Ep. 141 – Reclaim Your Brain: Outsmarting Your Hardwiring with Dr. David Perlmutter

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We are delighted to have Dr. David Perlmutter joining us today. He is a Board-Certified Neurologist and five-time New York Times bestselling author. He also serves on the Board of Directors and is a Fellow of the American College of Nutrition.  

Dr. Perlmutter has written several books to educate people on the importance of the physiological connection between the gut and the brain. In this episode, he talks to us about his most recent book, Brain Wash, which he co-authored with his son, Austin Perlmutter, also a physician. The release of Brain Wash was very timely, given the current state of affairs with the growing pandemic, both in the United States and the rest of the world. Be sure to listen in today to find out what motivated Dr. Perlmutter and his son to write Brain Wash and what you can expect to learn from reading it.

“The pre-frontal cortex part of the brain is the gift that we have, as humans.”

Dr. David Perlmutter


  • Dr. Perlmutter talks about what inspired him and his son, Austin, to write the book, Brain Wash.
  • We need to recognize that there is hard-wiring in the brain, which relates to how we make our decisions.
  • Dr. Perlmutter describes the two fairly distinct areas of the brain that deal with each type of decision-making.
  • Dr. Perlmutter explains the interesting fact that was discovered about the pre-frontal cortex area of the brain.
  • Dr. Perlmutter explains the detrimental effect that electronics and some other factors have on the evolution of the pre-frontal cortex of the brains of children and teenagers.
  • Dr. Perlmutter talks about how we can go about reconnecting and bringing the pre-frontal cortex back online. That information forms the heart and soul of the book, Brain Wash.
  • As a global community, we need to cultivate the ability to remain  open-minded and have cognitive empathy.
  • We need to accept and embrace the notion that people will change their views and their position on things over time.
  • Dr. Perlmutter explains how the quality of our sleep impacts our decision-making.
  • The impact that social media has on our notion of connectedness as humans.
  • Dr. Perlmutter explains how the stress of the pandemic has impacted our brains and the outcome of the pandemic. Our biological age can differ from our chronological age. Dr. Perlmutter explains how that could impact our immune system and our risk for the outcome of Covid.
  • Dr. Perlmutter talks about the powerful benefits of exposing ourselves to nature and the profoundly positive impact it has on our brains.
  • Dr. Perlmutter talks about the importance of getting enough exercise, and why a bit of stress is good for the body. He also shares a way to calculate your ideal heart rate.
  • The three foods that Dr. Perlmutter feels are most beneficial for the brain, to keep the amygdala at bay and serve the executive function of the pre-frontal cortex.
  • Dr. Perlmutter talks about the book that he is working on currently, due for release in 2022.


David Perlmutter, MD, FACN, ABIHM 

Dr. David Perlmutter is a Board-Certified Neurologist and five-time New York Times bestselling author. He serves on the Board of Directors and is a Fellow of the American College of Nutrition. 

Dr. Perlmutter received his M.D. degree from the University of Miami School of Medicine, where he was awarded the Leonard G. Rowntree Research Award. He serves as a member of the Editorial Board for the Journal of Alzheimer’s Disease. He has published extensively in peer-reviewed scientific journals, including Archives of Neurology, Neurosurgery, and The Journal of Applied Nutrition. Also, he is a frequent lecturer at symposia sponsored by institutions such as the World Bank and IMF, Columbia University, Scripps Institute, New York University, and Harvard University. He serves as an Associate Professor at the University of Miami Miller School of Medicine. Dr. Perlmutter’s books have been published in 32 languages and include the #1 New York Times bestseller Grain Brain: The Surprising Truth about Wheat, Carbs, and Sugar, with over 1 million copies in print. Other New York Times bestsellers include Brain Maker, The Grain Brain Cookbook, The Grain Brain Whole Life Plan, and Brain Wash, co-written with Austin Perlmutter, M.D. 

He is the editor of The Microbiome and the Brain. It was authored by top experts in the field and published in December 2019 by CRC Press.

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Connect with Cynthia Thurlow

About Everyday Wellness Podcast

Welcome to the Everyday Wellness podcast with Cynthia Thurlow! Cynthia is a mom of 2 boys, wife, nurse practitioner, and intermittent fasting and nutrition expert. She has over 20 years experience in emergency medicine and cardiology, but pivoted to focus on food as medicine. She loves to share science-backed practical information to improve your overall well being and is grateful to be interviewing leaders in the health and wellness field.  Her goal with Everyday Wellness is to help her listeners make simple changes to their everyday lives that will result in improved overall wellness and long term health. 



Presenter: This is Everyday Wellness, a podcast dedicated to helping you achieve your health, and wellness goals, and provide practical strategies that you can use in your real life. And now, here’s your host, Nurse Practitioner Cynthia Thurlow.

Cynthia: Today, I’m delighted to have Dr. David Perlmutter. He’s a board-certified neurologist and five-time New York Times bestselling author. He serves on the board of directors and is a fellow of the American College of Nutrition. Good morning. It’s so nice to have you today.

