Grain Brain, by Dr. Perlmutter - my notes through the end of chapter 1.

Warning – this blog post is ridiculously long (and the formatting from Word did not come through well - I tried to correct the formatting, but it's getting late and I have a lot to do today).  If you are not interested in learning about what the book Grain Brain is about, don’t even bother reading it.  This post covers the introduction and first chapter of the book, which are pretty dense.  A lot of the post is simply my notes from the chapter, which I took with the intent of making the information stick.  I found the book to be very interesting and I can’t help but believe Perlmutter is spot on in his observations.  As is my style, I breezed through the book the first time I read it.  It made enough of an impact that I decided to read it again and take notes.  I know I will be making further changes to my lifestyle as a result of reading this book.  I thought some of you might find this information interesting, so since I was taking notes anyway, I decided (with the encouragement of Ruth and George) to share them with you.

For the most part, I have tried to indicate when I am using direct quotes, but since this post is from my notes, I may have either neglected quotation marks here and there or mistakenly indicated something as a direct quote when I have actually changed a word or two.  Sorry about that.   

The rest of this post is my notes (and a few of my thoughts) on Grain Brain, through the end of the first chapter.

In Brain Grain, Wheat Belly heads north.  David Perlmutter, MD is a Board certified neurologist and a fellow of the American College of Nutrition – the only doctor in the country with both of these credentials – and in Grain Brain he writes about how our daily habits impact our brain.  In the book he focuses on three things:  food, sleep, and exercise.  After reading the book I think about food differently…again. It seems like I have been spending a lot of time the last few years changing the way I think about food.  I don’t know what to say about that.

Dr. Perlmutter starts Grain Brain with a few quick sentences that set up the rest of the book succinctly:

"Your brain… 

• weighs three pounds and has one hundred thousand miles of blood vessels.  (Is that possible?)
• contains more connections than there are stars in the Milky Way
• is the fattest organ in your body.
• could be suffering this very minute without your having a clue."

In the introduction to the book, Perlmutter states that the point of the book is to prove to us that brain disease can be largely prevented through changes we make in our lives; that it is not our destiny to develop brain disorders or to go senile.  He informs us that diabetes & brain disease are the USA’s costliest and most pernicious diseases, are largely preventable, and that they are uniquely tied together.  I knew that type 2 diabetes is largely preventable, I did not know that brain disease and having diabetes doubles your risk for Alzheimer’s.  Did you?

Perlmutter throws a hint into the introduction about how he feels about what he calls “Big Pharma” and, in particular, cholesterol reducing statin drugs.  He informs us of a recent report in the Archives of Internal Medicine that stated that postmenopausal women put on statin drugs to lower cholesterol had a nearly 48% increased risk of developing diabetes than those not put on the drug; more on that later in the book.

Basically, what Perlmutter wants us to know by the end of the introduction is that brain dysfunction is no different from heart dysfunction – it develops over time through our behaviors and habits and it is largely preventable.

The next section is a self-assessment of your risk factors for developing brain disease.  I took it.  Here are my results:

      Self-Assessment 

      Answer all questions true or false 

1. I eat bread – False  
2. I drink fruit juice – False    
3.  I have more than one serving of fruit a day – True       
4. I choose agave over sugar – False      
5.  I get out of breath on my daily walk – False       
6. My cholesterol is below 150 – False      
7.  I have diabetes – False      
8.  I am overweight – False      
9. I eat rice or pasta – True (no pasta, just brown rice, but he does not distinguish between the two)   
10.  I drink milk – False    
11. I don’t exercise regularly – False    
12. Neurological conditions run in the family – True (would you consider this true?  Grandmother was senile, does that mean it “runs in the family?”  Was that mostly alcohol related?  Your thoughts on this?)    
13. I don’t take a vitamin D supplement – True    
14. I eat a low fat diet – False    
15. I take a statin – False    
16. I avoid high cholesterol foods – False 
17. I drink soda – False 
18. I don’t drink wine – True 
19. I drink beer – False 
20. I eat cereal – False

I had 5 Trues – the more trues – the higher risk for brain disease and disorder.  The only one that really surprised me here, and the one that makes me anxious, is #3 – I have more than one serving of fruit a day.  Is that a habit that will increase my risk of brain disease?  It can’t be!  Perlmutter talks a lot about glucose and fructose later in the book.  We’ll get into this later.  I welcome your discussions and comments on this point (as well as any others) as we go along.

