Brain on Fire: How Dietary Induced Neuroinflammation Causes Mental Illness, Aggression, Violence and Dementia - Transcript

Dr. Mark Hyman: Coming up on this episode of the doctor's pharmacy.

Dr. Austin Perlmutter: So what happens in the gut and, impacts the brain and vice versa? There's a a couple of pathways that have been isolated down bottom up. Right. I guess bottom up being more specific in this case to the cut to the brain, but, sure, both ways. And again, I think we will learn in the future that maybe this part is not in as much control as we thought.

Dr. Mark Hyman: Welcome to doctors' farmacy. I'm doctor Mark Hyman. That's farmacy will have a place for conversation that matter. And the truth is this conversation relates to everyone because we are having an epidemic of brains on fire. Something called neuroinflammation, which is affecting so many things that we're gonna talk about in a minute.

Dr. Mark Hyman: And our guest today is a incredible physician, Doctor Austin Promutter, who is deep into this topic of neuroinflammation. He's a board certified internal medicine physician, a neurotized best selling author, and he talks a lot about neuroinflammation in his book called Brainwash. He's also a published researcher and an international educator. His mission is to help people improve their health by targeting the biological basis of stuckness in our brains and bodies who wouldn't wanna be free of stuckness. His writing and presentations, podcasts, and online educational programs explore how environmental factors influence our cognitive and mental state, and they've reached millions of people.

Dr. Mark Hyman: He's been featured on PBS, Rolling Stone, Newsweek, NPR and a wide range of other outlets. He's the co producer of Alzheimer's, the science of prevention series, and the host of the Better Brain Blueprint series, He currently serves as the Managing Director of Big Bolt Health, a food as medicine company focused on helping people rejuvenate health through better immune function where he is running a first of its kind study exploring the effects of plant nutrients on human aging through epigenetics. Now why this conversation is so important is that we are seeing an explosion of brain inflammation disorders. Everything from mental health crisis with depression, anxiety, bipolar, even psychosis, schizophrenia, all connected to brain inflammation, not to mention ADHD, autism, and even memory issues like Alzheimer's, all connected to brain inflammation. And what's more what we talk about in this podcast is how that brain inflammation is affecting us as a society, leading to increased divisiveness strife, oppositional behavior, aggression, violence, all of which may be linked in smaller, large part to neuroinflammation.

Dr. Mark Hyman: So we talk about how do we identify neuroinflammation, what causes it, how to resolve it, and what to do about it, in this fascinating conversation with Doctor Austin Perlmutter. And let's dive right in. Alright, Austin. Welcome to the doctor's Pharmacy podcast.

Dr. Austin Perlmutter: Mark, excited to be here. Excited for the conversation.

Dr. Mark Hyman: So, just this background, you know, you're dead, and I go back a long time.

Dr. Austin Perlmutter: A little while.

Dr. Mark Hyman: And, we're we're been friends for a long time. David Promutter wrote Rain Rain. Together, you wrote Rain Wash with him, which is really gonna be a lot of the top we're gonna talk about We had you on the podcast a number of years ago when that book came out with your dad. And, your dad really was one of the pioneers in helping us think about rain inflammation.

Dr. Austin Perlmutter: Mhmm.

Dr. Mark Hyman: And you you are now heavily focused on this whole topic of why our brains are inflamed, which leads to so many downstream problems. And pretty much everything that goes wrong with the brain from autism to Alzheimer's from anxiety to depression from bipolar disease to schizophrenia to Parkinson's. I mean, you name it. Anything that's going on in the brain that the brain's not working. It doesn't have a way of, like, say, out.

Dr. Mark Hyman: If your joints inflamed, it's red and sore and it hurts. When your brain's inflamed, it comes out as all these other manifestations and diseases. And so you you know, you you've been deep into the topic of this. And I I've been very impressed with your thinking about it. I just really came from a lecture that you gave at the help symposium here on neuroinflammation.

Dr. Mark Hyman: I learned a lot, actually. And and it really seems to me that that we are in an era of massive inflammation. Your dad used to show this slide with, like, the brain on fire. You know? And I think our brains are on our emotions on fire, our society's on fire, polarized, disconnected.

Dr. Mark Hyman: There's more aggression, more violence, more depression. We have a massive mental health crisis. Opioid deaths, disease, or despair, and there really doesn't seem to be a very coherent approach to it, right, other than, you know, suing the sackler family for OxyContin, which isn't really a solution. And there really doesn't seem to be a lot of coherent thinking about it. And, you know, I read even some crazy studies where they were like, we're gonna use these drugs called TNF alpha blockers to treat depression.

Dr. Mark Hyman: Because now we brain that's depressed is an inflamed brain. And I'm like, wait a minute. You're get you didn't take a $50,000 drug that increased risk of cancer and overwhelming infection and death to treat depression. How about figuring out the cause of the inflammation? So let's let's talk about an an neur inflammation as a concept.

Dr. Mark Hyman: What is it? You know, what's causing it? And and why are we seeing such an epidemic of or inflammation. And by the way, it's not really something I ever learned about in medical school. So and you you've got you graduated in medical school a lot more recently than I did, but I bet you didn't learn a lot about it.

Dr. Mark Hyman: I So kinda walk us through this whole kind of conceptual framework of neuroinflammation and why we should care about it and what it's causing and what why it's happening at such the rate it's happening.

Dr. Austin Perlmutter: Well, I think, Mark, let's start with the basics here. So it's the understanding that as we look at how people are doing today across the world. We have to have a realistic moment of pause. Ask whether people are doing well? Are people getting better across the planet?

Dr. Austin Perlmutter: Something we've talked about.

Dr. Mark Hyman: And Is this a multiple choice question? Because the the answer is all know.

Dr. Austin Perlmutter: For none of the above, depending

Dr. Mark Hyman: on the above.

Dr. Austin Perlmutter: So I think you can look at all these different disease states, but if you look at kind of underlying, the lowest common denominator for many of these cases, it is chronic inflammation. We understand this in the body. So 7 out of 10 of the causes of disease and death on the planet today Mark these chronic diseases, of which many of these are driven by chronic inflammation. And we've to terms with this as it relates to what's happening in our body. There has been this fundamental disconnect, though, with this expectation that we don't need to look at the brain and same way.

Dr. Austin Perlmutter: And you alluded to this with this strange sense of if inflammation's happening in the joint, we can point to it. We can say that a problem in this joint, and it is customary if a person has pain in their joint for them to go to the store and buy an anti inflammatory medication. Like a oximeter. Exactly.

Dr. Mark Hyman: I believe.

Dr. Austin Perlmutter: An NSAID. This is pretty prototypical. This is the way that we look at inflammation. We have kind of this loop that we follow. What does it look like when inflammation occurs in the brain?

Dr. Austin Perlmutter: And you've referenced some of these diseases, but what we know is so of the 300 plus million people around the world right experiencing depression, a sizable proportion of them have elevations in serum inflammatory markers. And so it's believed that And

Dr. Mark Hyman: what is which which are talking about there, Austin, is, like, the cytokines. We've heard about in COVID. The cytokines are the messenger molecule of the immune system. And what you're saying is 300,000,000 people out there with depression have high levels of these in their body. Right.

Dr. Austin Perlmutter: So it's typically speaking that people people who have depression have a higher likelihood of having evidence of elevated inflammation. You can measure it in a number of different ways. This is so important, though, not just in depression, but for conditions like Alzheimer's because by and large, as we look at these brain diseases, the standard of care sucks. It's miserable. So if you go through

Dr. Mark Hyman: Is that official, medical diagnosis. It's it's visceral. It's it's

Dr. Austin Perlmutter: but this is this is the the code. The the point being, though, if you were to look at, let's say, depression, for So again, 300 plus million people around the world who are experiencing depression right now. If you look at the kind of hit rate for our conventional antidepressants, roughly 50% of people will get a substantial improvement. Roughly 33% of people will get a actual remission. And some in the neighborhood of 20% of the American population is going to be diagnosed with major depression.

Dr. Austin Perlmutter: So thinking about what that means practice, our conventional therapeutics are not doing a good enough job. Similarly, when we look at Alzheimer's disease, so we look at conventional drugs for Alzheimer's. They just don't really work too actually mitigate the symptom or to mitigate the disease process in a meaningful way. So pausing there for a second, we say, is that sufficient? The answer is no.

Dr. Austin Perlmutter: We need to keep looking. And then we start to ask what systems within the body can help us to explain what is going wrong. And recently, as 2 years ago, they became out looking at serotonin and the serotonin hypothesis of depression, basically debunking the idea that serotonin was the principal driver of why people experienced depression. So with me,

Dr. Mark Hyman: low serotonin,

Dr. Austin Perlmutter: Let well, so low serotonin, but also changes in the receptors, changes in how those pathways are activated. The majority of our antidepressants work in theory on serotonin pathways, but it hasn't necessarily been proven. So it leads us to this conversation about is there another system at play? And inflammation has really risen to the top. As it relates to potential ways to explain what is going wrong.

Dr. Austin Perlmutter: What's really important and what I think we're going to get into here, it's not just talking about diseases. And we've get away from thinking that health starts when you get a diagnosis, something you've talked about extensively. So for everyone who's out there listening and maybe doesn't have a diagnosed mental health doesn't have a diagnosis aspect of who we are, how we feel, how we interact with the world. And to that end, it means that modulating, changing our inflammatory balance, in the body and in the brain is a way for us to change how we show up in the world. So not just at the extreme ends when things have gone so catastrophically wrong that we say you a diagnosis, you need a therapeutic.

Dr. Austin Perlmutter: But even in the day today, if you want to think better, be better in your relationships, help the planet, that is an inflammatory outcome.

Dr. Mark Hyman: Yeah. I mean, even if you don't have diagnoseable disease, any level of inflammation that's it's a little bit out of control in the body will contribute to dysfunction, which can be symptomatic as brain fog, fatigue or just not sharp or little depressed, little moves up, but not, you know, you're not meeting the criteria for a disease, but you still I I call it FLC syndrome. That's when you feel like crap. Another official diagnostic here. Absolutely.

Dr. Mark Hyman: And a lot of people it out there. You know what I'm talking about. And I and I I think it's it's it's important to start to realize we need a different thinking framework for how to assess this issue because our current assessment of psychiatric disease of of neurodegenerative diseases of neurologic diseases is sort of archaic. It's very descriptive. We're gonna describing things and labeling things.

Dr. Mark Hyman: But, you know, there's a there's kind of a joke in neurology, which is diagnosed and audios, you know, or treat them in street. I mean, I'll basically, like, get them out the door because there's not much you can do for them. And and the truth is there's a lot that can be done, and your dad is really piling a lot of the waste you're doing. You're leading the way now I think that, we we need to sort of think about neuroinflammation as this common framework for understanding a lot of what's wrong with our brains and all the things that go run with their brains from all the mood disorders, attention disorders, autism disorders, neurodegenerative disorders, all these things that we don't really have great treatment for in professional medicine are actually very, amenable to treatments that address the root causes.

Dr. Austin Perlmutter: And I'd say for mention. And I think that's key to this conversation. So I don't know what it was like back when you were learning these strategies, but for the most part, you screen for depression in the clinic. And person meets criteria, then they get into the algorithm. Person's feeling a little bit low.