Dr. Perlmutter: I’m just delighted to be here with you, Cynthia. Thank you.

Cynthia: Absolutely. Well, I have been reading your books for many years and you were probably the very first person that introduced to me, I’m a traditional allopathic trained nurse practitioner, to the concept of how important gut-brain physiology and connection is. So, thank you for all of the work that you’ve done. But I really wanted to spend today talking and unpacking your new book. I have been thoroughly enjoying Brain Wash and for any of the listeners that are familiar with your most recent book, it’s really, incredibly, timely given the current state of affairs, and not just here in the United States, but worldwide with this growing pandemic. So, I’m curious, I knew that you wrote this book with you and your son, who’s also a physician, but what was the initial impetus? Obviously, you probably did not have a crystal ball. You would have no idea that we would be in this nearly year-long pandemic.

Dr. Perlmutter: True. We had no idea that there’ll be the pandemic or that there would be as much division as we see around us now. Book was published a year ago. So, we were not prescient in terms of the situation that we’re in currently, but the concepts were valid then and they’re more valid now and what I think provoked us to write the book in a good way is actually in this very room where I am right now, we were having a discussion about what challenge us most as practitioners of medicine. We really both came to a place of understanding that the biggest challenge we have is not that we don’t know a lot of stuff. We know a lot of stuff. We sure don’t know as much as we’d like. But we know a lot of information. We do our best to transmit that information as you and I are doing right now to others. But the real challenge is the lack of follow through, the acquiescence on the part of the patient. The degree of follow through is really very low. About 50 to 80% of the information that clinicians give to patients is typically not followed. So, that’s the challenge.

What typically happens is, we label those patients as being “noncompliant.” They’re not complying with our recommendations and something’s wrong with that person because we’ve done our very best to tell them now that you’re type 2 diabetic, here’s what you need to be doing in terms of your diet, and why don’t you do it? Every time you come back, your blood sugars are higher and you’re gaining weight. Something is wrong with you. It becomes a blame game, not just in terms of the clinician to the patient, but it certainly becomes a blame game in terms of when that patient goes home and looks in the mirror, you know, it is self-castigation, “Why can’t I exercise, sleep better, eat the diet that my doctor has recommended?”

We realize that it’s time to stop that. It’s time to recognize that there are some brain substrates. There is hard wiring in the brain that relates to how we make our decisions. Either we decide to do things, “Right now, it’s what I want.” World be damned, myself be damned, or do we make decisions based upon thinking it through, thinking of how will my decision right now affect me immediately, but also, how will this decision play out tomorrow, next week, lifelong, and even beyond that? And importantly, how will the decisions I make affect other people, affect my community, affect the planet upon which we live? We call that empathy. Thinking of how our actions play out in the lives of other people. We learned by studying this and it became a very fascinating project, that there are two fairly distinct areas of the brain that deal with each type of decision making. On the one hand, we have a very primitive part of the brain called the amygdala, that is involved in the impulsivity type of decision making. I want that jelly doughnut right now, darn it, end of story. I’m going to eat it. Yeah, it is highly refined carbohydrates, ultra-processed, this and that, full of who knows what, but I want it and I want it now. It sounds like a five-year-old, doesn’t it?

On the other hand, that’s for me, it’s a very narcissistic approach to decision making and really a narcissistic approach to the worldview. It’s all about me, the rest of the world be damned. We’re going to frack, we’re going to use Roundup on the crops, whatever, because we want it, we want it now. Versus, another part of the brain called the prefrontal cortex, up behind the forehead. That is really a gift that we have as humans. Other animals have a prefrontal cortex, but our prefrontal cortex takes up a third of our whole cerebral cortex, the top part of the brain. The next best is the chimpanzee where it’s about 17%. So, we have this area of the brain that allows us to say, “Whoa, take a minute here. Let’s think about how this is going to play out what it’s going to be like tomorrow, because you decided to do this day, how might this affect other people?” And really allows us to understand how these decisions play out in the long run and also allows us to make more complex behavioral changes. We call it executive function or executive decisions to bring in all kinds of nuances to bear on how we make our decisions. And that is, again, part of the functionality of this other part of the brain called the prefrontal cortex.

Now, most importantly, what we discovered is that this prefrontal cortex, this area behind your forehead exerts control over that more primitive part of the brain, the amygdala. We call that top-down control. Basically, it is having the adult in the room, whereby the childhood brain wants to do this, and I want to do it now, and that’s it. We want to bring on board the top-down control that the parent come into the room and say, “Yeah, you know, I know you want to stay up all night and do whatever you want to do. But you’re not going to feel well tomorrow. You’ll be cranky or whatever.” So, this is connectivity, then, that is so highly valuable. This top-down control, the connectivity, whereby, one part of the brain, prefrontal cortex exercises control over the more primitive part of the brain, that is impulsive and self-centered. And it’s this connection that is threatened by so many of our lifestyle choices today. The food we eat, the lack of sleep that we get, or lack of exercise, or lack of socialization, or lack of contact with nature, or desire not to do things like meditation for example, all of these things play in to fostering a brain that thinks only of ourselves, that thinks only of making decisions for right now and really becomes a very isolationist view.

