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#23 – How to Detox your Brain from Big Tech and Bad Food with Dr. Austin Perlmutter

How many times a day do you check your cell phone? Does the 24 hours news cycle leave you feeling informed, or stressed out? Feel like you can’t stop with junk food? This episode is for you. Today, we talk to Dr. Austin Perlmutter, co-author of BrainWash (View on Amazon), a modern day instruction manual for reclaiming clarity and mental health. Many of the tips for reclaiming mental health shared by Dr. Perlmutter are of particular relevance during the COVID-19 pandemic.

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This Episode Covers:

  • Why most medical interventions don’t work over the long haul [4:30];
  • The decision making process in the brain and how it affects health [8:00];
  • How technology hijacks your brain [12:00];
  • Ideas for using technology more responsibly [15:00];
  • Spotting burnout [22:30];
  • Narcissism and social media [26:00];
  • The desire to change [33:00];
  • Thinking of your future self [37:00];
  • Location and mindset [43:00];
  • The biomarkers Dr. Perlmutter cares most about [50:00];
  • Leaky gut and the brain [59:00];


John: One of the main things that I like to talk about is news, is watching the news, taking in the news, and how it’s kind of this fallacy that this is somehow productive. We call it being informed. What does that actually mean? I’m not saying you can’t participate in the news. I’m not saying you can’t watch the news. I’m not saying you can’t read the newspaper. But if you start watching the news and 10 minutes in, you feel your heart rate going up because it’s the latest coronavirus numbers or whatever it might be, you’ve gotta ask yourself, is it worth it for you? Is this where you want to be at this point of the day?

Welcome to the “Gene Food Podcast.” I’m your host, John O’Connor. Hey, everyone, before we get into introducing today’s episode, I would encourage you to check out our custom nutrition plan product, which you can see on the website under DNA testing kit. For our podcast listeners, we can offer a 15% discount using the coupon code, PODCASTGF, all caps, PODCASTGF. With that out of the way, today we are very excited to bring you, Dr. Austin Perlmutter.

Austin has co-written a book with his father who some of you may have heard of of “Grain Brain” fame, Dr. David Perlmutter. And together they put together a book. It’s called “Brain Wash.” And the idea behind the book is that we have this chronic illness epidemic in the country. People are kind of looking for answers about how to feel better, how to feel happier, social media use is up, phone use is up. Technology is pervasive. There’s a lot of issues with the way that different foods, especially processed foods, kind of hijack our brains.

And so they’ve written a book that combines a lot of really high-level science with some very practical tips for reclaiming your brain from the grip of some of these outside pressures, whether it be technology, whether it be food. And I was just very impressed with Austin in our conversation. He’s a very thoughtful guy, and he has a lot of insight into kind of the collective state of mental health in our society. So we really enjoyed speaking with him. Without further ado, here’s Dr. Austin Perlmutter, discussing his new book “Brain Wash.” We’re here with Dr. Austin Perlmutter. He’s been nice enough to stop by the Gene Food studios as it were. It’s great to have you.

Dr. Perlmutter: It’s great to be here.

John: Yeah. And so you’re in New York for the Integrative…

Dr. Perlmutter: Healthcare Symposium.

John: Yeah. I’m actually gonna check out the talk you and your dad are giving on Friday.

Dr. Perlmutter: Fantastic.

John: Yeah. So, how does that rank for these…I mean, that’s a pretty big functional medicine conference, right? What’s that all about?

Dr. Perlmutter: Yeah. There’s definitely a lot of overlap with functional medicine. This is one of the bigger conferences when it comes to integrated medicine. The definitions of what is meant by integrative, alternative, complementary, functional tend to vary a little bit depending on who you talk to. But what I really like about this is it integrates multiple different aspects of what it means to achieve wellness, some of which is the more traditional allopathic medicine piece, which I was trained in, and some of it which is more about mindfulness, some of it which is more about nutrition, which, oh, my goodness, turns out to be part of health, and again, tries to integrate all of that into messages that can be relevant for a variety of people. This is geared a little bit more towards practitioners, health practitioners, but there’ll be lots of people there who are just hoping to learn about what’s happening in the world and how to apply that in their own lives.

John: This book that you have, “Brain Wash,” is kind of a product of your passion aligning with your dad’s passion. You know, he’s bringing the nutrition side, and you’re bringing sort of a mindfulness, an awareness of the role of technology and what it does to our brains. Speak to kind of where your passions are right now and why this book.

Dr. Perlmutter: Sure. Let me give you a little backstory on this. My dad is a neurologist. He’s a brain doctor. I’m an internal medicine doctor, which is more of a generalist. And the reason I chose internal medicine as opposed to something like neurology or psychiatry is because I wanted to understand what we’re doing for the diseases that kill more Americans than anything else. The top causes of disease or I should say of death and…so morbidity and mortality in the United States are these chronic diseases, things like heart disease, diabetes, and hypertension.

So internal medicine gave me a training where I saw what it is we’re doing for these conditions. Now, what we’re doing for these conditions is largely trying to slow the rate of decline. It turns out that when most people come in with heart problems, when I’d see them in the clinic, they already had the heart problems. And our goal was to keep them from getting too much worse. And we didn’t usually succeed in that, but we try.

So the paradigm that setup that both my father and I understand all too well in medicine is that a patient comes into the clinic, you use all your years of education, in my case on chronic diseases, and in his case on neurologic diseases, and we try to use that education to inform the patient to give them that data so that they can then translate that information into action. It’s a pretty straightforward plan. The problem with this, which both my father and I were looking into, is it doesn’t work. And by that, I mean up to 80% of the time when I give my patient the necessary information, or really just any provider gives their patient the necessary information, they’re not able to take that information and act on it.

So let’s say a patient comes into the clinic and they have high blood pressure. I say, “Hey, I’ve done all this training in high blood pressure. It turns out here are the things that seem to contribute to high blood pressure. Maybe we should, I don’t know, put you on a DASH diet.” That’s one that’s popular right now where you talk about limiting certain dietary micronutrients, specifically salt to lower hypertension. I give them that information I say, “You should also exercise. You should also maybe eat less certain foods.” They are not going to generally follow through it. They’ll come back to the clinic, and here we’ll be a month later, and their blood pressure is the same, and they weren’t able to make the dietary changes. They weren’t able to start exercising. And then I wind up putting them on a blood pressure medication.

So what happens then is that I write in the chart that the patient was non-compliant, non-adherent. Those are the words we use, and those words basically mean the patient failed at this intervention. And that bothers me because I’d like to think that what I’m doing is helping people, and if all this time I’m spending counseling only works, let’s say, half of the time, it doesn’t seem the most practical use of my time or the patient’s time.

So I’m talking to my dad about this, and we’re trying to figure out where things are going wrong. And again, he’s a brain doctor, and so we stumbled on this question, which seems so straightforward but is really fundamental to understand, which is why are our decisions not going the way we want them to? Why is it that despite having this information about what we need to do when saying, yes, I want to lose weight, I want to eat less refined carbohydrates, we just don’t do it? This isn’t just patients. This is you and me as well. And it turns out that there’s a pretty simple explanation for where our decisions come from, and it’s the brain, right?