Dr. Austin Perlmutter: You maybe make a note in the chart, but you're not necessarily following up on that. We'd say that's part of the spectrum of normal human experience. We do a similar thing when it comes to MCI or pre MCI, meaning mild cognitive impairment. What we're talking

Dr. Mark Hyman: about pre dementia. What you're

Dr. Austin Perlmutter: talking about?

Dr. Mark Hyman: Exactly. Yeah.

Dr. Austin Perlmutter: Exactly. So if a person comes into the to say I'm not really thinking clearly. You might start a workup. You might check B Twelve and some other markers, but in a traditional sense, you're not necessarily doing much until they've received a diagnosis So what about somebody in their thirties just coming in saying, you know, I just don't feel like I'm as sharp as I used to be. What can I do?

Dr. Austin Perlmutter: Conventional medicine would say, well, I exercise, get some good sleep, and, you know, we'll we'll do some evaluations in the future, unless things get really bad. And to that NSA again, prevention is the key. It's my belief, and I don't know if you share this, that mental health is kind of the absolute final outcome that we need to care about. It's what may makes life worth living. Everything else is a surrogate Mark for mental health.

Dr. Mark Hyman: Yeah.

Dr. Austin Perlmutter: It's true. If that is the belief, then we should be happy.

Dr. Mark Hyman: A quattier life. Exactly. Relationships, it determines, our behaviors because if we're not happy, we're gonna do something that might be self harming, like eat junk food or not exercise.

Dr. Austin Perlmutter: That's it.

Dr. Mark Hyman: Drink too much. Or

Dr. Austin Perlmutter: Yeah. I mean, if you push them, but hard enough and ask them why do you care about that? So maybe they say, I'm really I care about making a ton of money. Why? What does it mean to you?

Dr. Austin Perlmutter: Eventually, you get to, it makes me feel good. Kind of at the end of the day, the thing that matters most. So if we agree and, hopefully, we do that mental health matters more than anything else, then if we work backwards, we say, what are we actually doing to optimize for mental health. And for the most part, we do very little until things get bad enough that it necessitates a diagnosis, pharmaceuticals, And that's just a problem because we take so much time now to think about preventive cardiology. Right?

Dr. Austin Perlmutter: You should be jogging each day to decrease your risk of heart attack. What are we doing each day to prevent depression, to prevent anxiety, to prevent Alzheimer's disease? I would argue that is even more important. So, yes, heart disease kills more people than does dementia and Alzheimer's directly. But if our goal is quality of life and mental health, then that actually should come first.

Dr. Mark Hyman: I had just such a critical point you just made because you know, we think about certain things like, oh, I can prevent diabetes if I eat better. I can prevent heart disease if I exercise and eat better and and relieve stress. And there's sort of a understanding within traditional medicine, even though it's not applied. Right? Just take your stat.

Dr. Mark Hyman: Right? Take your Ozempic. But but there's not even framework for understanding how to improve brain health or prevent brain diseases or prevent depression And the truth is there's so much we know about this that's in the evidence based literature hasn't been translated into clinical practice. And that's really one of the fundamental problems in just such a lag time. And even within traditional approaches, there's a lag time.

Dr. Mark Hyman: And forget about things like systems biology and medicine medicine. I mean, they got microbiome, played a huge role in mental health, but how many psychiatrists are checking a poop test?

Dr. Austin Perlmutter: Not a lot.

Dr. Mark Hyman: Not too many.

Dr. Austin Perlmutter: I I think, to go into that for a second here, I mean, think about where we should be heading as it relates to, upstream thinking for depression. Our population is 1, and I'll I'll try to say this as carefully as I can. Where at least in the United States, it behooves most interest for us not to have solved for mental health. And why is that? It's because when person is when a person is feeling good about what's going on immediately around them, when their cup is full, they're not as likely to buy all the unnecessary stuff to fall victim to all of these unnecessary ploys for their money and for their time.

Dr. Austin Perlmutter: So this is not to say necessarily that we've created an evil society It's simply the fact that our incentive structure has very little to do with better mental health. And The opposite. It exactly. It is it is better for most large entities corporations companies for us not to feel good because if we feel good, we don't need their x, y, or zed.

Dr. Mark Hyman: Yeah. Yeah. You know, I don't I don't even saw that, Austin, but there was a recent article in Fortune Magazine about the CEO of the company that makes Ozempic. Mhmm. Which by the way, and I don't think they sell in Denmark.

Dr. Mark Hyman: It's the biggest contributor to the GDP of Denmark right now. And the the C kinda called it out, but he was getting phone calls from all the junk food makers concerned that they were gonna be in trouble because of this drug cutting into their market share or stomach share. And and and I think, you know, when I I don't you saw the Super Bowl, but this year, in the first half, there were 11 commercials for junk food.

Dr. Austin Perlmutter: Mhmm.

Dr. Mark Hyman: The rest of the commercials were other than the Christian commercial. Where where for basically addictive things, gambling, and alcohol, and junk food. So when you think about what's being told to us and the things that are being shown to us and the pressures on us to kind of consume and buy things that are gonna numb us, dumb us down, make us sick, It's kind of frightening. It's it's literally, like, wow. This is the most watched show on television.

Dr. Mark Hyman: And the entire show was was punctuated by pushing us to become more addicted and more oppressed and Mark obese and more sick. And it it was sort of striking to me. And I was like, wow. I

Dr. Austin Perlmutter: It it's also just a great rep to be able to afford those ads on TV. So their margins are big enough that they can put up a couple $1,000,000 commercial for x, y, or z, and that is a direct reflection of the fact there is that degree of consumer buy in. You're absolutely right, though. I mean, it's is the irony of watching professional athletes and then watching them in commercials advocating for the things that would absolutely destroy their careers if they were, you know, if they continued to consume. But you're right.

Dr. Austin Perlmutter: So whether it was the beer or the food or the gambling, these are the things that we default to. And, again, I think there's there's an important point to be made here, which is it's easy to go to the place of saying evil corporation I think it's just this is what corporations are incentivized to do, and humans find places of minimal resistance or least resistance in has been discovered by people over primitive parts of our brain when you take away psychological pain that people are more likely to buy your product. So whether that's a sugary food or a gambling, app on your phone, you are in essence taking away short term psychological pain at the expense of long term health. And I think that is the fundamental nature the problem. We have in essence outsourced decision making to corporations that are not evil, but rather do not have our best interest.

Dr. Mark Hyman: I may, you know, I mean, like, when you're putting little children in functional MRI machines and showing them images of different junk food and seeing which images light their brains the most. So they'll be likely to want it and buy it or whine and cry and scream until they get it. Yeah. I I do you know

Dr. Austin Perlmutter: about the term?

Dr. Mark Hyman: That four is on evil to me. I mean, listen, those are our children. Those are the future of our country. If we're if we're if we're actually figuring out how to make our children addicted through sophisticated scientific investigations and and and experiments, that that's frightening to me.

Dr. Austin Perlmutter: So And

Dr. Mark Hyman: I'm and by the way, I'm not making this is in the New England Journal Medicine. This is published data Right. On what's actually happening with key marketing and children in this country. So I don't wanna get tuned on that, Robert. Hold on.

Dr. Mark Hyman: When I wanna to is is the the neuroinflammation because I think it's it's frightening how much of a problem this is, but it's also encouraging that there's a real pathway Mhmm. In our understanding of science about how to modulate inflammation through diet, lifestyle, nutraceuticals, other therapies that actually help to fix the brain, to repair the brain, to improve the connectivity of the brain, to reduce the amplitude of the the the anxiety and depression and the aggression and the violence and the the behavioral issues we're having in the societal polarization all not to mention all the neurodegenerative diseases and all that stuff. No. We know how to do this. It's not like you and I do this in clinical practice.

Dr. Mark Hyman: This is something we see in our patients and it works. But most people don't wanna access this. So why don't we kinda back up and talk about what is neuroinflammation and and and why does this Hyman?

Dr. Austin Perlmutter: Right. So nerve inflammation is a little bit variable as far as how it's defined. I'm gonna use some technical terms here, and then you could walk me back if we go too far. But, basically, what we're talking about is an activation of the immune system within the brain with certain markers that tell us this is inflammation. Inflammation is just a state of activation of the immune system.

Dr. Austin Perlmutter: In the brain, what we're talking about

Dr. Mark Hyman: No. No. No. Inflammation is bad. You need it.

Dr. Austin Perlmutter: And that's and that's You gotta

Dr. Mark Hyman: call want information to fight the virus if you got COVID, but it's been overactive and it's overactive for too long a time, and it's triggered by the wrong things.

Dr. Austin Perlmutter: Exercise increases inflammation, but it's not bad because it's a short, short burst in inflammation that over time actually suppresses inflammation. So as a caveat here, what we're trying to talk about is either an incredibly high level. So something like what might have been seen in the cytokine storm or a chronic low left which is what we really see in metabolic diseases, and that's the one that's been more associated with conditions like dementia and depression. Yeah. So in the brain, what we're talking about is when a breakdown of the blood brain barrier.

Dr. Austin Perlmutter: That's the barrier that surrounds the majority of the brain and is supposed to help protect the brain from what is happening in the bloodstream. The second thing to consider is that the brain has immune cells within it, and this will be news to people who think about the brain as separate the rest of the body.

Dr. Mark Hyman: Yeah. That was a big library of mathematics. It's called the blood brain barrier. Nothing gets through.

Dr. Austin Perlmutter: Nothing gets through.

Dr. Mark Hyman: I'm like, well, not really. We have leaky brains, guys. We're gonna talk about that.

Dr. Austin Perlmutter: Think about what's in your brain right now. I guess your brain Mark, you probably have somewhere in the neighborhood of 80 to a 100,000,000,000 neurons, which is is amazing. That's that's plenty. You're doing great, but the really interesting part of it is that you have about the same number of glial cells. These are the cells that in essence do so much for how you think, how you act and how you feel.

Dr. Austin Perlmutter: And in some ways, kind of tell neurons, how to behave. Of that number, something like 20,000,000,000 R cell called a microglial cell, and a microglial cell is a bonafide immune cell that lives in the brain. Its role is not just to protect the brain against outside threats, but it's actually an immune cell that modulates how neuro on fire, how they work. And this is really the cell type that has been very carefully researched as it relates to using our risk for brain health conditions, mental health, cognitive health conditions. Is that the immune system of the brain?

Dr. Austin Perlmutter: It is. If you're going to remember the immune cell of the brain. The answer is microglial cell, but I will say, and as I talked about earlier, turns out all the cells in your brain participate in immunity neurons are immune cells in that capacity, astro sites, oligodendro sites, they all kind of participate in this immune conversation. But for the purposes of this, the one to know is the micro real cell because they seem to be the master orchestrators of your brain's immune state. And in doing so, regulate whether your brain is inflamed or is moving towards more of a state of resolution in anti inflammatory state.

Dr. Mark Hyman: And so so how do you measure that? Like, I, you know, I'm a doctor. I'm like, how do I measure brain inflammation? Hyman gonna a little, burr hole.

Dr. Austin Perlmutter: Yeah.

Dr. Mark Hyman: It'll brittle, you know, brain biopsy measure the tissue.

Dr. Austin Perlmutter: Don't do that. Yeah. Don't don't do that in the clinic. That's not a good idea. It's it's a great and you are using most of your brain right now as a my, hopefully.