So, that was our premise, that was developed as I say right here in this room. And as we got into it, you can imagine how exciting that was because until then, we have been giving advice like yourself, giving out information about what the decisions should be. But now, we’re taking it to a higher order kind of playing field in terms of how do we make those decisions in the first place, whatever they are. They may be different types of recommendations whether you’re going to recommend somebody go keto, or gluten free, or vegan, or whatever it may be. The whole notion is whatever we, as healthcare practitioners are recommending that the idea of giving people tools to stick to these decisions, we found to be really empowering.

Cynthia: I can only imagine and if I recall and my background is not neurology, but I do recall that there’s a point at which the prefrontal cortex is fully developed. So, you have teenagers and young adults that probably their brains are still evolving if you will, and I would imagine in children, teens, very young adults that their brains are actually more susceptible to damage from some of the things you’ve alluded to if they’re not doing, and I would imagine that the influence of electronics and things like that may have a detrimental impact on this evolution. Is that correct?

Dr. Perlmutter: Well, without question. There are lifestyle choices that people can make and anyone can make that will keep that disconnection going strong even into adulthood. What we’ve learned and we talked about in Brain Wash is the mechanism that’s involved in destroying that connection, which we so desperately need that top-down control. One of the powerful mechanisms that threatens that connection is inflammation. So, inflammation brought on by any number of our lifestyle choices will lock us in to having that childhood brain that thinks only of oneself, that remains impulsive throughout adulthood. And we certainly see plenty of examples of people that we know of [crosstalk] upset or oh, I hear a dog barking. I always put my dog away for podcasts. But had I known you would have been sitting right here. But anyhow, so, the good news is, the empowering part is story is that, when we recognize in ourselves or in others that a decision making isn’t where we want it to be, our worldview is what we want it to be. We notice we’re self-centered and want to be more compassionate and empathetic towards others that we can make that happen.

We can absolutely bring that prefrontal cortex online, hopefully, back online, because it was online before but if it never was, it can be brought online by simply re-engaging that connection. That’s basically, the heart and soul of Brain Wash, it’s how do we reconnect, how do we dissolve this what we call in the book, ‘disconnection syndrome.’ Because the disconnection, not only threatens our decision making, that’s how we got started on the journey. But it threatens our ability to engage empathy, it threatens our ability to see things from another person’s perspective and recognize that we don’t have all the answers. And ultimately, that’s really very important because it allows the sharing of ideas as opposed to locking into one ideology. When we share ideas, we come up with novel solutions and we move the ball down the field. That’s progress. And then, I call it like it is, and we’ve had for many, many years, a lot of division in our government. I’m not going to take sides here but people who run for office often say, “What I’m going to try to do when I’m elected is reach across the aisle.”

Now, I think that’s great. But I submit that what we should choose as a goal is getting rid of the aisle. We shouldn’t have this division, a physical division between people who think one way and people who think in other way, we should assign seats based on the alphabet or drawing numbers in a hat, whatever it is, and now, you’re sitting next to somebody, hopefully, distance appropriately, who has probably a different ideology than you do, and you’re going to talk. There may be people who want to convince me that the world is flat. I don’t believe it right now, but I’m going to be willing to listen to why you believe that as opposed to strengthening that division between the two aisles or the two groups and saying, “We’re going to vote along party lines and we’re not going to have any discussion. We’re only going to discuss what we believe.” It goes well beyond government. It goes to the interactions that we have with other countries, the interactions that we have with our neighbors who live on the opposite side of the fence that separates our yards, and have a different frame of reference and different point of view. We have to cultivate the ability to experience cognitive empathy, which means the ability to at least try on the other guy’s point of view and see what it feels like.

Now, I will try on the notion of a flat earth. I don’t think it’s going to work for me based upon my understanding of physics and the universe. But nonetheless, we’ve got to remain open minded. When we lock in, we no longer engage this incredible gift of the prefrontal cortex that we’ve been given. That has allowed us to make such incredible progress thus far.

Cynthia: I think it’s such a beautiful point. The irony is that, this is my second podcast recording today, and my last podcast guest, also a physician, had a very similar outlook that he filled in so many ways that we as a country, a nation, a world have gotten so off base in terms of being able to see both sides of an argument or a discussion. I think it’s really critical, certainly when I went through my first undergraduate program, I was a poli-sci major, and we used to have vigorous debates. But at the very end, we always came back to the same thing we can agree to disagree, and sometimes, someone else’s opinion or belief will cause me to reconsider my own belief system, and that’s not a bad thing. I think it’s really important for us to be in a position where we can see other people’s perspectives and not just our own. I think that’s a [crosstalk]

Dr. Perlmutter: We bring up a really good point, Cynthia. What you just said is that, we should accept the idea that people will change their position on things. Somebody once wrote an interesting, not very flattering article about me in a national magazine saying that, “Dr. Perlmutter used to tell us that we shouldn’t eat eggs and we should be on a very low-fat diet.” Did I say that? Yes, I absolutely did. That’s what I was able to extract from the most well-respected peer reviewed studies that I could find, argued against eggs because they had a lot of cholesterol, high fat diet, because, oh, if you ate fat, well, terrible things would happen. Your children would be born naked or who knows what.