Surprise, surprise, the way that the brain is wired determines how we make decisions. That’s not super novel, but when you let it sink in, it really is a helpful tool in understanding patient care. Why is that? Because, as I said, the traditional paradigm for looking at why patients do or do not do what they do is to fault willpower. It’s saying, “If I gave you the information and you didn’t follow through, you must not have cared enough.” And that blames the patient. And if I was to blame you and say, “Hey, listen, I gave you this information, you didn’t follow through,” you’re gonna feel pretty crappy. It’s not gonna make you more likely to go home and say, you know, “Now I really need to do what the doctor said.” You’re gonna go home and eat those very foods that cause the problems in the first place.

So, if we can say, “What is going on in the brain that enables us to either make good decisions or leads us to bad decisions,” then we have a new framework for looking at this whole picture. It’s like saying, if a person has a kidney problem, we don’t blame them because their kidney isn’t filtering very well. That’s a problem with the kidney. So what if we were to say…instead of blaming people for making poor decisions, we say, “Well, maybe there’s an issue in your brain.” And what we discovered in the research for this book is that there are very clear factors that kind of program our brains for bad decisions or, on the other hand, factors that we can harness to program our brains for good decisions that enable us to reach these outcomes we care about like good health and like lasting happiness.

John: There’s two areas you guys identify in terms of corporate interest in food, weaponizing food and weaponizing technology. So, tell the audience…I mean, this stuff you guys have in the book about the prefrontal cortex and how the brain is being hijacked, and I think it’s not going too far to say your view is in some ways deliberately by these corporate interests. Tell people how they may be making decisions right now that are being to some degree chosen for them by the consumer environment that they live in, the food environment that they live in.

Dr. Perlmutter: So I’d say, if you’re not making your own decisions, chances are somebody else is making them for you. And that might be okay. If you’re a little kid and your parents take you to a restaurant, you may not know there were other unhealthier restaurant options. The parent kind of cuts out some of the choice for you. That works out in your favor because then you’re not worrying about all that junk food you could eat. But if you think about corporate interest today, I think it’s really easy to demonize corporations and say, “These are all these evil fat cats sitting up there…”

John: The smoke-filled room.

Dr. Perlmutter: Yeah, exactly.

John: This, “Ha, ha, ha, These chips are, you know, really gonna get…”

Dr. Perlmutter: Right. Right. That people are gonna be miserable, and we can’t wait. No, these people are just incentivized to maximize product and profit. That’s not that exciting, but what we need to understand is let’s say…let’s start with, okay, a food corporation. If you’re a food company and you produce something that you want people to eat, what are the levers you can use to get people to buy and eat that product? Food science has come a long way. We have literal scientists, and they’re trying to make the most addictive food products possible. This isn’t brand-new news to most people, but those tend to be the things that are high in certain types of fats, certain types of refined carbohydrates and added sugar.

Sugar is added to about 68% of food and drinks that you can buy in the grocery store per a UNC study of about 1.2 million foods in the United States. Why are they adding all of this sugar to our food and beverages? They know that that’s going to make them sell. They know that when you eat a sweet product, you are more likely to feel that dopamine rush, and it’s going to make you want to continue to do that in the future. Now, to be fair, you may feel a little bit of pleasure, short-term pleasure, when you eat that bowl of ice cream, let’s say. But chances are an hour later, you’re not saying, “Fantastic. I’m so glad I just devoured that Ben & Jerry’s on the couch while watching Netflix.” And Ben & Jerry’s is great. Don’t get me wrong. I don’t wanna castigate them.

But what I’m saying is these are products that are designed to hit our short-term reward centers, and it kind of takes our higher-level thinking offline. So what we know too is that stress tends to induce people to eat certain types of unhealthy foods. Sleep deficit tends to make people more likely to choose unhealthy foods. And again, if you are a producer of these unhealthy foods, you’re not going to be telling consumers, “Hey, listen, you need to really be thinking, weighing the pros and cons of consuming this.” You’re going to be trying to do everything you can to get people to consume these products. So, when it comes to our decision making, they are better off if you’re not thinking through these decisions as to eating the ice cream, the potato chips, the french fries. You’re better or they’re better off if those responses become habitual if you just kind of do them without thinking.

Let’s move to the digital technology arena. So I think that…you know, Tristan Harris is one of the, as you said, people who’s most out there about what is going on and why things are going wrong. I think that it may be a little bit too early to say that technology clearly has these detrimental effects on our brain wiring. There’s been some early studies, and we talk about some of this in the book that shows that people who use social media excessively show changes in parts of their brain. It’s not clear whether that’s going to be a net detriment.

But what we do know is that when you are engaging in these digital technologies for hours a day, an average American spends four hours watching TV, another two hours on their phone, you’re not doing the other stuff. You’re not going to the gym. You’re not spending time in person with your friends. And clearly, these reward systems that we talk about with regard to food networks in the brain are also activated by these habitual or habit-developing social media tools. So I think the takeaway I would say for people is that, again, if you’re not making your decisions, other people are more likely making them for you. And when it comes to our engagement with digital technology and when it comes to the foods that we eat, they’re not set up for you to be happy. They’re not set up for you to be healthy. The default, the status quo when it comes to foods is that you’re gonna eat things that make you sick. That’s an unfortunate truth. If you’re not aware of what you’re eating, you’re going to probably wind up sick because the foods that are labeled “foods” are not good for you.

And when it comes to our digital media exposure, too, these are traps set up for you to spend as much time as possible. That’s what these digital corporations want you to do. They want you to spend your time, attention, potentially spend your money. And they know that they can activate certain levers when it comes to sensationalizing news, let’s say, when it comes to presenting polarized social channels in whatever social media network you use, that activates stress and anxiety and also make it more likely for you to continue pushing those buttons.

So, I would just caution people. We don’t wanna say that all food is bad, right, that anything you buy in the grocery store is bad. We don’t wanna say that all digital technology is bad. That is certainly not the case. But we definitely need to be more conscious about what we’re taking in, food and digital technology. Otherwise, we’re gonna wind up kind of with where we’re at right now, which is most people in the United States have a chronic disease. Thirty percent of people in the United States will develop anxiety at some point in their life. Twenty percent of these people will develop depression at some point in their lives. We’re just not doing that well. So we’ve gotta look at the things that are going into our brain because that is what is either setting us up for success or failure.

John: Yeah. This year for Christmas, I turned off my phone. I literally put it in a drawer, and I went home, and I did not have my phone for the entirety of Christmas. And I came back, and I found that I was almost scared how much of a difference that made for my mental health when I came home, just even attacking my business and dealing with employees, I was so much more clear-headed. And I was happier, and I was calmer. The problem is…and this is why I’m hoping you can give us some wisdom on your individual protocols because, when I came back, inevitably, that tech creep comes back. And I can feel myself getting more tied into my phone. I can feel myself checking my WHOOP Strap in the morning more frequently. I’m just on it. I’m checking Slack. How do you know as somebody who’s…you know, wrote this awesome book about mental health and trying to improve it, how do you know you’re out of balance with technology and food? What do you do in your day-to-day life to try to stay feeling happier and protected from these stimulants?

Dr. Perlmutter: Sure. Well, I would say that when I was in my medical training, those decisions were made for me. There just wasn’t time to be on Facebook in the hospital, and everyone around you would castigate you if they saw you playing on your phone. So, that’s one way you can do this is just set up an environment training-wise or otherwise that you just can’t be on your phone. That’s not gonna happen for most people, and I don’t recommend most people go into medical residency. The things that I found most helpful are to have accountability partners. For me, that’s my girlfriend, and that means that if I’m sitting there scrolling through Instagram, she says, “Hey, what are you doing?” And so we pull each other out of these spirals, which means in the morning, we do meditation, 20 minutes. And if one person is getting pulled into email or otherwise, we say, “No, no, that’s not the plan.”

