The Doctor's Farmacy with Drs. David and Austin Perlmutter

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Episode 91
The Doctor's Farmacy

The Brain Science Behind Social Conflict And Depression

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We’re living in a more divisive time than ever before. I’m not just talking about politics—we’re at aggressive odds over everything from diet (vegan versus Paleo) to sports and we’re even seeing an escalation in road rage. 

There’s actually a reason this is happening. We’re disconnected. Social media is actually isolating us; we ignore the importance of sleep and nature; stress is at epidemic proportions. These lifestyle disconnects cause structural and functional disconnects in the brain that lead to more divisive and angry behavior. Our ability to make good decisions pretty much goes out the window. 

But it’s not too late to reverse these negative effects. I was so excited to sit down with my good friends Drs. David and Austin Perlmutter on The Doctor’s Farmacy to talk about these modern challenges and how we can detox the brain to restore better decision making and overall health. 

We dive into our conversation by gaining a deeper understanding of how stress impacts our decision making. In all its many forms (overworking, undersleeping, poor food choices, etc.) stress leads to inflammation. Inflammation actually kills the brain cells that help us make good decisions, and it makes those in the fight or flight part of the brain grow. This leads to anger and opposition and supports the negative behavioral changes I mentioned earlier. 

There’s also another impact: structural changes of the prefrontal cortex and the amygdala, leading to an increased state of “us versus them” thinking.

The really good news is that the things we can do to stop this are mostly free strategies that take us back to our more natural state. Limiting social media and internet time and using them more mindfully. Getting movement and spending time outside. Prioritizing good, deep sleep. Avoiding sugar. And there’s so much more we can do. 

Learn more about the book Brain Wash at David and Austin Perlmutter walk us through the solutions for modern brain challenges in this week’s episode.  I hope you’ll tune in. 

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I hope you enjoyed this conversation as much as I did. Wishing you health and happiness,
Mark Hyman, MD
Mark Hyman, MD

In this episode, you will learn:

  1. How the prefrontal cortex acts as the adult in your brain
    (7:37 / 11:56)
  2. The way in which chronic stress rewires your brain and affects empathy and decision making
    (10:09 / 14:28)
  3. Regaining control of the ways in which our brains are being manipulated by media
    (13:56 / 18:15)
  4. How making bad food decisions affects the brain, drives inflammation, creates depression, and leads to more unhealthy decision making
    (23:20 / 27:39)
  5. How excessive social media use affects the brain
    (30:25 / 34:44)
  6. The fundamentally important and underrated role of sleep on the brain
    (38:38 / 42:57)
  7. Removing blame from our inability to make healthy decisions
    (44:08 / 48:27)
  8. Why healthcare providers need to reframe their perspective and approach to working patients who do not follow through with lifestyle changes
    (48:08 / 52:27)
  9. How Inflammatory food perpetuates impulsivity, aggression, and violence
    (57:10 / 1:01:29)


Mark Hyman, MD

Mark Hyman, MD is the Founder and Director of The UltraWellness Center, the Head of Strategy and Innovation of Cleveland Clinic's Center for Functional Medicine, and a 13-time New York Times Bestselling author.

If you are looking for personalized medical support, we highly recommend contacting Dr. Hyman’s UltraWellness Center in Lenox, Massachusetts today.

Dr. David Perlmutter

Dr. David Perlmutter is a Board-Certified Neurologist and four-time New York Times bestselling author. He serves on the Board of Directors and is a Fellow of the American College of Nutrition. He serves as a member of the Editorial Board for the Journal of Alzheimer’s Disease and has published extensively in peer-reviewed scientific journals including Archives of Neurology, Neurosurgery, and The Journal of Applied Nutrition. His books have been published in 34 languages and include the #1 New York Times bestseller Grain Brain, The Surprising Truth About Wheat, Carbs and Sugar, with over 1 million copies in print. Dr. Perlmutter’s new book Brain Wash, co-written with his son Austin Perlmutter, MD, was just released on January 14, 2020.

Dr. Austin Perlmutter

Dr. Austin Perlmutter is a board-certified internal medicine physician. He received his medical degree from the University of Miami and completed his internal medicine residency at Oregon Health and Science University in Portland Oregon. His academic focus is on understanding the decision-making process, how it is influenced by internal and external factors, and how it changes our health and illness outcomes. He is also interested in methods of improving burnout and poor mental health in the medical field. He writes for Psychology Today on his blog, The Modern Brain.

Transcript Note: Please forgive any typos or errors in the following transcript. It was generated by a third party and has not been subsequently reviewed by our team.

Dr. David Perlmutter: The westernization of the global diet is threatening our behavior, threatening our decision making and fostering an us versus them mentality that is pervasive around the world.

Dr. Mark Hyman: Welcome to The Doctor’s Farmacy. I’m Dr. Mark Hyman, and that’s farmacy with an F, a place for conversations that matter. If you care about your brain, if you care about decision making, if you think you are being brainwashed by our culture and the media and digital media, then this conversation is going to matter to you because it’s with none other than my good friend from decades and decades, Dr. David Perlmutter of the Grain Brain Fame. Before he was the Grain Brain doctor, he just was the neurologist that I would go to for anything and everything that had to do with anything regarding anything because he’s so freaking smart. He’s got an amazing heart, a deep soul. I just been honored to call my friend for all these decades and he’s taught me so much.

Dr. Mark Hyman: When I was very sick, he helped me do things and helped me get better. David, thank you so much for being on the podcast. David’s a board certified neurologist. He’s a four time New York Times bestselling author. He’s the Board of Directors and as a fellow of the American College of Nutrition. He went to the University of Miami Medical School. He got lots of awards and he’s on the editorial board of the Journal of Alzheimer’s Disease. He’s published extensively in many journals including neurology, neurosurgery, the journal of applied nutrition. He lectures all over the world. He’s gone to the World Bank, the International Monetary Fund, Columbia Scripts, New York University, Harvard University. He’s killing it. His books are in 34 languages including the number one New York Times bestseller that was on the list for a long, long time published in 34 languages. Amazing. Grain Brain, The surprising Truth About Wheat, Carbs, and Sugar with over 1 million copies in print.

Dr. Mark Hyman: He’s the editor of the upcoming collection, The Microbiome and The Brain that’s going to be authored by top experts in the field. His new book with his son, Austin, is called Brain Wash and it was just released in January 2020. And David, this is I think one of the most important books you’ve written because without fixing the things you’re talking about in this book, it’s going to be hard to do everything else you’re asking people to do or that I’m asking or that anybody wants to do to change your life. Thank you, David.

Dr. Mark Hyman: Austin, I’ve known you for a long time. I’ve heard about you since you’re a little baby boy, but now you’re a doctor. You are a board certified internal medicine doctor. You went to the University of Miami following your dad’s footsteps, I guess.

Dr. Mark Hyman: You did your residency in Oregon, a health and science university in Portland. Your academic focus is on the decision-making process and how it’s influenced by internal and external factors. How it changes our health and our illness outcomes because our decisions determine our health. That’s true, right? Without your decision making fixed, all the rest of it doesn’t matter, right? You can decide you want to eat better and exercise unless you have the right decision making apparatus. It’s not hijacked, which it has been. We’re going to talk about that. You can’t make those good decisions. You are debuting with this book, Brain Wash, right?

Dr. Austin Perlmutter: First one.

Dr. Mark Hyman: Mazel tov. He’s also interested in methods of improving burnout and poor mental health in the medical field. Because, yes, doctors are among the most stressed, high suicide rates, drug use, et cetera. It’s pretty bad. Welcome to The Doctor’s Farmacy, David and Austin.

Dr. David Perlmutter: We are delighted to be here, that’s for sure.