Dr. Austin Perlmutter: You don't wanna be taking out big pieces of tissue to study under the microscope. So unless a person is hospitalized unless something's going pretty seriously wrong, we're not going into the brain to take a biopsy. So in the absence of that exactly. Or an infection, right, you need to know whether it's infection or malignant, But in the absence of that, certainly, you can look at CSF. Again, this is final final fluid.

Dr. Austin Perlmutter: Yeah. Exactly. Not super convenient. So we wind up looking at other tests. There's a lot of imaging research that's been done using MRI, using PET scan to look at various kind of correlates of inflammation.

Dr. Austin Perlmutter: And this gets technical again, but there's a certain a protein called TSPO that when activated, when we see more of that on imaging, is an indicator that there may be more activation of microglial cells, inflammation in the brain. Again So

Dr. Mark Hyman: now there's advanced imaging that looks at the brain on fire, but it's not really available for everybody.

Dr. Austin Perlmutter: It's not something that I don't have

Dr. Mark Hyman: one mic playing.

Dr. Austin Perlmutter: We shouldn't be routinely testing that. And to that end, the important piece is to look at the data that we have available, and that can be everything from, you know, waist to hip ratio. It can be looking at a hemoglobin a 1c. It can be looking at potentially things like zonulin, insulin resistance. These are surrogates for inflammation in the body, and they correlate with risk for neuro immune, neuro inflammatory diseases.

Dr. Mark Hyman: Okay. So I'm gonna unpack that a little bit because it was a big mouthful and it went fast, which is essentially what you're saying is people who have biomarkers of poor metabolic health and make poor alcoholic healthy mean somewhere on the spectrum from slightly imbalanced glucose and insulin regulation to pre diabetes to full blown hypo diabetes, which leads to increased belly fat, which is very inflammatory, and it leads to other biomarkers in the blood, like, C reactive protein, you mentioned Xyluline, which is a marker of, something that gets triggered in the gut and often in relation to gluten that can cause a leaky gut. And we'll talk about the gut brain in a little bit more detail because I think that's a really important center for for the source of inflammation. Right? And and so, basically, what you're saying is between kind of the gut being messed up in our diet and its consequences for our metabolic health, that's driving a lot of the brain and nation that's related to the ultra processed food and starch of sugar and refined foods that were eating dinner, generally inflammatory.

Dr. Austin Perlmutter: I think to expand it a little bit. If you look at

Dr. Mark Hyman: Did I get that right?

Dr. Austin Perlmutter: You're you're you're correct. But to expand it a little bit, your brain a reflection of the inputs. You give it what you consume. And if you think about what you're consuming, of course, it's what you put into your mouth, which is all the food that you eat, It's also what you inhale. So it's a reflection of the quality, the air you breathe.

Dr. Austin Perlmutter: And then the piece that many people don't pay enough attention to is what you consume your eyes and through your ears. And so I'd say in that sense, it is an ultra processed consumption of data from a number of sources That hit is a very easy one to get into because it's something we have a choice around.

Dr. Mark Hyman: Some of

Dr. Austin Perlmutter: us don't have as much choice around the other pieces, certainly all of these things contribute to brain inflammation.

Dr. Mark Hyman: Yeah. I mean, obviously, like, you know, the the the media that we now mostly consume, whether it's news or social media, is basically, like, junk food for the brain. Yep. It's highly effective. It's,

Dr. Austin Perlmutter: it's no nutrients.

Dr. Mark Hyman: It's no nutrients. It's like It's not up leveling yourself. Not at all. I mean, I just it's it's a sync, a assess pool of stuff that that activates, anger and activates your primitive limbic brain, your amygdala, your dopamine activation, you end up in this vicious cycle of of addiction to that too. I mean, I I see myself.

Dr. Mark Hyman: Like, I wanna see what's happening in the world, but, like, it shouldn't be called news. It should be called bad news. And but there's so many good news happening in the world. We never hear about think, we really have to think carefully about what we ingest both, like you said, through our mouth and through our eyes and our ears and our relationships as a big factor because all whatever the input is, the end result is the same. I always think of inflammation as the final common pathway for bad stuff.

Dr. Mark Hyman: Right? So there's insults, it's sort of the way the body responds out of this reactivating this inflammatory process or this fire in the body, which is also ends up in the brain.

Dr. Austin Perlmutter: It you're right. And I think taking a moment here to consider this through kind of an evolutionary lens, if we may. One of the experiences many people may be familiar with is how they feel when they get sick. So if you got a cold, if you got the flu, if you came down with illness, how your thinking is, and how you interact with the world. This has been deemed sickness behavior.

Dr. Austin Perlmutter: This is the terminology for it Hyman, by and large, when they get sick, act and feel in certain ways. What's really interesting about this is they feel pressed. They feel socially withdrawn. And so it's been hypothesized that this makes sense, again, evolutionarily because you want to be somewhere safe. You want to kind of go back somewhere that you can recover on your own, and you don't want to infect other people with whatever sickness you're experiencing.

Dr. Austin Perlmutter: So that makes sense in the context of an illness. Yeah. But but think now about the fact that really what it is is inflammation telling your brain how to be and how to withdraw from other people and how to have more kind of walls up against maybe hearing what other people are talking about now appreciate that that same inflammatory pathway be chronically activated by our interactions with the modern world, and you can start to understand perhaps some of the behavioral changes seeing at scale across the planet with polarization with people, in essence, having more trouble connecting with others. This is really, I think, think an impactful way to look at the real power of the immune system is changing human behavior at scale.

Dr. Mark Hyman: I mean, this is a really important topic. Awesome. Because it's not being discussed much. Right. You know, we're we're understanding that, you know, maybe bad food causes depression, maybe, you know, in metabolic syndrome and and some resistance lead to Alzheimer's disease.

Dr. Mark Hyman: And that, you know, there's this sort of inflammatory process that happens as it relates to lifestyle, but not really in terms of our way of seeing the world, feeling the world connecting in. And there's a really important kind of thing for people to understand and maybe kinda unpack it a little bit is this relationship between what I call the adult in the room. And and the lizard brain. And and the lizard brain is like it basically wants to do what it wants to do when it wants do it. Mhmm.

Dr. Mark Hyman: It it's focused on survival. So it's feeding. Called we used to call it the for us in medical school, feeding, fighting, or, you know, or

Dr. Austin Perlmutter: There we go.

Dr. Mark Hyman: Fleeing or reproduction.

Dr. Austin Perlmutter: Yep.

Dr. Mark Hyman: And and that and that and that and and now it's also gonna be, fall as another one of those. But it's there's these these behaviors that are just ancient behaviors that are built into our brain that, if we listen to all those things, if we then on all those thoughts. And we all have those crazy thoughts. So I whether it's I wanna eat that entire pint of ice cream or I wanna go and make out with that person on ice on the subway I don't know them. Like, you know, you have these crazy thoughts, but you don't do it because you have an adult in the room.

Dr. Mark Hyman: This is not it's probably not such good idea, Mark. You probably don't wanna do that. And and so what what's happening and this is what the stress takes me with the science is increasing amount of scientific literature that points to inflammation Mhmm. Communication between the adult in the room who makes coherent decisions that protect themselves, their community and society, and the kind of reptile dinosaur in the room that wants to attack and eat everything. So can you explain the science behind this and and the and you did a lot of work on this in your book brainwash.

Dr. Austin Perlmutter: Right.

Dr. Mark Hyman: And and I think it's becoming even more relevant as we're seeing our any breakdown. And as we're seeing this, you know, globally, we're seeing polarization. Globally, we're seeing increased hatred, increased violence, increased polarization, and and it's it's it's really concerning to me, and I think there's a solution for it. But can you kind of explain the science behind this disconnection for people?

Dr. Austin Perlmutter: The idea here is, as you've alluded to, we have ways of looking at parts of our brain. Everything, of course, is networked, but certain aspects of our brain when they communicate in a positive way seem to help regulate our decision making process. So the area of the brain that we really focus on is the prefrontal text as being that adult. When the prefrontal cortex is active, when it's kind of able to do its job, it is able to calm down and speak to the more perhaps primitive parts of our brain that are very helpful, very necessary, but shouldn't always be the ones making decisions. So if you think about it, the the primitive parts of the brain are the ones that hear a bump in the night and think there's a monster under the bed.

Dr. Austin Perlmutter: It doesn't probably make sense to most adults, but it might pop maybe it's a snake, maybe it's something else. And the adult, the prefrontal cortex says, I know that's what you think, but it's just windy.

Dr. Mark Hyman: Yeah. I was I was trying to I was the other night because I had to leave the door open because my Right. My wife basically came late and

Dr. Austin Perlmutter: she drew

Dr. Mark Hyman: that with some friends, and she forgot her keys. So I left the door open in the hotel room. I'm trying to fall asleep, and I'm thinking, oh, maybe someone's gotta come in and attack it. Oh, I had a kid fall asleep. I tried this whole conversation in my head, between my amygdala That's it.

Dr. Mark Hyman: And my friend alone. And I eventually, my friend alone, which I'll save, but it was it was not that easy.

Dr. Austin Perlmutter: Well, sometimes is a real danger. And I think that's important too. Right? Like, if you're walking if you're walking to the forest and hear a rustling in the underbrush, that might be amounts in line. Probably not.

Dr. Mark Hyman: Yeah.

Dr. Austin Perlmutter: But maybe it's just the wind. And the point is as it relates to our day to day decisions, we need to have that adult present because the impulsive choice. The emotionally, biased choice is most often the thing that's going to detract from our ability to have high quality of life. If you think about why a person, let's say, chooses an unhealthy food, it's not always that they think this tastes good, and this is the decision I want to make. It's often an impulsive choice one of the things that's been very clear in this research around the prefrontal cortex to kind of amygdala connection and the quality of it, and we can unpack that a little bit because really what you want is directional communication is that stress seems to take the prefrontal cortex offline, which is why if you are stressed, you're more likely to eat junk food.

Dr. Austin Perlmutter: Similarly, if you're sleep deprived, this connection becomes a little bit more

Dr. Mark Hyman: Interesting. Right.

Dr. Austin Perlmutter: So it becomes a little bit less concrete. And to that end, it helps to explain why people who are sleep deprived. Have trouble making healthy choices. They tend to eat a lot more food, and they eat a lot more junk food.

Dr. Mark Hyman: Oh, yeah. And I don't see if I want sugar carbs. Give me that cookies ice cream that I've written books all about why not to eat that. I still want it.

Dr. Austin Perlmutter: Absolutely. I think in the long run, what we're looking at is what are the effects of chronic inflammatory stimuli on kind of dismantling the ability of the prefrontal cortex to stay in control. And that's where it gets really thing. Because as we're thinking about these insults, the foods that we're eating, the air that we're breathing, the things that are functionally disabling the ability of our prefrontal cortex to make good decisions, it can help us to explain why we're seeing certain aspects of the world not make as much sense. People not doing the things that maybe we would think they should be doing or that would be beneficial to even the people if you were to ask them.

