisdom that transfers through, and we eat plants that are rich in these molecules. That's more of a synergistic effect then just saying, I'm getting a gram of quercetin today, that's asking, does What is the context in which it exists and why is it that the plant makes that level of that polyphenol and why does it combine it with these other polyphenols?

It does something for the plant. It kind [00:59:00] of evolved alongside plants and fungi. So maybe there's something that is important for our health as well. 

Dr. Brighten: Mm hmm. And when you look at how cultures have integrated these things, They often have them in traditional dishes where they're synergistically taking effect.

So I think a lot about how curcumin and like turmeric had its day. And then, you know, people were like, just put turmeric on everything. And when you go back to how it is an Indian food, well, as it turns out, the pepper that they're using, the dairy that they're using, the fats that are there, all of these things help you actually absorb it better.

Absolutely. When we look at other cultures, like looking at, um, Persian food, Middle Eastern food, Chinese, um, I mean, really, every culture has this integration of these herbs that are so beneficial. I want to ask your thoughts about saffron because that's a really interesting one. 

Dr. Perlmutter: Yeah, I mean, saffron has some literature suggesting benefits to mental health, right?

I think it is a good example of of [01:00:00] basically pulling out a single thing. I mean, saffron is a plant. It's a spice. It's also very expensive. But yeah, you know, if you're 

Dr. Brighten: getting it for cheap on Amazon, it's not saffron because it's expensive. 

Dr. Perlmutter: Yeah. I think it is of the kind of medicinal plants, maybe towards the top of the list of evidence based for mental health conditions.

Um, alongside, you know, curcumins having its day as well. Um, But I think that the challenge is always over indexing towards the belief that any one thing is the solution and so While I love the idea of saying that a natural, uh, a plant is capable of having these outsized effects and while I think it is great kind of adjunct to, I don't think it's to say, okay, well now we have this and so this should replace conventional medicine or it's, it's sufficient.

I think this applies kind of across the board, right? So I think there's a tendency to say that if it's natural, it's fine. better, even if the quality of [01:01:00] the research is not as good. And so I think that is an example in which there actually is some peer reviewed research, which is nice. And we just have to put it into the larger context of ideally a practitioner that is looking at it as one potential solution for the right person, as opposed to, you know, The alternative to a more comprehensive approach.

Dr. Brighten: Mm hmm. Well, when it comes to mental health, it's never, it's never just the serotonin. It's never just one thing taking place. I wish we could just be like, oh, it's just your inflammation. Yeah. Because there's also habits that form with that. There is. The community component. There's so much more. And with Saffron, what I find really interesting is that some of the research shows it rivals SSRIs in terms of helping with depression.

But if somebody still needs the SSRI, we know one of the biggest side effects is anorgasmia, inability to orgasm, loss of libido. And Saffron's been shown to help so that if you're still on, if you still feel like the SRSRI is serving you, it's not an all [01:02:00] or nothing kind of thing. 

Dr. Perlmutter: I mean talking about SSRIs for a second, I think they're absolutely necessary in certain people and they kind of suck as a drug class.

You 

Dr. Brighten: mean to say the side effects kinda suck? Side effect profile is 

Dr. Perlmutter: miserable. Withdrawal profile, which nobody talks about, is miserable. 50 percent of people having these really significant side effects when they stop taking the antidepressant, a medicine which was never studied for the duration of time where most people are taking it.

Mm hmm. And so, You know, depending on the study you look at, let's just, we'll index towards benefit. SSRIs are marginally more beneficial than placebo with all the side effects. And they are essential sometimes. And, you know, being in a scenario where you have to prescribe a medication for somebody who is acutely having mental health crisis, not that it's necessarily just an SSRI, but I mean, Uh, antipsychotics and psychoactive medications are essential.

And I think coming back to what you just said, I mean, when you think about the amount of time that a person is going to be experiencing these side effects that can dramatically detract from [01:03:00] quality of life, you have to look at the data. Now, from what I know, Saffron data is much, much smaller than what we have for SSRI, so incredibly small.

And 

Dr. Brighten: who's going to fund Saffron? Saffron, 

Dr. Perlmutter: I mean, big saffron. 

Dr. Brighten: Yeah. I mean just, but if you think about Saffron is expensive enough, they may have the funding 

Dr. Perlmutter: it, it is, it is expensive enough. Again, if you've got a Saffron guy, don't hold out on me because I don't use it too much in my cooking for that exact reason.

Yeah, it tastes great, by the way, as a, just an adjunct to it. Uh, I want to, I think this, this is a good kind of way to continue moving through this. So. We've talked about the polyphenols, right? We've talked about the other nutrients in food. And I also want to say that there are a number of other bioactive molecules within food, uh, fungi being a great example.

So I'm a huge fan of mushrooms. We talked about this before. You're like, I 

Dr. Brighten: like to forage as if it was this hush thing. I'm like, Oh, yeah. I love foraging. I love mushrooms. I'm like, what can I make with lion's mane? Like I, it's like my favorite mushroom ever. If you could find 

Dr. Perlmutter: a foraged lion's mane, I would love to know your spots.

I'm going 

Dr. Brighten: to introduce you to some people that [01:04:00] I know. Like I'm going to introduce you to some people. Yes. Okay. 

Dr. Perlmutter: We have, we have some variants, but we, I've never found a wild lion's mane. We have, where I live, it's all chanterelles, lobster mushrooms. If you, don't, big year for hedgehog mushrooms 

Dr. Brighten: and porcinis.

Yeah. So if you don't follow chaotic forager, I will shout her out. Um, she just found the biggest lion's mane. Okay. If people are like, when the hell is lion's mane? Um, arguably the best mushroom that ever lived. I mean, they're all kind of great, but, um, I love like lion's mane. I used all through college. So it actually make this cocktail.

What's coffee. I say, I always call things cocktails, but, uh, when I was studying and it was lion's mane added to my coffee, some cayenne pepper and then straight up cacao powder. And I swore by it. I was like, this makes my brain go. And then sniffing rosemary the whole time. Cause I was like lost. Listen, like if the Greeks did it, they probably knew something.

Ha ha ha. So, that was, I would just say that was probably more of a, you know, superstition. Like the rosemary part. 

Dr. Perlmutter: I don't know. I think [01:05:00] people are going to be asking for that recipe later. 

Dr. Brighten: Yeah. Well, so, let me just say though that Lion's Mane has, you know I mean, tremendous benefit for your neurological health.

So Paul Stamets actually taught, so we have a whole herbal medicine course. He taught the whole mushroom, medicinal mushroom segment. I feel so blessed to like, have had that education from him. Um, but so lion's mane, you can probably speak a lot more to brain health, but, uh, it's a beautiful white mushroom.

It does look like a lion's mane. I love, if you guys have followed me on social media, you've seen my lion's mane frittatas. My Lion's Mane Enchiladas, tacos, like I have done so much with Lion's Mane, um, so yeah, I could talk about mushrooms forever 

Dr. Perlmutter: I could, too So I think we probably better say one I need your spots if you've got a Lion's Mane spot and two is a wonderful way to Mhm We'll see, but we'll have to go back and do that.

And also we wanna make sure for the parents and the children, that they can actually watch this video. So we've got the one being [01:06:00] eaten and the other being 

Dr. Brighten: the slightly different side of the mushroom. And so you can tell they're doing pretty well with it. And so they're trying to, they're having a little bit of a, a little bit of a fitness challenge.

So they're trying to 

Dr. Perlmutter: figure out how to do that well. you can watch this video and see if they're doing better. So if you're not a vegan, you can watch this video and Brain focused nature activity when you're foraging so that that counts. 

Dr. Brighten: Yeah, 

Dr. Perlmutter: but what I've become really fascinated by is kind of tryptamines in general so tryptamines are a class of molecules that are psychoactive forming kind of the basis for Psilocybin for DMT and what I think is super super interesting to kind of extract from this is how many Neuroactive molecules are in our food and how potent some of them can be.

Mm-hmm . Now polyphenols, you, you could eat, I don't know, a pound of turmeric and chances are you're not going to be experiencing some, uh, amazing change in your cognitive state. Mm-hmm . With that. Maybe your 

Dr. Brighten: bowels by it. Oh, it's do something. Your cognitive state or you 

Dr. Perlmutter: do the cinnamon challenge, you'll experience something.

No, do not do, 

Dr. Brighten: do [01:07:00] not , but it's not the 

Dr. Perlmutter: polyphenols. 

Dr. Brighten: Yeah. 

Dr. Perlmutter: But there are other molecules in food. I mean caffeine. Right. And coffee has a immediate well. 15 minute, I guess, or so delay, but immediate effect on how you think, right? And for me, as a big personal proponent of coffee, it is absolutely, uh, the light at the start of the day until around 2 p.

m. until I cut myself off for the day. But so, there are all these different molecules in foods. Going back to tryptamines, um, I spend a lot of time trying to understand why psychedelics do what they do within the brain. 

Dr. Brighten: So now we're going to different mushrooms, people. Right, 

Dr. Perlmutter: so Yeah, I mean, I guess there's, there's some overlap because you can consume.

I mean, I'm sure there's some calories in psilocybin containing mushrooms. The bottom line here being that these are, uh, things within your food that can have an immediate effect on your brain function and bringing this back to the central theme of neuro inflammation. What's been interesting is seeing.

seeing the research on what psychedelics can do to a human's immune system. Now there there's some [01:08:00] variability here that seems to differ depending on the psychedelic. And to be clear, some people will define molecules like ketamine MDMA as, as not kind of conventional psychedelic. 

Dr. Brighten: Yeah. 

Dr. Perlmutter: So when you look at molecules, okay.

Dr. Brighten: So when we're talking about psychedelics, what are we talking about in this conversation? So 

Dr. Perlmutter: here we're talking about more classic psychedelics. Um, specifically psilocybin and DMT, um, which can be found in a number of different molecules. Um, they're all kind of analogs around, uh, they look like serotonin, the trypanines.