So you wanna have a protocol for your day, which means ideally, you wake up, the first thing you do is not check your phone, and so that you can know when you’re deviating from that because the pull from these devices is really impressive. It is so easy to check the social media account right before you go to bed. It’s so easy to check it first thing when you wake up in the morning. And I know there’s a voice inside of me as probably there is in you saying, “This is you being productive. There’s actually a reason for this.” But when you look at what it does to our mental health, it’s not actually clear that that is the case.

One of the things we developed for the book is this acronym. It’s the test of TIME, and I think it’s probably the most helpful way…I’m certainly biased, the most helpful way I’ve seen to try to mitigate some of the downsides of our engagement with technology. So it’s an acronym as I said, T-I-M-E. T is for time-restricted. What does that mean? It means that when you are going on let’s say social media, you don’t go on social media and then find yourself two hours later saying, “Wow, I wish I didn’t spend this much time.” When you’re turning on a Netflix show, you might have a great show you wanna watch, maybe it’s “Altered Carbon” Season 2, I don’t know, but the sign was humongous in Times Square, and Season 1 was great. So let’s say you wanna watch that show, you don’t then find yourself four hours later having binge watch most of it. You say, “I’m gonna set an alarm for 45 minutes,” or whatever that first episode is.

John: Or four days later. Honestly, four days later you’re just like, “Oh, my God, what have I been doing?

Dr. Perlmutter: What happened, right? Three seasons have gone by, and I don’t mean the seasons on TV. But what you want to do is to say, “I’m going to be in control of this. So I’m gonna set a timer for, let’s say, 30 minutes, an hour,” and you literally set a timer so that when that timer goes off, you say, “This is my reminder, it’s time to be done.” And then I is for intentional, meaning, when you go into one of these digital environments that is purposely designed to captivate your attention, you have a plan. You’re just not casually finding yourself, as we all have, scrolling through whatever social media account it is and saying, “I don’t know what I’m doing. I was literally on the subway, and the next thing I know it’s been 30 minutes.” So have a plan, whether that’s to watch a TV show with your partner, that’s wonderful. Whether it’s to go on Facebook and check on your cousin and see how they’re doing since the graduation, that’s fine. That isn’t the problem. The problem is then you’re looking at some stranger you haven’t heard from in four years.

John: You go to ex-girlfriends. You go from cousins and then your ex-girlfriends and then your ex-girlfriend’s friends and you’re like weddings, and it’s like, “What happened to my life?”

Dr. Perlmutter: Yeah. You’re checking to see if MySpace is still a thing.

John: It’s bad.

Dr. Perlmutter: These holes. So, again, it’s intentional. And then M is for mindful, and that’s a word that gets thrown around a whole lot these days. What we’re talking about here is that you wanna be conscious of how you are experiencing this digital media. One of the main things that I like to talk about is news, is watching the news, taking in the news, and how it’s kind of this fallacy that this is somehow productive. We call it being informed. What does that actually mean? Do we think that our knowledge of exactly what’s going on in politics right now translates into anything tangible as far as a productive way of improving this country? I’d say no.

I’m not saying you can’t participate in the news. I’m not saying you can’t watch the news. I’m not saying you can’t read the newspaper. But if you start watching the news and 10 minutes in you feel your heart rate going up because it’s the latest coronavirus numbers or whatever it might be, you’ve gotta ask yourself is it worth it for you? Is this where you want to be at this point in the day? And then E is for enriching, and I think that’s the most important part of this here. You want to come away with your experience with a net positive, and it’s pretty easy once you’re done watching TV or going on the computer or on your cell phone to say, “Wait a second. Did I actually get out more than I put in?” A lot of the time the answer is no, and you know that.

John: Almost always it’s no.

Dr. Perlmutter: Right.

John: Yeah. It’s so rare that…you know, with the work that we do at “Gene Food,” a lot of it’s online. But I just find when I go online, I do have productive things that happen but, man, I just…there needs to be more books like this, and there needs to be more awareness. And I think having your partner there with you like your girlfriend, that’s a great tool because people are just, “Man, I’m checking email 100 times a day.”

Dr. Perlmutter: Yeah. Well, this is status quo.

John: I mean, I’m just doing it.

Dr. Perlmutter: Right. Because you could always get that new message, that new LinkedIn message from that CEO that’s gonna change your life.

John: Yeah. It’s slot machine, you know.

Dr. Perlmutter: I think too what I said before is that we validate this by saying that there’s something to this. It’s helpful to be on my computer 24/7 because I don’t wanna miss even one tiny opportunity to grow my business, to connect with somebody, or to have somebody say, “Hey, I really like your work.” But this is your brain playing tricks on you. It’s not necessary. And if you’re trying to optimize for a life of wellness, this just isn’t the way to do it. Do you know what I mean?

John: Yeah.

Dr. Perlmutter: You could get up and be on your computer every waking minute of the day, and you wouldn’t miss any emails. But what would you be doing with that? And at the end of the day, you become a little bit more successful perhaps in business, but chances are the opposite is true because what we know is when you’re sacrificing sleep to check your email, you’re gonna be more emotionally reactive the next day. And why does that matter? So let’s say finally that LinkedIn message comes and says, “I wanna offer you this million-dollar job. Let’s meet for coffee.” You’re gonna show up there sleep-deprived, and you’re gonna yell at this person and tell them something horrible and blow the whole thing. So you’ve gotta look at the bigger picture here, and technology is not the bigger picture.

John: It’s true. It speaks to burnout culture. It’s funny, I was telling my sister about this, and she acknowledged that it was a great article, but I think it went viral like three years ago. So I’m just now kind of coming onto the scene with this article. It was a BuzzFeed article about basically burnout and errand fatigue, which is something that I notice when I’m in New York and I’m like, “Okay. Ray and I have talked about this.” Uniquely as the experience of living day after day in the city, it seems like it can be really difficult. You’ll have something on your radar that you need to do. It could be mailing a check. It could be, you know, taking care of my dog going downtown and getting him some meds that he’s run out of, and it just feels like a herculean effort to get in and do these small tasks.

Dr. Perlmutter: Well, let me start with my experience with burnout, which is basically the medical burnout, and it’s something that’s been studied a lot. It’s something that turns out to be a major problem for medical trainees as well as for practicing physicians with some data supporting the fact that almost half of practicing providers are burned out. And what does that mean? Well, burnout means that, you know, they’re not getting that same quality that they had when they were early on in their job. It means that they are feeling like they don’t care as much about their patients. They don’t care as much about their job. And that translates into worse outcomes.

It turns out that empathy for patients predicts better patient compliance. Who would have known that if you care about your patients, they’re more likely to do what it is you tell them to do? So, burnout is a major problem for us, and it’s associated with a lot of things. It’s associated with spending all of our time doing digital technology, again, by charting for patients. It’s associated with all of these administrative tasks that we have to do as providers.

The bigger context and what you’re talking about with living in New York, there’s this hustle mentality that is so pervasive today. And there’s this idea that being busy is always good in and of itself, but I think it has to come back to the question, again, of what are you trying to get out of your life? There are times where it’s worth pushing hard or it’s worth engaging in stressful pursuits such that you can then get to that outcome that is more meaningful to you.