Dr. Mark Hyman: Yeah. It's interesting. You know, it sort of reminds me of, this trial back in the in the in the seventies. The there was a for the guy, this guy, Dan, white, who killed the mayor

Dr. Austin Perlmutter: of San

Dr. Mark Hyman: Francisco, Jordan Moscone and his Riser Harvey Milk. And and, and the the lawyers mounted what they called the Twinkie Defense Mhmm. Which is a very famous legal defense, and they argued that the his consumption of basically junk food and Twinkies led to his disordered behavior. Mhmm.

Dr. Austin Perlmutter: And

Dr. Mark Hyman: they were able to convince a jury to not convict him of first degree murder, but of, voluntary manslaughter, which is a reduced charge. So that was really fascinating. Then, you know, we kinda began to look at the data on this. And I I know it's more and more research coming all the time on this, but there was a a recent study, looking at the link between junk food, sugar sweetened beverages, and psychological distress. And, you know, there was a study called the Caspi 4 study that took a nationwide sample of 13,000 plus Iranian children, adolescent 1618, and they basically looked at how much junk food they had and what their mental health And it was just striking that there was such a huge correlation, actually, between depression, anxiety, and things you might expect, but violent behavior like, you know, violence.

Dr. Mark Hyman: And and, you know, increasing junk food led to a 39% increase risk in the odds of physical fighting, 19% increased odds of being a victim and 55% increased odds of bullying other people. Yeah. So you know

Dr. Austin Perlmutter: yeah. So let's let's dive into this just a little bit because I think this is the message that very few people are aware of, which is it's not just that people may make worse choices as far as I'm gonna eat this junk food. I'm gonna skip sleep to watch another 3 seasons on Netflix. I'm not gonna call my mom. We're talking about real world violence behavior.

Dr. Austin Perlmutter: So one of the biggest studies that was ever done on air pollution looked at the link between a certain air pollutant PM 2.5 and risk for violent year. And what they found is after awaiting 10 years to see if these correlations survived is that PM 2.5 exposure correlated with not just any any crime, but violent, impulsive crime. And that's important. This isn't premeditated stuff. What we're talking about is that it changes people's brains their thinking such that they're more likely to do things like hurt another person.

Dr. Austin Perlmutter: So there's actually work being done now on questioning what should be done in prison systems to help people with aggressive behavior as far as what nutrients do people need? Because the reality of it is that we've just ignored this complete We have operated under this assumption that why a person does what they do is a reflection of a psychological construct like willpower.

Dr. Mark Hyman: Yeah. I I think that's right. And you just hit on something huge, which is that we misappropriate the meaning of the behavior. In other words, we say it's because you know, they they're crazy here because they're whatever. It's not because maybe their brains are inflamed, and then they're really acting in ways it are not kind of willful in a sense because they're controlled by this underlying bias.

Dr. Mark Hyman: Twinkies. The Twinkies. Right. The Twinkie event. So so, you know, I mean, I don't think people should be absolved in responsibility for doing bad things, but I think it sort of speaks to the massive prevalence of things that are driving inflammation.

Dr. Mark Hyman: And I think we we hit on 2 big ones, which is ultra processed food, sugar, starch, and then environmental pollution. Whether it's air pollution, heavy metals. And I think, you know, these are things that we don't really talk about when we're talking about these issues in society. We're talking about our mental health crisis, and it's talked about an asylum. Let's get more mental health care.

Dr. Mark Hyman: Let's get more drugs. Let's get It's like, no. Let's figure out why the brain's not working properly.

Dr. Austin Perlmutter: That's it. There's there's not a lot of upstream about this, and I totally agree. Need more emphasis on how to support people who already have these issues. That is absolutely necessary. At the same time, we need to be thinking about why our prevalence rates for these diseases continuing to go up despite the fact that we have solved for technological issues that we never thought we would.

Dr. Austin Perlmutter: And I'd like bringing one other kind of line of science here. So a lot of recent work has focused on something called maternal immune activation, MIA. The idea here is that mom's exposure to inflammation while the child is in utero can influence outcomes in children. And so a big study was just published in the last couple of days, and it looked at, in essence, mom's inflammatory status when pregnant 24 weeks, and then it looked at children's rate of developing ADHD at age ten. So we're talking a long time later.

Dr. Mark Hyman: Yeah.

Dr. Austin Perlmutter: 40% increase rate. Now why might that be the case and why does research suggest that maternal unit activation correlates with Tourette Syndrome, with ADHD, with autism, with schizophrenia, it is very likely that the immune status of the mom, the immune state of the mom, inflammatory status is able to speak to the children by way of the central transfer. It seems like it might modify epigenetics. It seems like it might speak to my, microglial cells.

Dr. Mark Hyman: Yeah.

Dr. Austin Perlmutter: So what we're talking about here is not just ourselves. We're talking about a generational effect of our pro inflammatory lifestyle that may not be visible until decades later.

Dr. Mark Hyman: So we're talking about what the mommy

Dr. Austin Perlmutter: That's a

Dr. Mark Hyman: her diet. Yep. And the programming that happens to the baby's epigenome. Mhmm. Well, determine not only the risk of obesity or cancer or heart disease, but the risk of mood disorders, their behavior, violence aggression.

Dr. Mark Hyman: And and, you know, when you think the fact that, you know, 65 percent of our diet is ultra processed food. And then Americans eat about a £150 of sugar and a £130 of flour a year each this is a this is like a national emergency.

Dr. Austin Perlmutter: It is. I mean, this is this is the stuff that matters most. It's how we think. It's how we act. It's how we feel.

Dr. Austin Perlmutter: I think one of the challenges here is when you look at things through the pharmaceutical lens, the effects of a food of a lifestyle modification or not may not be experienced the next day or a few minutes later. Right? So Right.

Dr. Mark Hyman: If

Dr. Austin Perlmutter: you push EPI, you're going to see an effect on the patient pretty quickly, you would hope. But if you change a person's diet

Dr. Mark Hyman: That's epinephrine. That's a drug we're using in the at all allergies and heart attacks.

Dr. Austin Perlmutter: And Right. You don't wanna be doing that casually, but the point being you will see an effect. And if you change somebody's diet, they may not think clearer immediately. They may.

Dr. Mark Hyman: Honestly, I I would say if you are effective enough by using a big enough lever, in other words, dramatically changing the diet enough, you'll see change in literally based.

Dr. Austin Perlmutter: So I have seen that. I guess the point I'm making though is when we're looking at these global factors Yeah. This is where it becomes challenging because we would say, oh, well, as an evidence based intervention. If we give somebody a a bowl of kale as opposed to a hamburger, we didn't necessarily see their depression alleviate overnight. So let's just stick with what we have.

Dr. Austin Perlmutter: Right. But if you look at term data, for example, the Mediterranean diet on rates of dementia, on rates of depression, it's pretty profound. Yeah.

Dr. Mark Hyman: It is. Yeah.

Dr. Austin Perlmutter: The the challenge is how do we get people to care enough implement it? How do we decrease the barriers to making those the norms in our diet? And I think this is where our food tree has us in a really bad spot.

Dr. Mark Hyman: Yeah.

Dr. Austin Perlmutter: Because what they would say is, well, everything in moderation and give people the opportunity to choose what they want. Yeah. Now that's

Dr. Mark Hyman: some one last note key in it. 1

Dr. Austin Perlmutter: Right. Everything in moderation.

Dr. Mark Hyman: So you can have your hamburger.

Dr. Austin Perlmutter: Don't do that. So you can have your hamburger. You can have your soda, but then have to make sure to exercise. And I like the it's part of a complete breakfast. Right?

Dr. Austin Perlmutter: You've seen this for the cereals where they have the cereal, but then they have the fresh fruit, and they have £5 of fiber on the side. Yeah. The problem is that we believe in this idea, this myth, that it's great to promote freedom and that you can do that through letting people have freedom of choice, but the reality is you don't.

Dr. Mark Hyman: Well, we well, you don't have choice unless you understand. Right? You know, you can't make a choice unless you have the knowledge to make the choice.

Dr. Austin Perlmutter: And then access.

Dr. Mark Hyman: And and knowledge, even in terms of the food labeling, food marketing Right. Advertising, it it corrupts our understanding. And unless you're a PhD in nutrition and even then, it's understand a nutrition facts label or an ingredient list for most people. And in other countries, they don't have this problem. They've eliminated all the the advertising, for kids on junk food.

Dr. Mark Hyman: They put limited all the car cartoon characters in Chile on the Frost and Flakes. There's no more turning the tiger. They've gotten rid of all, junk food in schools. They put front of package labeling on big stop signs that say, don't eat this. This is gonna kill you.

Dr. Mark Hyman: And, essentially, you can eat it, but it says, don't this is really bad for you. Right. And so it's it actually changed behavior, and it it it changes what people choose because they have the right information. We don't have that. I'm actually working Washington now Mhmm.

Dr. Mark Hyman: On on a food labeling effort to change food labeling so we can protect our children Yep. And have a clear grading so that we know what's in the food and people can actually understand it.

Dr. Austin Perlmutter: That's so important because what you're bringing up is the significance of defaults. And this is an aspect that requires policy. It requires higher level intervention we do things that are easiest to do. And at scale, that plays out. So many researchers now have been looking into how do you make the healthy choice easier to make at companies like Google.

Dr. Austin Perlmutter: So there's a stoplight system. This food is green. This food is red. And this stuff is really important because it's often the subtle things that have the biggest effect. I would just say going back to what you described as far as the, cartoon animals, we won't name any of our friends, but, you know, we know these animals on the boxes of of degree serial.

Dr. Austin Perlmutter: These things have an impact. There is a reason that they're there. And when you look at an adult's preference for serial decades later, it is consistent with what they were given as a kid because of some of the fun association they had. United States is one of only 2 countries though that allows direct to consumer pharmaceutical advertising. So we're hitting people on both sides of the spectrum with the belief again, give people freedom of choice.

Dr. Austin Perlmutter: But it's not actually freedom of choice when the defaults are structured in such a way that you're almost certain to make the wrong decision.

Dr. Mark Hyman: Yeah. Although, I'd be fine if it, if they had, you know, junk food ads on television, the Super Bowl, but at the end, just like Hyman ad, they said, If you use this thing, it will kill you and cause diabetes and heart attacks, early death, stroke, depression, dementia, Alzheimer's, like, that be fine with that because that gives people choice. Right? It's actually information, education. I actually have a theory about why Washington is so screwed up.

Dr. Mark Hyman: I've been many times in Washington, walked through the sent in, walked through the house, been there, had to eat sometimes lunch there in the cafeterias. It's where the senators eat in the Congress meeting, all their staff eat, And it and, essentially, it's a cesspool of junk food. I mean, you know, monster size, sugar drinks, processed food, and also all the best food out are there. So, you know, McDonald's, Burger King, pizza, they're all there. And that's what they're eating.

Dr. Mark Hyman: And I'm like, well, that's what people are trying to, like, make make our country better, make decisions, and their brains and their bodies are all

Dr. Austin Perlmutter: So two things are on

Dr. Mark Hyman: this crap, and their brains are on flame. Wonder their emotions are inflamed.

Dr. Austin Perlmutter: So I think people forget the brain is built out of nutrients from food. It's not like we can, you know, take carbon from the atmosphere sequester it, we have to create brains, the rest of our body as well, out of the molecules in our food. So if you're literally building your brain out of junk food, that's going to have an impact on how you make choices. So the other thing I was just gonna say here, which I know you're incredibly familiar with. Yeah.

