Grain Brain: Perlmutter

Dr. David Perlmutter, MD, is a board-certified neurologist and a Fellow of the American College of Nutrition, as well as a leader on the use of alternative treatments to neurological disorders according to Dr. Mehmet Oz. Grain Brain: The Surprising Truth About Wheat, Carbs, and Sugar -- Your Brain's Silent Killers pretty much sums up what the book is about! Dr. Perlmutter's appreciation for the value of restricted grain diets came through success in treating his patients, despite the conventional wisdom of the "value" of whole grains to dietary health.

Here are some questions Dr. Permutter's began to ask himself as he came to the above realizations:

• Why did his patients get sicker when he recommended the "healthy" diet of carbohydrates and polyunsaturated vegetable oils?
• If a (small) percentage of the population found wheat, barley, and rye to be catastrophic to their digestive systems (i.e., celiac sufferers), what might be the impact on the rest of us?
• What is the link that often ties disorders of the brain to diabetes?
• Why do recent studies link increased longevity to high (i.e., "unhealthy") cholesterol levels?

Clearly, many of the dietary recommendations that we've been getting from the medical establishment are, at best, incomplete. Dr. Perlmutter presents his perspective from his medical practice and a host of supporting clinical studies.

Here are some factoids to whet your appetite:

• To a large extent, neurological conditions of the brain are dietary in nature. Dr. Perlmutter describes Alzheimers as "Type 3 Diabetes."
• Although there are genetic components to both Type 1 and Type 2 diabetes, it is becoming increasingly clear that the environmental factors are more important than previously thought. Type 2 diabetes (previously referred to as "adult-onset diabetes" until it became epidemic in young people as well) is considered completely controllable and reversible if caught early enough through dietary and lifestyle changes. 
• As with coronary artery disorders, many if not most neurological disorders are strongly influenced by high levels of circulating glucose in the blood stream over prolonged periods of time.

We know that Type 2 diabetes is caused by insulin resistance -- the inability of our cells to respond to the overproduction of insulin in response to the over consumption of carbohydrates over time. This insulin resistance produces an upward spiral of poor blood sugar regulation, damage to the pancreas (that produces insulin), and eventually, cardiovascular events, stroke, and/or neurodegenerative diseases such as Alzheimers.

So what does this have to do with grains, especially "healthy" whole grains -- in particular wheat? There's a host of evidence contradicting the idea that whole grains are good for most of us, but the following two facts are the most compelling:

Fact 1 The wheat we eat today (Borlaug dwarf wheat) is NOT the wheat eaten by our grandparents nor the wheat discussed in the Bible (einkorn and emmer wheats). Although it can be argued that 10,000 years of human agriculture has not been enough time to adapt our genome (i.e., DNA) to grains, it's largely irrelevant since the wheat we eat today was created in the 1950's in a research project in Mexico, sponsored by the U.S. government. The goal to eradicate world hunger through developing a more highly productive, more disease resistant strain of wheat was largely realized, but without studying the long-term impact on our overall health. Borlaug dwarf wheat, with 42 chromosomes vs. 28 for emmer vs. 14 for einkorn, is as different as pigs to humans -- even more so!

Fact 2 The key issue with insulin resistance is glycemic index -- the level of glucose response in our blood caused by various foods. GI's are referenced against pure glucose with a GI of "100" -- the lower the better. Although we are led to believe that "healthy" whole-grained wheat would have a "good" GI, it is just the opposite. While table sugar has a GI of 68, a Snickers candy bar a GI of 55 and a banana a GI of 54, whole wheat bread tops the charts at a GI of 71. If you track the rise of wheat as a percentage of the Standard American Diet ("SAD") as Dr. Perlmutter reports in Grain Brain, it strongly suggests that wheat is the cause of the majority of our modern dietary and health problems -- especially the obesity epidemic.