So if we're considering what those do to the brain, though, we look at systemic immunity. And what we see is that they seem to actually have a kind of short term potentially inflammatory response. They are stressful to the body. And over time though, that may lead to a net benefit. It's kind of like exercise exercise.

Is an inflammatory stress. If you measure a person's levels of interleukin 6, perhaps the single most prototypical inflammatory molecule in their bloodstream that correlates with what happens in their brain, it goes up immediately after exercise, but the long term [01:09:00] effect is a relative quieting of inflammation.

So, so I think it's Just to add a little wrinkle of nuance here, it's not just about a question of anti or pro inflammatory. It's looking at area under the curve at a regulation of the brain's immune system. That makes sense. So mushrooms, other psychoactive foods, uh, we talk about caffeine a little bit.

We talk about polyphenols. That's, that's another level of input that changes your brain's immune system that you can consume. There's a whole side topic here of the microbiome. And I think Are you going to talk oral 

Dr. Brighten: microbiome or gut microbiome? 

Dr. Perlmutter: So that's the thing. There's, there's, I think an hour's worth of content just talking about the microbiome inflammatory connection.

So I'm wondering if maybe we should just brush it very gently and then continue on. 

Dr. Brighten: Well, let me say this. We had Victoria Sampson, Dr. Victoria Sampson, who I should definitely introduce you to. She is a brilliant dentist from London who made the connection between periodontitis and worse bowel disease.

COVID outcomes and a lot of her research paved the way for dental [01:10:00] offices being able to reopen in the pandemic. We did a whole talk about Alzheimer's risk going on in the mouth, what's happening with the microbiome. So I'm going to reference people to that for the mouth, but I think we should talk about in terms of the full microbiome, that gut brain connection.

Dr. Perlmutter: Well, I think there's nothing that's more. Okay. Um. Yeah. So, um, So. Okay. Um, so it's, it's, it's, it's a great question. So, um. Um. Um. Um. Um. Um. Um. Um. Um. You know, gut health is everything. Now going back to one of the principle points I made, there's no panacea in my opinion. Gut health is a lot of things, but it's not the only thing.

So if a person, you know, is in a car accident and they have a TBI, that's not a gut issue, right? That's something that is a direct cause of some damage to the brain. 

Dr. Brighten: But have you seen the research about like [01:11:00] getting a TBI and what happens to the gut? 

Dr. Perlmutter: Well, so, okay. Yes. So, so there are many ways to get back to the gut.

Trust me, I understand. The point I was making is. Uh, you know, the gut is many things. Is it everything? I'm not convinced, but it is. Maybe most things, even as it relates to the brain. What we know is that what happens in the gut programs neurons and it programs micro glial cells. And a lot of this research has been done in germ free mice who are probably not having a great life.

No, not 

Dr. Brighten: fun. 

Dr. Perlmutter: No, they, they're, they're not having a good time. Um, but the point being that the data from the gut and in particular, the gut microbiome programs, our brains, there's another kind of interesting concept here, which is the question of whether. We as humans are just vehicles for the microbes that live on us.

Are we just acting on what's best for little meat puppets, right? But there are a couple of conduits by which the gut microbiome influences the brain's immune system. I would say the two biggest ones to know about one is the vagus nerve that people have probably heard about the longest [01:12:00] cranial nerve runs from the gut to the brain.

Most of the connections go from the gut to the brain, which would indicate that the majority of data is running to the brain. So it's sensory, uh, interpreting what's happening in the world. The vagus nerve has all of these little tendrils, these afferent tendrils that kind of, uh, penetrate right up to about the level of the gut border.

And they receive information from the bacteria in our gut. Um, and they're able to transmit that based on rate of firing and other signaling to the brain to influence the brain's immune system. This is kind of, The idea of there's even this inflammatory reflex that the vagus nerve is involved in, which helps to quell systemic inflammation based on what the vagus nerve is up to.

But the cornerstone idea here being that the brain's immune system is tasked with understanding what's happening in the outside environment. We talked about stress. We talked about food. It also has to pay attention to the microbes because the microbes are honestly one of the best signals as to what is happening in the outside world.

We know the microbiome [01:13:00] Changes depending on what we eat, we know it changes depending on where we live, depending on where we were born, depending on, uh, the means in which we were birthed, all of these different variables. And there is an absolutely insane amount of data there, right? That the body is responding to.

The microbiome is not good or bad. It is comprised of a host of different bacteria, archaea, fungi, protists, all of these different, uh, microbes. And. That data has to be transmitted through the gut and reach the rest of the body, vagus nerve being central to that. What's also really interesting, though, is that what happens in the microbiome influences the local immune cells in the gut.

Historically, we've thought about the gut owning the majority of the immune cells. Some recent research suggests otherwise bone marrow lymphatic system, but there's still a lot of immune cells in the gut. Mm hmm. And they change in response to the, uh, signaling from the gut microbiome. So the other kind of major conduit by which what happens in the gut microbiome influences brain immunity is the bloodstream.

So the changes in the [01:14:00] local immune system within the gut can signal to systemic immunity and that can then reach the blood brain barrier and through a A wide variety of different signaling pathways speak to the microglial cells and program the brain's immune system for the better or for the worse.

So it sounds like you've already talked about P. gingivalis and what's happening in the oral microbiome and how that influences potential risk for brain health outcomes. There is so much that we still don't understand. But what we do know is that there are changes in the gut microbiome seen in neuroinflammatory conditions like Alzheimer's and depression.

I don't think we're quite at the level of saying, Oh, we can target specific strains of microbes. There are psychobiotics, that's what they intend to do. But I don't think it quite generalizes the point where we can say this will treat depression. This will treat Alzheimer's. We might get there. What we do know in the interim is that the relative makeup of the gut microbiome has an effect.

brain and it seems like one of the principal pathways [01:15:00] is by its effect on microglial cells and regulating brain inflammation. So this, this gives us an opportunity to ask the question each day as to, are we setting up a microbe population that is helping or hurting us? 

Dr. Brighten: And 

Dr. Perlmutter: I kind of think about sometimes every time you eat, you're eating for.

39 trillion, right? The bite of food that you take is not just for you. It's to feed all of these little beings, creatures, whatever you want to call them inside you so that they care for you. Because if you don't look after them, then they tend to turn on you. And again, one of the more kind of consistent, um, integrations here is when there is dysbiosis, when there are issues with the gut immune system, then you have an increased penetrance of LPS.

And 

Dr. Brighten: by dysbiosis, we're talking an imbalance in the gut flora. 

Dr. Perlmutter: Right. Just exactly. Basically, you have too many bad guys, not enough good guys. And this can increase the penetrance of this molecule, lipopolysaccharide, in the bloodstream. This molecule may reach the [01:16:00] brain and is probably the single most potent instigator of microglial activation towards inflammation.

So LPS is a really interesting molecule. We mentioned it earlier in the context of depression. Yeah. But where it comes from. And people who are not being injected with this molecule is by passing through the gut lining. And it's really not supposed to, I mean you can have a good amount of LPS living in your gut and be okay.

It's when it gets into the bloodstream that it creates all this havoc. 

Dr. Brighten: So 

Dr. Perlmutter: that is a reflection of the relative health of the microbiome. And again, it's a vote for why. What we do, which we know it's not just food, it's all of our lifestyle activities, it's drugs, it's all the things we do, uh, to keep our microbiome in a relative state of balance.

So, we've covered eyes, ears, and mouth so far. We've covered a couple of the infant streams. Yeah. There's one more too though, uh, just to complicate it a little further before we move away from the face. It's the, it's the nose and it's the mouth because it's what we breathe. And I think this one is the one that most people don't know and it's, it's so potent.

So we're sitting right now in [01:17:00] Mexico City. It's a very lovely city. It has an air pollution issue. I was going 

Dr. Brighten: to say right now, but in a few months, the air pollution will kick up. I mean, 

Dr. Perlmutter: it, it, it is better than it used to be and it's still significant. And Mexico City has a reputation as being one of the more polluted, I mean, it's, it's a huge city.

Yeah. But there are tons of cars and not unexpectedly, air pollution is a major issue here. They have done research in Mexico City. where they have looked at microglial cells in both humans and dogs, and what they found is that microglial cell activation, basically inflammation in the brain, correlates with exposure to air pollution.

And it's some of the most direct research we have from any environmental input in increasing markers of brain inflammation. I'm 

Dr. Brighten: trying not to freak out right now. 

Dr. Perlmutter: It's, it is, it's scary stuff. What I will say, because there's a lot of research I can cite here, there's just came out in the last few years JAMA, which is a significant medical journal looking at PM [01:18:00] 2.

5, small particles, air pollution, the most concerning air particulate matter, and risk for dementia, risk for depression, risk for anxiety, um, risk for violent crime, risk for worse test, test taking in children. 

Dr. Brighten: Um, 

Dr. Perlmutter: there are a lot of things. 

Dr. Brighten: Yeah. 

Dr. Perlmutter: And I want to empower people to know that the majority of a person's exposure to air pollution is happening.

inside your home from things that you can control. 

Dr. Brighten: Like? 

Dr. Perlmutter: Right. So the, the top sources of air pollution in the home are usually going to come, well, it's combustion. And combustion is basically, you know, burning things. Yeah. Or exploding things, but mostly burning things. 

Dr. Brighten: Exploding things is fun, but don't do it in your house.

You're probably not doing this much. 

Dr. Perlmutter: Um, so, so the, the main source there is going to be Really cooking for most people. 

Dr. Brighten: Yeah. 

Dr. Perlmutter: And. I don't know why everything in the United States becomes an issue with politics, but there was this article about gas stoves that came out. Oh yeah. And then it became a political issue as opposed to a scientific issue.

It 

Dr. Brighten: always goes that way. Trust. I work in women's [01:19:00] health. It's like if they can legislate anything about our bodies, they're on it. 

Dr. Perlmutter: Well, it just became a scenario where there was an intended outcome, which is, Hey, you should consider this from a health perspective. And then it became this industry political thing.