Dr. Mark Hyman: Okay. That’s half the podcast. I’m so excited about this book. You really made a cultural impact with Grain Brain helping break through the confusion about what’s the deal with wheat and grains and brain function and overall health. Your book brainwash is a little bit different because its subs, it’s upstream. It deals with the cause of why we get to where we’re getting to with our decisions and how our modern world threatens our ability to make good decisions. Life presents us with all sorts of opportunities and all sorts of temptations, which I certainly am pulled by every single day when I pick up my phone, whatever we can eat, when we want, we can eat whatever we want, wherever we want. We can have vast, exciting amounts of digital media that can take up all of our day. I had a friend once, I was sitting in an event lecture with her and she was on her phone calls and I said, “Give me your phone.”

Dr. Mark Hyman: I went to a screen time button and I opened it and said a thousand pickups in the day. I was like every 30 seconds she’s picking up her phone. How that affects our decisions, our concentration. We can buy goods and services come overnight and we’re in New York you can get a drone delivery practically. You can have some in five minutes delivered to your apartment. This 24/7 hyper-reality poses real risk to our physical and mental states and our connections to other people because we’re losing our social networks by being on social networks which is a real problem and it even disconnects us from the world at large. How has our health, our relationships, and even our thinking being damaged by modern culture in a word or two? You can think as long as you want.

Dr. David Perlmutter: We’ll be right back. I think that you well-characterized it by saying this is top order kind of attention that we need to spend. It doesn’t matter what advice people get. Whether they read my book or your book or all the wonderful books that our colleagues are putting out it. We don’t suffer from a lack of information. We suffer from a lack of action and that’s what this book is all about. It’s about regaining control over that process that you mentioned, the process of decision making. All of our chronic degenerative ills that plagued the world today are really a result of poor decision making of more impulsivity. Catering to those types of foods that we know we all would want those sweet foods, highly processed foods that are palatable, hyper palatable that are designed really to hack into our primitive desires.

Dr. David Perlmutter: We know what makes for a good lifestyle choices. We know we should exercise, we know we should pay attention to the amount of sleep and the quality of sleep that we get. Most of us know that meditation happens to be a good thing that we should get out and exercise, reconnect with nature but unfortunately so many of us don’t do that. And you know, one of the revelations that we had in the book was that we as healthcare providers, and this is what God, Austin and I started on this path, tend to blame our patients for not following through. We go to campus-

Dr. Mark Hyman: Yeah. I told what to do to get better. Why didn’t you just do it?

Dr. David Perlmutter: Exactly. We go to campuses, we read the books. We get our CMEs, continuing medical education. We learn as much as we can.

Dr. Mark Hyman: You mean our CPEs.

Dr. David Perlmutter: Whatever that may be.

Dr. Mark Hyman: Continuing Pharmaceutical Education

Dr. David Perlmutter: Right. Well, basically, yeah. Didn’t you hear me say that? Then we transmit that information as best we can verbally to our patients, through written media, et cetera. Then the ball was dropped and we accuse our patients, why don’t you follow through, and beyond that people are doing a self-blame thing, “Why did I drop my new year’s resolutions? I know I should be following Dr. Hyman’s advice and eating this and not eating that.” Yet they don’t follow through and it’s not necessarily their fault. When we recognize through many of the things you’ve mentioned that in our modern world, the deck is stacked against us.

Dr. Mark Hyman: Yeah. How does it affect our thinking and our decision making? How does that work?

Dr. Austin Perlmutter: Absolutely. What we’ve learned a lot in recent years about what actually goes into decision making and it’s really complex. It’s this field called Neuroeconomics.

Dr. Mark Hyman: Wow. Neuroeconomics.

Dr. Austin Perlmutter: Yeah. It’s a relatively nascent field but what we now understand is as it relates to decision making. There are a couple of core pieces we can pull out and that is the prefrontal cortex which is the front most part of the brain, one of the most recently developed parts of the brain. It turns out to be absolutely essential in allowing us to make good, well thought out decisions. To put that into a little bit easier to understand context, the prefrontal cortex is like the adult. It allows you to weigh the pros and cons to think about what are the long term outcomes of these decisions. You really want that prefrontal cortex to be activated to allow you to think through your actions. Now on the other hand, there are other parts of the brain that do great things for us. These include parts of the brain like the amygdala and the general reward circuitry, they’re essential.

Dr. Mark Hyman: That’s like your ancient fight or flight reactive brain.

Dr. Austin Perlmutter: Exactly.

Dr. Mark Hyman: Unless the frontal brain goes and, “Hey, wait minute guys, shut up. It’s not so bad. You’re not going to die. This is okay.”

Dr. David Perlmutter: It’s the adult in the room.

Dr. Mark Hyman: Right. The adult in the room, the adult in the brain.

Dr. Austin Perlmutter: That’s really it. Again, it’s a complex system. If you can understand a couple of the big parts of this decision making apparatus that is the brain, then you can understand how certain aspects of it, again, that more reactive, more primitive part of the brain can be targeted by marketing, can be targeted by these hacks into your more primitive brain to keep you making these impulsive short term decisions that then lead to all of these problems we see in the world. These preventable chronic diseases, high rates of anxiety, high rates of depression.

Dr. Mark Hyman: Political division and divisiveness and violence and oppression.

Dr. Austin Perlmutter: Exactly.

Dr. Mark Hyman: What you said just really struck me, Austin, because we are living in a culture where we’re in constant conflict. I’ve never been alive and I’ve been alive 60 years in a time where there’s so much divisiveness, so much opposition, so much hatred whether it’s between Republicans and Democrats, white supremacists and black like me folks, or whether it’s between vegans and paleos. It’s like what is going on. We are so in conflict and why is our frontal lobe not kicking in? How has our culture, the digital media, the food we’re eating and other stress factors hijacking our ability to make decisions and damaging our frontal lobe connection?

Dr. Austin Perlmutter: Well, let me speak to the stress piece first. I think probably you want to talk about inflammation as a fundamental piece of this too. We all know chronic stress is a problem in our lives. No one’s out there looking for more chronic stress. Now what we understand is that chronic stress disables the prefrontal cortex. When you look at these animal models, you see that the neurons in the prefrontal cortex shrivel up when they’re exposed to chronic stress. On the other hand, in the amygdala they expand. You get more dendritic branches. It creates more connection in the amygdala where you don’t want that. In essence, being exposed to chronic stress is rewiring brains to favor the types of activities that create chronic stress. Again-

Dr. Mark Hyman: Sorry. Let me just break this down. What you said was when you’re in the chronic stress, it kills the brain cells in your adult brain that helps you make good decisions and it makes the ones grow in the fight or flight part of your brain where you can be angry, divisive, and run or fight, right?

Dr. Austin Perlmutter: Exactly.

Dr. Mark Hyman: That’s not good.

Dr. Austin Perlmutter: I wish it wasn’t that way but you look at these long-term studies in humans who have undergone chronic stress and you see that the prefrontal cortex is smaller. You can actually physically see it is smaller. People who have had these life experiences this chronic stress over time.

Dr. Mark Hyman: Like I got frontal lobotomy by stress?

Dr. David Perlmutter: It’s actually in a way is very similar because it is a disconnection. We talk in the book about something, a term that we coined which is disconnection syndrome.

Dr. Mark Hyman: Yeah. Tell us about that? What is that?

Dr. David Perlmutter: Well, that is exactly what you were just alluding to and that is disconnection of this prefrontal cortex from the amygdala, disconnecting, taking the adult out of the room, allowing the amygdala to make these decisions that are impulsive and self-centered, meaning narcissistic that lack empathy. That really enhance this us versus them mentality. Strengthened by whatever it is that locks us into the amygdala is disconnected from the prefrontal cortex and you brought up our digital experiences. What does social media do? It’s anything but social. You go to a social media site that only caters to your point of view at the cost of castigating others who have a different point of view.