Dr. Austin Perlmutter: It's it's miserable that at the highest levels, the people who are in charge of our decision making, powering their bodies with junk. But this happens in the hospital at an even more extreme level. So I know we don't have to get into this, but I remember being on my residency interviews and being at some very prestigious centers that were actually very close to where we are now. Yeah. And going into the cafeteria and seeing that the quality of that food was worse than what you get at kind of a gas station rest on.

Dr. Mark Hyman: Yeah.

Dr. Austin Perlmutter: And it just seems

Dr. Mark Hyman: like the doctors and the nurses and the staff are leaving.

Dr. Austin Perlmutter: And and the reason is because we assume that it doesn't matter that much. Right? It's just we'll wait and when things get bad enough, we have drugs. Let's not focus on things that maybe are not worthy of our time and money. And it's so backward.

Dr. Mark Hyman: Too bad. Not much

Dr. Austin Perlmutter: what you feed people in hospitals.

Dr. Mark Hyman: No. It's terrible. I I I actually, 2 little anecdotes. One one, I I used to work in the emergency room, and and and I would take this night shift on time that would work from you know, I don't know, 11 in the morning, 11 at night to 7 in the morning. You know, and I kinda missed the cafeteria hours because they were only, like, 8 to 9 in the morning, 12 to 1 lunch, and then 6 to 7 at night.

Dr. Mark Hyman: The only thing that was open from, like, I think it was 6 in the morning till 2 in the morning was McDonald. Of course. And, you know, at Cleveland Clinic when I started working there, Toby We've essentially tried to get McDonald's out of there. Couldn't do it because it was a long term contract, but the, literally, the day the contract expired, I was there. And the McDonald was there one day, and he walked in the next morning, and he was gone.

Dr. Mark Hyman: Like, he literally had it boarded off and completely shut down when I but should be illegal. I mean, I think it should be a law as a like, you can't smoke in a hospital.

Dr. Austin Perlmutter: Be honest. It's not about health.

Dr. Mark Hyman: But you can't smoke in a hospital.

Dr. Austin Perlmutter: Right.

Dr. Mark Hyman: Why should we be serving food that actually chills people in the hospital.

Dr. Austin Perlmutter: What you're saying makes sense. I think if you were to actually take a blade blanket statement and say, this is the place where we're going to optimize for healing, then that is true. But As we know, that is not necessarily the case in all institutions and that the for a number of reasons, there are, wanting to give people access to freedom of choice. Yeah. And that I think is part of the illusion that's been created, which is we're not doing anything wrong because it's you that has to pull the We're just creating the food.

Dr. Austin Perlmutter: We're just creating the scenario, and you have to be the person to come eat it. Now

Dr. Mark Hyman: that food brain is just regulated. It's hard to make the right

Dr. Austin Perlmutter: which by definition, if you're in the hospital. So mean, we could talk about this a little bit. One of the best instances that I saw early on of how inflammation impacts the brain was in the ICU. We're up to 70% of people. Our experience delirium.

Dr. Austin Perlmutter: Right? Delirium is a very common thing in the hospital. Why is that happening? What actually correlates with levels of inflammation in the bloodstream? So as you increase inflammation in the context, often of these kind of severe infections and metabolic dysregulation, you're thinking gets messed up.

Dr. Austin Perlmutter: Yeah. So we see this in the hospital. We have the connection with inflammation and people's cognition getting worse. And then we think about what are the lifestyle variables that map on to information. So we should be advocating for a Mediterranean diet healthy menu in

Dr. Mark Hyman: the hospital. There are some breakthroughs

Dr. Austin Perlmutter: that I've seen happening around the but by and large.

Dr. Mark Hyman: And that doesn't mean pizza and pasta. Right. Because that's Italian. I'm not gonna be miniature anyway. Yeah.

Dr. Mark Hyman: You mean whole foods, lots of vegetables, nuts, and seeds.

Dr. Austin Perlmutter: Fuji grandparents would eyes. However, you wanna describe it. Yeah. Yeah.

Dr. Mark Hyman: Yeah. Exactly. Right.

Dr. Austin Perlmutter: Yeah.

Dr. Mark Hyman: Because men, they're a element here as a universal definition of Mediterranean diet. So it's really

Dr. Austin Perlmutter: Real foods. Yeah.

Dr. Mark Hyman: Real foods. And, you know, I I think, you know, speaking of of sort of real food and how important that is, we've talked about how our ultra processed diet sugar, starch, all that drive inflammation in the brain. I wanna we're gonna get to how the gut plays a role.

Dr. Austin Perlmutter: Mhmm.

Dr. Mark Hyman: We we've learned about high environment toxins, whether it's air pollution or plastics or petrochemicals or, heavy metals, all can interrupt the brains and drive inflammation. Right. I mean, we know this. You know, the the the, you know, the felt, felt maker hat makers back in the, you know, in in London, you know, in the 1900, 18 were all crazy because they used mercury

Dr. Austin Perlmutter: Mhmm.

Dr. Mark Hyman: To make the felt stiff. And so that's where the mad hatter came from from the house in Wonderland. Right? And some heavy metals for sure. But but there's a flip side to it, which is there's an antidote.

Dr. Mark Hyman: And and then this one study really compressed me with a study of, young adolescent girls, who ate, you know, more sugar and starch and junk food. And and if they the more they ate, there was a 1400% increase in aggressive behavior.

Dr. Austin Perlmutter: Mhmm.

Dr. Mark Hyman: Now for those listening, if in medicine you see a 20 or 30% delta change, in something, that's like a blockbuster. So statins reduce the risk of heart disease by 30%. Right. Wow. Yeah.

Dr. Mark Hyman: Blackbuster Drug. We're talking about 1400 percent increase. It's not something that's unlikely to be correlated. And it was then more interesting was when they looked at the case control state, if there was more fiber in the diet, more omega threes, and more vitamin k, there was a lower association with aggressive behavior. And this tracks against other studies that I've talked about and that I wrote about in my book Foodfix were in prisons, for example, where they took prisoners who were by in prisons, and they gave him healthy food.

Dr. Mark Hyman: There was a 56% reduction in violent crime. If they added a multivitamin, it was an percent reduction in prisons. They did this with juvenile detention centers where they took kids who were eating junk food. They gave him a whole food, and they saw that a 97% reduction in in bad behavior or 75% reduction in restraints and a 100% reduction in sides, which is the 3rd leading cause of death in teenage boys. So that's massive data.

Dr. Mark Hyman: And Yeah. And yet to me, this should be things that's, you know, shouted from the rooftops that all academic medical centers should be implementing that policy makers should be paying attention to that we should be really getting to the root of this mental health crisis, which is you know, it's not just it's not just that it creates more polarization and disruption in society, but the depression, the anxiety, the things that go along with it, are huge impacts on our economy You know, when you look at, there was a macroeconomic study looking at the cost of chronic disease, and it was estimated it was gonna cost $95,000,000,000,000. Which is a lot of money. That's like, I think, you know, our GDP is, like, 20 trillion or something. And And it was $95,000,000,000,000 over 35 years.

Dr. Mark Hyman: And the number one contributor, because they measured direct and indirect costs, not just back health care costs was loss of productivity and disability and dysfunction from depression.

Dr. Austin Perlmutter: Yeah. Well, think that it's universal, but what you reference as far as behavior is a reflection of this out aided ideology, which is that behavior is a reflection of who a person is, and the best ways to change behavior are going to be reward and punishment And that's it. Right? It's basically you are who you are. If you do something wrong, we're going to put you in your room.

Dr. Austin Perlmutter: Right? We're going to allow you to have time to reflect on this so you don't do it again. And historically, this doesn't really work well. In certain cases, for example, drug recidivism after people are punished for using a drug is pretty high because it turns out that the reason people were using the drug was to feel better and that when you made them feel bad in jail and you didn't necessarily give them any of the things that were vary to improve their quality of life, they will go back to using these molecules again. So it's this idea that behavior is a fixed reflection of who a person is what we're talking about with this neuroinflammation can be controversial because what we're saying here is you are dynamically changing moment to moment.

Dr. Austin Perlmutter: So in your body, your immune cells turn over as a reflection of total number every couple of months. In your brain, you are growing new neurons all the Hyman, and you're more importantly, changing the strength of the connections between those neurons all the time. Since your thoughts, your feelings are a reflection of your neuronal state and of your brain state, that means that you as a person as an identity as a belief system are changing moment to moment when you appreciate what immunity means to that because immunity is a master system that modulates the strength and number of the connections between your neurons. Yeah. It changes how you think, changes how you feel.

Dr. Austin Perlmutter: You realize you're kind of operating on the core operating them, but what makes you you. And that can be a scary thing. I think it's opportunity.

Dr. Mark Hyman: Yeah.

Dr. Austin Perlmutter: Because we don't have to sit and blame people for the way that they are. We can curious about saying what is happening with you right now? There's some low hanging fruit that you can change that every person can change as it relates to optimizing their overall immune health and improving their brain's immune balance. And if you do those things and you feel less aggressive and you feel less impulsive and you feel happier and you think clear, I mean, that's kind of all of the things that we would define as who you Mark, your interest change. There's a really nice

Dr. Mark Hyman: with your neighbors. Yeah. You don't have road rage. Alright.

Dr. Austin Perlmutter: So an interesting study looked at microglial cells, and it found that it might predict people's personality traits, meaning the state of microglial cells. This is really fast. Designating stuff because we're talking about, one of the areas in which you kinda change who you are. So not to go too much on this tangent, but psychedelics seem to increase trade openness. Right?

Dr. Austin Perlmutter: So open mindedness, these are things that can happen and really in some ways should be happening, not saying that specific to psychedelics, but changing who we are and updating our prior assumptions is key to what makes humanity unique. Right? And when we get more locked into patterns of thinking, which I believe neuroinflammation does. Yeah. We lose our best chance at actually participating in this life for all it's worth.

Dr. Austin Perlmutter: Kind of the, the cost of that, the fringe cost is that we're more likely to allow this world to fall into chaos and to allow the climate to be destroyed. These are things that

Dr. Mark Hyman: are grown up in the room in the world. Right? That's it.

Dr. Austin Perlmutter: That's it. We've gotta be, thinking about what are the things at scale that will promote more adult level thinking. Yeah. And one of the things we can do is optimize our brain immune state, neuroinflammation.

Dr. Mark Hyman: It's it's so important what you're saying, Austin. I wanna I wanna get into the details of how we regulate your inflammation. But before we do, I wanna hit on one more key point that you've kinda touched on a little bit, which is the gut brain connection and the micro I am. And I just I wanna start out by a little anecdote, or anecdote data or end of one trial, which was a little girl I saw years ago, who came to me because her mother didn't know what to do with her. And, she was I had written my book Ultra Mind solution, which was about how to fix brain by fixing your body first, essentially dealing with the inflammation by changing your diet, lifestyle.

Dr. Mark Hyman: I wrote this book 15 plus years ago. It was way ahead of its time. It's still I was talking about the gut and my brain and all this stuff way back then, and no one really should be talking about it. And this girl, you know, I I just said, I don't know what's going on there. She's this beautiful little girl, but she was so violent.

Dr. Mark Hyman: She was attacking her sister all the time. She was nine years old. She was a violin in class. She was kicked out us multiple times a day on the bus home should be kicked out the bus. They have to stop the bus, you know, a dozen times on the way home.