Gas stoves produce more air pollutants than do induction cooktops, then do electric stovetops. But all of those pale in comparison to burning, you know, a fire. If you're at the main point here being. The biggest signal for indoor air pollution is smoke. 

Dr. Brighten: Yeah, 

Dr. Perlmutter: if there is smoke in your home That is the most concentrated source of PM 2.

5. Mm hmm. There's also gases so one of the issues with gas stoves is that they kind of perpetually release this stream of gas pollutants nitric oxides and others that Uh, have been shown to be risk factors for inflammation and for oxidative stress. So you don't want that. But smoke, I think is the main thing.

Dr. Brighten: Mm-hmm . 

Dr. Perlmutter: And so just talking about cooking, definitely vent your stove top if you can. Mm-hmm . And try not [01:20:00] to cook. Things that generate a ton of smoke. I mean, I know charring meat is a great idea as far as flavor, but you probably don't want to be doing that on your stove top unless you have great ventilation.

Dr. Brighten: I'm just laughing 'cause I'm. So got to give this clip to my husband. Cause whenever he wants to try me and I'm like, knock it off, don't do that. We're not doing that. 

Dr. Perlmutter: It's not a fun one, honestly, because so much of cooking is about, you know, the F the flames and the charring and the smoke and all the other things.

But the reality is, because I have done this, if you sit there with an air quality monitor and you look at what happens, it is an absolutely absurd increase in pollutants. And specifically, we're talking about these. PM 2. 5, which are the ones that have been best studied to correlate with Alzheimer's disease, with depression, with violent crime, with worse cognition in children.

There's even a study showing that moms who were exposed to higher rates of air pollution in their homes when they were pregnant, uh, had higher rates of postpartum depression. 

Dr. Brighten: So 

Dr. Perlmutter: there's all of these different correlates to it. So Coming back to the practical thing, [01:21:00] definitely the, the cooking, but the ones that I'm just gonna say because people get annoyed with me when I do, incense is a concentrated source of indoor air pollution.

Yeah, and it has observed and research backed, uh, effects on worsening cognition and worsening overall health. So scented candles also, they might smell nice. If they're smoking, they're bad. And if they smell really nice, it's because Often you're inhaling these volatile organic compounds that are incredibly synthetic that have been linked to worse in cognition They actually did a study where they took people Put them in an office and they measured whether ventilation and VOC is correlated with cognition What they found is that when VOC's went up people And we're not talking years, we're not talking decades, had worsened cognition.

So, the point being here, a lot of the things that are contributing to neuroinflammation are related to air pollution, and they're happening inside our homes, inside our vehicles. Don't even get me started on air fresheners, which are about [01:22:00] just concentrated sources of VOCs that we put into our vehicles that spray in our homes.

Dr. Brighten: Yeah, I was, I, whenever I talk about environmental toxins and cleaning up your house, the three tips I always give, so number one is get rid of all the plastic in your kitchen that you can and anything, you know, anything you can get in the glass, let's do that. But the two big ones are open up your windows, daily if you can, at least once a week.

I know sometimes people in Minnesota are like, what daily? No, but error out your house. And if anything, you got a fragrance that you're spraying on your furniture, if you're plugging it in, if it's a can't throw it out, throw it in the trash. And when Yankee candle season comes along, don't go to your friends houses.

Is that half them? 

Dr. Perlmutter: Like you don't need the pumpkin spice, apple cider stairs. Spice, bring back simmer 

Dr. Brighten: pots, people bring back simmer pots because they're amazing. 

Dr. Perlmutter: Well, what I think is really interesting about this conversation is we've kind of ventured into the realm of products that [01:23:00] are, are marketed as improving wellness.

It actually has the exact opposite effect. And so the air freshener aisle in at least United States, grocery stores is, is packed with the I mean, it's not just the immune piece. That's really where my focus is. But I mean, this is an area that I'm sure you have a lot to say about because the fact that these molecules can disrupt endocrine signaling is really scary stuff.

And now, as we're looking at correlations between exposure to some of these indoor air pollutants and rest for things like. Obesity and risk for things like infertility, you realize it's not just about, oh, well, maybe I got a little lightheaded or maybe I was a little bit foggy headed because this person was burning this, uh, seashore scented candle for five hours.

Dr. Brighten: You know the one. It's blue, 

Dr. Perlmutter: it has a shell or two in the candle. 

Dr. Brighten: Yeah. And it doesn't look like, and nature made it, that's for sure. No, it is 

Dr. Perlmutter: not a natural blue. 

Dr. Brighten: No, 

Dr. Perlmutter: but it's very popular in coastal towns in the United States, 

Dr. Brighten: at least. It really is. Uh, and you [01:24:00] know, as we were having this conversation, like it comes up all the time where friends and I will joke about like, remember when we thought we needed to smell like berries and champagne or like vanilla.

Um, so I appreciate you bringing out the endocrine disruptors, the indoor air pollutions. Talk to us about golf courses because sometimes people are like, I leave the city for my like golf course, like, you know, retiree life. 

Dr. Perlmutter: I think, I think this is a tricky one. Um, and so. Because 

Dr. Brighten: golfing and being with friends is good for brain health.

We can say that. 

Dr. Perlmutter: Yeah. Um, to start, this is just a real side tangent. The idea of controlling the lawn and the amount of resource that goes towards managing lawns. Yeah. Is absurd. And a golf course is the most, It's the most absurd representation of this attempt to control nature and standardize it. Um, I wrote an article one time, uh, about the kind of psychological backing behind the American lawn.

And I write mostly about [01:25:00] brain science. Um, this was one of the most popular articles I've ever written, because there's so much about it that's representative of our desire to control nature. So, just a little side note there. Golf courses are Probably the most concentrated sources of kind of synthetic control over nature of any aspect of what humans do, at least in the United States, at least from what I know.

I grew up in Florida. There's a golf, there are three golf courses. 

Dr. Brighten: Then you know golf courses, friend. Yeah, 

Dr. Perlmutter: I'm pretty sure that most of Florida is a golf course. Yeah. Golf courses not only require an insane amount of water and resources that we could argue should really go potentially other places. Uh, I guess this probably isn't an environmental science conversation, but I will argue it like 

Dr. Brighten: burn every lawn to the ground, reclaim the earth, grow food.

I will say that. 

Dr. Perlmutter: I will say that. I think golf courses are a little different because they're a commercial entity, but at an individual level, I think people should take a moment and ask themselves why is it so important to [01:26:00] have a well manicured lawn? I think it is. It's 99 percent psychological. It is trying to control entropy and if you can have a well manicured lawn, you can sit out there.

Do you ever watch the show King of the Hill? 

Dr. Brighten: Of course. With your friends and say, yup, 

Dr. Perlmutter: like you've got it on lock, then you don't have to deal with so much of the other challenges. But zero scaping is a popular trend. I'm a huge proponent of it and basically means putting in landscaping that doesn't require that much water.

And especially because in many places where lawns are popular. There's no actual lawn that exists naturally there, Florida, great example. I mean, crabgrass will grow well, but people import this Northern grass that dies almost instantly because they want to believe that that is something that should exist there in terms of what goes into.

A lawn of any sort, because it's not just golf courses, it is a ton of chemicals to keep them, uh, looking nice. Yeah. Right? So there are a number of different pesticides and other chemicals used on golf [01:27:00] courses. There have been some really interesting association studies showing that proximity to golf courses correlates with children's development and risk for developing certain neurodevelopment or neurocognitive issues in adults.

Dr. Brighten: Mm hmm. 

Dr. Perlmutter: Um. I think this is a little bit of a contentious subject, so I, what I'm going to say about it is just. 

Dr. Brighten: People can get mad in the comments, that's okay. They can always argue with us. I look forward to it. I'm okay with, uh, you know, people countering. 

Dr. Perlmutter: I mean. If you just think about it practically, there is the concept that people have that somehow if you, uh, are near to nature, you're healthier.

And if you're away from nature, you're less healthy. There are variants in which that is true and variants in which that is less true. But if you're thinking about how much exposure, I mean, God forbid you want to plant a garden next to a golf course, how much extra runoff there is, how much exposure there is to those pesticides.

Dr. Brighten: Yeah. 

Dr. Perlmutter: I think it is a risk. And I think that not just in terms of the practical aspects of proximity, but also because of some of these studies, um, we can drop a couple in the comments if people are interested. Oh [01:28:00] yeah. I would love that. Looking at brain related conditions and proximity and it's everything from again, uh, neurocognitive issues in children to neurodevelopmental issues in children and neurocognitive issues in adults and risk for, um, conditions like Parkinson's.

No. I know that it steps on some toes personally. I would not love to live next to a golf course. Um, and also having grown up in Florida, I know that that is kind of the ultimate goal for many people is to retire and be as close to golf as possible. So I think it is it like anything else. You know, the closer you are in terms of exposure to, uh, pollutants, similar things can be said for exposure to air pollution from traffic.

Um, traffic related, uh, air pollution is a well studied phenomenon. Um, it basically drops off pretty quickly once you get away from highways and from major thoroughfares. But it is true that the homes that are closest to heavy traffic, those people are exposed to [01:29:00] dramatically higher levels of pollutants that will damage, on average, cardiovascular health, respiratory health, neurological health, reproductive health.

The difference here being is you kind of have these two extremes in terms of who chooses these things. Most people don't want to live near traffic. And so what you see is that there's kind of this. For ponderance of exposure in minority populations where they are taking on the majority of the burden of that air pollution, whereas.

I might argue that people who are choosing to live near a golf course tend to choose that as opposed to being forced to live totally near the ninth hole of a course. Yeah. So I think these things are important variables. They're not always things that we can do something about immediately. 

Dr. Brighten: Yeah. If we can't move, what can we do?

Dr. Perlmutter: Right. So, In terms of exposures in the world around us, there's been kind of a conversation around how you just create your sanctuary for brain health. And I guess specifically talking about neuro inflammation. Maybe we need to 

Dr. Brighten: build this place. We can build it. Yeah. And forage for mushrooms. [01:30:00] 

Dr. Perlmutter: There you go.