Cynthia: [laughs]

Dr. Perlmutter: Over time, have I changed my position on those dietary recommendations? You bet. Will I change my position moving forward? I certainly hope so. Because if I do, it means that I’m keeping my ear to the ground. So, we need to embrace the notion that our ideas are going to change with time, and others should be appreciative of that fact as well that we’re given that opportunity, we’re given that space to change our views, and that dynamic sort of approach to ideology, I think allows progress if we lock in. I think there’s a tendency in practicing medicine to lock into what you learn in your residency and that’s pretty much dogma for you. I think that is a disservice to the people that you serve if you are going to practice for 30, 40 years and not be amenable to change, then, people that you’re trying to help are not going to be able to benefit from that.

So, I want to get back to the notion that we can regain connection, we can offset disconnection syndrome. It might well be that the idea that a patient who is seeing you with, let’s say, diabetes and obesity is making very poor dietary choices, and it might well be then that the first time around with this individual, you actually don’t make a dietary recommendation. But that’s the biggest problem he or she, and you may say. But it turns out that most likely that person knows the right information, has heard that right information from other healthcare providers for many, many years. So, it’s beating a dead horse. You’re not going to make progress. We have to work on the decision-making apparatus first. We have to build that foundation, and then, layer in the top floors. So, it might be that first visit with this individual is, look, guess what, we’re not going to even talk about a lower refined carbohydrate diet, more dietary fiber, maybe higher levels of good dietary fat, we’ll get to that.

But right now, I’m not going to recommend that you make any specific dietary changes. That will be surprising. [unintelligible [00:16:55] come? We’re going to work on your decision making. So, you can, when it’s time, be in a better place. A better place to make better decisions and to stick to them. So, what are we going to do? Well, how do you sleep? Why are you asking me that? Well, because again, we want to pull as many levers as we can to get you to a place of better decision making. We’re going to start with sleep, or exercise, or getting out in nature, or meditation, or keeping a gratitude journal, whatever. Let’s start with sleep because you’re overweight, probably, you’re not sleeping well. Well, I sleep eight hours every single night. Okay. That’s a good number. I can be comfortable with that. But what is the quality of your sleep? How will I know? I have no clue. I go to sleep at 10 and I wake up when I wake up. Great.

But what we might know or learn rather is that, while this individual may think that he or she is sleeping eight hours a night, which would be wonderful, they may not be getting restorative sleep. So, while they’re in bed, eyes closed for that period of time, they may wake up unrefreshed. And in a situation, that’s increasing inflammation, therefore, further disconnecting from the prefrontal cortex and threatening their ability to make good choices. So, what do you have to do? We have to get a metric on the quality, not just the quantity, but the quality of that individual’s sleep. Now, they can go to a sleep lab and get wired in for oxygenation, brainwave activity, EKG, leg movements, all the things. I’ve done one of those studies. It’s hard to imagine that it’s fully valid because you’re sleeping out of your home in a laboratory where somebody is watching you on a TV camera ostensibly all night long. It’s very weird. Or, you can wear a wearable device, which is what I do. I happen to wear a particular type of ring and every morning, I download information into my smartphone and it says, “David, you slept eight hours and 12 minutes. It took you 10 minutes to fall asleep.” That doesn’t normally happen. It’s usually for me pretty quick. You had a what certain length of sleep in of that total, you spent two hours in REM sleep, you spent one hour and 13 minutes in deep sleep, and your heart rate was, my case, 48. Your level of heart rate variability was whatever it was. Therefore, we know, we have a great metric.

For this patient, he or she thinks they slept full night. But look what we found out. We found out that matter of fact, they were awake four times during the night though they may not have known it that their heart rate went up for some reason what that is we don’t know, that they didn’t really get any deep sleep almost to speak of which is the time that your brain cleans itself up. And therefore, this individual is at great risk for inflammation threatening his or her decision making. Wowser. This is suddenly a tool that we have that we can then leverage moving forward to help this person make better decisions. So, now, what do we do? In this case, looking at sleep, we could look at other things. But this is a powerful onramp, as it were, at better decision making.