Dr. Mark Hyman: Should be ripping pictures of, like, family, like, ripping her sister out and just, like, really crazy behavior. Yeah. And, you know, they talk her to the fair best. They did this. And they got nothing help.

Dr. Mark Hyman: And I'm like, I don't know what's going on, but let's just have a look. And so I just screened her for her gut health and of urinary, organic acids, and look

Dr. Austin Perlmutter: at,

Dr. Mark Hyman: the the microbiome, the turnout should severe elevations of biomarkers for bacterial overgrowth, and the gun for used to overgrowth. So I literally gave her an antibiotic and an antifungal.

Dr. Austin Perlmutter: Mhmm.

Dr. Mark Hyman: And, like, boom, overnight, she was a different person. Like, a perfectly behaved sweet little nine year old girl. And and that was when the light bulb went off in my head of, like, holy cow. Like, what else is going on here? And and so it's really it's really been this this incredible treasure chest.

Dr. Mark Hyman: We've been able to open up understanding that link between the gut health and everything in the body, but I we're gonna focus on particularly the brain right now and neuroinflammation. So can you unpack for us how our gut and our microbiome and gut inflammation and leaky gut and leaky brain are all connected and to kinda unpack that story for us because I think it's really important because there's so much we can to optimize our microbiome?

Dr. Austin Perlmutter: I think it's it's a really incredible area of research, and there are certain domains that overlap between conventional medicine and kind of the wellness domain. And gut health is one of them because it's interesting to my friends who are practicing conventional gastroenterology, and it's interesting to friends who are nonmedical, but think maybe this is a way to get healthier. What I first saw as it relates to this, and I think you've spoken about this previous podcasts is hepatic encephalopathy. Right? This is an instance in which people, for one reason or another, develop liver failure.

Dr. Austin Perlmutter: They build up these nitro is compounds, and basically they get altered. They get loopy. They they kind of lose themselves in this haze of hallucinations.

Dr. Mark Hyman: They get delirious and rain fog. They're not yeah.

Dr. Austin Perlmutter: They're they're getting out of bed. They don't remember who they are. And the reason for it is basically the absorption of these nitrogenous compounds as a reflection of what is happening in the gut and the conventional therapy.

Dr. Mark Hyman: Toxic toxic metabolites of gut bacteria that are getting absorbed and poisoning the brain and causing the brain to be crazy.

Dr. Austin Perlmutter: Causing us. So this is this is a direct connection between the gut and the brain because the intervention for this are flush out the gut or give antibiotics to kind of re regulate the gut. Those are the conventional therapeutic.

Dr. Mark Hyman: Yeah. Neil seem to clear out all the it's like a it's like a nuclear bomb for all the gut bacteria. Right. And then you give basically a plunger called lactulose,

Dr. Austin Perlmutter: which flushes the gut It's like Exactly.

Dr. Mark Hyman: A super laxative. Yeah. And all of a sudden they wake up. It's like, boom. Right.

Dr. Austin Perlmutter: And and you track improvement by how many bowel movements they've had. How many bowel movements does this person have? Because the goal is to flush out all of those toxins producing bacteria so that they don't absorb all of these nitrogenous compounds. So they

Dr. Mark Hyman: have shit for brains is basically what you're saying.

Dr. Austin Perlmutter: Again, official diagnostic code there. The point is there is a direct connection between the gut and the brain in sense. There's research, as you know, going back nearly a 100 years looking at what had happened as far as when you removed parts of the gut that was being done for a variety of different reasons. The the point here is we've known for a long time that there's something connecting the gut with the brain, but we've only more recently started to get specific as to how that happens and what we can do to modulate. So couple of the statistics.

Dr. Austin Perlmutter: For a few years, we're a quote. Right.

Dr. Mark Hyman: By what you're saying about hepatic and self laughing, that has been something we've learned forever in school. Every traditional doctor knows this, and yet it doesn't translate into the rest of their medical practice that the gut could affect the brain. Right? Right.

Dr. Austin Perlmutter: I I think I think that's accurate. I think this is the instance of knowing that there is this connection. We have a specific protocol in place, but by and large You don't think it's generalized. No. Right.

Dr. Austin Perlmutter: Exactly. So going back to what we now know, I think it is fair to say that the gut brain connection or really just gut health in general is is revolutionizing the way that we look at our own health. We know that the gut has, I think, the most recent update is 39,000,000,000 microbes. The majority of them clustered in the large intestine, which is important because from a bacterial perspective, of the majority of those are bacteria. That's about the same number of cells as we have in our bodies.

Dr. Austin Perlmutter: And micro have ten times the DNA. So as a relative ratio, we're we're more bacteria than we are human, which is kind of a crazy thing.

Dr. Mark Hyman: We're just basically a a walking, carrier for all the bacteria in our in our guts.

Dr. Austin Perlmutter: I think that's true. And there was a recent study that I was discussing with our friend, Jeff, plan that suggests that social mission of microbes is a big explanatory reason for why we think and act the way we do. So wait a few years and you'll find out that it's not about us. It's about the the microbes on it and us that are actually defining our interactions. But to go back to this, what we now location.

Dr. Austin Perlmutter: So what happens in the gut and, impacts the brain and vice versa? There's a couple of pathways that have been isolated down bottom up. Right. I guess bottom up being more specific in this case to the cut to the brain, but, sure, both ways. And, again, I think we will learn in the future that maybe this part is not in as much control as we thought.

Dr. Austin Perlmutter: Yeah. So the the gut can interact with the brain through the bloodstream through molecules that are created in the gut that get into the bloodstream, go up into, and either bind 2 receptors on the blood brain barrier go through the blood brain barrier. Then we have this whole bypass system, the vagus nerve. Right?

Dr. Mark Hyman: Wait. So you just just slow down. You just basically said that molecules from poop from your bacteria in your gut get absorbed. Right. And then go up into our brain and get absorbed into our brain and our is correct.

Dr. Mark Hyman: With our brain and regulating our brain. That's causing inflammation in our brain.

Dr. Austin Perlmutter: Or helping to suppress it as in the case of short chain fatty acids, but you're correct. The idea is that on the pro and on the on-site. So the the bad ones, we would think about lipopolysaccharide being the best example. This is a component of a bacterium that when absorbed is a potent regulator increases inflammation. The talks.

Dr. Austin Perlmutter: It is a toxin. It's believed to mess with basically everything in our bodies it seems to specifically activate microglial cells. It binds to a receptor called the Toll leg receptor 4, which maybe is just interesting trivia, except for you realize the microglial cells are listening for what is happening in your gut to be able to make decisions. And I'll just say one more thing. Looking at animal titles.

Dr. Austin Perlmutter: We know that microglial and neuronal development is in part contingent on what happens in the gut, which means that our gut helps to char brains, how to kind of grow and establish themselves. Really, really interesting stuff. Wow. So what happens in the gut absolutely influences the brain. One way is the bloodstream.

Dr. Austin Perlmutter: And the other way is through the vagus nerve because the vagus nerve runs all the way from the brain down to the gut, down to the majority of the gut, I should say, and is mostly, fibers that carry messages from the gut to the brain as opposed to the other way around. So these are 2 of the most important pathways the other thing I'll just lay in here, which I think is really key to this conversation, the gut is where we have a reservoir of the majority of our immune cells. And the reason for this is because our immune system is not just a defense system, but it is designed to learn from what is happening in the outside world and trans submit those signals through the rest of our body, including our brain. So your immune cells live just below your gut lining, and they actually send up little arms, to grab pieces of food, to to interact with bacteria, and they take that message down. They change the way that they function, and they can actually send those signals through the rest of the immune system and in doing so influence the brain.

Dr. Austin Perlmutter: So this is a constant bidirectional communication. And

Dr. Mark Hyman: this is just straight up medicine science. We're not talking.

Dr. Austin Perlmutter: This is just the science. This is, you know, nature kind of high level papers.

Dr. Mark Hyman: Well understood now, everybody. It's not it's not kind of quacked, side hustle we're doing here about poop and the brain. It it actually is really deep science.

Dr. Austin Perlmutter: And this is established.

Dr. Mark Hyman: It's not being used in clinical medicine at all, really. It's just sort of like, okay. Well, we get it now. Now what? No.

Dr. Mark Hyman: Because most actors have no idea how to normalize the gut bacteria because like you said, there's there's not no. Not all of bacteria are good, and they do so many good things for us. If we have the right collection of bacteria, but if we have noxious bacteria, they produce more of these toxic compounds. They produce more lipopolysaccharides than than absorb and increase this cascade, and it doesn't just affect the brain. So lipopolysaccharide also will cause you to be more insulin resistant and diabetic even if you don't, you know, change your diet.

Dr. Mark Hyman: So literally, you're you're you're and these experiments just blew me away. I don't know if you read this in, like, an animal model, but they would literally take the the the the, poop of a mouse and put it in a a mouse that had sterilized gut. There was a skinny mouse.

Dr. Austin Perlmutter: Mhmm.

Dr. Mark Hyman: And then the the skinny mouse would have those bacteria. I think you mean the same would gain, like, 57% more weight.

Dr. Austin Perlmutter: Right. There's similar data for depressed humans into mice. It's it's absolutely fascinating. I think just the

Dr. Mark Hyman: backup depression with a poop transplant?

Dr. Austin Perlmutter: It's it's not out of the range of possibilities

Dr. Mark Hyman: or treat or treat obesity with a poop transplant. They've done that with that.

Dr. Austin Perlmutter: These are these are things that are happening These are things that are being considered. Just to take this one step back, the idea, which is a very basic idea that most people are at this point in the conversation would agree with is that what we eat influences our brain function. We if we believe that, which I hope we do, we could ask, well, what should we eat to positively influence our brain function, our brain immune balance? When I did medical training, not all that long ago, there were really only 2 domains in which we connect diet with brain health. 1 is deficiency.

Dr. Austin Perlmutter: So if you were eating the tea and toast diet, you could get a b 1 deficiency. You get a b 12 deficiency. And these are conditions that we learned how to treat. So if an alcoholic came in, we give them thymies. These are things we knew.

Dr. Mark Hyman: Oh, wernicke's and stuff

Dr. Austin Perlmutter: like that,

Dr. Mark Hyman: right, which is a kind of insanity you go from actually being vitamin deficient from being alcoholic.

Dr. Austin Perlmutter: Exactly. Exactly. The other piece of this was the metabolic component. So we knew that if somebody's blood sugar drop below 50, for example, they may go into a coma. That's not a good thing.

Dr. Austin Perlmutter: That is, a real problem. If they came in with diabetic ketoacidosis or any state really high blood glucose, they would, patients might have a higher chance of being altered, right, mentally unstable, in the sense of delirium and otherwise unsafe. So we knew that blood sugar had a direct correlation with brain state at the extremes. Extreme. Beyond that, though, there was nothing else.

Dr. Austin Perlmutter: What is the diet a person should be eating? And more specifically, are there customized nutrients, patterns of eating that we should be using to program our brain for better health? So we were so many steps away from the gastrointestinal tract unless somebody had a functionally, disabled GI tract. We had to think about putting in a tube doing an IV feeding, but that was literally it. Yeah.