So we'll have mushroom foraging. There'll be meditation. We'll have sleep classes and healthy food. 

Dr. Brighten: Polyphenols all around. 

Dr. Perlmutter: And you will leave with perfect cognition. And then the second you step outside, you'll be. Having to reintroduce all the exposures. Um, I am always of the mind that the best thing you can do is the next best thing, not the perfect thing.

Right. And so, uh, while I could lay out a 25 step protocol for perfect brain health, I think the most important thing for listeners is to understand where they are in the continuum of making these changes and what is the next best thing that they can do. So for some people. The next best thing they can do is cutting back on sugar, sweetened beverages.

As simple as that, you know, exercise we didn't talk about in too much detail is probably one of the most powerful ways to regulate your immune system, including within your brain and improve your brain health. 

Dr. Brighten: What kind of exercise though? Cause the debate on social media is 

Dr. Perlmutter: on the debate on social media is there's only one right answer for everything.

And anybody who [01:31:00] disagrees, whether it's carnivore or vegan or a high intensity interval training, everyone else is wrong. For exercise. I believe that any type of exercise is good is walking as good as moderate intensity exercise for 30 minutes. If you want it to be objective about it, probably not.

However, is walking a hundred times better than nothing. It absolutely is. When it comes to regulating the immune system, when it comes to benefiting the brain, I actually think that resistance training or basically weight training is highly undervalued in terms of its benefit. And the reason for this is because historically we have thought about exercise and its role in brain health as beneficial because it acts on pathways.

like brain derived neurotrophic factor, which is a molecule that is upregulated, improves neuroplastic change, and is upregulated in particular with exercise, some dietary strategies, but mostly exercise. And so we've said, okay, well, uh, people who do aerobic conditioning, they get that. So that's good. We've also thought about [01:32:00] exercise is good for the brain's blood flow, which it is.

Your brain needs to get energy, Persistently blood is how the energy gets there. It's also how oxygen gets there. So we can use the energy and exercise is great for blood flow. But the new science is talking about a class of molecules called myokines. 

Dr. Brighten: Yeah. 

Dr. Perlmutter: Muscle signaling, 

Dr. Brighten: super exciting research. It changes everything 

Dr. Perlmutter: because muscles are not just some sort of a, you know, uh, Move the bones, right?

Right, right. That makes you look good in a swimsuit. Yeah. Muscles are an endocrine organ. They're an immune organ. They produce these molecules that change the way our bodies work. And the most interesting stuff here is that when you look at certain, uh, myokines that may regulate neuroplasticity, brain metabolism, brain immunity, quell neuroinflammation, these are molecules that are produced when we activate, uh, skeletal muscle groups.

So then we say How do we do that? Well, a person's largest skeletal muscles, not just you, but a person in general's largest skeletal muscles are [01:33:00] in their lower body. Um, so I think gluteus maximus is actually the largest skeletal muscle group, 

Dr. Brighten: but 

Dr. Perlmutter: the legs, right, and so, You know, I grew up in a time where people would say, bro, don't skip leg day because you're just a wimp.

And now I'm living in a time where people say, don't skip leg day, because that's where the myokines come from. And certain myokines like irisin are really important to cognitive health. And so what the research is showing, I guess, to kind of distill this down. Ideally, you're getting a combination of resistance training, weight training, where you're involving large muscle groups, especially your legs, anaerobic conditioning.

And so. I'm not going to put together my perfect protocol for you have to do this many reps of a squat and these deadlifts, but I think combining some weighted exercise with some aerobic exercise where you get your heart rate up, uh, that's going to be the key for long term brain health. I will just say one statistic here, which I think is a really good one.

This is a paper that just came out recently in JAMA, the Journal of the American Medical Association. It showed that at roughly the 10, 000 step a day, [01:34:00] uh, level, You know, I think was actually popularized because of a wearable. Yeah, that's what you need. It wasn't based in science, but now they've studied it.

And they've said that around 10, 000 steps a day over a seven year period correlates with a 51 percent reduction in risk of developing Alzheimer's disease. Yeah. So start with just moving in some way, shape or form. And that will absolutely benefit your brain health, again, through these pathways, including metabolism and 

Dr. Brighten: neuroinflammation.

I'm just giggling. I put this post up on social media where I talk about like the best hormone hacks and I always list squats. And I don't know why people fight me about squats, but they'll always come in and be like, why squats? I'm like, Optimize your insulin, like prevent osteoporosis, and I'll list all these things.

I'm going to reference this, but, uh, and my friend, Dr. Stephanie Acima, saw it like going down in my comments, and she's like, how about just have a nice butt? Like you could just have a nice butt. I was like, well, you know, I, I'm talking about hormone health, but now we're going to talk about brain health and squats.

So I love that you [01:35:00] brought this up. That's why I was chuckling when you were saying that, because I'm like, someone's going to fight us about squats. Right. 

Dr. Perlmutter: Thank you. I mean, exercise is just a thing where people get so defensive about the exact right way to do it. I will say, if you're somebody who doesn't exercise, don't go to the gym, put a bunch of weight on the squat rack, and go for it.

No, keep 

Dr. Brighten: your back, keep your knees. I think, 

Dr. Perlmutter: I think this is where trainers are ideal, because it's, it's about, you know, Area under the curve, longitudinal benefits. It's not, I went to the gym one Thursday and I did the squats. So I'm good. It's about how many years, how consistent over those years can you be exercising?

So if you don't have a routine, if you don't have the movements, don't try to figure it out because if you injure yourself, you're out of the game for potentially months, potentially longer. So especially if you're somebody not familiar with the gym and you're trying to optimize your brain health, I think that's the perfect, Scenario to get a fitness person a coach to walk you through the motions But yes squats and deadlifts and leg press and anything involving large muscle groups I mean, I think bench press is good [01:36:00] too.

But anything that loads your muscles is excellent. I mean, I also love bands I also love all these other exercises you can do in the gym. 

Dr. Brighten: Yeah, but the 

Dr. Perlmutter: point being If your muscles are straining, your brain is benefiting. 

Dr. Brighten: Mm hmm. Oh, I love that. I think that's a beautiful way to put it. And, you know, I'm just curious, have you seen in the research, because often we talk about things that are like 10, 000 steps and things that assume that everyone's able bodied.

Right. When it comes to people with disabilities and, and activity, like, what have you seen in the research in terms of benefits for brain health? Like, how can they be approaching this? Yeah, 

Dr. Perlmutter: I think Coming back to the point I made before, this is not a question of doing the perfect thing that every human should do.

Um, you know, this isn't something where if you can't do X, Y, or Z, you won't get the benefits. And so if you come to what the kind of core mechanisms are of the benefits, it's not just the muscle groups, it's motion in any way, shape, or form that seems to be important. There's other benefits. You're activating lymphatic flow.[01:37:00] 

Um, There's a host of, of research showing that yoga practices, Tai Chi practices, um, low intensity exercise can still have significant benefits to brain health. So we're not saying you got to get in the sled and push up 400 pounds. What we are saying is if you can find a way to move your body. In one way, shape or form.

It doesn't even have to be all of your limbs. You know, there's some really interesting research showing the benefits that come from just, you know, single arm exercises in terms of, or single leg exercises. The point being that if you can activate your muscle groups, that's ideal. If you can get your heart rate up, that's ideal.

And it doesn't necessarily have to be in the conventional way of going to the gym. Who don't want to go to the gym. No, they're loud. They're 

Dr. Brighten: stinky. There's a lot of bright lights. I'm that person. I used to work in a gym for like over a decade and I'm still like, I just don't really, I will do, I will work harder at home.

Like when I'm not overstimulated. 

Dr. Perlmutter: I [01:38:00] totally agree with you. I think the other piece of this is trying to find a way to make it work within the constraints of a person's life. And so I spend a lot of my day in front of a computer. Yeah, that is suboptimal for a number of reasons. But I got a standing desk with an under desk treadmill.

Dr. Brighten: I that like I have had that for the last four years and it has been the best thing I ever did. I wrote a book wearing a baby on me with my treadmill desk because I could walk and he would just sleep on me and then I was like, Okay, I can work like I'm good. 

Dr. Perlmutter: You beat anything it's a 

Dr. Brighten: weighted vest. Like these small humans.

It was a weighted vest. . Okay. Not an, not 

Dr. Perlmutter: an addition to the baby . 

Dr. Brighten: No, no, no. I wore a baby. No, I wore a, I wore a baby. But not additional weights. I'm just saying you could wear a weighted vest. Oh, I see. To be matched . 

Dr. Perlmutter: All right. You had to had to step it up. That's fair. Yeah. But it's exactly that. It's finding ways to incorporate it into your day and similar to nature exposure.

So nature exposure is a major talking point I have because 

Dr. Brighten: yeah, it 

Dr. Perlmutter: is free. It is enjoyable, and it's been shown in study after study to correlate with better brain health. How in part, because it regulates the immune system, there's a study [01:39:00] I love where they took people in downtown Ann Arbor, Michigan, and they put them into an urban park for 20 minutes, once a week.

And they showed a significant decrease in salivary cortisol, meaning it's increasing their levels of this stress hormone measured in the saliva. And I think that's just one of those things where you don't have to go and camp in Yosemite for two weeks or do an outward bound trip to get these benefits.

And again, the perfection being the enemy of the good ear. Just talking about going for a walk in a place where there are some trees or a lake. There's even some fascinating research showing that when we're exposed to virtual natural environments, it biases our brains towards better decision 

Dr. Brighten: making.

Because I was going to ask about areas, you know, there's been, um, initiatives. to in, in more of these urban areas to bring in plants, to bring in nature because they do see a correlation with less violence, less crime, like the community is happier overall. But to hear that, okay, if you can't have access to that, you can take this [01:40:00] virtual route and basically hack your brain.

Nothing's as good as nature, but it could be a fix for somebody who's like, look, I can't get out to nature, but like once a month, 

Dr. Perlmutter: I think that is true. And I think that. You know, in my perfect world, people would actually be in real nature, but there are other ways to do it. Having some plants in your home, depending on your level of expertise, mine is not super high.