We would look at the quality of that person’s sleep and ask ourselves, “Well. What can we do to address sleep hygiene in this person that might abode well for a better night’s sleep?” Maybe you have no more caffeine after 2 PM, maybe it’s that you’re on the computer at night in front of a blue light producing screen reducing your melatonin, and therefore you don’t sleep well. Maybe, it’s your partner who snores, or has periodic leg movements, or is up several times at night to urinate. Whatever it may be. Maybe, the room is not dark enough, quiet enough, or cold enough. There are a lot of variables that can be looked at really offer powerful tools to a better night’s sleep. I choose sleep to start off with because it’s so undervalued. We don’t exercise eight hours a day or most of us don’t anyway. We don’t eat for eight hours a day. And yet, well, most of us don’t, but yet, exercise and eating, diet get really into top run in terms of our attention. But sleep is something we do for a third of our lives, eight hours a third of the day. So, we really need to pay attention to sleep. When we don’t sleep well, then we threaten this connection. Even one night of non-restorative sleep, we talk about this and Brain Wash is associated with an up to 60% increased activity of the amygdala, the impulsive decision maker.

Stay up all night or most of the night, and what do you do the next day, you eat crap. We all know. We’ve all been there. I was a resident and we were up all night doing what we were doing, whether it was in the operating room, in the emergency room, whatever it was, the first thing in the morning, I would go to the pediatric floor and eat baby food, steal that out of the refrigerator, the banana was my favorite because it’s so high in sugar, and you just crave sugar, you crave foods that are bad for you. People who chronically don’t sleep well have an average increase in consumption of around 300 kilocalories per day, that adds up in 10 days to a pound of body fat. So, you could see, it doesn’t take long to increase your weight and when you increase your weight, what do you do? You sleep poorly. And what do you do then? You make worse dietary choices. So, it’s about looking at how we can reconnect to the prefrontal cortex and allow ourselves the gift of certainly better decision making. But the gift of getting along, the gift of empathy, the gift of compassion, the gift of recognizing that our connectedness to others is totally important as it relates to our future survival on this planet.

We have leveraged our prefrontal cortex to get us this far. We are very much social beings and therefore it allowed us to have for example, division of labor, where some people do one thing, other people do another, and we were able to survive all of these hundreds of thousands of years. Now, our sense of needing connectedness has been a powerful hack into our brains by something called social media. Whereby we have this sense of connectedness, therefore, it becomes something that we think we want to do, and yet, we recognize that our connectedness to the internet and to others through this powerfully positive, potentially experience is leading to our loneliness, our poor decision making, our lack of empathy. We know that, typically Americans spent 42% of their waking hours in front of one screen or another. Now to be clear, there’s a lot of upsides for the internet. It’s this democratization of knowledge that has been so wonderful. But we know that when we spend in a lifetime 22 years in front of a screen that has been said that when you’re doing one thing, you’re not doing something else. We need to get out into nature, we need to exercise, we need to connect with other people as best we can without being virtual if that’s possible today and it is.

And again, there are upsides of the internet interaction. But typically, our teenagers and young adults have 8.5 as an average social media account, which generally need to be serviced each day, typically, teenagers to young adults spend three hours of their day on social media. And is there some upside to that? Yeah, I guess. That is what isn’t necessarily going to be positive in terms of your online experience. So, frankly, I’m not sure what the original question was, but I’m hopeful that I covered it.

Cynthia: No. You did a beautiful job. There were so many things that you just said I’m trying to make sure I acknowledge several specific things. Sleep is foundational to our health and my listeners are probably, completely humored because you touched on the fact that I mentioned consistently and probably more often than they would like to know if sleep is foundational to our health. So, you want to control your blood sugar, you want to control your appetite, you want to control your weight, talking about the glymphatic system, this waste and recycling process in the brain that requires so much energy, and obviously, you are the expert, but it requires so much energy that we have to get good quality sleep. Spikes in human growth hormone, which is an area of tremendous interest in mind and then tying into the fact that we’re increasingly exposed and trying to find balance to having electronic time, social media time, internet time.

Over the last year, we’re in unprecedented times with this pandemic and people are not able to be as socialized as they would probably like to be. They’re not traveling. People are trying to find ways to be connected. So, this modern-day pandemic, how has that impacted our brains? I hear some family members and loved ones who say, “I just had to stop watching the news because it’s stressing me out.” I have other people saying, “It’s the only way I can stay connected is to be on social media and to be watching the news.” How has this really impacted the way that we view the world and how we are impacting our health?

Dr. Perlmutter: Well, by and large, news is fear inducing. It is threatening. We are told that we can’t turn it off because pretty soon another shoe is going to drop and we don’t want to miss that, because we have to stay informed so we can prepare. I’m going to tell you, there is a lot going on around us. No question. There are a lot of threats out there that we should be aware of. But understand that the constant flow of that information into your brain does nothing more than strengthen the connection, and the activity of the fear center. It’s been said that neurons that fire together wire together, meaning that, the more we fan the flames of fear in our brains, the more those pathways and relationships of the fear center of the brain to other areas become more and more indelible. So, it’s good to be informed. It’s good to understand each day what’s going on. Read a paper, spend 15 minutes, watch the news get caught up.