But when you wind up pushing, pushing, pushing so that you can get to maybe a week off a year, if the quality isn’t there in the day-to-day, then you need to make a change. And again, I think we fall victim to these traps of looking at what other people are doing and then assuming that that is the best way forward. The norms have changed such that hustling is now deemed the way to go, and I think we just gotta question that the key to all of this is to question. It’s what you talk about when it comes to personalizing medicine. Don’t just assume that because somebody made a blanket recommendation that that applies to you when it relates to being busy.

If you’re super anxious, if you’re super depressed, then don’t assume that continuing on that course is what’s right for you. And I think that’s specific to medicine. You hear a lot of doctors say, “Hey, listen, I had to make major changes to my practice because I realized that doing what I was told is the best way forward just didn’t turn out to make me happy.”

John: Right. Yeah. And one of the things that we should steer the conversation towards is we’ve discussed burnout as almost like it’s been described as like “irritable stasis.” You know, so you have this kind of just like constant irritation. Like you mentioned, it can make you feel worse about your patients. It can make you feel worse about whatever work you’re doing. You guys described protocols in the book that are actionable for reclaiming some of that sort of mental stability. Before we go there, one of the words that came up quite a bit in the book is narcissism. That was mentioned a bunch. You know, it’s something I’m really interested in in terms of the social media culture because you’re talking about comparison, you know, seeing what somebody else is doing, a kind of a filtered version of it. Talk to me about that. That’s a word you and your dad wrote a number of times. Like how do you see that manifesting?

Dr. Perlmutter: Well, I think to start, narcissism is a popular term right now. You go on Psychology Today…

John: That’s super popular.

Dr. Perlmutter: …all of the popular articles are on narcissism. It’s usually said that there are two types. There’s a grandiose narcissism, which is an inflated sense of ego, and then there’s a vulnerable narcissism where you just are really hoping that other people will prop you up, you’re struggling a bit more. As it relates to the modern world, our concern is that when you are constantly posting selfies and trying to get validation for what you’re doing, that is moving you towards narcissism. But where the research is a little bit more supportive is talking about the opposite of narcissism, which is empathy. And the research suggests that we’ve been losing our empathy as time goes on. Why is that such a problem? Well, empathy is the glue that binds our relationships together. You really can’t have a strong relationship with another person unless you’re willing to feel for them a little bit.

And as it relates to brain function, if you wanna put yourself in their shoes, you need to have a prefrontal cortex that enables you to do so. You need to have cognitive empathy. And these are the types of things that are lacking in narcissism. So what we’re talking about here is that people are moving from a state of worrying about other people, feeling for other people and instead saying, “I need to inflate my ego.”

Now, you can see this probably best in the political landscape. Who out there is saying, “I’m really thankful for all of these people who are helping me to get to this place right now,” as opposed to saying, “I’m the best. Look at my accomplishments, which I accomplished just by myself”? And whether you’re on Republican or Democrat party, this is happening all over the place. Nobody is willing to say, “Hey, listen, I’m still learning from other people, and I wanna put myself in the shoes of somebody in the opposing party.”

Who do you see out there saying, “Hey, I’m a Democrat, but the Republicans have some great points, and I wanna sit with this,” or Republicans saying, “You know what? As much as I wanna just bash on Democrats right now on Fox, instead, I’m gonna take a moment and say they have some great points. And I’m actually changing my perspective because of what they said.” So, to kind of tie this together, the concern is that certain aspects of the modern world are pushing us towards more ego-driven narcissistic behavior, some of which, as we described in the book, maybe this selfie culture of, “Look at me.”

But perhaps the bigger concern is that we’re losing the empathy, which enables us to see the bigger pictures, not just empathy for each other. It’s empathy for ourselves. It’s caring about the long-run version of ourselves. It’s saying, “If I stay up tonight for another couple of hours and watch TV, I’m gonna feel like crap in the morning.” But we’re losing our empathy for that morning future self. We don’t care about that person. They can deal with it.

John: Short-term thinking.

Dr. Perlmutter: Exactly.

John: That’s what you guys talk about, trading the short-term for the possibility of a better long-term. And then on the political analogy we touched on a moment ago before we started the show, it shows up in the diet wars. The diet wars are crazy. I mean, you get online now, which is something we touch on the podcast all the time, you have, you know, carnivore is a pushback against this very, very, very adamant vegan movement. You just go to these polarities. I mean, they’re just getting more and more extreme. You know, YouTube couples all the time. I went carnivore for seven months. It’s like, “Okay. Well, maybe there’s a small subset of people that need to be on that protocol.” What’s your take on the diet wars? Because it’s something your dad has weighed in on, and he’s arguably a very well-known participant in that conversation, although I would say to his credit, a nuanced participant. One of the things I like about interviews that I’ve heard your dad do is he tends to borrow from different…you know, you’ll hear him say, “Look, some people,” mentioning APOE4, “should be on a diet that’s…” So what’s your take on the whole state of the nutrition wars to the extent you’re involved?

Dr. Perlmutter: Well, let me say I do not consider myself an expert in nutrition. I wanna be very clear about that.

John: Can you read a forest plot, though?

Dr. Perlmutter: You know, after that interview, I just…the interview that Joe Rogan did. You know, yes, I did the epidemiology stuff. I know how to read a forest plot. This is kind of the issue. It’s saying, “Can we take a larger picture stance?” And if there are a ton of people out there saying one thing and a ton of people out there saying the other thing, chances are the answer’s somewhere in between. And the question nobody is asking is, “How could I be wrong?” You know, you get these YouTube people saying, “I did carnivore, and I lost 800 pounds, and I made $4 billion overnight.” Maybe that’s one. That’s an N of one. And you get somebody saying, “I went vegan, and everything went perfectly well,” again, an N of one. Are we able to ask the bigger questions of what is good in both of these camps?

And I think for me, again, as a person who does not consider himself a nutrition expert, the key takeaways here are that if you do what most people are doing in the United States, you’re going to wind up obese. Why do I say that? Because 70-plus percent of people in the United States are overweight or obese. Let me clarify that further point. It’s you’re gonna wind up overweight or obese. You’re gonna wind up with a chronic disease. So the default state of what people eat and do isn’t working. Now, both veganism and the carnivore diet are anything but the default state. Those are extremes. And why do those extremes exist? Because there’s such a gap, a delta between the average behavior of the American and what a healthy person looks like.

So what I think is if you stop eating processed foods in general, the stuff that people have messed with to no end, whether that’s meats that have been processed in grain lots, whether that’s carbohydrates that have been refined such that there’s no fiber left, or even fats, vegetable fats, you’re gonna be doing so well. And you’re gonna maybe be doing really well whether that’s a carnivore diet or a vegan diet. I think there are all sorts of moral reasons why people would maybe argue for veganism. I think there’s a lot of interesting stuff that we mentioned in the book as far as the environmental impact of some of these things. And I know there are people who argue on both sides for whether you can have sustainable agriculture, whether you can have sustainable meat farming. Again, the way that we’re doing things isn’t great. So can we have the conversations about what does a better system looks like as opposed to the best for an individual person?

John: Sure. You kind of have to touch on it, the diet wars. It’s sort of like the elephant in the room. I know that your passion through this book and just in your career in terms of, you know, your involvement with Psychology Today, you’re more interested in the whole behavioral aspect, the role of habit, how to reclaim mental health. And so let’s talk about that. Let’s talk about it in the book. You know, it’s called “Brain Wash” for a reason. I mean, it’s not literally to be brainwashed. It’s to detoxify your brain, detoxify your mind. So, you have the protocol you use for making sure that your internet activity is mindful. I mean, just walk us through kind of, you know, without spoiling too much of the book, the protocols that you have identified through your research that you think people should be aware of at home.