Dr. David Perlmutter: That’s not empathy. Empathy is me trying to see the world through Mark Hyman’s eyes. How do you view something or even something who has somebody who has really different views than I and seeing what is that like? We need that, in Washington it’s called reaching across the aisle, which isn’t happening.

Dr. Mark Hyman: Yeah. I mean I just had an amazing experience last week and if you’re not open. I met this guy, who in my role to be the enemy who works for one of the biggest food companies on the planet that’s doing massive destruction. That’s factory farming of animals. I could’ve been like he’s the enemy. I was curious and he was a human being and I was like, “Where are you coming from?”

Dr. David Perlmutter: That’s what makes things move forward.

Dr. Mark Hyman: “What are you thinking? What do you care about him? Why did you do this? What do you think about that?” It was like the most incredible relationship. I feel now this friendship with this guy who thinks differently than I do, but we opened the door and now where he’s interested in learning about what I think and caring about who I am as a person, what my conclusions were. It’s like that all is undermined by what you said the digital technology. Which-

Dr. David Perlmutter: Mark, you and I have talked years ago about the value of diversity in terms of our gut bacteria. The same thing holds for diversity of opinions. The more we are at peace with diversity of opinions, the more resilient we can be and the more we can move forward in terms of our knowledge base and understanding about how the world works. You hit the nail on the head that we are seeing much more about digging our heels in and defending our position. Saying the world is flat though it may not be.

Dr. Austin Perlmutter: Yeah.

Dr. Mark Hyman: I just want to go back to what you said there for a minute because I don’t understand the degree in which our data is being captured, analyzed, and targeted according to our personality. To our worst fears and personality traits, driving our decisions, driving our behaviors to the point that is literally creating artificially constructed rallies that activate white supremacists versus activists for social justice or African-Americans bringing them to a location to have a riot and they think they’re coming to these decisions all by themselves. The media is targeting them in very specific and scary ways and only people appreciate it and they think it’s their free will.

Dr. David Perlmutter: Exactly.

Dr. Mark Hyman: It just surfing our free will.

Dr. David Perlmutter: That’s the beginning of Brain Wash. We lay it out because it’s time that people really fully understand what in the heck is going on around them. You must do that if you’re going to regain control. You’ve got to understand how the deck is stacked against you; the degree by which you are being manipulated in terms of what you think is your free will and thought process and then moving forward in the program. What you can do to regain control to basically bring the adult back into the room.

Dr. Mark Hyman: We think of things as social issues, as emotional issues, but what you’re saying as a neurologist and as Dr. Austin is that the biology is clear about how this is happening in our brains to disconnect us and to disconnect the parts of our brain that should be talking to each other and activating one that’s causing divisiveness, conflict and hatred and fear and inhibiting the one that helps us have healthy relationships, empathy, connection, clear decisions, future thinking.

Dr. David Perlmutter: That is the fundamental premise of our new book.

Dr. Mark Hyman: Oh my God.

Dr. David Perlmutter: Again, that’s why we created this term called disconnection syndrome because yes, it’s a physical, a structural and a functional disconnection from the prefrontal cortex to the amygdala and back. It also manifests then in our disconnection from ourselves, our disconnection from our neighbors, disconnection from people who have other views and ultimately even disconnection from concerns about the health of our planet.

Dr. Mark Hyman: Yeah. It’s true. What you’re saying is that there’s this mental hijacking that happens, that our brains are manipulated and that the results in behaviors that leave us lonely, anxious, depressed, distrustful, prone to being sick and overweight unlike any time in history. Can you talk about this mental hijacking idea that you talked about in the book and how it undermines us?

Dr. Austin Perlmutter: Sure. Well, we’ve talked about this a little bit already, but again the social media construct, humans are by their nature, a species that thrive when they’re with other humans. It was essential to our survival. It’s how you survive that saber tooth cat coming up behind you. You had somebody there telling you, “Hey, you need to look out.” Maybe the raiding tribe, so we need to be integrated. People who have more connections tend to do better from a health perspective and when those connections are severed, they do worse. Social media-

Dr. Mark Hyman: Just belonging to bowling club or knitting group actually makes you live longer regardless of what you eat.

Dr. Austin Perlmutter: That’s it, right. Connection is so important and social media knows this. They know that we’re looking to link up with other people and they give us access to it but we’ve got to ask this question of is it actually what we’re getting out of it? When you go online and you go on one of these platforms, are you really fostering good, strong social bonds or you being polarized against other people? Are you just commenting on those people’s posts that you dislike? I think there’s a lot of good that can come from social media, but we have to be conscious of how we’re using it and find out whether it is helping us to build empathy. Or is it just, again, putting us into these echo chambers where we’re telling other people what they already know and becoming divisive.

Dr. David Perlmutter: What Austin said, I think brings up a very good point that we’re not anti-tech that’s for darn sure. Look at us right here. You’ve got your technology there and everything around us. We wrote a book just now based upon an unlimited access to knowledge. That’s utilizing technology for good purposes. I think it’s good to recognize according to Christian Lange stating that, “Technology is a useful servant, but a dangerous master.” That was in 1921.

Dr. Mark Hyman: That’s a great, great line.

Dr. David Perlmutter: 1921. Again, we’re not anti-tech, it’s great but we really want to be very mindful and intentional in terms of what we’re doing. We developed in the book the acronym Passing the Test of Time, T-I-M-E. T, how much time are you going to dedicate to what you want to accomplish online? I, is your experience intentional? What is your goal? Is it to connect to your high school class or is it to research something or whatever it is to go on social media, whatever it may be. M, are you mindful while you’re online that you are staying on the course and not being taken down a rabbit hole that’s harvesting exactly what you talked about, your previous time online?

Dr. David Perlmutter: Finally, E, does it turn out to be empowering and enriching? Is it a net positive when it’s all said and done? I think a lot of people when they finally turn off their tablets or phones don’t feel the ladder, don’t feel that it was net positive, feel degraded, insufficient and the need to purchase something or do something because of how their minds had been manipulated while they were having that experience.

Dr. Mark Hyman: Yeah. I very purposely do digital detox experiences because I feel so free when I don’t have my phone. I mean, Sunday I was in Big Sur, was up on a ridge and hanging out with some friends and the phone just put it in another room and I just was there watching the sun over the ocean and the sunset and I can’t tell you how spacious life feels.

Dr. David Perlmutter: You can tell us

Dr. Mark Hyman: You don’t remember Austin, but David and I are old enough to remember the time before the internet, the time before cell phones, the time before smartphones and there was so much of a different quality to experience, right? You were present and you were thoughtful. You were online for something. You might talk to the person next to you, you’re on a subway, and you don’t look at your phone. It’s like, I remember going to Google and giving a talk there and they gave me a tour and I walked around and to one of these rooms and they have this incredible food, green juice, and this and that, wheat grass and it was this beautiful room where they had lunch and there was this big giant couch and they were like maybe 25, 50 people sitting all in the couch on their computers quiet.

Dr. Mark Hyman: I’m like, “Is this the silent lunch room?” They were like, “No.” It was funny because when we talked to the HR people at Google about what the needs were for the Googlers, they call them, it was more social connection with each other and yet they didn’t know how and they’re all in their computer.

Dr. David Perlmutter: Well, getting back to your mention of being out in Big Sur and reconnecting to nature, that was part of what happened with you. That’s one of the big on-ramps for us in terms of helping offset disconnection syndrome. It’s something that needs to be talked about. When you realize that 7% of Americans of our time is spent indoors with another 6% of our time in our cars, it doesn’t leave a whole heck of a lot of time for being out in nature, which has some very powerful health benefits.

Dr. Mark Hyman: Well, you’re an outlier. You take your boat and you go away for fun for every summer. I love that.

Dr. David Perlmutter: Look there’s nobody who’s going to tell you, “Oh, I was out with nature.” I went for a wonderful walk in the park and I sure wish I could get back to the urban environment because I figured that-

Dr. Mark Hyman: I get back to my email.