But the problem is that, it is self-reinforcing. Because we’re told that, there’s breaking news, or we’re in the situation room, or alert flashes on the bottom screen, and who’s going to want to turn that off, because my life depends on knowing. Well, not just what the next bit of news is going to be, but certainly, what that next commercial is all about. So, the point is that it’s great for revenue for broadcast news, because they’re selling their ads. I’m sure their revenues are skyrocketing right now. We see the same sorts of pop ups geared at your attention by the way that appear on your feed as you are surfing the internet. Again, don’t get me wrong. I like to be informed. I think it’s reasonable as it relates to a pandemic. I read several of the journal articles each and every day. That way I’m informed, that way I can do my best to inform other people as well, as well as make good decisions for myself and help others as well.

But the constant barrage of the amygdala with fear-inspiring information makes the amygdala front and center. Moves it to the front of the class and puts it in the position of being decision maker. We need the amygdala out of that role. We don’t want to have the amygdala cause us to make impulsive decisions day in and day out, decisions that focus only on ourselves to the detriment of other people. Whereas social being, we need to interact, we need to make decisions that are more forward thinking that are more thought through. Not to say that the amygdala isn’t important. There are times when we need a sudden non-thought through type of decision.

Let me give you an example. You’re in your car, you’re backing out of the driveway, your eye catches something in the backup camera, you’re not even sure what it is but you stepped on the brake. Instantly, you stopped the car. Then, you realize, “Oh, that was a kid on a tricycle behind the car.” You didn’t need nor should you have wanted to process that information. With your prefrontal cortex thinking about it, what should I do, maybe I should slow down, maybe hit the brake, so, there’s a time for call it reflex action if you will, impulsive response if you will, which is good for us. But to respond impulsively when we see something negative on TV to want to attack somebody else because they don’t share our viewpoint, that’s impulsivity that we need to stay away from. That’s when we want to take a deep breath and say, “You know, maybe that person has a point. We need to think about that.”

If you’re watching news, it might be good to consider to watch a different network from time to time. I find watching a different network challenging, but my wife insists that we do it because it’s good for us to see what other people are thinking, because you know what they may be right about something. Who knew? That’s what reaching across the aisle is all about or as I said earlier, getting rid of the darn island in the first place. So, again, a lot of negativity out there and we cannot let it rule our lives in terms of affecting us. And to your point, affecting our actual brain wiring and affecting us when we are offline or the TV is off, that keeps smoldering, keeps us ruminating, and it affects our worldview, we then take a walk around the neighborhood or we interact with other people, we’ve changed people. We’ve got to realize that where we’re going may not be a good place.

Cynthia: Absolutely. I also think about the impact of being in this amygdala situation where your sympathetic dominant and you’re releasing a hormone that’s not a bad hormone, but chronically, high cortisol is not beneficial, and with this ever-growing pandemic that we’re in, we know that high cortisol over time actually impacts our immune function. This is what I was trying to weave into the conversation that, there are a lot of questions and concerns about how do I protect myself, how do I protect my immune function, and this is a way that I think is really important to re-emphasize that we don’t want our brains to be thinking we’re under threat all the time because the negative down toward effect, not only inflammation, but also this immune function that can be diminished over time.

Dr. Perlmutter: I think what you just said is absolutely profound. I think it’s not unreasonable to assume that the stress of this pandemic is worsening outcome. And it may be in some crazy way that this has been one of the permutations of the virus that it induces stress. It has and that has allowed it to propagate the way that it has. But again, to break down stress via upregulation of cortisol through what we call the hypothalamic pituitary adrenal axis, the HPA axis, cortisol does in fact help the body deal with acute inflammation. But chronic elevation of cortisol increases inflammation through a variety of mechanisms by changing the type of organisms living within the gut, to directly threatening the integrity of the gut lining that increases inflammation, to actually changing the expression of various immune cells leading to increased production of inflammatory chemicals that we call cytokines. So, this chronic elevation of inflammation brought on in this case by stress bodes poorly for outcome as it relates to getting this infection and then, how do you do in terms of will you survive or will you have that experience. Anything, in fact, that increases inflammation bodes poorly for outcome.

For example, as was demonstrated early on in this experience, individuals who have inflammatory disorders like type 2 diabetes, coronary artery disease, obesity have a significant increased risk of not doing well with this infection. It’s been recognized, then, we got to do everything we can now on the front end to keep people in a lower inflammatory state. What I’m saying is, maybe, easier to understand that we know people do poorly with COVID if they are immunocompromised individuals, like who’ve had chemotherapy, have an autoimmune type of condition, and on steroids. We say these individuals are at great risk because their immune systems have been compromised. But important to recognize that the immune system is compromised by age, obesity, diabetes seen in conjunction with coronary artery disease, cancer, these are inflammatory immunocompromised situations. By and large, the list includes issues for which our lifestyle choices play an important role.