I think the snake plant is an excellent story. They're hard to kill. It is possible. Um, I once, 

Dr. Brighten: you'll, you'll know though, did it shoot up a flower first? 

Dr. Perlmutter: No. 

Dr. Brighten: When they're stressed, they'll usually shoot up a flower first. Okay, so it's kind of a flare signal. I'm somebody that has over 50 houseplants, so, yeah.

Dr. Perlmutter: We have, we have that number, but I'm not taking any responsibility for why they're doing well. You're 

Dr. Brighten: like, I have a partner who he just married two weeks ago on a mountain. 

Dr. Perlmutter: Yeah, exactly. Yeah. And she does an incredible job caring for the plants. And I think, you know, You're getting back to the combination of science and what is kind of practical air or plants Don't really do a lot for air pollution in the home.

Mm hmm. We'd like to think they do NASA is [01:41:00] lying to us No, there's like it's a 

Dr. Brighten: snake plant 

Dr. Perlmutter: The NASA data has been overblown The the bottom line is no plant is going to be even a hundredth as beneficial as an air purification system. 

Dr. Brighten: Yeah, 

Dr. Perlmutter: but psychologically Having a plant is a wonderful thing. Caring for something, seeing the green, is great.

So I'm a huge proponent of indoor plants, and they certainly don't hurt the indoor air pollution. But going back to the kind of, the driver, what made me so interested in it, the research would show that when people are exposed to natural scenes, even virtual natural scenes, they are able to think more into the future.

Mm. Which is a crazy combination of things. Yeah. But one of the things that we discussed, kind of at length in Brainwash, is that patterns of decision making are the core driver of whether humans can continue to exist on this planet or not. Mm. And this relates to a number of variables, neuroinflammation being kind of top of my list, that the way we make choices at this stage, the Anthropocene, meaning that humans are kind of in charge [01:42:00] now, Is the biggest determinant of whether this planet can continue on in a semi positive way, or whether it implodes.

Yeah. And so, whether we make decisions that are geared towards what's best for other people, or just for ourselves, whether we make decisions that start wars, that lead to nuclear bombs, whether we make, uh, decisions that take climate change seriously, these are all important. Incredible, important variables that are a reflection of what happens in here.

And what nature seems to do is it connects us to more future oriented thinking, which is really important. It's not the impulsive, me only moment. It's what's the bigger picture at stake. What nature also does is it gives us a sense of awe. It connects us with the idea that we, as little creatures, I mean, if you do the thought experiment and just think about how small the planet is in this giant universe that we are not all that consequential and that we are part of something much bigger and when that happens, people generate more [01:43:00] empathy for nature and more empathy for each other.

So nature changes the way that we see the world. And this, this is the fundamental premise of the whole thing. Right. So neuro inflammation, neuro metabolic dysfunction, all of these things, they matter because they change how we see the world. 

Dr. Brighten: And 

Dr. Perlmutter: that certainly matters in terms of whether we're enjoying our lives.

But again, we've reached an age in which decision making of humans, really a small set of humans is the principal determinant of of whether we survive as a species and the degree to which we survive well or just get by. And so, all of these things that we've been talking about at scale are driving the brains of the people making decisions.

So, my subplot here, if there is one, is to promote better brain health for everyone in Especially our leaders who are faced with these challenges of trying to understand whether they make decisions best for a couple people or for many people. Whether they make decisions that are impulsive, [01:44:00] aggressive, uh, relatively self serving or decisions that are good for the planet 

Dr. Brighten: as a 

Dr. Perlmutter: whole.

And so what does that? Well, it's a lot. Quelling neuroinflammation, connecting to nature, um, turns out, interestingly enough, psychedelics connect people to that sense of connection to other people and to nature. 

Dr. Brighten: Which is an area you're starting to research more in too, right? I am. I am 

Dr. Perlmutter: doing that. And the point here being that these are things that reconnect us to something more than just this present, uh, kind of me first and impulsive thinking that has So much of where we exist now.

And so I think that's the really interesting correlate of it. If you walk out into the world, if you interact with people and ask how much they're thinking, uh, is focused on the meaningful stuff versus on the impulsive stuff, it has changed dramatically and it's a reflection of our brain state and it's a reflection of brain inflammation.

So. All this [01:45:00] is to say that these conversations matter for the individual and I want to empower each person out there to take steps to get their brain into a state of balance. But think about how important it is when we look at scale at populations and around the world as to the impact of either good brain health or poor brain health.

And the quality of life that that will represent for billions of people. 

Dr. Brighten: I have a question for you. Is there any coming back from neurodegenerative disease? Is there a place where there is no coming back, like, we've gone too far? 

Dr. Perlmutter: Well, I think it It kind of requires you to define what neurodegenerative disease means like everything else is a continuum, right?

So a person may have some neurodegeneration Because they drank a bunch of alcohol one night or because they were in or had a mild TBI You know, they're playing a contact sport when we talk about neurodegenerative diseases, though We're really talking about conditions like Alzheimer's disease, which is kind of a progressive state of not necessarily neurons dying but atrophy in the sense of You [01:46:00] decrease connectivity between neurons, so less data, uh, being able to transfer, wiring changing.

And so it seems like it's that atrophy that is really the issue. Can we reverse it? Some people believe that we can potentially completely reverse some of these conditions. So there are some, uh, doctors like Dr. Dale Predison who has found certain cases where Uh, he will state that he has reversed cases of Alzheimer's disease.

Um, He's also 

Dr. Brighten: a coffee proponent. 

Dr. Perlmutter: He is a coffee proponent. All the neurologists I know are okay with coffee. All 

Dr. Brighten: the people like into brain health are like, coffee, yes. As long as like it doesn't cause you anxiety. All the brain 

Dr. Perlmutter: health books were written, I feel like, using coffee. Sponsored by coffee. I 

Dr. Brighten: know, unfortunately, yeah, you never get sponsored by a good coffee company, right?

Dr. Perlmutter: I'll just do, I'll just do a shout out. I have been working with Purity Coffee for the last few years. I love them. I drink their coffee every day. Uh, they do all the testing and I think it just tastes great. So that, that's maybe the first commercial thing I've ever said in a podcast, [01:47:00] but I think Purity Coffee is doing a great job.

Dr. Brighten: Well, that's awesome. Well, we were talking about, okay, Dale Bredesen talking about in some of his cases of Alzheimer's, he's been able to reverse that. 

Dr. Perlmutter: And I want to go back, I want to go back to the point here that I made before, which is mild cognitive impairment, which is a precursor to Alzheimer's disease.

One third of these cases go back to normal cognition and not because people did all of these amazing things and applied lifestyle medicine, but because these things do kind of fluctuate. Now, historically, Alzheimer's being the prototypical neurodegenerative disease has been seen as a condition that once it starts, we'll kind of progress.

and over the next five to 10 years, most people will. Have such advanced Alzheimer's that they'll kind of die of the condition, right? I think we're starting to chip away at that. And so some interventions, for example, a ketogenic diet exercise, um, potentially some of these pharmaceutical interventions, which by and large had been pretty less than impressive, have indicated that maybe we could slow.

And in some cases, reverse slow. Certain symptoms of Alzheimer's disease do I think that we'll get to the point where we [01:48:00] can actually reverse Alzheimer's disease? I absolutely think that's possible. But right now I don't think we have solutions for it at scale I think it's happening on a case by case basis basis.

Dr. Brighten: Mm hmm. 

Dr. Perlmutter: Which takes resources. Which takes a lot of resources, which gets me to, you know, a lot of why this conversation is the way it is, which is we could go into kind of the biohacky level things that a person could do, whether it's a supplement stack or these expensive interventions, expensive tests, full body MRIs.

Getting an HBUT 

Dr. Brighten: in your house. 

Dr. Perlmutter: Sure. Sure. And, and this is not to detract from the question of do they work or not? But instead it's this question of saying at a, at a global level, what can we do to elevate brain health? And obviously we each of us want to be the best versions of our brains. And so for those who have the resources to make these things available, wonderful.

But for those who don't, the reason I talk so much about nature exposure, getting good sleep, just eating a diet that is slightly lower in sugary beverages. So I'm not trying to say, You have to sub out all of your cheap carbs for organic, you know, pastries, all the other [01:49:00] stuff. If you can great, but start with the thing that you really don't need, right?

Nobody needs really the added sugar in the beverage. And similarly, Most people can afford to get a little bit better quality of sleep. Now, it's not everybody, especially people with young kids. 

Dr. Brighten: You're like, I'm looking at you, toddler mom. 

Dr. Perlmutter: But, but the point being, those are outsized benefits from relatively low costs.

And I think that at scale has the best potential to elevate global cognition. Now, there are some things, and we touched on this very briefly, like psychedelics, that I think have, Also an opportunity to improve brain health. And we're a couple of years into the psychedelic conversation. I feel like the first couple of podcasts I was on, I was saying, Oh, you know, these are very potent medications and we don't know enough and we have to be very cautious.

And I think we've come or I've come to the point where I'm just. I don't want to get into this, but, um, but I think a lot of people are just angry that they're not more available to people because going back to what we discussed before, what are the current therapeutics for mental health [01:50:00] conditions and how effective are there, what are the side effect profiles?

And so when I hear people say, um, we're worried because psychedelics could lead to significant side effects and people could have a bad time. And I say, but how many people die of psychedelic overdoses in the United States when it's done in the right way? And then how many people die of alcohol related issues.

Uh, the numbers are not even comparable and if you expand alcohol, it's not just the alcohol itself. It's, um, fatty liver disease or not, sorry, not fatty liver disease. It's alcohol. So it's alcohol related, uh, liver disease, but also turns out that alcohol, non alcohol related liver disease or metabolic liver disease also driven in part by alcohol, right?

Think about all the cases of liver disease, of cancers, um, of Alzheimer's, dementia, that are directly influenced by alcohol consumption, uh, and say, we're okay with that. 

Dr. Brighten: Yeah. 

