Blood Sugar

#163: David Perlmutter, MD – Gut Bacteria, Carbohydrates and the Ketogenic Diet

by Mike Mutzel

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About David Perlmutter, MD

David is a board-certified neurologist and a Fellow of the American College of Nutrition. He was the recipient of the Linus Pauling Award for his innovative approaches to neurological disorders. With his books now published in twenty-seven languages, Dr. Perlmutter is setting new standards for what healthy lifestyle means around the world. He is the author of the New York Times bestsellers Grain Brain, The Grain Brain Cookbook, and Brain Maker, as well as The Better Brain Book and Raise a Smarter Child by Kindergarten. He lives in Naples, Florida.

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Interview Show Notes

02:07 Carbohydrates: Some carbohydrate based foods are fiber rich and good for you. Carb consumption, especially simple sugars, in modern diets is way over the top. It does terrible things to our metabolism, challenges our insulin sensitivity, and changes our gut microbiome.  In the late 1960s, the powers of the sugar industry influenced what was being published in the New England Journal of Medicine. This changed the dietary recommendations made by government agencies, which changed the diets of Americans and people around the world, and lead to a profound increase in chronic degenerative conditions. It probably lead to more premature deaths than WWI and WWII combined.
03:44 The Problem with Carbs: The dietary change to increase carbohydrates was profoundly negative, instigating changes in blood sugar and our ability to regulate our blood sugar, implicating insulin. This dietary change paved the way for people to begin eating food that had very little nutritional value. No fat or low fat foods became preferential. Fats, now avoided, are fundamentally critical to human health and disease resistance. The WHO now puts chronic degenerative conditions at the top of the list of causes of death in humans worldwide. Chronic degenerative conditions are lifestyle induced and nutrition has the largest impact.

05:29 Eating for Your Microbiome: Carbohydrates, fats and proteins have value. The type of protein is important: grass fed beef vs GMO antibiotic laden beef. Carbohydrates should be fiber rich and nutrient dense, providing prebiotics for your microbiome. This includes jicama, Mexican yams, dandelion greens, garlic, onions, leeks, and asparagus. These are mostly digested by our gut bacteria. Our bacteria then replicate, make vitamins, have a roll in neurotransmitter production, balance our production of vitamin k and b vitamins, and help to keep our gut epithelium intact – reducing permeability of the gut lining which is fundamental to the process of inflammation.

06:55 Chronic Degenerative Conditions: Coronary artery disease, diabetes, Alzheimer’s, and cancer  are inflammatory disorders and have a direct relationship to what goes on in gut. This means that they had a direct correlation to the foods that we eat.

07:44 Fat is Blamed: To deflect sugar as the detrimental component in our diets, fat was blamed and the low fat/no fat diet was created. Avocados, seeds and nuts contained fat and were restricted. Fat rich foods emulate what we have eaten for thousands of years. Fat was traded for low nutrient density carbohydrates.

09:00 Gut Bacteria Diversity: FMT (Fecal Microbial Transplant) has been published in medical literature for 50 years or more. Delivering probiotics or fully formed microbiota via the rectal route offers huge potential. Today, more than 500 hospitals in America perform FMT for the treatment of C. diff. C. diff can be contracted via the use of acid blocking drugs or the use of antibiotics, both of which disrupt the complexity and diversity of your gut microbiome. The success rate of FMT for C. diff is 94 to 96%. The approved standard treatment with antibiotics is about 26 to 28% effective.

10:07 C-Sections: Maria Dominguez-Bello at NYU Medical School has published a series of papers. The most recent of which in the journal Nature, where she has advocated putting a swab in the vaginal birth canal prior to a C-section and mandatory intravenous antibiotics, keeping the swab in a warm moist environment. After the baby is born, inoculate baby’s face and mouth with the contents of the birth canal. These are the seeds for the microbiome. There is persistence of these specific organisms when the child’s stool is checked many months out.  One third of births in America are C-sections, depriving the child of the balanced setting of baby’s immune system. People born via C-section are at a dramatically greater risk of type 1 diabetes, celiac disease, ADHD, autism and obesity.

13:30 High Fat in the Research: Research which showed that a high fat diet altered the microbiome in laboratory animals, utilized a high fat/high sugar diet. The benefits of introducing higher levels of fat into your diet are erased or made worse if you don’t cut sugars and low fiber carbs.

16:18 Oral Microbiome: Studies of the oral microbiome of our ancestors found two dramatic times when there were changes: 10,000 years ago and 200 years ago. These correlate with the development of agriculture and the development of processed sugar. The reduction of diversity in our microbiome is passed down to the next generation. Genetic shifts are trans-generational and even skip a generation. We control our genetic destiny. Our microbiome influences our genetic expression as well.