When we say that age is a risk factor for bad outcome as relates to COVID, we should really more appropriately say, biological age not chronological age. What I mean by that, it’s not the number of rings on the tree that really matter, it’s the health of the tree despite the number of rings. So, you can be 70 years old but if you are in really good shape biologically, in other words, you have the physiology of a person who’s 55, that’s really the metric I believe that plays the biggest role in terms of your risk for bad outcome or good outcome as it relates to COVID-19 infection. So, what we’re getting at is, and the corollary for that is, of course, that you can be 50 years old and have put yourself in a position with obesity, diabetes, or other issues that have aged your immune system dramatically and therefore, you’re at risk for bad outcome. So, it’s important then to understand that this senescence aging, if you will of the immune system is front and center it’s getting a spotlight right now in terms of what a person’s risk is in terms of this challenge. The point is that our lifestyle choices factor heavily in terms of the aging or slowing of the aging of our immune system. What I’m saying then the dots to connect are that the food we eat, the exercise we get or not, the amount of sleep that’s restorative that we get or not, choices that we make play a huge role in our risk for outcome, be it good or bad.

Cynthia: I think it’s such an important distinction for people to understand that there are things we can do to lessen the impact if we were to contract this virus or any other illness, there are things we can do now and in the future that can be very proactive. So, when we’re thinking about, you touched on sleep, which is absolutely foundational. You talked a little bit and touched on nature, and this is an area that I have personally, really embraced during social distancing because there’re a lot of things we cannot do that we would like to do. So, my poor dogs, [unintelligible [00:39:03] not to my poor dogs. I have two dogs and every day, they get four or five miles worth of walking in our neighborhood. So, the whole concept of getting sunlight in the morning and getting out in nature has become one of the most enjoyable parts of my day, generally trying to drag my husband with me so that we get to have a private conversation because we have teenagers at home.

Dr. Perlmutter: That boy needs to get out there with you.

Cynthia: Yes. [laughs]

Dr. Perlmutter: You tell him, I said so.

Cynthia: So, let’s talk about the benefits of nature and how has this profound positive impact on our brains.

Dr. Perlmutter: Certainly, we dedicate a lot of the book to these ideas and certainly, emphasize nature exposure. So, it’s actually a science now, and that science developed in Japan with the early research demonstrating that forest bathing as it is called there, really has some powerful effects on the immune system, on lowering cortisol, on even things like blood pressure, who knew, that simple exposure to nature for even 20 minutes is a very powerful tonic? Lowering inflammation, that’s our goal in terms of reconnection of the brain to the prefrontal cortex. But the studies are demonstrating now that even for people who live in a very urban environment, if they can get out to a place in their busy area that has a few trees, it’s very powerful in terms of lowering cortisol. We have technology now that allows researchers to measure what’s called a salivary cortisol level. Basically, you spit into a tube, they take it back to the lab, they can measure it.

And going from your home to the place of nature is demonstrated with lowering of that stress hormone that you brought up earlier as being, so threatening when it’s constantly elevated. So, it might be that people say, “Well, I can’t get out right now. It’s too busy, it’s too cold, whatever it may be.” And you can achieve these benefits from nature exposure by having photographs or paintings of natural environments on your walls, or having some house plants, or having an herb garden in your kitchen, where you have dill, and coriander, and other types of– these come from a tree, one of my favorites. But whatever it may be garlic that you want to grow, you’re able to do that, and that is rewarding. You’re connecting with nature, but it’s giving you a heck of a lot of benefits. Lowering inflammation, lowering cortisol, balancing immune function.

Now, to your point about getting your husband and your dogs in the morning, the sunlight part of that story really important helping you to adapt to the day-night cycle, light-dark cycle, you know that sunlight is coming through your eyeballs into your retinas, stimulating an area of your brain called the suprachiasmatic nucleus that’ll be on the quiz, and ultimately, it is allowing your body to say, “Hey, it’s daytime. I should be doing certain things.” Your body gears up for certain things that happened during the daytime. For example, digesting your food. That shouldn’t be happening to any significant degree once we’ve gone to bed. Melatonin is inhibited, and then, once it gets dark, melatonin is brought on board, helps you fall asleep. And so, that is really very, very important. Then, hopefully, you said four to five miles, as a brisk walk, that’s significant. I don’t know what your pace is but that’s wonderful. I mean, just getting out regardless of your pace, you’re walking for miles with your dogs and your husband, that is wonderful.

Now, to the topic of exercise, I would simply say that if you really want to dedicate to it and you’re out walking, or jogging, or on the elliptical machine, or biking, you really want to maybe add a little science into it if you want to get the most out of it, and that is to look at what would be a target heart rate for each individual. That’s based upon your fitness, it is based upon your age, etc. So, you need to determine what that might be. As a very, very broad recommendation, we recommend a heart rate of 180 minus your age. It’s a very crude place to start, but some people are on drugs, beta blockers, calcium channel blockers, their heart rate is going to be slower. Other people have a naturally higher heart rate. But with time, you’ll learn what a heart rate for you seems to be getting you to a place where you’re huffing and puffing a bit, but you can still carry on a conversation. That’s the sweet spot.