Dr. Perlmutter: Right. And so what I would say is, um, as somebody who is currently researching psychedelics and who [01:51:00] believes in their potential, is that, How can we not be open to this thing that has been used by people for literally thousands of years with a very safe side effect profile when used in the right set and setting?

And so many people, and I'm not talking about research here, I'm talking about people when surveyed in large databases would say has been such a transformative experience for their mental health. Why are we creating the degree of regulation around it? Compared to the things that we don't regulate. So I'm a huge proponent of doing the research.

I'm also just. I'm not a fan of the fact that we have singled out this family of things that, you know, looped in with heroin and other drugs because we think they're equally bad. 

Dr. Brighten: The last thing I want to ask you is in your book Brainwash, you talk about the negative impact of social media. A lot of people wake up and they scroll.

First thing. I want to talk about why that's a problem and how maybe we could have a [01:52:00] more ideal morning for brain health. 

Dr. Perlmutter: So let's talk about. The, the social media, the digital exposure. So the latest stats I've heard, it's 11 hours a day that Americans spend interacting with media, four hours watching TV, a little over two hours, uh, on social media.

Um, the reality of it is, I think that all of these conversations are nuanced. And if I was, if I had my hand on the switch and I could get rid of social media, uh, I would pull that switch. I would pull the lever. And the reason for it is I think that in aggregate, it's been a net negative. I think there are.

all these different iterations. And you've talked about earlier, the Facebook group that provided amazing support. I know that from a mental health perspective, social media, uh, groups and people in general can be very supportive. I think there's some wonderful long form conversations. Hopefully this being one of them that people can learn about.

Uh, how their bodies work, how their brains work, and take that insight and translate it into something really positive. But if you were to ask the honest question [01:53:00] about how most people use social media and is it a net positive in their lives, I think the answer might be no. And I think it's especially a risk for younger generations.

Um, you and I had an opportunity to have, uh, It 

Dr. Brighten: was the life. Right. No one documented anything we did. Right. 

Dr. Perlmutter: If you wanted to talk to a friend, you called their house and asked if they were home and you had to memorize their phone number and all the other things. If you were out with friends hanging out, you would maybe have to be home at a certain hour and you maybe have your watch on so you knew when that was, but you weren't texting even.

Uh, and you certainly weren't, you know, on social media, uh, checking in on everybody else to see if they were having more fun than you are. And so as it relates to the impact on brain health, I think there, there's still a little bit of a diversity of the research in terms of what it's doing. I think there is a camp of people who will say it's the absolute worst thing ever.

And there are a camp of people who say, Oh, well, it's not that bad, but I don't think you can make a strong argument that is that a net, a net positive [01:54:00] for people, maybe it's neutral. What the research would seem to indicate is that certain demographics, specifically young. girls are at a higher risk of developing mental health issues as a reflection of what's on social media.

And if we were to ask maybe why it doesn't take much time. It is perpetual social comparison. 

Dr. Brighten: Yeah. 

Dr. Perlmutter: If you're an adult, it might look like, Oh, my friends are in Fiji again and I'm here working and what am I doing wrong? They just bought their, Uh, third Rivian and I'm sitting here looking at my car, but 

Dr. Brighten: check their dad, right, right.

But it's the highlight reel, but you never know the behind the scenes. 

Dr. Perlmutter: That's exactly it. But I don't think our brains know that. 

Dr. Brighten: Yeah. 

Dr. Perlmutter: I think our brains have a really hard time distinguishing, uh, the fiction from reality. I mean, it's the reason why you can watch, uh, an animated movie. and feel so deeply about the little mermaid losing her voice, right?

I mean, that's not a realistic thing. I don't think there are mermaids. I could be wrong. Um, and certainly there's let us 

Dr. Brighten: know if you know, 

Dr. Perlmutter: if you have the insights, let us [01:55:00] know. But the point being, our brains still see that as real enough. Yeah, we can get on board with it and feel for these cartoon characters.

So now tell me about, you know, these other people on social media that are more attractive than us, that are more wealthy than us, that are going to all of these amazing events. 

Dr. Brighten: That are using 

Dr. Perlmutter: filters. Those are not, they're not real people, right? They don't exist in the real world. And when you meet the people behind the masks sometimes, I think there is an almost one to one relationship between the degree to which a person proclaims how well they have things figured out on social media and how poorly they do in real life.

And so, All of us are perpetually inundated with these messages of a surreality. And when it comes time for us to process and feel good about ourselves, I think it's inescapable that we carry some of that forward. So that's talking about, I think, I think kids are the most vulnerable to it. Because they, they have not had a time where they knew what it was to not be on social media.

Because [01:56:00] there are a number of kind of fringe effects of this. One being that socialization, or socializing in general, have really dropped off. And people, you know, for better or worse, but it feels like to me, largely for worse, it feels like, uh, the data would suggest, Later getting driver's license, later dating, less interest in hanging out in person, because these algorithms are so good that they keep our attention locked on the screens.

And we've heard the statistics in terms of the decades of a person's life that they will spend on their devices and the years on social media if the trends continue. The, the bottom line to me is Number one, the opportunity cost is too much. So whether you're an adult or a kid or an elderly person, if you're spending a good amount of your time on social media, you're not doing the things that are good for your brain.

You're not exercising, making food, spending time with people in the real world. You're not getting out into nature. You're looking at, uh, people dancing on Tik TOK. It doesn't mean they're not talented people. It doesn't mean it isn't enjoyable. It's hacked into a part of our brains and we can see it right now.

There are [01:57:00] several cases in the United States showing that various social media companies have intentionally deluded people 

Dr. Brighten: into 

Dr. Perlmutter: saying that their algorithms are not designed to be addictive. 

Dr. Brighten: Yeah. And 

Dr. Perlmutter: I think all of that is true. So I would say at the first level, it would be the opportunity cost is too much to where I could endorse a ton of social media time.

Dr. Brighten: And the 

Dr. Perlmutter: second level would be, I think for certain subpopulations, the mental health complications. are real. 

Dr. Brighten: Yeah. 

Dr. Perlmutter: So we talked about in brainwash and approach to it. And I want to say two things. One is I am on social media. I think that as long as it exists, I stalked 

Dr. Brighten: you there. I know that's 

Dr. Perlmutter: how you find out about a person, right?

Um, is a person a real person if they don't have an Instagram profile? I don't know. 

Dr. Brighten: Did this actually happen if you didn't post it online? 

Dr. Perlmutter: That's it. That's it. I 

Dr. Brighten: have to tell you, like, I'll, I'll share this that, um, I never like, so I'm like an awkward person and like the pressure of a pregnant, I am, uh, of a pregnancy announcement is like so odd to me.

And I have all of these followers online and I didn't know what to do about it. And then the time was [01:58:00] going by and I was like, I don't know how to do this. And then I just, it was like, okay guys, like, um, I'm about to have a baby soon. And by the way, there's this huge belly that you never saw. I, um. hadn't been on Facebook in like several years and I was like, oh, maybe I should like go on and like update our family and people were like, when did you have a whole ass baby?

Like when did this happen? I had no idea like any of this happened. And so I just uh, I bring all of that up because I think that It's a healthy thing if you aren't necessarily documenting every aspect of your life. Mine was just being awkward. I was just like, I don't know, how am I, I have, I have like, you know, half a million followers, how do I tell them I'm pregnant, like, how do you tell half a million people you're pregnant, and then like, you know, the almost other million if you add them up, like, how do you, I don't know, I didn't grow up with that.

Dr. Perlmutter: So, I mean, this is, this is almost a more interesting question for you, which is how do you manage a relationship where there are so many people who are [01:59:00] interested about learning about things that arguably some of them are better when people don't know, right? And so how do you choose which parts of you you want?

You, I think, I want to be authentic on social media. Yeah. I think most people would say if they saw me there and then they saw me in real life, I'm probably a little bit goofier, uh, maybe a bit more weird in real life, but not much. No, you're 

Dr. Brighten: fantastic in real life. I think on camera when I was like watching your videos, I'm like, oh, he's very professional, like very professional.

And then I like talking to you yesterday and I'm like, you're cool. We can hang out. All right. 

Dr. Perlmutter: So, so maybe I'm too stoic on social media, a little bit too professional. 

Dr. Brighten: No, you're very, you're very like, I'm a doctor. And I feel like I'm just. I'm awkward. I'm a goober. 

Dr. Perlmutter: But I think that's the amazing potential for social media is that you can actually make connections with people in terms of, I can relate to that person.

Like I get the way that they interact in the world. And the downside to it is when people start needing to weigh in on stuff that you don't really need them to. And so I feel like, again, it's, it's a domain that you play in a little bit [02:00:00] more than I do, where you have to make a decision about which parts of your life do you want to share with people and which parts of your life are better kind of served to be contained.

It all comes back to, I feel like I need to do the disclaimer. It all comes back to brain health because what we're talking about is the mental health component of what it is to be a public figure. And so what I thought was really interesting too, is that the aspiration to become a public social media figure has transcended something that a subset of the population cares about.

And it's actually the most popular aspiration when you ask kids what they want to be when they grow up. It used to be astronaut. 

Dr. Brighten: Yeah. And 

Dr. Perlmutter: now it's YouTube. influencer, which are pretty night and day in terms of what it represents. So I think, I think, again, a question to you is how do you protect your mental health as a influencer?

Dr. Brighten: Yeah. Well, I don't, it's so funny because, um, when you bring that up, there was actually a conference that I, it was, I have found conference and I was talking to people and someone was like, Oh, this is Jolene. She's an influencer. And I was [02:01:00] like, A doctor? Like, I'm a doctor? Like, when did, when did this? And I was like, what?

Like, and I realized that like, anybody who gets enough people watching them becomes this influencer. So I never really saw myself that way. In terms of protecting my mental health, so people know I've been pretty open about my fertility journey, but there are some times that I'm quiet. Um, I had two failed embryo transfers, which went back to back.