Dr. David Perlmutter: Yeah, right. That’s what we’d say; leave your phone at home. There’s a robust amount of data being generated that’s looking at the measurable, the quantifiable benefits of nature exposure. It may just be like you have behind you, a plant in your home or in your place of work or even a photograph of that plant or our natural environment.

Dr. Mark Hyman: Yeah. I was terrified because I heard the story of how this filmmaker made these extraordinary films of nature and they had this giant IMAX screen in Las Vegas where they show this because one day people are not going to have nature to go to. In the bank of America building in New York inside, they have these images displayed on these screens all over the offices of nature.

Dr. David Perlmutter: There was a very prescient moment in the movie Soylent Green where I think it’s Edward G. Robinson is about to die and just before he die, this is as oppose post apocalypse at time, Soylent Green, you know the movie and just before he die you get to see a movie of what the world used to look like. He gets, “Oh, there’s birds flying.” Then you know the rest, you know the rest of the story. We won’t go there. My point is though that what we’re offering in this book are the ways to counter this pervasive disconnection that is consciously created to take us away and to lock us in to impulsive, bad decision making.

Dr. Mark Hyman: Around food, like what size or that something. Right.

Dr. David Perlmutter: Around everything. What is so concerning is that making bad food decisions increases as you’ve written about, inflammation and inflammation compromises our ability to access the prefrontal cortex.

Dr. Mark Hyman: Tell us about this because everything causes inflammation, right? What cause inflammation and what does it do to the brain?

Dr. David Perlmutter: Right. Well, what causes inflammation? How long a list do we need?

Dr. Mark Hyman: A long one.

Dr. David Perlmutter: A lack of restorative sleep, dietary indiscretion, lack of-

Dr. Mark Hyman: Sugar.

Dr. David Perlmutter: Well, sure of sugar and other refined Carbohydrates, ultra-processed foods, lack of exercise, sleep, I mentioned, but very, very big. A lack of connection with nature for example.

Dr. Mark Hyman: Or people are humans.

Dr. David Perlmutter: Yes. Let’s just talk about food. You know a little bit about food. We could probably mention this in this context.

Dr. Mark Hyman: Yeah. I heard about that.

Dr. David Perlmutter: When you know we talk about inflammation as a mechanism underlying our chronic degenerative conditions. The number one cause of death on planet earth-

Dr. Mark Hyman: Is called Inflammaging, right.

Dr. David Perlmutter: Inflammaging as well. It enhances that whole cascade dealing with aging, but the number one cause of death on the planet are the chronic degenerative conditions which are basically inflammatory conditions. Now in brainwash, we identify inflammation as threatening this connection between the prefrontal cortex and the amygdala, which means that this westernization of the global diet that you’ve written so much about, aside from its concerns with reference to increasing Alzheimer’s, coronary heart disease, diabetes, you name it, the westernization of the global diet is threatening our behavior, threatening our decision making and fostering an us versus them mentality that is pervasive around the world. Just the dialogue.

Dr. Mark Hyman: This is headline news guys. I mean, this is a news for me and I feel like I’m in the know, but I didn’t understand that inflammation disrupts the connection between your frontal lobe and your amygdala, which is your adult in the room and your crazy uncle who doesn’t stop drinking, smoking and yelling and fighting with everybody. How does that-

Dr. David Perlmutter: That’s the aha moment, halfway through his book.

Dr. Mark Hyman: I’m like what.

Dr. David Perlmutter: Is halfway through this book, we looked at each other and we just said, that’s this, do you realize what we’ve uncovered now? We look around and see what’s going on around our planet right now with respect to total disregard for the planet. Total disregard for our neighbors and certainly aggressive approaches to what goes on in other countries. Now we understand that this isn’t the entire explanation, but it’s factoring in. You’ve talked so extensively about this global change in food, but it’s threatening our decision making and it’s-

Dr. Mark Hyman: What of the biology? How do the inflammations disrupt this link between the Amygdala and the frontal lobe?

Dr. David Perlmutter: Well, there are a lot of things. Go ahead, Austin.

Dr. Austin Perlmutter: Sure. Well, let’s talk about first of all, how inflammation changes thinking. It’s not news to most people that if you have higher levels of systemic inflammation, you have a higher chance of developing dementia. We know there’s this link between inflammation in the bloodstream and cognitive problems in the long-term. What researchers have found more recently is that if you induce inflammation in a person? So if you give them something that creates higher levels of inflammation, they start feeling off and they start feeling off in a specific way. They develop depression. They develop all the symptoms of depression.

Dr. Mark Hyman: Yes. Wait, headline news. Depression is inflammation of the brain.

Dr. Austin Perlmutter: There you go. Yeah.

Dr. David Perlmutter: It’s really beyond that. It’s total body inflammation. When we talk about inflammation, we say, well, Alzheimer’s is an inflammatory disease-

Dr. Mark Hyman: It’s everywhere

Dr. David Perlmutter: Of the brain. We’re talking about systemic inflammation. When we have this crappy diet that is global now, inflammation is induced throughout the body and affects us from anus to own that as it were from … And everything in between. Beyond that-

Dr. Mark Hyman: Not to your fingertips. It stops to your elbow.

Dr. David Perlmutter: No. It depends on a person.

Dr. Mark Hyman: Your butt to your elbow.

Dr. David Perlmutter: Yes. We’ve talked about it in the context of these degenerative conditions. Again, getting back to in the context of our mood, in our context of how we see our neighbors and understand that the prefrontal cortex that we’re trying to stay connected to is what allows us to be empathetic. It’s what allows me to look at your opinion and share the view of that you have through your eyes of the world around us. It’s that empathy that allows me to be more compassionate towards what I do with myself? How I plan to treat my future self, and even how I plan to conduct my behavior as it relates to the health of the planet itself. We are distancing ourselves from empathy. We are fostering hatred, fostering an us versus them mentality and locking ourselves into an impulsive mindset.

Dr. Mark Hyman: Literally the inflammation of the brain and the body causes the inflammation of our emotions and our behavior.

Dr. David Perlmutter: Exactly. It really does. We use that terminology.

Dr. Mark Hyman: The science behind this so much technology.

Dr. David Perlmutter: You bet. Use that terminology. I’m really feeling, “Oh, I’m just on fire right now.” We know it to be true. Let me give you an example.

Dr. Mark Hyman: He’s a hothead.

Dr. David Perlmutter: Yeah. A hothead. I love it. You’re up all night for whatever reason, you’re traveling or you’re a medical resident or whatever you maybe. How do you feel the next day? You darn well know.

Dr. Mark Hyman: You feel like crap.

Dr. David Perlmutter: You feel like crap and your decisions are impulsive. You eat crap because you just choose something quickly. You don’t think about your future.

Dr. Mark Hyman: You crave more carbs. If you don’t see.

Dr. David Perlmutter: You absolutely do. You crave carbs to the extent that the average increased caloric consumption in somebody who chronically deprived himself or she asleep is 380 kilocalories a day.

Dr. Mark Hyman: It’s like a pound a week.

Dr. David Perlmutter: It’s a pound about every week. That’s right and it doesn’t take long. When you gain that weight and you increase your body fat, what does that do? It compromises your ability to get a good night’s sleep that creates yet another feed forward cycle. We know that body fat is a prime source of inflammation in the body as well. This becomes feed forward and things get worse and worse and worse. What we offer in the new book are the off-ramps. Now we have a 10 day plan, 10 different things to think about but it doesn’t matter which off ramp you start with. Each of those will in some way improve your momentary decision making. It might be just dedicate that tonight you’re going to get a good restorative night’s sleep or finally get 20 minutes of exercises or learn how to meditate, whatever it may be which will then pave the way for better decision making moving forward.

Dr. David Perlmutter: Most importantly, most importantly, in the beginning of the book, we call out these hacks, these threats where things are being … They’ve gone askew.