But GI is just the beginning! The other major issues discussed in detail in Grain Brain are:

• Gluten allergies Gluten is Latin for "glue." Gluten is a set of sticky proteins in wheat that give it the desirable properties valued by bakers and processed food manufacturers, used to hold processed foods together. Unfortunately, many of us (estimates from 50% to over 90%) have allergic reactions to ingesting the gluten proteins -- glutenins and gliadins. Daily consumption of wheat results in a chronic immune system reaction to those proteins, resulting in auto-immune diseases such as arthritis, celiac, MS, and many more where the over-stimulated immune system attacks and destroys healthy body tissues such as ligaments and cartillage, bone tissues, organ tissues, skin, etc. Modern wheat has forty times the gluten of grains cultivated just a few decades ago.
• Glycation Glycation is a chemical process whereby sugars bind to other metabolic substances such as proteins and fats, potentially reducing their biologic value -- or worse. Glycation is the cause of the widely publicized plaques that are the principal problem in Alzeimer's and similar diseases of the brain. Although the body has the capacity to "unglycate" proteins under normal circumstances, the accumulated stress caused by years of uncontrolled blood sugar levels overwhelms its ability to do so.
• Chronic inflammation Although an important metabolic process, inflammation that is chronic and systemic places undo stress on the body, forcing the our organs to mediate the resulting stress levels. Chronic inflammation can result in organ failure and contributes to auto-immune problems.
• Leaky gut syndrome Gluten has been shown to be the cause of the leaky gut problem that characterizes celiac disease. Leaky gut allows toxins normally blocked by a healthy gut to "leak" into the bloodstream, resulting in serious immune system responses. It has been shown that many individuals with leaky gut do not exhibit celiac antibodies, but still suffer similar metabolic abnormalities. 
• Cholesterol There's not enough space here to review the details behind our misguidance on cholesterol; you'll need to read Grain Brain to fully appreciate them! Cholesterol is the basis for all hormonal systems in our bodies and insufficient hormonal levels results in sub-optimal health. LDL cholesterol, in particular, is not bad but is good. The "issue" with LDL and VLDL cholesterol is around oxidized and/or glycated cholesterol -- issues avoided with healthy blood sugar levels, promoted by low glycemic index diets. Current studies indicate that people live longer with higher cholesterol levels when dangerous statin drugs such as Lipitor are avoided. 
• Dietary Fats Like cholesterol, our understanding of the value and impact of dietary fats has been almost 100% wrong for several decades. Scientific hubris in thinking we were smarter than nature without a complete understanding of the complexities involved is notable. Now that we are just beginning to understand, some key take-aways are: (1) serum fat levels are primarily caused by dietary carbohydrates -- not dietary fat -- since the liver produces 4 times the amount of fat we ingest on a daily basis; (2) much maligned saturated fats comprise 50% of the cell walls in every cell in our bodies and are critical to proper cell protective mechanisms; and (3) polyunsaturated fats in cooking oils from vegetable sources (i.e., corn oil, etc.) are unhealthy and should be replace with coconut or palm oil.
• Excess Body Fat Any discussion of health issue would be negligent without consideration of the obesity epidemic in the developed nations. Despite the efforts of many people that watch what they eat and exercise (often excessively), they cannot shed excess body fat -- especially the more dangerous visceral body fat. Recent evidence shows that fat cells are not just store-rooms for fatty acids and triglycerides, but active organs that generate hormones affecting the entire system. Excessive body fat contributes to insulin resistance and the production of inflammatory chemicals linked to cancer, autoimmune disorders, and brain disease. Excess body fat is shed naturally with a ketogenic or paleo diet -- see below.
• Neurogenesis We were taught that brains cells do not regenerate, but that myth has been dispelled in the past decade. As a neurologist, Dr. Perlmutter was particularly interested in a recent finding based on brain-derived neurotrophic factor, or BDNF. BDNF is a protein expressed by a gene on chromosome 11 -- a key to "neural plasticity" -- which when activated, can reverse memory decline in the elderly. Several things can cause the BDNF gene to activate: (1) exercise; (2) following a ketogenic (i.e., fat-based) diet; (3) calorie restriction; and (4) certain nutrients such as curcumin and the omega-3 fat DHA.
• Anti-Oxidants Everyone is aware of the importance of anti-oxidants. The simple act of living involves production of incomplete chemical reactions that produce free-radicals -- highly reactive, unstable molecules that if left unresolved, will damage body tissues and DNA. We know that ingesting adequate "anti-oxidants" helps us to resolve these issues -- issues that occur in the mitochondria in every one of the trillions of cells in our bodies. The exciting new-news is the discovery of the nrf2 protein, which turns on anti-oxidant and detoxification pathways in the cell nuclei. Activation can be triggered by oxidation of DHA/EPA, calorie restriction, and dietary sources of curcumin (turmeric), green tea, silymarin, bacopoa extract, DHA, sulforaphane (from broccoli) and ashwagandha.