Perlmutter states that more than 10 trues is a hazard zone for serious neurological ailments that can be prevented, but not necessarily cured once you are diagnosed. I neglected to mention that this topic is a personal one for Perlmutter.  Not only is he a neurologist and a nutritionist, his dad (a former neurosurgeon) has been suffering from severe Alzheimer’s for the last 15 years.  

Before we even start chapter 1 we are informed that:

•  Obesity is now a well-documented risk factor for brain disease.
• Preventable, non-communicable diseases account for more deaths worldwide today than all other diseases combined.
• Many of today’s epidemics are rooted in inflammatory pathways run amok.
• The origin of brain disease is in many cases predominantly dietary – the result of consuming too many carbs and not enough healthy fats.

And finally – we get to start reading the book!

Part 1 – THE WHOLE GRAIN TRUTH

For many, many years it has been common knowledge that a poor diet can lead to obesity and diabetes, but can it also lead to a busted brain? It kind of feels like a, “Well, duh?” question when I think about it now, but I never thought about it before.  I knew that eating the wrong food might make my brain a little fuzzy and mess up my cognitive function, temporarily, but lead to brain disease? Cause Alzheimer’s?  Cause permanent brain damage?  I never, ever thought about it that way.  But Perlmutter is here to inform us that a poor diet can lead to permanent, non-curable, brain disease.  He informs us that studies have been describing Alzheimer’s disease as type 3 diabetes since as early as 2005.

Chapter 1 – The Cornerstone of Brain Disease

Just like Younger Next Year and Wheat Belly, Perlmutter talks about our ancient selves and how our bodies are not designed to eat our “modern diet.”  He works hard to prove to us that diabetes and brain disease are linked to each other and to our diets, and he starts with a quick discussion about diabetes which I will summarize here.

For most of our existence, glucose – the body’s major source of energy – has been scarce, so the body developed very efficient mechanisms to turn other foods into glucose and store it.

Gluconeogenesis is defined as the manufacturing of glucose from fat or protein.  The body can turn fat and protein into glucose, but it requires more energy than the conversion of starches and sugar into glucose.

The function of insulin, a hormone produced by the pancreas, is to allow sugar molecules into cells. Healthy cells have a high sensitivity to insulin, but when cells are constantly exposed to high levels of insulin they adapt by reducing the number of receptors that respond to insulin.  In a constant high-insulin environment our cells desensitize themselves to insulin, causing insulin resistance, which then causes our cells to ignore the insulin and fail to retrieve glucose from the blood.  The cells now need more insulin to get the needed sugar into the cells, so the pancreas responds by pumping out more insulin.  This cycle eventually culminates in type 2 Diabetes.

If you have type 2 Diabetes you have high blood sugar because your body cannot transport sugar into cells, where it can be safely stored for energy.  The excess sugar in your blood is toxic and causes a lot of damage leading to blindness, infections, nerve damage, heart disease and (according to Perlmutter) Alzheimer’s.  Inflammation is running rampant through the body.  Perlmutter discusses inflammation as being the root cause of most preventable diseases later in the book.  

Insulin is an anabolic hormone that stimulates growth.  Insulin promotes fat formation and retention and encourages inflammation.  It has a “domineering presence” which can adversely affect other vital hormones when it is uncontrolled.  Insulin resistance sparks the formation of the plaques that are present in diseased brains.  The plaques are the build-up of a protein the essentially hijacks the brain and takes the place of normal brain cells.  It is because of this ability to now associate high levels of insulin with brain disease that the term “Type 3 diabetes” is starting to circulate among researchers. 

Perlmutter never claims that diabetes causes Alzheimer’s, what he is trying to do is make the point that they have the same origin.  He claims that both illnesses result from foods that force the body to develop biological pathways that lead to dysfunction and illness.

After this brief discussion of “what is diabetes,” Perlmutter makes a rather awkward jump to talking about gluten sensitivity.  He states that, “gluten sensitivity represents one of the greatest and most under-recognized health threats to humanity.”  Perlmutter informs us that all the latest science points to “the bane of gluten in triggering dementia, epilepsy, headaches, depression, schizophrenia, ADHD and a decreased libido.”  While people are becoming aware of the fact that gluten can impact intestinal health, very few are linking the consumption of gluten to neurological wellness.

Perlmutter states that, “As many as 40% of people cannot properly process gluten, the rest of us could be in harm’s way.  What if we are all sensitive to gluten from the perspective of the brain?”  There are an increasing number of studies that link gluten sensitivity to neurological dysfunction.