Dr. Perlmutter: Yeah. Well, let’s start with the key to it all is starting with awareness, and as I’ve said before, people in the United States aren’t doing that well. So, if you’re listening to this, there’s a good chance that you’re not doing that well. But unless you care about making a change, anything I say will be without value. So if you feel like you’re doing fine, then you’re gonna keep doing whatever fine means. So before any protocol is gonna work, you have to have a desire to change something. Now, whether that’s your weight, whether that’s your A1C, whether that’s your relationships, whether that’s your depression. If you’re content with how things are, then there’s no further conversation.

Now, let’s say you’re listening to this podcast, so chances are you’re aware of wanting to learn at least. Then you say where are you trying to get to. And what we talk about in the book is this disconnection syndrome in that we’re disconnected from our health, from our happiness, from each other, from the planet as a whole. If you’re listening, you’re probably gonna find one of those domains where you’d like to make a change.

John: Yeah. And the domains, I have them right here, it’s, you know, mindfulness, activity, impulsivity, loneliness, chronic stress, chronic inflammation, instant gratification, narcissism we touched on, poor relationships.

Dr. Perlmutter: So, what are the things that a person can do to try to get from where they’re at to a better place, whatever that might mean for the individual? What we described in the book is that the pathway in can be as simple as a little crack in the door, and that might be different for each person. I would have patients come into my clinic all the time, and I’d say, “You need to exercise,” and they would say, “I hate exercise. I would rather do anything in the world than exercise.” And I say, “No, you need to exercise.” Stalemate. That’s the conversation. I’ll put it in the note, they’ll come in again…similarly with cigarette smoking. They come in and I say, “You need to stop smoking,” and they say, “I don’t wanna stop smoking.” And I do that every single time.

I was looking at some recent research, which looked at people who use substances, and the top reason why people didn’t want to engage in protocols to stop using substances, why they didn’t stop using, is because they don’t want to, right? That sounds so silly, but that’s the case for a lot of people. So what I’m saying is let’s say, again, there’s that patient who refuses to exercise. What if we said, “Let’s table that for a second, let’s look at the things that you are interested in?” Because most people are interested in making better decisions so that they can reach better outcomes, whether that’s watching the game with your kids or going for a walk around the neighborhood. It doesn’t really matter. What matters is finding what matters to people and then working backwards from that. So exercise is perhaps off the table for a moment, but what if there were other interventions we could use to improve brain function so that they made better decisions in general?

For example, we talked about in the book the benefits of nature exposure. It sounds like a silly thing. Of course, nature is a good thing, but it turns out that nature exposure may improve the quality of our decisions. And how does it do this? It lowers inflammation. It lowers chronic stress. It improves immunity. It improves mental health. So maybe that person who hates exercise instead goes out and looks at some trees for 20 minutes once a week, which has been statistically shown to lower levels of the stress hormone cortisol. Well, now as you’re lowering cortisol, you’re lowering stress. When we lower stress, it improves the quality of our decision-making. So now maybe a month or two goes by. Their brain’s now set up for better decisions. They come to the clinic, “Would you like to exercise?” “Maybe I’ll consider it.” So the goal here with this program…

John: Because they’re gaining some equanimity by the first protocol. Like, the first protocol puts them in a state where they can be a little more mindful about, “Okay. I’m getting benefits here. I’m calmer so I can make better decisions.”

Dr. Perlmutter: We only ever do what we want to do, and that’s kind of a weird thing to say. But if you eat potato chips, you say, “I wish I didn’t do it,” you still wanted to in the moment, otherwise, you wouldn’t have done it. Whether it’s a conscious choice or not, if you didn’t wanna do it, you wouldn’t do it. And so what we’re talking about here is can you make plans for your future self such that it will be more in alignment with your ideal self?

John: And start small.

Dr. Perlmutter: Exactly. I think that’s such a key step. There are a lot of people talking about small habits. For example, BJ Fogg is a big one on that right now. But find interventions that will work for you such that you then build into a habit loop of making better choices. And what we’re talking about, which makes it a bit different from people who are specifically focused on habit formation, is that in order to move from bad habits to good habits, you have to have the insight of what those two things are.

So if you’re driving by every day the donut shop and when the light goes on, you pull into the donut shop, and you get a dozen, and you eat them, you may think that’s a bad habit. But in order to think it’s a bad habit, you need to have that executive function to be able to weigh the pros and cons of the habit. You need to have the awareness that maybe I shouldn’t be eating a dozen donuts each day.

And so before you’re able to make any of these habit changes like driving a different direction so that you don’t go by the donut job, you’ve gotta have that cognitive control. And the cognitive control comes from an area of the brain called the prefrontal cortex, which is what our interventions are trying to target to activate to make better connected with other regions of the brain so that you’re able to think about making the better choice in the first place.

John: And that’s the long-term decision-making because…I’ve heard you guys do a couple other interviews. I think it might have been your conversation that you and your dad had with Dr. Mark Hyman, and you were talking about how the prefrontal cortex in a specific state allows you to think long-term. And correct me if I’m wrong, this might not be exactly it. As the brain has been subject to these inflammatory processes by lack of sleep, you know, the dopamine hits from technology, these different foods that are lighting up our pleasure centers, you’re essentially unknowingly being, what, weakened to make long-term decisions? How does that work?

Dr. Perlmutter: You know, I look at the brain as an incredible organ that is constantly subject to neuroplasticity. It’s always changing in response to the environment. But if you give the brain certain types of food…and by food, I don’t just mean the macronutrients, but if you give the brain stress, if you give the brain anxiety-type behaviors, it’s gonna get really good at that. And so when you wake up in the morning, your brain says, “I’m all ready for a day of what I’m good at,” which is stress and anxiety. So thinking through how you develop the brain and how that then reflects your decision-making.

We talked about in the book certain regions of the brain that have been linked to certain patterns of behavior and thinking. We talked about the prefrontal cortex, and that’s really the key takeaway is that the prefrontal cortex, which is thought to be what gives us some of our distinctly human capabilities, has been linked to the ability to weigh the pros and cons of decisions. Specifically, a part of the prefrontal cortex called the dorsal lateral prefrontal cortex seems to be the adult in the room that enables you to say, “Hey, maybe I shouldn’t stay up until 4:00 binge-drinking this morning,” right? It gives you that ability to reflect on your decisions versus other parts of the brain, which involve the amygdala, which involve the dopaminergic reward system that are more engaged with, “Let’s do these short-term behaviors in a way that is going to give me the best reward in the moment.”

And the amygdala is really key here because if there’s any part of the brain that’s been implicated in disorders like anxiety, PTSD, aggression, even depression, it’s the amygdala. The amygdala we know well is the fight-or-flight center of the brain. Okay. That’s all fine and dandy, but when you think about what that actually means is it does a great job of getting us out of trouble if we’re, you know, going to be attacked by a bear. It does a great job of helping us to survive if we’re exposed to these acute dangers. But in the modern-day, those acute dangers are coming through our eyes and ears when we watch the news. That’s revving it up. That’s the type of thing that gets activated when you get a stressful email. And so when that happens over and over again, that part of the brain gets activated. It gets stronger, and so you’re then making more decisions from that impulsive center as opposed to the prefrontal cortex.

Now, one other point here I’m gonna make is that these parts of the brain are all integrated into circuits. It’s not like you have the amygdala here and the prefrontal cortex here, and occasionally they exchange letters. There are circuits that have bi-directional communication between these two regions of the brain. What we want in order to be able to function at an optimal state is to have the prefrontal cortex, again, the adult in the room, calming down the more impulsive amygdala.