The Modern Paleo Diet

So, operationally, what can we do with the above information? I think the easiest way to summarize is by understanding the concept of the modern, paleo diet. Paleo diets are not new, having formed the basis for the Atkins diet popularized (and daemonized!) in the 1970's. What's new is our improved understanding of why the paleo diet has been successful for many people and why it is in fact, a healthy diet! Some paleo advocates resist the "diet" label, insisting that paleo is a template for proper eating. "Diet" seems to imply a prescription, while "eating paleo" can be and should be personalized.

The simple idea behind paleo is to think about what foods our ancestors had access to prior to the advent of modern agriculture -- a recent event occurring just 10,000 years ago! Since it takes about 40,000 years for our genome (DNA) to adapt to changes, many modern, man-induced dietary changes are incompatible with our genome. The introduction of grains in the last 10,000 years has not given us time to adapt -- especially the addition of massive amounts of gluten into the Standard American Diet at levels not seen until recently.

For two million years, animal products dominated our "paleo" dietary intake with fats and proteins comprising 60-100% of our calories, depending on the season of the year. Vegetables were often not available in the colder seasons and fruits were used to "fatten up" at the end of the growing season in preparation for winter. The "modern paleo diet" is based on 60% good fats (no man-made transfatty acids like hydrogenated vegetable oils or oils corrupted by frying), 20% good protein sources (preferably grass-fed animals and mercury-free fish!), and lots of fresh (and fresh frozen) vegetables. Although whole fruits (not juices) are healthy, the impact of high fructose levels places a demand on the liver that should be minimized; hence, one apple a day keeps the doctor away -- not a lot more! High-fructose corn syrup is a manufactured toxin that should always be avoided.

Thanks to modern medicine, we are living longer, more productive lives. We are on the cusp of major improvements to the quality of life based on our new understanding of the genome and proteome. The most recent breakthroughs have been occurring in our proper understanding of diet and its impact on health. I do not believe it is an overstatement to say that improper diet and health-style is the cause of the major diseases/conditions affecting life in the developed nations today. The major causes of death -- heart disease, stroke, and diabetes -- are preventable -- a case well-documented in Grain Brain. 

Hopefully, the summary presented above will catch your attention. If you've weary of being innundated with yet another trendy idea on how to eat, please do not stop here. I've been on a quest to understand the impact of nutrition and diet on our health for two decades -- as confused as everyone else -- and I believe firmly that we are now beginning to make true progress. Grain Brain is one very good example of an excellent blend of science that we can understand with common-sense advice on how to work our way to a dramatic improvement in our quality of life. I personally have been practicing some of these ideas for years with very beneficial effects, but without understanding the science behind them. I am now more motiviated to continue based on this new understanding of our species! If you are intrigued, I would highly recommend that you read Grain Brain.

Another key book published in 2013 on the topic of wheat auto-immune issues was Wheat Belly, written by a cardiologist with similar experiences to Dr. Perlmutter in his practice. Click here to compare notes!