And I just told my audience, sorry, I gotta take care of my mental health. Everybody was like. We hear you, we see you, like fantastic, and I dropped off, and I didn't post in, I'd been posting like daily since 2018, and just recently, I didn't post for two weeks. I was like, I'm just gonna take off, because We don't know whether or not I am here for two weeks, isn't going to make a break.

I have all of this content, other places to serve people. So I just look at like, what do I need? And then in terms of what do I share? There are times I am very clear about my boundaries, but I also I'm like, [02:02:00] if I am in my luteal phase, if I am at a. No, but for real, if I'm like edging on my period, if something has happened in my life, if my, something's happened with my children, they need more of my energy and attention.

Social media, when people start a frenzy, it can pull you in and you then put your energy and attention there. And I've learned this the hard way. And I'm like, I just need to be mindful, checking in with myself, where is my energy at? What do I have capacity for? And also recognizing that whenever I share.

It's not that, like, influencer take of like, Hey guys, this is just my life. Like, this is just my life. It is that take of like, how does this actually serve? How does this support people? Yesterday, I gave people a glimpse into how crazy it is because people were messaging me being like, How do you have it figured out?

As a mom, your oldest is homeschooled, like, you, you work, all this stuff, you've got everything figured out, and like, and you keep your stress in check. I'm like, let me show you this wild, crazy day, that is the craziest day that's [02:03:00] happened in the entire year, and I will only allow one day to be like this.

But to like, show people behind the scenes of like, No, I don't. Like, look at how chaotic it is. Look at, look at what is going on. So, I think that's another aspect of things of like, do you show up to social media for like, your gratification, for your ego? I always have seen it as a place of service. I show up to like, support other people.

So that it also helps keep the boundaries because I'm not just gonna like, floodgate open everything up. But when I get enough DMs of people being like, you know, you sharing your fertility journey, you sharing these things has really helped. Like I definitely like, you know, I look at that and I take that into account.

My son, are you familiar with pandas? My son developed pandas when I, I shared that when that happened, which was seven years ago. And I still get people who come to me and they're like, I need help with pandas. Like, I think my kid has it. No doctor will believe me. And because I shared that story, I actually have people I refer them to and I can put them into to network with.

[02:04:00] So it's all about finding that balance and recognize and I say like finding that balance for you as an individual and recognizing you're going to fall on your face and be like, I messed up. Don't ever do that again. Like go back and then and to know that like. As you know, as you're talking about, part of what makes social media so difficult is that people are not taking care of their own mental health and they're using social media as a way to not Sit with the discomfort of their own body.

And when you attack complete strangers on the internet, So people are in your DMs saying hateful stuff, Commenting hateful stuff, like bullying other people, You're not mentally well. Mentally well people don't do that, And so I would say, This is something I always remind, whenever people are like, how do you handle social media?

I'm like, I have the privilege of having sat with people who are not well, and being able to see that show up on social media and be like, I am not your doctor. I am not here to heal you. And you are lashing out. We have to block you. We have to bless you and send you on your way [02:05:00] and hope that you get the help you need.

Yeah. I don't know if that helps anybody. It 

Dr. Perlmutter: helps me. I think it's, it's, you know, there's this balance of being truthful about what's going on in your life, but not necessarily taking on everybody's opinions about it. But what I really love is that the vulnerability allows for you to reach people in a way that just pure information wouldn't.

Dr. Brighten: Yeah. 

Dr. Perlmutter: Right. I think that's been one of the things that even at a smaller scale, I've observed if I talk about stuff like, you know, my, My grandfather's having Alzheimer's disease or stuff that I experienced with poor mental health in the hospital and how I went to a psychiatrist. He's like, Oh, you need a sleep medication.

Fine. Well, what about why I'm struggling so much with my mental health? These are the things that most people experience. And I think that it's a really amazing thing when people who are prototypical experts, doctors in this case. Are saying, this is a struggle that I am having. Yeah. With a thing that I'm trying to figure out.

And it feels like people really resonate with the being the explorer and [02:06:00] trying to solve for that thing. Mm-hmm . As opposed to simple expertise. Yeah. And so I, I love what you, what you said there, and I think that like, I'm gonna use that. So thank you for that. Thank you for that gift today. For 

Dr. Brighten: sure. And the thing I would encourage anyone listening something, it's uh.

that has been said, the biggest compliment that I get when I meet people in real life. So last night we were at an event, all these people, there were people there. It was so amazing. People that were like, I went into nutrition because of you. I like started following you like back in 2016 and did it. And I'm just like, Oh my God.

And now I'm like getting to meet you. But when they say, You're exactly like you are on social media and I'm like good because I've met plenty of people and I'm sure you have as well who are the most jovial, wonderful, kind, warm people on social media and you meet them in real life and they're an absolute horrible diva who treats people like just like garbage.

I have just like a rule in my life. If we were at a restaurant, like anyone who wants to do business with me, collaborate, [02:07:00] I'm like we have to eat together. And if you treat a waiter, Or waitress. What do we call them these days? Waitstaff? I don't know. Uh, somebody will tell me, like, you were not politically correct.

I'm sorry. But if you treat them poorly or I see you look down at somebody and treat them as if they're less than you, you're out. Like, that is a hard, fast, non negotiable for me that you like, never. No, there are no second chances in that if you are ever treating anyone as if they're the lesser than you.

And so, I'm sure you've met those people. And that's something that I always, uh, You know, when people are asking me about this conversation, I remind people that, like, you are absolutely nothing if it's not for the people who support you in your life. Whether that is your community, your family, or on social media, and you always need to have that respect.

But also, like, You're touching lives. You have influence, right? It's why it's called an influencer and you really, right back to the beginning, with great power comes great responsibility. You have to think about how you impact people. 

Dr. Perlmutter: I think [02:08:00] that's, that's so right. I mean, this is, I feel like general good advice in life, not just in, in being an influencer.

Um, I, I also think there's, There's an interesting conversation here too about kind of what are the standards that you hold yourself to and how does that then ripple out across the different domains of life that you interact in and to try to tie it a little bit back into the, I guess, the, the theme of the brain state.

I have learned that a person is only as capable of showing up and being kind and all the other stuff as what their brain state is. Maslow's hierarchy or whatever framework you have, you're only as able to show up. Uh, as kind of the resources that you have available, what, what a frame shifting thing to when you experience other people behaving in ways you disagree with, instead of saying they're a bad person, they don't have good willpower, whatever to ask what's going on in their brain and what is depleted them to the point where they feel like this is a reasonable interaction.

Yeah. Simultaneously, I think you have to draw kind of a line in terms of the people that you surround yourself with because it's going [02:09:00] back to protecting your own ability to stay at those higher levels of energy. where you can be helpful to people and still be able to preserve your own mental health.

Dr. Brighten: Well, not just you. So I guess I should clarify this too because you have a team that supports you. We all have people who support you. If I see you treat someone who you think is below you poorly, you're going to make my assistant hate her life and she's my bestie and she makes my whole life go around.

You're going to talk poorly to people in my company. Like it's going to be a situation where you create so much drama. And again, Like, I, it's fine, you are who you are, you're working on your own stuff, but I'm not your therapist. I'm not here to heal you. I want to bring this back though, in closing, because, will you come back, can we just like talk again?

to. We're going to definitely do it again. But. The optimal day. What, how could you start your optimal day if everything's perfect and I want everyone listening to try to find one thing out of an optimal day that they could do just one thing. It doesn't have to be the optimal day. 

Dr. Perlmutter: So I'm not going to do the [02:10:00] version.

Where it's saying, here's my morning routine and it's four hours long. Oh my God know. And it costs $2,000 and the day's over and then it's uh, you know, so people, 

Dr. Brighten: so I remember being on podcasts and somebody was like, tell us about like your routine. Like you're a super healthy person. What does your morning look like?

Yeah. And I'm like, uh, I just had a baby. And like, they usually I get spit up in my hair and like, I am drinking cold coffee 'cause I forgot about it. And so like, I feel you on this. But, but I'm setting it up as like the ideal day just to pick and choose something from the buffet. 

Dr. Perlmutter: Here's what I say. So the first part of the day is obviously the waking up.

This is the best opportunity you have to set a plan for a day that works. The second you start doing stuff, you're already on a track. You've already kind of pushed yourself into one of the adventures that the day holds for you. So I think as much as possible owning that first hour after bed is the key.

So for me, I mean the basic stuff, I'm not. incredible in terms of saying I or [02:11:00] anyone else should jump out of bed and meditate for four hours or anything like that. So the basics, you brush your teeth. Uh, but then I do meditation. Oh, you brush your 

Dr. Brighten: teeth? 

Dr. Perlmutter: I do. I do it in the morning and I do it in the afternoon or in the evening.

So if you want to hear about my 

Dr. Brighten: Oh, so only twice a day. You're not a three times a 

Dr. Perlmutter: day. Yeah. I have, I have some considerations around that, but yeah, I can give you this whole routine. Uh, brushing my teeth and flossing my teeth and brushing my tongue, which is an important thing I've learned. Um, but in terms of what I think is optimal, I think meditation, mindfulness, first thing in the day, when you can, right?

Not when you're being awoken by a baby's crying, you say, Oh, before I go to that, I'm just going to take a half an hour and do some breath work. Right? Yeah. But when possible, I think that the, the mindfulness stuff in the morning, which for me is just great. Paying attention to my breath, closing my eyes and paying attention to my breath is really important because it's simultaneously an intervention and a diagnostic, I can get a sense very quickly as to how my brain is going to be functioning across the next whatever many hours [02:12:00] I'm awake based on where my thoughts are at, based on, you know, am I already frenetic?

Am I already all over the place? Or am I relatively balanced? It's an indicator of the quality of the sleep that I received. It's also an indicator of how much stress I'm under in my life. So I'm not talking about any crazy amount of time in brainwash. We talk about around 12 minutes, but I think even 10 minutes can be amazing.

The point is just to carve out time where the only thing you're doing is this diagnostic intervention in your brain, where you are getting a sense as to where you are, and you're also doing one of the most important things in terms of getting your brain to a place of. not equanimity, but relative peace to start the day.