Now, what are you doing? You’re reducing cortisol, ultimately. You’re balancing your immune system, you’re reducing inflammation, you’re also increasing your body’s production of something wonderful for your brain called BDNF. Brain Derived Neurotrophic Factor, that tells your brain to make more brain cells. Now, who wouldn’t want that? So, it’s all about getting into a target zone. Now, some people might want to take it further and reach a certain target zone for a two-minute period of time, and then, recover. That’s called high intensity interval training. It also very, very powerful in terms of the science behind that in terms of what it can do for you. But we shouldn’t underestimate how important exercise is and it really needs to be what a person is comfortable doing. When I say comfortable, the important point here is to get to a level that it’s not perfectly comfortable. And what’s perfectly comfortable? Probably, laying on a lounge chair with a tall drink, a little umbrella in it, and sunglasses, and hanging out, that’s comfortable.

Good to be a little uncomfortable, good to stress our bodies, whether it’s by restricting the amount of food that we eat, or fasting a given day or two, or involving ourselves in what’s called time restricted eating whereby we don’t eat through most of the day and begin to eat during a six-hour window, lots to discuss if we had time. But the point I’m making is a little bit of stress for the body is a good thing and ultimately, we have to identify what is that sweet spot whereby we do some exercise, not too much and not too little. It’s the Goldilocks zone in terms of exercise, in terms of what we eat, in terms of sleep, in terms of all the things that we look at with reference to our lifestyle choices.

Cynthia: Such important points and I want to be really mindful of your time, but I definitely want to end talking a little bit if you could think of three foods that you feel are most beneficial for the brain in terms of keeping the amygdala at bay if you will, and really servicing the executive functioning in the prefrontal cortex, what would they be?

Dr. Perlmutter: First would be exercise. I’m the guest, I get to say that. But I know you said food. But it’s so important. You can’t exercise away a crappy diet. But specific foods, and that’ll change with time. I would probably put broccoli sprouts on the top of the list. Organic broccoli sprouts, chew them thoroughly, activate the glucoraphanin when you chew it the myrosinase enzyme to create sulforaphane, man, oh, man, I cannot imagine a more powerful superfood. The next would be any source of an omega-3 called DHA, that can be vegetarian. It can come from marine algae, it can come from, if you’re not vegetarian, from fish or fish oil. I think that would have to be a superfood. The next thing would be, I think, a broad category of prebiotic fiber. And that is to nurture your gut bacteria who play a fundamental role in keeping us healthy, keeping us from becoming senescent, allowing our immune systems to be a wonderfully adaptive, keeping us in a good state of mind, managing our gut lining, helping to reduce stress, a lot of things our gut bacteria do are helping us deal with stress.

So, I would say, prebiotic fiber would be the third important food and that can be from garlic, onions, leeks, jicama which is one of my favorite foods, Mexican yam, Jerusalem artichoke, chicory. Most vegetables have some degree of prebiotic fiber as a supplement. I like prebiotic fiber that comes from acacia gum and baobab fruit. Acacia tree is that big shade tree that you see the giraffes in Africa chewing with– During the mid-day, they’re getting shade and having lunch. So, I think that we should consider prebiotic fiber to be a macro nutrient. So, desperately important. We can’t really do that because it’s basically a carbohydrate. So, it falls in that category. But I think anything I can do to raise people’s awareness of the importance of prebiotic fiber would be a good goal to achieve. Again, broccoli sprouts, wow, what a powerful superfood.

Cynthia: Oh, that was absolutely wonderful. I’ll definitely have to have you back. What are you working on right now?

Dr. Perlmutter: Well, right now, throw your curveball.

Cynthia: [laughs]

Dr. Perlmutter: I’m working on the oven. I’m trying to replace one of the heater element in the oven. That’s not what you were looking for. I have a new book that we are working on right now, which deals with fructose and its connection to uric acid, and how that plays a profound role in the way that fructose is such a threat to human health. So, that book will be coming out next year. Yeah, it will be coming in the spring of 2022 and that’s taking a lot of time, we’re doing a lot of obvious work now in terms of cultivating the research, culling the research, and working on doing my very best to make hay while the sun shines. I think it has a tendency to involute right now because the world has changed so much. Every day is sacred and I would encourage everybody to recognize that we each get a finite number of days so to squander them away because things are a little bit disturbed right now. We can achieve some great stuff right now.

Cynthia: Wonderful. Well, let my listeners now what’s the easiest way to connect with you online, and your websites, your preferred social media channels?

Dr. Perlmutter: Well, Facebook, Instagram, Facebook is David Perlmutter, M.D., Instagram, I think is @davidperlmutter or maybe @davidperlmuttermd. I think the probably the best place is to go to drperlmutter.com. D-R-Perlmutter dotcom. My books are there around the world. For people who are watching, we’re in 34 languages now available in bookstores around and on online, of course. And I’d say those are the best channels.

Cynthia: Awesome. Well, thank you so much for your time. It’s been an honor and a privilege to have you on, Dr. Perlmutter.

Dr. Perlmutter: Cynthia, thank you for having me. I hope you have a terrific day.

Presenter: Thanks for listening to Everyday Wellness. If you loved this episode, please leave us a rating, and review, subscribe, and remember, tell a friend. And if you want to connect with us online, visit the link in the show notes.