Dr. Mark Hyman: We’re going to get into the details of how to protect ourselves from being brainwashed, your 10-day brainwash program or reset for your brain. Before we do, I want to come back to the science of what the internet and digital technology does to the structure and function of our brain, to our decision making. How do we lower that risk? How do we manage that? I mean, like I said some my friend who had a thousand pickups on her phone and this was like in the afternoon already, just in one day. How do we deal with that? What does the science tell us about the effect of these technologies?

Dr. Austin Perlmutter: Sure. Well, I think it’s clear that we’re still early on and knowing what happens when we’re exposed to the amount of digital technology that we’re exposed to. We know that the average American spends about four hours a day watching TV, and that person will also spend about two hours a day on their smartphone. That isn’t even including all these other exposures to media that we’re getting just walking around and New York City. The question is then, what is that doing to our brains? We’ve got some initial evidence and one study they showed that people with excessive social media use had changes in the Corpus Callosum so less connectivity in the part of the brain that literally connects the two hemispheres of the brain. You can see that too with internet addiction.

Dr. Mark Hyman: It’s a super highway between the two sides of your brain and it’s not working right?

Dr. Austin Perlmutter: Right. That’s exactly it. Yeah. Again, I think it’s early on, so we’re not exactly sure what are the implications of this? What we can say though is it’s worth questioning what we’re doing with this digital exposure time. For example, if you’re turning on the TV and watching the news each day and that news is incredibly stressful, we know that’s not good for you. If you turn on the news-

Dr. Mark Hyman: Where’s the good news channel, I love bands.

Dr. Austin Perlmutter: Where is it?

Dr. David Perlmutter: I’m not going to watch it. Who’s going to be-

Dr. Mark Hyman: I am like inspiring stories.

Dr. David Perlmutter: The Dalai Lama said that the brain we build reflects the life we lead. That means that if you constantly are exposing yourself to negativity and fear based media, you’re going to rewire your brain to gravitate more towards that type of life and therefore you’re not going to watch the good news channel.

Dr. Mark Hyman: It’s true. I have a friend who’s probably the happiest person I know, maybe other than the Dalai Lama. She knows nothing about what’s going on in the world. I went and send her a picture of me and Vice-President Biden at the vice president’s house in Washington and she’s like, “Who’s that old guy?” I’m like, “Ah, that’s the vice president.” I’m like, “Wow, maybe that’s good.” Maybe-

Dr. David Perlmutter: It might well be. We know that as humans, there is this negativity bias and that might probably have served us well in our ancestral times to be really aware of things that were negative that were potentially threatening to us. These days that type of bias is being … It’s truly being preyed upon. We are being preyed upon day in and day out and we have a wonderful graph in Brain Wash that demonstrates the increased negativity of news over the past several decades. It’s like the frog in the water that’s getting warmer and warmer. We don’t really respond to it acutely, but it’s happening. I mean, watch the news and just ask yourself how much it’s positive.

Dr. David Perlmutter: There’s always the human-interest story at the end of a firefighter saving the cat or whatever it may be. By and large it is so aggressive. There’s either an alert sign flashing on the bottom of the crawl or on the bottom of the screen or you’re in a situation room or everything is breaking news and it’s always lighting up the amygdala. The more you challenge that, the more you light up your amygdala day in and day out, the more it’s going to function, the more it’s going to grow. The less likely you are able to tap into the part of the brain, which is our gift as humans this prefrontal cortex that allows forward thinking decisions and acting with empathy.

Dr. Mark Hyman: Yeah, so powerful. Now let’s talk about how to fix this disconnection syndrome. There’s a lot of medicines you use that are unconventional, but they work. When I’m in medicine, I mean things like food, exercise, meditation, nature. Tell us how you plan to get us to be able to make good decisions, to decrease the inflammation in our brain, to dial down the amygdala and regulate the frontal lobe and do it in a way that actually works so that we can make good decisions for ourselves and for our communities and for the planet, which we all desperately need.

Dr. Austin Perlmutter: Yeah. What a question.

Dr. David Perlmutter: I know, it’s so fundamental.

Dr. Austin Perlmutter: The bottom line is the things we’re recommending are for the most part completely free. You might have to buy a pair of tennis shoes, but it turns out that this ancient wisdom about what we need to be doing to reconnect to balance in our lives, to high quality of health, it’s all there and it’s now been substantiated in the research. What we talk about is a series of steps that a person can jump in on at any given point, which will give them now access to that prefrontal cortex. When you do that it allows you to then make more and better decisions. It’s a feed forward cycle in your favor. You’ve outlined some of those steps.

Dr. Austin Perlmutter: The first one that we lay out is you need to reclaim your control over your digital habits, right? This is a very functional thing that you can do to start regaining some autonomy from these stressors in your life. Then we move very quickly into what can you add in to start improving the quality of your life and something that-

Dr. Mark Hyman: I should have all my devices duct tape to my body at all times.

Dr. Austin Perlmutter: It makes it hard to go through security at the airport.

Dr. David Perlmutter: Hang on a second. I got a call coming in.

Dr. Austin Perlmutter: Again, it’s setting healthy boundaries with the things that are not helping you and then it’s bringing in the stuff that is going to help you. We talked about nature. Getting outside for 20 minutes a week has been associated with lower levels of stress. It doesn’t take that much. We said you can just put a plant in your home; you can even put a picture of nature in your home and be getting these benefits as well as something like essential oils. Then we build into that. We talk about how do you start fostering the empathy that is going to help you connect to other people and propagate this sense of completion with this balanced part of your brain where your prefrontal cortex is activated, you’re fostering more oxytocin which then connects you from the-

Dr. Mark Hyman: I love hormone.

Dr. Austin Perlmutter: Yes, it is. It’s gotten a lot of press recently, but something that we don’t talk about enough is it actually integrates the prefrontal cortex with the amygdala and lets them communicate so you don’t have that tired-

Dr. Mark Hyman: More sex.

Dr. Austin Perlmutter: More sex. Yeah.

Dr. Mark Hyman: We have to connect with people. We have to hold hands. We have to look at each other’s eyes. We have to touch each other. We have to hug each other and just smile at each other.

Dr. Austin Perlmutter: Absolutely. That’s the way we’re designed, right? This isn’t anything brand new to people. This is how humans were designed to be wherever you think that design is coming from. We’ve been spending a lot of time doing that and it’s worked out pretty well for us, but as of late we’ve decided isolation is superior to being connected.

Dr. David Perlmutter: That is what is called social media. What a misnomer. We’re not social on social media. We are isolated.

Dr. Mark Hyman: Yes. It’d be isolation media. How do we get control of our digital technology? Because it’s hard, I mean we’re on our phones or checking our email. We get text messages, notifications. We turn off our notifications. Do we put our phone on airplane most of the time and then just pick it up and how do we delete all the apps? Do we delete social media?

Dr. Austin Perlmutter: Well, I think everything you’ve said is something that you could do, which would be of benefit. Now we know that even when two people strangers are sitting next to each other and they put a phone between them, it lowers the quality of their interaction. It lowers the amount of perceived empathy that they expected the other person was giving towards them. Putting your phone in the other room, it is so simple and yet it will probably do more than just about anything else to improve the quality of your interactions with the people around you. That mean-

Dr. Mark Hyman: When I have dinner parties, I have a box in the center table.

Dr. Austin Perlmutter: There you go

Dr. Mark Hyman: Puts the phone in the box, close it up and nobody can touch while having dinner.

Dr. David Perlmutter: It used to be the keys not our self

Dr. Mark Hyman: Right.

Dr. Austin Perlmutter: Yeah. It’s distracted driving, putting your phone away when you’re driving in the car. You talk about a really quick way to lower accidents across the country, but-

Dr. Mark Hyman: I was wondering how the Uber driver texts me back when I’m-

Dr. Austin Perlmutter: You probably don’t want to wait.