After that, then there's a lot of opportunity for things to go in different directions. Um, I know people have different perspectives on the timing of coffee, right? You don't want to do it for this long and that on the other. I think if you're a person that enjoys coffee, then enjoying it in the morning is the best time.

And the reason is because coffee has around a six hour half life. 

Dr. Brighten: [02:13:00] So what 

Dr. Perlmutter: you don't want to do is, Prolong your caffeine consumption into the late afternoon. So if you're going to drink coffee, I think doing it in the morning is a wonderful time to do it. And I'm not a stickler for saying you have to wait a certain amount of time after bed.

I haven't necessarily seen the research to support that. I do think getting some natural light in your eyes is a good thing for your brain. It helps keep your circadian rhythms in check. Uh, I live in the Pacific Northwest. So for half of 

Dr. Brighten: nine months out of the year, as you know, well, um, 

Dr. Perlmutter: that might be, uh, switched out for a, um, uh, a light that I put near my face to get some of that bright light and some of the benefits of that.

Um, and then in terms of, you know, the big stuff that I think people care about exercise, I like to exercise in the morning. I find that exercising in the evening revs me up. It makes it really hard for me to sleep. Um, and I don't think that's unique to me. So not to say that if you only can exercise in the evening, you shouldn't, but I think doing it earlier in the day is great because the other important variable for brain health is we know that as the day goes on.

Your time gets [02:14:00] captured by other things. And so if you're trying to do stuff for you, for your brain, the morning is the best time because that's the lowest generally demands on you from other things. So exercise in the morning, we talked about resistance. We talked about aerobic. Um, for me, what I've really tried to optimize towards is doing about 20 minutes of pretty intense slope, but relatively slow on a treadmill.

So I'm getting my heart rate up, but I'm also getting, uh, doing it for a little while and then resistance training. Um, and then after that, you know, there's, there's a lot of opinions on breakfast. Yeah. They probably have opinions on breakfast, the right timing. Should you do a 18 hour fasting window? All the other things.

I think. I am not convinced that prolonging the window to an absurd length is all that helpful for people. There are a number of reasons for this. One is I don't think we have data in humans that 18 hours does anything for autophagy. So that's been kind of proposed as an interesting thing. I don't think it's as strong as we think.

I do think it's good to give yourself a [02:15:00] at least 12 hour window between dinner and between eating breakfast. But I'm just not as convinced that you have to prolong it quite as long as most people say. And. The other variable, which I talked about in my talk today, is when people skip breakfast and go to the office, what seems to happen is then they get hungry and they eat junk.

Dr. Brighten: Yeah. 

Dr. Perlmutter: And if you're home, you can control those variables. So I've experimented with both, you know, doing 16, 18 hour, uh, or basically compressing my eating window to like eight hours or so, or expanding it a little bit more. or doing multi day fasts. And I think each of these things is interesting for different reasons.

And I'm kind of excluding here kind of the benefit that comes from, uh, some of the metabolic immune benefits of longer fasting. But I think if you're powering your body for success and you're powering your brain for success, the variables I think about in terms of eating, not necessarily the timing of eating, are am I getting protein?

Am I getting some healthy fat? Am I getting some fiber? 

Dr. Brighten: Yeah. 

Dr. Perlmutter: And I hope you'll agree with this. [02:16:00] the most important variable around breakfast is to understand that most breakfast is junk food 

Dr. Brighten: and 

Dr. Perlmutter: not to eat that. 

Dr. Brighten: Yeah. 

Dr. Perlmutter: If you want to have a bowl of scrambled eggs or some kale or something at five in the morning or at four in the morning, or you wake up and eat a midnight snack of, uh, uh, Healthy foods.

I still think that's better than waking up and eating a bowl of fruity. 

Dr. Brighten: Yeah, 

Dr. Perlmutter: loopy Charms, which I don't think had any brand names because it was a kind of an amalgam. 

Dr. Brighten: It was a hybrid there. 

Dr. Perlmutter: Exactly So I think it's it's really saying When you eat because you will and whether it's a little later in the day or a little earlier in the day Prioritize foods that are rich in protein that have healthy fats.

So omega 3s if you can find them I don't think breakfast has to be a sweet meal It can be a savory meal And then trying to prioritize fiber for a number of the reasons we've already described but Supporting the gut, supporting the gut brain connection. So we talk about what specific foods that might be, but there are a lot of different ways you can do this.

For people who are [02:17:00] vegan, there's still some really solid options on the table. It's the avocados, it's the chia seeds. I am a fan, a fan of eggs. I think there's still this active debate over whether eggs are the worst possible thing. I've always been 

Dr. Brighten: team eggs. You'll never take them away from me. 

Dr. Perlmutter: Whether or not a person believes that eggs are a disaster because something, something cholesterol or whatever.

I think the reality of it is that people And then 

Dr. Brighten: they have like, you know, four beers at night. Right, or they say, 

Dr. Perlmutter: or they say, don't eat eggs. What you should be eating is a breakfast, or is it some pancakes? 

Dr. Brighten: Yeah. 

Dr. Perlmutter: Pancakes is really not a real food compared to an egg, right? And considering what our bodies are used to consuming, there's a very big difference.

So I'm a big fan of eggs. I think Greek yogurt can be wonderful. I like feta cheese. Um, black beans in the morning I think is delightful. Um, avocados, olive oil. These are all great. in my opinion and based on the research that I've reviewed, excellent ways to promote long term brain health and to promote satiety and to promote healthy brain function over the course of the [02:18:00] day.

Different people have different opinions on it, but that's what I've seen work and it's what works for me. So once you have your breakfast at whatever hour you choose to have your breakfast, then you have the rest of the day. Most people are doing something That is going to require them to commit to being in a place working in some location.

I would say if you're going to do that, then the variables we've already discussed, maximize your air quality. So if you have an HVAC, that's great. If you don't think about an indoor air purifier, match the clean air delivery rate to the size of the room that you're in. Don't use an air freshener. These are the things that are passive in the background that are destroying brain health.

If we get on top of them, it can promote good brain health. And if we don't, they're just perpetually eroding. our cognitive state. Uh, and then thinking about how you create a work environment or home environment that is conducive to brain health. So that would mean basically, uh, trying to create space so that you don't get perpetually stressed.

It would mean not spending your entire day on social media or watching the news and getting perpetually [02:19:00] stressed. It would mean ideally integrating connection with other humans, which of any variable is probably the single most important one to promote good brain health because important point here. I know people, and myself, have optimized sleep, have optimized diet, have done great exercise, have meditated, and have still felt like my mental health was suboptimal or even poor.

And I think there's a trap to think if you can just optimize those variables, you're set. And connection to something bigger than ourselves is the variable that has to be put into place. Without that, you're basically just a lab rat trying to optimize the food you eat and how much time you exercise. So finding connection, which can be calling a friend, going on a walk with somebody, coffee date, texting people during the day.

These things are, they are seen as distractions and sometimes they're far more important than the actual work that we're doing in terms of optimizing brain health. Um, and then really, you know, The afternoon, the main variable to consider is preparing for good sleep that night. [02:20:00] So, for me, my sleep routine really starts in the morning and trying to think about how I time things and how I promote good sleep that night.

As you hit around noon to two o'clock, that's where the caffeine window should stop. And again, it's because it has a six hour half life. So, if you drink a cup of espresso at six p. m., then at midnight, half of that caffeine is still floating around. Um, so, Similarly, alcohol consumption in the hours before bed is a major disruptor of sleep architecture.

Every 

Dr. Brighten: perimenopause woman knows this. There you go. There you go. 

Dr. Perlmutter: And many people know it and many people do not. Yeah. The whole idea of the nightcap, it's, oh, I'm just going to pass out. Not quality sleep. Mm hmm. So thinking about maximizing sleep quality from the afternoon on means that after, depending on the time you go to bed, but really in the two hours or so before bed, you're minimizing stressful content consumption.

That can mean having some conversations with your partner about which things you bring and talk about in the bed. 

Dr. Brighten: Yeah. 

Dr. Perlmutter: That's one that I've tried to work on. My head hits the pillow, I want to talk about everything. And I have been told, correctly, it's not the time [02:21:00] or the place. Yeah. It's minimizing light exposure and stressful content, otherwise in the bedroom.

It is trying to decrease the temperature in your bedroom to around 65 to 68 degrees Fahrenheit because that promotes, uh, good sleep. It's trying to reduce noise in the bedroom. I think a white noise machine is an amazing way to do that if you can't live somewhere that's super quiet. And it is basically saying that getting good sleep is the goal of the second half.

of your day if your goal is good brain health. So just a couple of considerations. Um, and again, you didn't hear anything here about sauna and ice baths and hyperbaric oxygen. And 

Dr. Brighten: wait, you're going to come back. I don't think you come back and talk about, we can talk about 

Dr. Perlmutter: all these things. I think they're interesting.

Yeah. 

Dr. Brighten: Yeah. 

Dr. Perlmutter: But my goal is to maximize value for the majority of people listening and not everyone's going to be able to put these things into their home or get access to them. It doesn't mean they're not beneficial, but I do believe. that the vast majority of the value that the average person will get in optimizing their brain health comes from the variables we've already discussed.

And the [02:22:00] other things are kind of the icing on the cake rather than the necessity, which is a very different perspective I think from saying, if you're not doing my exact protocol, you shouldn't even try. 

Dr. Brighten: No, I appreciate this and how you set this all up. And it's exact thought I had as I was like, this is the foundation, like conversation of everybody can start at this foundation and find ways to start building optimal brain health.

And now we can have you come back. We'll do another episode where it's like, let's talk about the saunas. Let's talk about the HBOT. Let's like talk about like the NAD and all of these other things and how much research is actually behind them. But I love how accessible you just made this day, how you made this conversation.

So I appreciate it so much. Thank you for being here. 

Dr. Perlmutter: Thank you for a delightful conversation. This is a longer one, but I feel like we've covered some important ground. 

 

Dr. Brighten: Yeah, I like to go long.