So you want to have what’s called top-down control where let’s say you were driving in traffic and somebody cut you off, your immediate impulsive reaction is, “I can’t believe this guy. I’m gonna go cut him off. I’m gonna go 120 miles an hour, swerve him off the side of the road, bang on his door,” and who knows what. What you need in that case is to have the prefrontal cortex show up and say, “Hey, listen, it’s not a huge deal. Let’s take a few deep breaths.” But you need a connection between these two parts of the brain, and it turns out that modern-day activity is like not getting enough sleep and chronic stress disable that connection so that the amygdala is saying, “Oh, well, no one’s telling me otherwise. We’re gonna actually chase after this guy.”

John: Yeah. Yeah. I mean, you talk about…there’s so many things to unpack there. I mean, the first thing, nature, I mean, that’s something we’re really into here is the whole role of location and how location plays a role in health. I spent a couple weeks in Wyoming, and I brought my dog. And I came back, and I noticed I was talking even just to my doorman here. And I was so calm. I was just like listening. I was just patiently sitting there listening to what he had to say, digesting it. You know, and then I noticed after I’ve been in New York for a month-and-a-half, I’m on the cadence of New York, and I’m just out and I’m kind of a psycho. And I’m just sort of like, you know, just rapid-fire caffeinated. And it’s incredible how the location dictates that. I mean, have you guys got into that? That’s a little woo-woo. I know that’s getting a little…I mean, you guys…

Dr. Perlmutter: Let’s go woo-woo.

John: Okay. Let’s go woo-woo. I mean, because you guys have a very science-backed book. That’s sort of this woo thing I’ve observed my whole life. What do you think about the role of actual just you take one human and you put them in location A, B, and C? How do you guys see that? I mean, what’s your view on all that?

Dr. Perlmutter: You know, I really don’t think this is that woo. The Dalai Lama said, “The brains we develop reflect the life we lead.” And who is going to contest the fact that if you live in New York, your brain and your behavior are going to be more similar to somebody living in New York than somebody living in Wyoming? We’re products of our environment. So there’s a lot of research suggesting that our exposure to nature changes the way that we perceive the world. There’s a study we talked about in the book where they basically wanted to see how impulsive people’s decision-making was. And before they gave them the test of impulsivity, they exposed them to one of three different sets of pictures. One set was photographs of nature. One set was photographs of urban settings, basically New York, right?

John: Yeah.

Dr. Perlmutter: And then one set was a control set, which was geometric patterns. And what they found is that after 10 seconds of looking at nature compared to the other 2, people were less impulsive with their decision-making, 10 seconds.

John: That’s incredible.

Dr. Perlmutter: So, imagine then the difference between 10 seconds of photos and actually going out into nature. There’s a fascinating study where they send kids out into nature for a few days, and they bring them back into the city, and they do a test on how well they can read other people’s emotional state based on their faces. How well can you interpret what the other person is experiencing? And they found that those who went out into nature compared to those who stayed in town had better understanding of what other people were experiencing.

John: Ooh, that’s a scary thought. As you get more stressed and as these parts of the brain light up with inflammation as you get more fearful, you’re losing your ability to actually read other people, right, get proper cues from them in terms of…yeah.

Dr. Perlmutter: And to be fair, you’re probably gaining something else. Like I said, you’re probably developing a brain that does stress really well, and I don’t mean well as far as your mental health but just like it’s set up for stress. And you think about what that might have meant back in the day. Let’s say you have a tribe of people and a couple of people are constantly exposed to stressors, they have that pack of saber-toothed cats encroaching on their territory or another tribe that’s constantly trying to sneak in and kill them all. Those people are gonna have brains that are very sensitive to stress, and so they’re always on guard against what might happen. Now, they may not live as long, but no one really lived as long anyway.

John: I love that one. They might die really soon, but they’re really good at handling stress.

Dr. Perlmutter: They may die of stress-related conditions, I don’t know, but what they probably are less likely to die of is getting eaten by that saber-toothed cat. So imagine now, you’re living in New York City. You need to be on guard because everyone out there is trying to honk at you and cut you off in traffic and take your lunch. Like that’s the way the city is set up. Everyone is out to try to improve their quality of life over other people’s life. So your brain is saying, “Okay. This is what we’re doing. I might as well become as good as I possibly can at this at the risk of long-term complications to your health.”

And I think as it relates to maybe more germane to this discussion, at the risk of your mental health, because we have this weird thing called consciousness where we’re capable of experiencing the way that we experience things. So what that means is, yes, your threat level is going to be…or your alarm system in your brain is gonna have a hair-trigger, and you’re gonna escape from that saber-toothed cat, or in New York, you’re gonna be able to get ahead a little bit but at the cost of feeling really crappy on any given day about what you’re doing with your life.

John: Yeah. Are you experiencing that? I mean, you’re coming from Florida, and I know your kind of happy place you’ve said is the Pacific Northwest, which is clean air and beautiful. I mean, the Pacific Northwest is one of those magical parts of the country. Do you experience that as you come into the city? You’re here for this conference. Like do you feel that right away? Do you feel what we feel in terms of just the energy just hits you and it makes you feel a little different?

Dr. Perlmutter: I think I have to have a general statement, which is the Pacific Northwest is horrible. No one should move there. Everyone should stay on the East Coast. But it is a really good point. Right now I’m living in Florida and in South Florida where things are actually still a little bit stressful. People down there are a different type of aggressive. Yeah. They’re not aggressive with purpose, you know, with the driving. They’re just trying to get from A to B fast and show off in their Lamborghinis. But as it relates to my time in New York, definitely, it’s a totally different dynamic. I look at this as incredibly energizing for short periods of time. I love having conversations like the one we’re having right now. I love walking around in New York when it’s cold out and you have a coffee, and you’re meeting with and talking with other people who are committed to growth.

John: Motivating. It can be…the energy motivates, doesn’t it? Yeah.

Dr. Perlmutter: Yeah. I would say that’s a good term. But I try to be cogent of the fact that these are things that are affecting my brain. So sitting in the hotel this morning trying to meditate, I was noticing that it was harder to get to that point of equanimity than in general.

John: Yes, it is harder to meditate in New York City. It’s funny you say that because I have noticed that 100%. I’ll go to a bunch of different places if I’m in San Diego. You know, I’m in San Diego a decent bit. I have noticed exactly that, much easier to get to that point in the meditation practice. I come back to the city, it’s not that it’s impossible, it’s just harder. It’s funny that you mentioned that specifically.

Dr. Perlmutter: Well, so this is kind of what meditation does, is it allows you to…I think I said cogent before…conscious of the fact that you’re maybe a little outside your comfort zone. This is the awareness piece, which is that we do a lot of stuff on any given day. I think people have said…well, a study has shown that about 40% of the time we’re doing kind of unconscious habits, and there’s data suggesting that around that amount of the time, we’re just mind-wandering, maybe default mode activation depending on who you listen to. And so meditation gives you, in theory, a little bit of a portal into understanding where your mind is at. There are so many metrics that people look at with regard to, let’s say, their A1C or the genetic profile or their inflammation levels. I think meditation, you get immediate feedback as to the state of your internal function at any given point.

John: You do.

Dr. Perlmutter: And so ideally, you then make adjustments, right? Or you say, “I need to tolerate this for a certain period of time, but here’s what I’m willing to tolerate.” Now, the problem is if you’re not meditating, then you’re no longer conscious of it, and then you get out of the habit, and you become a product of whatever environment you’re in, which in New York can be a problem.