Dr. David Perlmutter: I don’t want to know. Let me pick up from where Austin was and that is a step number two or it could be step number one depending on what your needs are. That is the incredibly undervalued importance of sleep. No one talks about it. Here’s something we do for a third of our lives. We don’t exercise for a third of our lives eight hours a day. We don’t eat for like eight hours a day, but yet this is a-

Dr. Mark Hyman: Which we need within our care.

Dr. David Perlmutter: It’s not downtime, is anything but downtime. We recognize that sleep is when our glymphatic system is activated; we’re taking the garbage out. As we’ve talked about before. How fundamentally important is for the consolidation of memory, et cetera. We know that one-night sleep deprivation in one study led to a 60% increased activation of the amygdala. When people were confronted with negative images, 60% increased response of the amygdala. People saw something threatening versus those who had gotten a good night’s sleep that means just that single night has a huge effect on the amygdala. Let’s spin that if we can get.

Dr. Mark Hyman: When you have coffee on top of that.

Dr. David Perlmutter: Yeah. That’s it’s a-

Dr. Mark Hyman: I mean why not.

Dr. David Perlmutter: The spin is then we know that a good night sleep can be really good at placating the amygdala, at least keeping you level and that might be the entrance point. That might be the on-ramp for you or for somebody else to say, “Look, I’m going to dedicate tonight to getting a good night’s sleep.” Even further, I’m going to dedicate to learning more about my sleep. Yeah. I go to sleep and I think I get seven hours of sleep, but what is the quality of that sleep? Who knows? Do you have enough REM sleep? Do you have enough deep sleep? What is your sleep latency? There’s a lot of wearable devices out there now. We use an Oura ring, I know you’re big with an aura ring. That gives us great information about the quality, not just the quantity, and I think that’s really important. This is incredibly underrated. When we recognize that reduction of restorative sleep activates the amygdala increases impulsivity and therefore-

Dr. Mark Hyman: You give the tips for fixing your sleep in there.

Dr. David Perlmutter: We have a whole section on that. Increases our impulsivity and our self-centeredness are less likelihood to be involved with things that are empathetic. We want to reconnect, so getting a good night sleep is a powerful tool to offset what we’re talking about. Disconnection syndrome, reconnect to the prefrontal cortex, allowing more thoughtful decision making and implementation of all the great information that’s out there.

Dr. Mark Hyman: I wonder where I messed up. 70% of Americans don’t get good sleep.

Dr. David Perlmutter: That’s a little bit of an overestimate from what we’ve read, but it’s that way in Japan, that’s for sure.

Dr. Mark Hyman: A lot.

Dr. David Perlmutter: Great book, Matthew Walker, Why We Sleep. I mean, who knew all the reasons that sleep is so darn restorative? We used to think, “Oh, it’s just passive, it’s downtime.” We know the brain is exquisitely active in various stages of sleep, doing things, housekeeping, and consolidation of memory. Now we recognize the importance of sleep in offsetting disconnection syndrome.

Dr. Mark Hyman: It’s also anti-inflammatory, right?

Dr. David Perlmutter: That’s a very powerful mechanism. Also is associated with reduced cortisol.

Dr. Mark Hyman: Cortisol is again, the stress hormone, fight or flight hormone, the one that’s going to create divisiveness, conflict and bad decision making in response to others and yourself.

Dr. David Perlmutter: Yes. Let me just take that a bit further for any of your tech Winnie, avid who really like to follow the science. We understand that inflammation through what’s called the kynurenic acid pathway may compromise available serotonin in the brain that we were aware of it. Cortisol does the same thing.

Dr. Mark Hyman: Yeah. What David’s saying is that when there’s inflammation, your brain chemistry gets screwed up and you can’t make a happy mood, chemical serotonin from the precursors. You end up creating these inflammatory byproducts, kynurenic acid and quinolinic acid, picolinate which all create inflammation. We actually contested. I see that on my patients with an organic acid test, you can actually see these patients, who are inflamed, their brain chemistry isn’t right. We bring brain fog and flame brains and depression, anxiety and sleep issues.

Dr. David Perlmutter: As you would expect. When we see this all the time and review this literature, it just solidifies what we’re trying to do here in the outreach.

Dr. Mark Hyman: At the end of the day, you want people to reclaim their lives; you want people to reclaim their decision-making ability. You want them to disconnect from the forces out there that are pushing us in ways that drive harm to ourselves and harm to our communities and harm to society. It’s essentially what you’re saying is about.

Dr. David Perlmutter: I mean Austin has always said, if you don’t take control, somebody else will. That’s what’s happening. As it gets back to this decision making, it really doesn’t matter a lot if you choose to be vegan, paleo or you want to go full in on keto, whatever it is. These are probably pretty good diets across the board in terms of inflammation, but it doesn’t matter that you’ve chosen one or the other. It’s the implementation part.

Dr. Mark Hyman: Right? How do people get to the right decisions? What else do they have to do?

Dr. David Perlmutter: Go ahead and hit us.

Dr. Austin Perlmutter: Sure. I want to just make one point as well.

Dr. Mark Hyman: Refixes your decider.

Dr. Austin Perlmutter: Yeah. That is the central question. I want to just outline this so that everyone understands exactly what we’re talking about. When it comes to the health outcomes or outcomes in general, we care about. We know that we want to be making good choices that lead us towards losing that extra belly fat maybe, that get us to the gym when we want to go to the gym. As providers, we tell our patients, here’s what you need to do. We take it upon ourselves to say, I know what I need to do. When we don’t do those things, we say it’s a deficit of one of two things. One is it’s the information. We didn’t have the right information, we weren’t eating the right foods or we say it’s a deficit in willpower, right?

Dr. Austin Perlmutter: We say you just didn’t want it enough. That is a paradigm that creates a whole lot of blame, a whole lot of fault or patients. Sure, but as we’ve said before, for each of us individually. When we can’t bridge that gap between who we are now and who we wish we could become if we made those good decisions and what we’ve missed in this is the role of the brain in determining our choices. It is as you said, it’s the decider. It is the decision-making engine and what we’re talking about here is how the environment, how our lifestyle modifications and the like change our brain. How those changes in the brain then lead to good or bad decisions … Set us up for good or bad decisions.

Dr. Austin Perlmutter: As you said, right in the beginning, it’s getting upstream and no longer just putting all the blame on ourselves or on other people for this lack of willpower or lack of information. It starts with again, the first half of the book, understanding where these people have hacked into our brains, where corporations who. Maybe aren’t evil or anything but are just trying to sell, let’s say a sugary product, are hacking into our more primitive reward mechanisms and keeping us hooked. Keeping our neural structure or our neural architecture literally programmed so that we can escape these traps.

Dr. Mark Hyman: Yeah. Some of these big food companies hire research scientists to put kids in a functional MRI scanner to look at it, what it is in their brain the most. That’s frightening to me.

Dr. Austin Perlmutter: That’s right. This is the point that my dad also just made, which is if you don’t do anything, if you say, I’m going to take the world as it is and not worry about it, other people will make your choices for you. What does that mean? Well, we get the world we have right now where people are struggling with these preventable conditions. It’s even by not making that choice of worrying about it, you’re still making a choice. You’re choosing to let other people define your brain and choose your decisions. The alternative is exactly what we’ve been talking about today which is if you start first understanding how that’s happening and next, how you can make interventions to rebuild, rewire, and reconnect your brain for good choices. You’re taking back your life and you’re taking back those outcomes.

Dr. David Perlmutter: We’ve said that people make bad choices, eat the bad foods, don’t sleep enough, and don’t get exercise. The reality is when you don’t get enough sleep and eat the bad foods and don’t exercise, then you’re making bad decisions. It compromises your ability to make bad decisions.

Dr. Mark Hyman: It’s like a circular.