Dr. Austin Perlmutter: So what we're saying is the science has gone so Mark, and there's so much that we can glean from these microbiome and gut studies that really should be supplemented today for BRAIN Health based on the research being published in literally the top journals on Earth.

Dr. Mark Hyman: Yeah. Well, there's now well, there's now a whole field of what we call psychobiotic Right? Which are probiotics that have effect on mood and depression, anxiety, sleep, I'm I'm trying what now, which is basically a sleep robotic. Mhmm. Those increased deep sleep.

Dr. Mark Hyman: I don't know if it's working, and I'll tell you later. But, you know, it's interesting that there's these compounds starting to be customized probiotics to actually regulate these various mood and mental health states.

Dr. Austin Perlmutter: Again, this all makes sense when understand the pathways involved. There's a a quote that many people bring up, which is the majority of your serotonin is produced in the gut. Now that's nice. However, serotonin in the gut doesn't cross the blood brain barrier. But it can interact with the vagus nerve and vagus nerve signaling can change the brain.

Dr. Austin Perlmutter: And, also, there are other metabolites like tryptophan, which is the precursor that can be produced in the gut and then can get into the brain. So there is absolutely a correlation between what happens in our gut and our brain state, both in terms cognition. And in terms of things like sleep, one thing I'd just like to say on that front is if we think about what actually induces sleep. There are a number of variables. We think about adenosine and other things happening in the brain, but inflammation was actually one of the first variables that was studied as what dry of sleep, a hypnotoxin, basically, they looked at animal studies, and they derived kind of an immune marker that predicted sleepiness.

Dr. Austin Perlmutter: And it made Even if they're

Dr. Mark Hyman: more inflamed more likely to just wanna sleep?

Dr. Austin Perlmutter: So that's part of it. And it can help explain why people who are sick tend to be very tired. We ever wonder why that is, it's interesting when a person is incredibly inflamed in the context of something like sepsis, their immune system might actually be eating up 40, 50% of their energy reserves in their body. So this isn't, you know, kind of rocket science. If you don't have energy, ATP going around, you're probably going to be a little bit more fatigued.

Dr. Austin Perlmutter: But it does seem like the immune system in sleep are really closely bidirectionally interacting. And so if the gut influenced the immune system, the immune system influences sleep, then the gut microbes seem to be to this process.

Dr. Mark Hyman: Yeah. It's so important. So let me set a summarize a little bit, and then we'll get into, like, what the heck do we do about neuroinflammation? So clearly, we're in an epidemic of inflamed brains. And the drivers of it are our diet.

Dr. Mark Hyman: Black of protective foods, which we'll talk about in a minute. Too much ultra processed food, particularly sugar and starch. Hyman environmental toxins,

Dr. Austin Perlmutter: which are

Dr. Mark Hyman: ubiquitous, all the petrochemical toxins, heavy metals that are everywhere. Air pollution. Mhmm. And our gut and our gut microbiome. And the disturbances in that because of our lifestyle diet mentioned a few of the things that drive neuroinflammation, like lack of sleep, stress, lack of exercise.

Dr. Mark Hyman: Mhmm. So these are that we actually have fair bit of control over. We can't Right. Control air pollution, particularly, and maybe we can get air filter in our house. But a lot of these other things we can control.

Dr. Mark Hyman: So those are the things that seem to be driving the neuroinflammation that's leading to this sort of epidemic of mood and and behavior to orders and neuropsychiatric and neurodegenerative disorders, even neurodevelopmental disorders. What is the sort of right approach to take care of your brain? You mentioned there's no preventive neurology, right,

Dr. Austin Perlmutter: but

Dr. Mark Hyman: there's preventive cardiology. There's no preventive psychiatry, but Right. What there should be. So what does that look like? And how do how do people, you know, start to prioritize those things?

Dr. Mark Hyman: We know that our our things we should be avoiding or things we should be adding in to to optimize our brain health.

Dr. Austin Perlmutter: I'd start with kind of a psychological construct here, which is you and I have talked about lifetime modification for help for many years. And many people listening, watching, will have heard about things before?

Dr. Mark Hyman: I've been talking about more years than you've been

Dr. Austin Perlmutter: alive, obviously.

Dr. Mark Hyman: It's probably accurate.

Dr. Austin Perlmutter: The the the crux of the matter is something that we've discussed, which is people change when there is psychological pain. And I think that's the key to it. And it's defined in energy within yourself that's going to fuel this because reality is any of us could do a diet for a few weeks. Any of us could join a gym for a few weeks. The the core constituent elements of lifestyle modification are well known to most people.

Dr. Austin Perlmutter: And I think at least for me, it's that I've had 2 grandparents die of Alzheimer's disease.

Dr. Mark Hyman: Yeah.

Dr. Austin Perlmutter: I have seen so many patients and people I know suffer from mental health conditions and neurodegenerative diseases. And I refuse to accept that that's the best we can do. And I think if we have that within ourselves, which is the understanding that if you do not make changes, you will, by the law of statistics here, law probability, why up with at least one chronic disease on at least one medication at an incredibly high risk of developing Alzheimer's disease and a mood disorder. Now I'm not trying to say can prevent all of it, but I'm saying that for me, I am unwilling to accept the status quo. Yeah.

Dr. Austin Perlmutter: So if that is for you, if you're somebody who's saying, no, that's not me. I want to better than average, then you start to gain some actual energy behind making some of these changes. And I think that's the the really important kind of driver

Dr. Mark Hyman: people don't even know that they can make a difference or that they those things are connected.

Dr. Austin Perlmutter: And and that's that's the next piece of it, which is to know that by simple lifestyle modifications, you can dramatically decrease your risk for brain inform inflammatory conditions like dementia, like depression, and a host of these other ones that we've discussed. So let's go through some of these things. Right? I think diet is probably the one that most people are interested in hearing about. And for good reason, because we actually have a lot of choice over what we eat.

Dr. Austin Perlmutter: So we may not be able to modulate the air quality day, we may not be able to get as much exercise as we want, but we have to eat. And, therefore, we can change the quality of the food that we eat. By and large, based on the research that I've reviewed, the best diet for preventing neuroinflammation and promoting brain health is some variant of the Mediterranean patch diet. So the Mediterranean or it's close cousin, the mined diet, these are not complicated things, and I want to stress that. These are not high the restrictive diets.

Dr. Austin Perlmutter: They're not fad diets. These are diets that incorporate a wide range of primarily plant based foods. There's fish. There's some tree, but it's really getting a wide range of plants. And these are things that are rich in polyphenols.

Dr. Austin Perlmutter: These molecules of which there are thousands found in a variety of plants across the that seem to be correlated with better cognitive outcomes and especially correlated with better immune outcomes. So we're talking colorful fruits, vegetables. We're talking things like spices. So herbs and spices are actually some of the most concentrated sources of polyphenols.

Dr. Mark Hyman: These are natural anti inflammatories.

Dr. Austin Perlmutter: Exactly. And we know coffee, which is one of my personal favorites, for her reasons beyond the polyphenols, but the polyphenols help. Wine has some, we could talk about that. Yeah.

Dr. Mark Hyman: Too much of that last night with you, Austin. Sling was good as I liked him.

Dr. Austin Perlmutter: There you go. It was a really good wine. Wow.

Dr. Mark Hyman: I only have one when it's really good, and I don't usually have it that often. But when I do it, I like it. It was a good wine. It was a good wine.

Dr. Austin Perlmutter: So, again, it's it's just eating real foods, most of the time. I think there's a lot that can be said for substitutions. And, obviously, you know, we're doing this work with this Himalayan Tartery Bucky because it is a better version of what most conventional grains Mark, it happens to be a lot higher in polyphenols than almost any flower on the market. So it's really kinda concentrating a diet that is rich in real foods. And I know and I've I've listened to guests on your podcast and other podcasts.

Dr. Austin Perlmutter: Everyone has their slants on ideal diet. You think what you talk about with the vegan diet, what you talk about with eating real foods. Yeah. This is the key to it. And this is the benefit here is that this is the that is most strongly associated with lower levels of inflammation.

Dr. Austin Perlmutter: There was actually a study just came out, 166,000 people. They followed them for multiple years. And what they that was basically rates of people developing dementia on. So they looked at how anti inflammatory was their diet? Was it a Mediterranean or was it a more conventional diet.

Dr. Austin Perlmutter: What they found is that people who ate the anti inflammatory diet, the Mediterranean diet, lower risk for dementia, and, bigger which is the memory center of the brain. So this doesn't have to be super complicated stuff. It doesn't even have to be super expensive stuff. It's basically eating real food most of the time. So that's that's my of dieters.

Dr. Mark Hyman: On fiber too for the microbiome, prebiotics, foods, and probiotics.

Dr. Austin Perlmutter: The fiber comes along with the prioritizing real, minimally processed plant based I do think that we're learning more and more. I mean, a study just came out showing that fiber consumption, inversely associated with the all cause mortality, This is it's good stuff. It's real stuff. We could talk about mechanisms, but, yes, fiber prioritization comes alongside with eating foods that people have messed with the least, specifically plant based foods.

Dr. Mark Hyman: Yeah. Don't eat that's a good one. Don't eat food that's been messed with.

Dr. Austin Perlmutter: Unless it's Hyman amazing chef.

Dr. Mark Hyman: Yes. Right. It's like a tomato from the plant. Okay. Right?

Dr. Mark Hyman: If it's an egg from the farm, okay.

Dr. Austin Perlmutter: Can you name it?

Dr. Mark Hyman: Right. My my my questions. We used to, speak at at churches, and I was doing this work with, faith based wellness was the the rules for eating are really simple. If if man made it, leave it. If god made it, eat it.

Dr. Mark Hyman: You know, did god make a Twinkie? No. Leave it. Did god make avocado? Yes.

Dr. Mark Hyman: Eat it. It's pretty simple. Anybody can understand that.

Dr. Austin Perlmutter: Yeah. Yeah. Food made by plants, not in plants.

Dr. Mark Hyman: That's right. That's right. So, so food is such a critical aspect of this and a critical aspect of immunomodulation, you know, rejuvenate And now, you know, your one of your day jobs is the Managing Director of Big Holt Health, which is an extraordinary company that I am an advisor to an investor in that's been found funded by by my mentor, Jeffrey Bland, who's the father of Functional Medicine. And, it's a long story. We talked about it on the podcast before, but but this this particular plant, Himalayan Tari Buckwheat, has particularly immunoreres ruminating anti inflammatory properties.

Dr. Mark Hyman: And it comes from plant that's grown in extremely difficult circumstances, high in the Himalayas in terrible soil at high altitude and cold weather, and it forces it to be really robust. And the way plants become robust is they build defenses. And the defenses that plants have are these phytochemicals. So these phytochemicals are found in extraordinary numbers and levels in this particular plant. Now you can make pancakes out of it, which is great.

Dr. Mark Hyman: But but there's a new there's a new, and then you can take it as a concentrated supplement, which I do, and I recommended it's 1st in bioclateralids, many other things. But there's a there's a new product that that's come out of this, and it's all through regenerative agriculture. This plan has grown in America now is, Himli and Terry Buckley sprouted Right. Powder. Right?

Dr. Mark Hyman: What's it called? Sprouted?

Dr. Austin Perlmutter: Yes. Sprout powder.