John: Much more reactive. Yeah. Well, this has been a phenomenal conversation. I wanna end by asking you, you’re a new doc and, you know, one of the things that comes up in a lot of our conversations with nutrition is there’s this, you know, medicine recognizing nutrition, medicine recognizing lifestyle. I think we’re getting a sense of this having spoken to you for the last hour, but two-part question to close out. You mentioned A1C a couple times. What biomarkers do you think now that you’re out of medical school and you’re kind of thinking about wellness and things, because we nerd out on biomarkers, what biomarkers, two or three biomarkers do you think are the most important in terms of for you? Where do you wanna go with your practice? Where do you see yourself over the next few years? Like how do you wanna help out?

Dr. Perlmutter: So two good questions, first one more specific. You know, I think that trying to be as inclusive as possible with biomarkers is helpful because a lot of people out there don’t have access to the fancy tests. And I’ve done some work in functional medicine. I’ve done a lot more work in traditional offices and specifically in the VA where, you know, no one comes in there with a 23andMe. That’s just not happening. So, what can we use to get an idea of how the body is functioning with basic labs?

And as it relates to this book and as it relates to thinking, the big ones that we look at are markers of inflammation. What are our markers of inflammation? There are obviously a lot of them. I think the CRP is probably the best place to get started. A1C is also a marker of inflammation, which not everyone knows, but it’s not the most sensitive test necessarily for insulin sensitivity and all that, but it gives you an idea.

And then I’ve become fascinated as of late with interleukin-6. I’m not necessarily recommending that people get serum levels of iO-6, and what’s interesting about it is that it’s pro-inflammatory in certain cases, seemingly in the brain in chronic doses, and then in the muscle, it seems to be a myokine that has good effects, meaning that it helps to build muscle. But again, I would say going with CRP, A1C, and homocysteine, if you can get it, to give you an idea of inflammatory status.

You know, beyond that, I would say I’m more in favor of tests of people’s impulsive decision-making increasingly because trying to look at objectives with changing serum biomarkers is one thing, but giving people a visual of where they’re thinking is at is kind of another. So that kind of segues into your second question, which is where do I see myself going in clinical medicine. My sense, and hopefully people listening have the same sense, is that we’ve focused very little on how people make choices, good choices, bad choices, especially as it relates to medical outcomes. And we’ve focused all of our energy instead on treating the manifestations of poor decisions.

So if a person comes in with high blood pressure, you could say, “Well, this is due to a lifetime of eating bad food, not exercising, and having chronic stress.” Fortunately, there’s a drug that is going to activate or deactivate your angiotensin, right, fantastic, or maybe you have trouble with weight. Fortunately, we can do a bariatric surgery on you, or we can give you one of these medications that may lower your appetite. But what if we instead ask, “What are the decisions people are making 10, 20, 30 years beforehand or even in the moment?”

And as it relates to that, I think there’s so much work we can do with regard to these factors we’re describing today, which is how do you understand what’s programming your brain for poor decisions? Get rid of as much of that as you can and then bring in elements like nature exposure, exercise, certain dietary patterns, meditation that connect your brain up in a way that you will make good choices. And so taking that and bringing in aspects of other fields, so general psychology, people’s biases, but then also behavioral economics, understanding the subtle nudges that either move people towards good decisions or push them towards bad decisions.

And then the whole habit system gives us a framework for appreciating how people make decisions, and more importantly, how we can help them to make better decisions. So I see this as hopefully a role in educating providers about how they can incorporate this into their framework for approaching patients. So maybe it isn’t just the first visit we need to figure out how to get you to lose weight, but instead, let’s focus on how to get you to make better choices so you can get to the outcomes you care about. And then also in educating patients and the lay public about ways that they can go from making a whole lot of bad decisions to a couple of good decisions, which will put them onto a path of global better decision-making and, by the way, reduce their risk of developing these diseases of poor decisions, which include things like obesity, high blood pressure, cardiac disease, diabetes, the top killers of Americans.

John: Well, that’s great. I mean, I’m impressed on the habit side. You and I talked about it. It does seem that’s where things are moving with this whole army of health coaches that are kind of coming online, but it’s cool to hear, you know, an MD talk about that too and recognize just how important the decision-making process is. I’m very impressed by your mention of interleukin-6. We actually report on interleukin-6 as part of our histamine panel on the Gene Food nutrition plans, not to say that’s gonna give you a total picture of what interleukin-6 levels are, but it is a gene that we report on. So I was kind of a cheerleader for that.

Dr. Perlmutter: I’m bullish on iO-6.

John: Wow. Okay.

Dr. Perlmutter: And specifically I’m bullish on it because it seems to be one of the most consistent neuroinflammatory markers in that it seems to be involved with…we’ll go technical for a second.

John: Our podcast is very technical.

Dr. Perlmutter: Great. Well, what I’m really fascinated in right now is what actually happens in the brain that changes our thinking patterns, what actually happens in the brain that shifts us towards depression or anxiety? And we talked about these changes in these different parts of the brain. Okay. But it’s not like you experience something and then that part of the brain changes. There are messengers. There are all these other factors in play that would cause your brain to change the way that you think.

And what seems to be the case is that there is this unbelievable circuit, which probably starts in the microbiome and gut permeability, leading to increased inflammation, which then is transmitted to the brain. It’s both systemically through the bloodstream and also probably through the vagus nerve that then differentially activates microglial or immune cells in the brain such that they phenotype switch from arresting M0 state to an M1 inflammatory state, which then propagates inflammation in the brain and migration of these microglial cells to, oh, my goodness, the prefrontal cortex leading to the manifestation, which is something like depression or poor decision-making.

John: Is this like the enteric nervous system that we’re talking about here, essentially the…?

Dr. Perlmutter: Absolutely. That’s part of it with the idea that there is an entire nervous system in the gut. It’s a multi-faceted region down there in that there’s certain aspects of it that come from our own enteroendocrine cells in the gut, right? So those respond to whatever we put in, and they release hormones that then change, let’s say, your satiety or your appetite. But then, too, there are all these vagal nerve projections that get into the gut. They don’t go quite into the actual through the gut lining, but they receive input from these hormonal cells but also from the microbiome in the form of, you know, some of these microbiome products, these short-chain fatty acids.

But also, these bacteria can produce what’s called lipopolysaccharide, which is an inflammatory modulator which when injected into people induces depression, strangely enough. But these vagal nerve afferents, which is the fibers that go up to the brain, turn out to be a whole lot more than the ones going down. So it seems there’s a lot more information going from the gut to the brain than the other way around. So what I see is it’s the brain is sampling, right, from the environment through the gut, and it’s bringing that information up to the brain such that then the brain can adapt to whatever is going on in the world. And so you see how, you know, to put it all together, you eat foods that are bad for you, that perhaps leads to inflammation in the gut by way of altering your microbiome by way of opening up those cell junctions such that…

John: The greater production of zonulin. Yeah. One of the things we’ve nerded out on is uncleared histamine up-regulating zonulin production and that being a mechanism for leaky gut.