Dr. David Perlmutter: It is a vicious cycle and we drew it out in the book as a graphic. The good news here, the positive spin is Newton’s law that says, “An object in motion tends to remain in motion.” Meaning if you just get yourself to go into motion exercise that enhance your decision to making to commit to further exercise and you will then stay in motion. We’ve got to break these vicious feed forward cycles and to emphasize a point that we talked about earlier, the self-blame part of this, I didn’t follow through on my new year’s resolutions. Why did I eat that? How come I didn’t go to the gym?

Dr. David Perlmutter: All these things that we know are good for ourselves. People looking in the mirror and blaming themselves, feeling this incredible self-blame that is not productive in any way, need to realize how much the deck is stacked against them moment to moment so that they can’t make those good decisions. For us as healthcare providers, we’ve got to reframe the way we look at people who don’t make good decisions and realize how much the deck has been stacked against them and work with them at this higher level now to first foster, better decision making and then give the information so the field is ready to accept the players.

Dr. Mark Hyman: Are you saying if someone comes in with diabetes from eating all kinds of junk, we shouldn’t be focused on fixing their blood sugar, but fixing their decider?

Dr. David Perlmutter: Well, if you fix their blood sugar, obviously their decision making is going to improve. Interestingly-

Dr. Mark Hyman: You’re saying go upstream.

Dr. David Perlmutter: Absolutely. This is higher level.

Dr. Mark Hyman: Why 50-80% of people don’t do what they’re taught or tells them it’s not because they’re bad people. They don’t care

Dr. David Perlmutter: Its exact statistic, I’m impressed.

Dr. Mark Hyman: I know.

Dr. David Perlmutter: You had done some reading in the book.

Dr. Austin Perlmutter: This is the parent 128, right? This medical paradigm we basically have is that your patient goes into the office, they sit down with the provider, provider says, “I don’t understand. We talked about this. You need to exercise more. You need to eat healthier food. You haven’t done it. Do you not get this?” The patient says, “Oh no, I get it. I just couldn’t do it.” The doctor says, “Well, patient is noncompliant.” That’s what goes in the note and then you sign the note because there’s one of two options.

Dr. David Perlmutter: That’s terrible.

Dr. Mark Hyman: It such as judgmental. You’re a noncompliant.

Dr. David Perlmutter: We need more empathy. We need to understand now as you well know that people are having their decision making.

Dr. Mark Hyman: No. I’m not complaining. I’m ineffective in doing the right thing because I don’t understand how to actually fix your desire.

Dr. David Perlmutter: We’re going to work on that.

Dr. Austin Perlmutter: Yeah.

Dr. David Perlmutter: Our mission moving forward is to really get this word out that we as healthcare providers need to be thinking about this, that people don’t have the hard wiring in their brains to make dosage-

Dr. Mark Hyman: I’m a doctor, I see patients, and you guys are doctors. I’m in my office. Someone comes in and works with them a bunch and I got him all the right information. They’re struggling so we’ll do it, but a lot of are struggling. How are you going to help me fix my patients as decider?

Dr. David Perlmutter: You look at your patient and I said look there are a host of things that you can do to get better from whatever the problem may be. If it’s these lifestyle issues, the weight gain, the diabetes type to type or whatever it may be. I’ll tell you what, first of all for the next week we’re going to focus on sleep. Let’s just see if we can get you a good night’s sleep and you as mentioned to the how prevalent sleep issues are. Let’s just focus on that. Then next week when you come back and you’ve got a week of good sleep under your belt, we’ll look at a couple other things that we can incorporate into your program. Maybe you’ll teach that person how to meditate. We know that meditate is a super highway to the prefrontal cortex and really transcends all types of meditation and even prayer. It all does the same thing so maybe we introduce that now-

Dr. Mark Hyman: It all starts with forks and now with the meditation.

Dr. David Perlmutter: You bet, or even the medication because people don’t often take there … We go meditation before medication. Because people don’t often take even the medications that they are prescribed, so set the stage for them to be more acquiescent to be more likely to follow through before all the recommendations are made. Otherwise, you set yourself up for failure as a physician.

Dr. Austin Perlmutter: I think the other point on that is when we lay out all of these different interventions, things like changing your diet, getting more exercise, going out into nature or even meditating that gives you a menu now and so the patient comes in and says, “I can’t exercise. Not because I’m physically unable, but because I’m mentally unable. I cannot get myself out onto the street and jog, do pushups or whatever.” That just isn’t their thing. Now we know exercise is good for executive function, for better decision making, so that would be nice if they could but that’s not where you start. You say, “Well, are you willing to go outside and spend some time in nature?” Maybe they are.

Dr. Austin Perlmutter: You give them that 20 minutes of nature exposure which lowers stress, which lowers inflammation, which fosters better decision making and then you come back to the exercise. Now they have a brain that is engineered for better choices and it may not seem to be this incredible mental block anymore. Again, it’s finding these backdoors into where you’re trying to get to because so many of these times, patients know what they want. They want to be somebody who exercises, but they can’t get their brain to be on their team. They say it, “I want to be somebody who eats healthy.” The brain says, “No. We’re going to eat ice cream and chips tonight.” That’s what winds up happening. The goal here is to get your brain on your team so you’re not constantly fighting against it and having people label you as not having enough willpower. That’s just not as sufficient answer anymore.

Dr. Mark Hyman: Yeah. That’s true. It’s interesting. I just had this recent experience that was really shocking to me, even though I’ve been doing this forever. Over the holidays I went to New Zealand, my wife’s family, there are all kinds of stuff. I ate pretty well; I cooked Christmas dinner though I’m Jewish. I made it super healthy and it was just like-

Dr. David Perlmutter: It’s empathy.

Dr. Mark Hyman: It’s really, really healthy but it’s delicious. I didn’t have any junk and we had like chocolate for dessert and stuff but there were other places I went where it wasn’t like that and it was ice cream and those are stuff that I usually don’t eat. I just felt myself like falling off and wanting more and more. Then I came back and my wife and I decided to do like a 10-day reset which is based on my new program, a 10-day reset program which you can get it in and then we did a clean vegetable diet. We actually do three days of juice fasting, just green juices and then started back in with the 10-day reset.

Dr. Mark Hyman: It’s been so fascinating to me because I know exactly what to do. I’ve written a bazillion books about it, but I don’t always do it. Sometimes I fall into the bad decision making. When I did the reset on my system, I know it decreased inflammation. I know it helped me sleep better. I know it helped me actually function physiologically better. I now find it like not a problem. I was traveling in airports on this, I’ll break down and I was like, “No. It’s no problem. I have no issues.” Someone is eating a pizza across from me. I don’t care. I wouldn’t order the food on the airplane.

Dr. David Perlmutter: You’ve reconnected. You brought the adult back into you, that’s our central thesis here.

Dr. Mark Hyman: Yeah. It was fascinating. It’s so fascination to me because I was like, wow, I know. This was such a visceral experience where my desires change.

Dr. David Perlmutter: You’re in the same boat as the patient who doesn’t follow through. I mean you have a doctor that’s speaking to you. It happens to be your own voice saying you shouldn’t need to do this, but yet you can’t help yourself. It’s a terrible planned word. It’s a feed forward cycle. You had a couple of indiscretions while you were out in New Zealand. You ate some ice cream. Next thing you know your willpower is caput, but you at least tried to rein it in by doing one thing or another. That’s really what we’re getting at and imagine in the doctor patient relationship and say, “You know Mrs. Jones, we’re going to work on this and it’s not going to happen overnight. Before we really jump into your program, let’s say, here’s what I want you to do.”

Dr. David Perlmutter: Again, as I mentioned good night’s sleep. I want you to walk around the block a couple times, and by the way, I would like you to buy a house plant, leave it at that. Maybe next week you bring a couple of things into the else into the program. You’d talk about meditation, you talk about reconnection, you talk about keeping a gratitude journal. All of these things to further strengthen the connection. Then you end up like you ended up after you finally did your reset, finally in control, able to walk through an airport and bypass the Cinnabons.