19:00 Butyrate: There are series of short chain metabolites that have influence. The ribosomes within our cells influence genetic expression in a number of ways. We used to say that butyrate is the preferred fuel of the colonocyte. We now know that butyrate is a critically important product of some of the bacteria that live within us. It regulates gut permeability. It is a messenger molecule with significant epigenetic activity. It even seems to regulate the permeability of the blood brain barrier.

21:46 Trimethylamine-N-oxide (TMAO): It is a bacterial metabolite that some research may have connected to increased risk of coronary artery disease.  TMAO is a manifestation of a certain bacterial milieu of processing carnitine. The bigger picture is how these things are viewed by the microbiome. Eating meat is a quality issue. It is not fair to talk about meat consumption, but not differentiate between meat from grass fed cattle and cattle that have been fed GMO pesticide laden food and or treated with antibiotics. Antibiotics make animals fatter by changing the microbiome.

25:33 Testing for Glyphosate: The FDA has indicated that it will test for glyphosate residue in our food. Glyphosate is the largest used herbicide on the planet. It is estimated that next year 1.35 million metric tons of this poison will be sprayed on the food we eat.

26:53 Ketogenic Diet: The ketogenic diet appeared in medical literature in the 1920s as a cure for epilepsy. Humans have been on some version of ketogenic diet for over 2 million years.  They didn’t have carbs. There is much research being done on ketogenic diets and weight loss, activating gene pathways to reduce inflammation, to amplify mitochondrial health and reduce free radical production. The ketogenic diet can be used as a therapeutic intervention for cancer (Cancer as a Metabolic Disease by Thomas Seyfried). Ketones are the preferred fuel of the brain. Glucose is highly toxic for the brain. The more your blood sugar goes up (even abnormalities as low as blood sugar levels of 105 or 110), the greater your risk of Alzheimer’s disease/dementia. Normal is average, but not optimal. The ketogenic diet optimizes dietary lipid profiles and markers of inflammation like C-reactive protein.

31:25 BDNF: BDNF (brain derived neurotropic factor) is like growth hormone for the brain. It plays a role in the growth of new brain cells, the way the cells connect (neuroplasticity) and the way that our synapses form (synaptic plasticity). We want lots of BDNF. People with the lowest BDNF have the highest risk for developing dementia. Intermittent fasting and going into a state of ketosis promotes BDNF. Aerobic exercise for 20 minutes per day, increasing heartrate, bumps BDNF levels and increases growth of cells in the brain’s memory center (hippocampus). Turmeric increases BDNF and decreases mental decline. DHA omega 3 has a significant role in increasing BDNF. Those of us with the highest levels of DHA have the lowest risk of dementia. Whole coffee fruit extract has been researched for upregulating BDNF and will probably soon be available as a product. There is no prescription way to increase your brain’s memory center size and functionality and make you more resistant to dementia.

36:40 Stop and Connect: Gratitude and mediation are part of Dr. Perlmutter’s recommendations. Stop and connect, whether it be prayer or formalized meditation. Disassociate from what is going on around us allows us to bring knowledge into our bodies and connect with ourselves. This is a profound moment of the day. There are huge and measureable benefits in deterring the disease process. It is something that humans have always done, along with intermittent fasting, sleeping well, and being physically active.

38:21 Dr. Perlmutter’s Morning Routine: He does not eat breakfast, though he does not advise that for everyone. He exercises aggressively and then meditates, giving gratitude in the morning. Distancing yourself from negativity is important. He also writes something in the morning, whether it be a book, a scientific paper or poetry. Many of the things he writes are created during exercise. There is a lot of creativity produced during exercise. He also plays guitar every day.

40:48 Dr. Perlmutter’s Favorite Nutrient: Magnesium is his choice. It is a pivotal cofactor in more than 300 fundamental enzymatic systems in human physiology. It plays a role in how we manufacture DNA, RNA, protein, the basics of oxidative phosphorylation and how we make energy from the food we eat. More than half of Americans are getting less than the RDA, which is already low.

41:33 Dr. Perlmutter’s Elevator Pitch: The WHO is pushing the envelope, telling us that chronic disease is threatening the health around the planet and is calling for a global tax on sugar-sweetened beverages. WHO determined that glyphosate, the active ingredient in Roundup, is a probable human carcinogen.

42:45 Book Bonus Material: There is a free download on Dr. Perlmutter’s website from his public television program, Brain Maker, which dealt with gluten, carbs and sugar.

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  1. Hi Mike, great episode!
    You mentioned the workshops you are doing at the beginning of the episode and that you would provide links in the show notes, I don’t see them? I would have loved to have come to the Vancouver one, so sorry to have missed that! Where can we find more info on the upcoming events and also replay?
    Thanks, Julia

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