Dr. Mark Hyman: Sprout powder. And and it's, you go to big both health dot com and check it out. But it it's it's really a kind of an amp up version of the Himalayan and tardy buckwheat flour, and it's it's something you can it's sort of already precooked, sprouted so you can eat it in raw. And I throw it in my smoothie. My wife puts it in her coffee, like, blends it up in a little, a neutral bullet.

Dr. Mark Hyman: So tell us about how that plays a role in modulating inflammation and how that can, you know, be an adjunct to some of the dietary things you're talking about?

Dr. Austin Perlmutter: I think that the core idea here is the idea of food is medicine, which is the idea that food can help people to heal. And if you believe that, then certain foods are better than others. Right? Certain foods are the opposite. Certain foods are poison.

Dr. Austin Perlmutter: They're taking away from the quality of your life, the quality of, every aspect of what it means to enjoy our existence, and certain foods are able to enhance that. So I training as a conventional medical doctor, you know, I learned things about it. I learned things about how to make recommendations mostly through the Institute for Functional Medicine and other similar programs, hearing you speak actually a long time ago. Within this field, I learned that in order to scale out nutrition

Dr. Mark Hyman: based solutions for people, you

Dr. Austin Perlmutter: have to actually pay attention to how that food is grown, who is growing that food, and how you get food to people. So as much as I would like to

Dr. Mark Hyman: say taste.

Dr. Austin Perlmutter: Yeah. Absolute. Well, that that that's a big piece of it. So as much as I like to say, here's my top 5 foods at Costco. I don't have a whole lot to say about the quality of the Costco organic olive oil, which I think is actually pretty high be.

Dr. Mark Hyman: But Yeah.

Dr. Austin Perlmutter: Point being, I'm not necessarily involved in that supply chain. So at Big World Health, Jeff has decided that he wants to really take a a more solid role in participating in that entire process. So we have these farms in upstate New York. We're inoculating this plant with kind of fungi and bacteria in order to promote a healthier soil microbiome, which is something I've been learning about more recently. It's kind of an interesting thing.

Dr. Austin Perlmutter: The soil itself has a microbiome speaks to the plant and actually by way of that bidirectional interaction with kind of the plant brain and the soil brain and the microbes changes the amount of the plants immune chemicals, these polyphenols.

Dr. Mark Hyman: Yeah.

Dr. Austin Perlmutter: So we grow it in New York where it's colder where we have higher levels than these phenols to start with, then we inoculate it to further increase it. Then we grew this plant, and we've been, kind of putting this tardery buck, this Himalayan tardery it into the market for a couple of years. And one of the things we've heard is that people wanted a more convenient version of it. So we said, how can we make it more potent and how can and more convenient. So we found this incredible research, this literature showing that when you sprout foods, it actually can increase levels of a number of different minerals vitamins and also certain polyphenols while decreasing some of the trouble that people have with question when they might be eating in a non sprouted foods.

Dr. Austin Perlmutter: Yeah. And had mess around with sprouted foods as,

Dr. Mark Hyman: by the way, buckwheat is neither wheat or grain.

Dr. Austin Perlmutter: It's a fruit seed, actually, of all things, which, again, very confusing name. It's not a wheat. It's it's not a grain.

Dr. Mark Hyman: Yeah.

Dr. Austin Perlmutter: So we we've partnered with group when we started sprouting it, and we measured the levels of these polyphenols, things like rootin and quercetin. We found that they were, on average, around four times higher in the sprouted powder which is super convenient because, actually, I've used your pancake recipe several times, and it's great, but it's kinda more of a weekend Sunday morning type. Sure. You're not just gonna whip it up on your way to office. So what makes this brow powder unique is that it's it's, 1st of all, tastes a little bit less bitter because of the way that it's sprouted, and it's just super convenient travel with it.

Dr. Austin Perlmutter: You can put it in your smoothie. You can put it in your coffee because it's kinda like a sprout matcha latte kind of thing.

Dr. Mark Hyman: Connor. Yeah.

Dr. Austin Perlmutter: But it's been fun.

Dr. Mark Hyman: It's great. Yeah. That's amazing. And and and the reason I brought it up is because it's, you know, in it's sort of one of those compounds, in our in our food supply that can be used to modulate our immune system, right, regulator inflammation. And there's obviously many others, but I just sort of wanted to highlight that.

Dr. Mark Hyman: And then, of course, you know, there's other things we're gonna have to do for our brain. Right?

Dr. Austin Perlmutter: No. You're done. You got it.

Dr. Mark Hyman: What? That's it? That's it? No. We have to sleep.

Dr. Mark Hyman: We have to deal with stress. We have to exercise. Yeah. All that's a given. And we have to fix our microbiome.

Dr. Mark Hyman: Right, and part of the sprout powder is it contains a lot of fiber that helps with the microbiome. Right?

Dr. Austin Perlmutter: That's right. And what makes the whole targeted buckwheat story in in my work with Jeff Interesting is that we're trying to actually study this in a more systematized fashion. So there's a study that I know you're aware of where we were actually at what happens when you give people the polyphenols in Himalayan Tardery Buckley, and you measure their immune system. And specifically, you measure the epigenetic of the immune system is complicated stuff. But it is some of the first research looking at if we believe in this idea of food as medicine, how how does food actually heal?

Dr. Austin Perlmutter: We have, for years, operated under this antioxidant paradigm where certain foods have more antioxidants than others. It hasn't certainly panned out. So what we do know is that certain diets correlate with certain immune states. What we didn't know is why. And I think the mechanism that we're looking at here is through epigenetics by changing the way the DNA is being used.

Dr. Austin Perlmutter: And that's what we've been looking at in this study. And at least in the data we have so far, it looks like when people's immune systems are aging faster. So in the group of people who are kind of, getting older in their immune system Mark than than others that it actually slows the rate of aging when people are taking these, polyphenols that are found in Himalayan Tartery Buckley. So This is early stuff.

Dr. Mark Hyman: Early early research, SunMacy reverses biological age, like a epigenetic age.

Dr. Austin Perlmutter: Right. In the right population. And, again, early stuff, but the the crazy thing for me at least about this is we are starting to get to this core mechanism of food as medicine. Okay. But and why.

Dr. Austin Perlmutter: And if we're literally changing the way our DNA is being used through the food that we eat, think about the possibilities. This has been looked at in certain cancer therapeutics, and we're starting to look at it as it relates to just general health. Meaning, when people eat certain foods, you are changing the way your DNA being used and in doing so are going to modulate a person's risk for a host of issues and potentially use it to up regulate pathways linked to better health, which is what I'm excited about. It's not be all about disease. Let's talk about how to get people.

Dr. Mark Hyman: Right. Is this the whole concept of it? Not just anti inflammatory, but immunorejuvenate. Right. Which is how do you because that's what I care about.

Dr. Mark Hyman: I don't I don't have any diseases, but I wanna optimize. I wanna rejuvenate. I wanna feel better. I don't I'm not in a disease state, but I I wanna get into a better optimized state. So there's there's a whole that's all another conversation.

Dr. Mark Hyman: I I think, you know, I just wanna sort of close by instead of pointing out that, you you know, this research is is is is backed up by a lot of of evidence. This whole concept we're talking about. And and there's randomized human clinical trials, for example, the Smiles trial.

Dr. Austin Perlmutter: Mhmm.

Dr. Mark Hyman: They looked at basically diet and antidepressants, and it was basically as effective, if not better than antidepressants, need a Whole Foods diet. The finger trout looking at Alzheimer's, like, an a multimodal intervention using lifestyle intervention dietary interventions, optimizing biomarkers, actually reversed cognitive decline in Alzheimer's patients with something that doesn't actually happen. It doesn't there's no drug that does that. So we're raising looking at at these interventions, which maybe seem like soft or not real medicine, they actually are the most effective medicine. I

Dr. Austin Perlmutter: and also the is your best chance at living a healthy happy life. This this is it. What we've got right now, it's not like there's some drug that is going to come and save you. Drugs are really great when things go wrong enough to justify drug use. But by and large, the way that conventional pharmaceuticals work is they slow the rate of decline.

Dr. Austin Perlmutter: You're already on the slope. You're already on the slippery slope. You may not slide as quickly. So what we're talking about here is preventing yourself from getting on that slope in the 1st place.

Dr. Mark Hyman: Yeah.

Dr. Austin Perlmutter: And that is such a powerful message because so much of my work, I seem to interact with people who are a little bit older, in further years. And there's so much that they can do to improve their quality of life, but I really want to reach out to younger generations. I see so many people, my age and younger, who haven't yet started to prioritize their brain health. And inevitably, they all follow the same kind of continuum they ignore it until it gets so painful that they have to do something about it. And I don't want people listening to be the person brought in the ER or brought into the clinic by their partner when they're seventy years old, and everything's already gone wrong.

Dr. Austin Perlmutter: This is your best chance to seize health today.

Dr. Mark Hyman: Yeah.

Dr. Austin Perlmutter: So I just that more young people take that to heart.

Dr. Mark Hyman: Yeah. Thanks so much, Austin. This is such a great conversation. I could touch for hours, but I I I just to sum up, I I think, you know, what we touched on is this this really important concept of brain inflammation driving a lot of the stuff that's wrong with their society, mental health, the polarization, neurodegenerative disease, kids issues with ADD, autism, we didn't really touch on that, but it's all linked to this neuroinflammation. And and the good news is we know why and we know how to fix it.

Dr. Mark Hyman: We're still learning. There's some more to know, but I think at this point, we still have the we have enough tools to make a difference. And so I encourage people to check out your book, brainwash, when your dad, you know, pro mother, check out Big Both Health. Anything else you wanted to know about?

Dr. Austin Perlmutter: If you're interested in Brain Science, free newsletter

Dr. Mark Hyman: Check it out. Thanks so much, Austin. Thanks for listening today. If you love this podcast, please share it with your friends and family.

Dr. Mark Hyman: Leave a comment on your own best practices on how you upgrade your health and subscribe wherever you get your podcasts. And follow me on all social media channels at Doctor Mark Hyman, and we'll see you next time on the doctor's pharmacy. I'm always getting questions about my favorite books, podcasts, gadgets, supplements, recipes, and lots more. And now you can have access to all of this information signing up for my free Mark picks newsletter at doctor Hyman forward slash Mark picks. I promise I'll only email you once a week on Fridays, and I'll never share your email address or send you anything else besides my recommendations.

Dr. Mark Hyman: These are things that have helped me on my health journey, and I hope they'll help you too. Again, that's doctor Hyman. Thank you again, and we'll see you next time on the doctor's pharmacy. This podcast is separate from my clinical practice of Tremoma Center and my work at Cleveland Clinic And Function Health, where I'm the chief medical officer. This podcast represents my opinions and my guest opinion.

Dr. Mark Hyman: And neither myself nor the podcast endorsements of views or statements of my guests. This podcast is for educational purposes only. This podcast is not a substitute professional care by a doctor or other qualified medical professional. This podcast is provided on the understanding that it does not constitute medical or or services. Now if you're looking for your help in your journey, seek out a qualified medical practitioner, you can come see us at the UltraBonus Center in Lenox to choose it.

Dr. Mark Hyman: Just go to If you're looking for a functional medicine practitioner near you, you can visit, and search find that your database. It's important that you have someone in your corner who is trained, who's a licensed health care practitioner, and can help you make changes, especially when it comes to your health.

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