Dr. Mark Hyman: Yeah. I mean I usually don’t go over Cinnabons, but I’ll buy that chocolate covered almonds. I’m like, “Oh, I feel bad for myself. I’m traveling, I’m all by myself. I wouldn’t be home with my wife. I’ll just buy some chocolate.” None of that was there and like I easily could have done it and it was all around me, but it was just the most interesting thing, I was like, “wow, this really works.”

Dr. David Perlmutter: Being aware of it is really important, but that’s an impulsive type of behavior that’s ultimately threatening to make things worse. It’s like Gary Taubes talked about saying that, “We don’t get fat because we eat more, we eat more because we’re getting fat.” Meaning that, our fat cells have their own agenda.

Dr. Mark Hyman: They have a mind of their own.

Dr. David Perlmutter: They want more fat cells. They want higher levels of ghrelin and they want to increase inflammation which further locks us into impulsivity.

Dr. Mark Hyman: Yeah. It so great. I mean I think this is a Meta book, right?

Dr. David Perlmutter: It is exactly a meta book.

Dr. Mark Hyman: This is a meta book because there’s a lot of great advice out there. There’s a lot of great programs. You and I have written them and some people take it and run with it, but a lot of people don’t. A lot of people struck and the sustainability issue is the key. Anybody can do something for 10 days, but then how do you sustain it? Unless you deal with the Meta issues of how your brain is working or how your brain is broken, you can’t change your life. You can’t show up in your family and be loving and connected. You can’t show up for your work and mission in life. You can’t be in service which is the highest gift that we can all give to ourselves and others because you’re stuck in a brain that’s in fight or flight. The adult’s gone from the room.

Dr. Mark Hyman: You’re making bad decisions and it’s taking the world down. I do believe that a big driver of this is our inflammatory lifestyles and that is driven by lack of exercise, stress and so forth. The food is got to be the biggest driver of inflammation. It’s such a doorway and if people can get this inflammatory know.

Dr. David Perlmutter: It is. It’s a doorway out, with food, yeah.

Dr. Mark Hyman: It’s the outer diet.

Dr. David Perlmutter: That’s why we so honor the perspective that you are taking moving forward to really address what’s going on with food on a global level and how exciting that is. We have involvement with how that is happening. That is a huge driver. Again, it’s a feed forward cycle that perpetuates impulsivity. When we see that here in America of the 1.2 million different foods sold in the grocery stores, that 68% have added sugar or sweeteners. It’s hacking into our desire for sweet and creating this persistently

Dr. Mark Hyman: The additives and chemicals. I just remember reading this study I wrote about in my book Food Fix, right? Which was about feeding kids and violent kids in juvenile detention center’s healthy diet. What it did to them was so striking. Their regression levels changed, their oppositional behavior change, their violent behavior change, their willingness to be cooperative and helpful, improve, their homicide … I mean they’re, sorry, suicide rates dropped a hundredfold.

Dr. David Perlmutter: Why would we want to change their diets if we could just medicate them?

Dr. Mark Hyman: Yeah. That’s a good idea. By stocking the drug company, forget about the food. No. It doesn’t work. The medications actually don’t work. They’re not powerful enough to overcome the effects of the food.

Dr. David Perlmutter: That’s answer we’re looking for.

Dr. Mark Hyman: I mean, if there was a drug that could reduce violent behavior, aggression, opposition, conflict by 50 to 100% I mean it would be the best-selling drug of all time. There is one it’s called food.

Dr. David Perlmutter: Yeah. If they were a drug, this is a bit off topic that was associated with such a profound reduction in Alzheimer’s risk as exercise. It would also be a home run drone.

Dr. Mark Hyman: Yeah. Yeah. When you stack all these things, where you go talking about, sleep, meditation. It’s interesting how you talked about the primary things not being exercised and diet, but sleep and meditation. Which I think is important for people to hear because you can’t start to unwind that stress response that’s activating the amygdala unless you start to get sleep and calm your brain down through meditation.

Dr. David Perlmutter: We’ve all, we’ve all been in situations where our mega liter is really kicked in and it’s not necessarily easy to rein it in in an acute way. I mean, I described an experience I had in a big box store once when somebody was being, may I say disparaging first towards me and I was cool with that, but then aggressive towards my wife and I was within moments of being aggressive and inappropriate. Luckily, I was able to bring the adult into the room and reign in my amygdala based-

Dr. Mark Hyman: Response.

Dr. David Perlmutter: You bet. We know that that often isn’t the case with many people who do not have that highway connected to the prefrontal cortex and can’t reign themselves in. You accidentally cut somebody off in the car and the next thing you know they’re driving you off the road. You know how people respond. I watched it just the other day and I couldn’t believe my eyes. I watched it unfold rising in front in a parking lot. Somebody cut somebody off. That said-

Dr. Mark Hyman: I did that once, I’m not getting off an off ramp, but I didn’t really realize that I cut somebody off and then, I heard did something and he was in front of me on the off ramp and he stopped the car on the off ramp, blocked me and ran out of the car and started jumping on my car, smashed it. I had locked the door, I was terrified. I’m like, road rage, what the hell? This guy probably had no-

Dr. David Perlmutter: You can say whatever you want. You can say sorry, whatever. You know, things happen. To conclude on a positive note, an empowering note, a note that looks forward to a better time at a better place. Everybody’s got the tools, we just … They’re in everybody’s toolbox. They just need to know how to use them.

Dr. Mark Hyman: Yeah. Like Dorothy and the ruby red slippers, we can go home all the time.

Dr. David Perlmutter: Just tap your heels together.

Dr. Mark Hyman: Yeah. Its meditation, sleep, anti-inflammatory, diet, exercise, and a right relationship with your digital technology which you talked about all in the book. It’s one of the greatest contributions I think to science.

Dr. David Perlmutter: Oh, my goodness.

Dr. Mark Hyman: How we have to get out of this mess of conflict, divisiveness, chronic disease and destruction. I am so excited about this book, Brain Wash. It’s I think the culmination of a lot of years of thinking and work that you’ve done. It’s something that is going to, I think change the way we think about how people change their behavior and change their lives and change their ability to make good decisions, which determines everything in your life. I mean, if you make good decisions, you have a great life. If you make crappy decisions, grab your life? Right? This is a tremendous book and I am so excited about it. I think everyone should have a copy, Detox your Mind for Clear Thinking, Deeper Relationships and Lasting Happiness, Brain Wash. You can go to, is that it?

Dr. Austin Perlmutter: Brain Wash book.

Dr. Mark Hyman: Brain Wash Book, and check it out, order it, use it, fix your picker and decider and you’ll be happier for it. Thank you, guys for joining us on The Doctor’s Farmacy.

Dr. David Perlmutter: Thank you, Mark.

Dr. Mark Hyman: If you loved this conversation and it mattered to you, please share your comments with us. We’d love to hear from you, share with your friends and family on social media. If you don’t subscribe already, subscribe wherever you get your podcasts and we’ll see you next time on The Doctor’s Farmacy.

Dr. Mark Hyman: Hi everyone, it’s Dr. Mark Hyman. Two quick things. Number one, thanks so much for listening to this week’s podcast. It really means a lot to me. If you love the podcast, I really appreciate you sharing with your friends and family. Second, I want to tell you about a brand-new newsletter I started called Mark’s Picks. Every week I’m going to send out a list of a few things that I’ve been using. Take my own health the next level. This could be books, podcasts, research that I found, supplement recommendations, recipes, or even gadgets. I use a few of those, and if you’d like to get access to this free weekly list, all you have to do is visit That’s picks. I’ll only email you once a week, I promise, and I’ll never send you anything else besides my own recommendations. Just go to, that’s P-I-C-K-S to sign up free today.

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