Dr. Perlmutter: Right. So zonulin, it is one of the central mechanisms of keeping those cells together. So, yeah, let’s say now you have a slightly more permeable gut. You have these inflammatory products getting through being sampled by your vagus nerve going into circulation, which then goes into your brain. And this is the fascinating thing because people still aren’t sure how the messages from the gut, or from the body I should say in general, get through the brain unless either the brain barrier, the blood-brain barrier is made more permeable, a leaky brain, unless there are receptors that suck in these signals and then send them out into the brain, or it could be going through, again, the vagal nerve, or it could actually be going through what’s thought to be the lymphatic system in the brain, right? So there’s a whole lot of ways that this information could get to the brain. But then it’s if we can understand how the information from outside of our bodies gets into our bodies, goes up to the brain, and then alters the cellular infrastructure, both by changing the populations of microglial cells but also potentially altering the nerve populations, the neuron populations.

John: And what I’m hearing you…because I know you talked about at the VA, and it’s very true, a lot of people don’t have access to these tests, but are you talking about something that would…the end result of here might be like a neuroendocrine panel where you’re testing for like glutamate, GABA…?

Dr. Perlmutter: Well, yeah, so that’s a good question. The problem with that is that levels of neurotransmitters in the serum don’t necessarily reflect levels of neurotransmitters in the brain where it actually matters, not with all of them I should say, which is why, you know, you don’t have a serotonin level even though you’re depressed. It’s not like people say, “Let’s find out if you’re depressed. Let’s measure your serotonin,” because who knows, right? You could have high serotonin in your bloodstream. There’s actually a disease that causes that. Those people aren’t necessarily happier.

John: Interesting. Wow. I love it. This is the stuff that we love to get on the subject matter experts for these types of conversations. I mean, so if the neuroendocrine panel just does…I know there’s a few people listening at home that are like, “Okay. This is really good information.” Is there a biomarker at the…? I mean, I know you can test for lipopolysaccharides as part of like basically like leaky gut panels that some of these companies will offer. Is this a thing where we need to just go more woo-woo, we just need to get a sense of how we’re feeling and pay attention intuitively? Or if you’re so inclined, if you’re super in the “biohack…” you know, the overused term the “biohacking” world. Is this something that you think is even valuable to test for on some level or is it just gonna cause more stress than…? What are the end biomarkers here that we can look forward to kind of try to identify where these issues are popping up?

Dr. Perlmutter: Well, I think it’s clear in certain conditions that there is this almost causal pathway between, let’s say, inflammation and depression, right? A lot of people have talked about how inflammation may cause depression at least in certain subtypes, which is inflammation-related depression. So, if you get a person’s CRP level, that may actually now predict people’s responsiveness to antidepressants.

John: Really?

Dr. Perlmutter: Yes. There is research being done in that. Similarly, though, you know, you might be able to see, based on people’s levels of CRP, how impulsive they’re going to be as decision-makers. There’s actually data suggesting that A1C predicts people’s levels of impulsivity. So, there are all sorts of ways to tie this together. And what I think will probably be my next kind of project is to see what are these biomarkers we can use and what are the more cognitive test-type batteries that we can use that enable us to get a feel for where somebody’s decision-making is at and then try to make interventions to improve that and then probably track some of these biomarkers, yes, but also track how they test on certain levels of impulsivity?

I think that there’s going to be an explosion of understanding of, you know, what happens in the brain that then correlates with different conditions and then how can you then measure something like LPS, something like TNF alpha that gives you a feel for what it is your interventions are doing? But what I would say for most people is, you know, get a sense for how you’re feeling, right? How are you generally doing? Because it may be that if what you’re experiencing is baseline anxiety, that you don’t need to necessarily measure anything in your serum to know if your anxiety is coming down. So if you have anxiety, just get a sense for where you’re at. It might even be as simple as writing a 1 to 10 anxiety level this morning and then tracking that and then putting in some intervention, let’s say meditation, which seems to help for anxiety. If that’s helping, if it’s lowering that, you don’t need to see, you know, anything more than that.

So maybe not as specific as you would have liked because I think we’re still early on as it relates to some of these cognitive issues, but I would say for the average person, understand that inflammation is linked to cognitive decline. It’s linked to depression. It’s also now being linked to impulsive decision-making. So interventions to lower inflammation are going to give you dividends when it comes to chronic disease management, when it comes to your mood, and also to your decision-making capabilities.

John: Yeah. And it puts a perfect bow on the whole conversation because, at the end of the day, a lot of people…these biochemical pathways aside, which are very interesting, people know that there are certain behaviors that they engage in, whether it’s drinking too much caffeine, whether it’s not getting enough sleep. I know that sometimes I’ll take a hit. I’ll go get a couple pieces of pizza. I’m not gonna feel great after I do that. You know, or I eat a bunch of bread. Just for me personally, I don’t feel great after I eat gluten. So a lot of people already know. It’s just a matter of getting the headspace through protocols like you guys are recommending to get a little bit of a safe distance to beat back some of those habits. And I think that’s…we all know what triggers us, I think, in a lot of ways.

Dr. Perlmutter: Yeah. I think it’s, again, there’s this delta between your current self and your future self and that future self could be 10 minutes later. It could be an hour later. It could be a year later. The goal is to try to bridge that gap just a little bit so you’re not always making these decisions that you’re regretting in the very near future. If you can push that out and say, “Let me just question how I’m gonna feel after I eat that pizza,” and bring a little awareness in, then maybe it’ll make it a little bit more likely that you don’t eat the pizza. And I’m not telling people don’t eat pizza. You can do that, but you should at least be aware of that decision. Don’t let that be an unconscious loop.

So what we’re talking about in this book is a protocol that will enable you to make better decisions, and that’s really what it comes down to is we’ve got the information. You’ve got these books. They’re sitting on your bookshelf. Everyone knows that they don’t need to be eating donuts. That’s not news to anyone. That’s not the problem, right? No one’s sitting out there saying, you know, “I don’t know if I need to exercise. Is the data conclusive that exercise is good for my health? I’m gonna wait. Let’s give it a few more years.” We know exercise is good, and most people probably know meditating a bit is good. It’s not that. It’s that we don’t do those things, right?

So how do you do that? You build a brain that enables you to make better decisions. This is a meta, right? This is looking at what it is that actually makes the decisions so that we’re not constantly sitting around blaming ourselves, which gets us nowhere, feeling like, “If only I had the willpower.” I just don’t think that’s the most productive way of doing things. And the reason for that is that’s what we’ve been doing for the last couple of decades. We’ve just been saying, “If only I had the information, if only I had the willpower, then finally I would get to, whatever, I would get to Equinox once in a while.”

John: I’m gonna try to go after this interview. It’s motivating me to go.

Dr. Perlmutter: But it may just be a walk around the block. The bottom line’s we know what we need to do. So what I’m saying is look at your brain as something that you can intervene on in order to make all the other things more likely. Don’t worry so much about forcing yourself to go to the gym. Instead, change the decision-making engine to make better choices more likely to happen.

John: Yeah. It’s a great message. That’s an important book. I really appreciate you stopping by. It’s been a ton of fun chatting with you…

Dr. Perlmutter: Absolutely.

John: …Dr. Austin Perlmutter, and we’ll be seeing you on Friday at the conference.

Dr. Perlmutter: Fantastic.

John: Thanks, man. The “Gene Food Podcast,” is our attempt to synthesize the latest developments in the fields of genetics, nutrition, and medicine and offer you practical tips and stories you can use in your own unique health journey. If you enjoyed this podcast, you can find more information online at

John O'Connor

John O'Connor is the founder of Gene Food, a nutrigenomic startup helping people all over the world personalize nutrition. John is the host of the Gene Food Podcast and a health coach trained at Duke's Integrative Medicine Program. Read his full bio here.

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