We’re informed by Perlmutter that the cornerstone of all degenerative diseases, including brain disorders, is inflammation.  Every time I read this I think about how my hands swell up and I gain 2 or 3 pounds whenever I have a crappy food day.  Now I process that information like this:  Inflammation = water retention = opportunity to develop degenerative disease, including brain disease.  Wow, it makes me think hard about why I “allow myself” to eat crap, ever.

Researchers have documented that gluten and a high-carbohydrate diet are among the most prominent stimulators of inflammatory pathways that reach the brain.  Unfortunately, knowing the impact inflammation is having on the brain is much harder to detect, early on, than the affect it is having on our gut.  Our gut responds to what we eat with gas, bloating, constipation, and diarrhea emerging rather quickly.  But neurological problems are more subtle and develop more slowly.  Unfortunately, once symptoms do develop it is very difficult, if not impossible, to reverse the damage.

Perlmutter claims that we must free ourselves of a few myths in order to reduce our risks of neurological challenges.  “The two biggest myths are: 

1. A low-fat, high-carb diet is good 
2. Cholesterol is bad.”

He claims that cholesterol is one of the most important players in maintaining brain health and function.  High cholesterol reduces the risk of brain disease and increases longevity.  High levels of dietary fat (the good kinds) have proven to be a key to health and peak brain functions.

Perlmutter refers to the Framingham Heart Study a lot so I will list the parameters of the study here.  The study 

• commenced in 1948
• commenced with 5,209 men and women between the ages of 30 and 62 from the town of Framingham, Massachusetts.
• None of the participants had suffered a heart attack or stroke, or developed symptoms of cardiovascular disease prior to the start of the study,
• Since 1948 the study has added multiple generations stemming from the original group.

In the mid-2000s a group of researcher from Boston University looked at 789 men and 1,105 women from the original group. In 2005 the study’s report was published with the following statement, “There was a positive linear association between total cholesterol and measure of verbal fluency, attention/concentration, abstract reasoning, and a composite score measuring multiple cognitive domains.” Moreover, “participants with ‘desirable’ total cholesterol (less than 200) performed less well than participants with borderline high total cholesterol levels (200 – 239) and participants with high total cholesterol (greater than 240).  “Lower naturally occurring total cholesterol levels are associated with poor performance on cognitive measure, which placed high demand on abstract reasoning, attention/concentration, work fluency, and executive functioning.” 

In addition to the Framingham study, research reports keep coming in from labs around the world:

·        From the journal Neurology, people whose blood sugar is on the high end of the “normal range” have a much greater risk of brain shrinkage

• The study parameters
• 249 people age 60 – 64
• Blood sugar in “normal range” 
• Underwent brain scans at start of study and four years later
• Factored out:  age, high blood pressure, smoking and alcohol use
• Observation:
• Blood sugar on the high end of normal accounted for a 6 – 10% shrinkage of the brain
• Suggests 
•  Blood sugar levels could have an impact on brain health even for people who do not have diabetes

Perlmutter introduces the word, “Diabesity” as the term now used to describe a range of metabolic imbalances from mild insulin resistance to pre-diabetes to full-blown diabetes.  He claims that within the next decade, 1 in 2 Americans will suffer from diabesity and 90% of these cases will not be diagnosed.

And then he throws us back into a discussion about inflammation:

We’re told that our body’s natural response to stress is to create swelling and pain, which are hallmarks of the inflammatory process.  Our body is trying to defend itself against something it believes to be potentially harmful.  Whether it is to neutralize an insect’s toxins or reduce movement in a sprained ankle to allow healing, inflammation is vital to our survival.

The problem is when inflammation is out of control.  Inflammation is meant to be a spot treatment, not to be turned on for prolonged periods of time.  “When inflammation goes awry, a variety of chemicals are produced that are toxic to cells, leading to cellular dysfunction, followed by cellular destruction.  Inflammation is the fundamental cause of the morbidity and mortality associated with coronary artery disease, cancer, diabetes, Alzheimer’s disease, and virtually every other chronic disease you can imagine.”  Unfortunately inflammation in the brain goes unnoticed by most of us because the brain does not have pain receptors, so we can’t feel inflammation in the brain.  The research of the last decade consistently points to inflammation as a likely cause of a variety of neurodegenerative conditions.

Perlmutter describes oxidative stress as a biological type of “rusting” and tells us that this gradual corrosion happens on all tissues and is a normal part of life.  Unfortunately, when oxidative stress becomes rampant and out of control, it can be deadly.  Oxidative stress is caused by a single oxygen atom, not O2.

Now we get to read about free radicals, described as molecules that have lost an electron.

“Forces such as stress, pollution, chemicals, toxic dietary triggers, ultraviolet sunlight, and ordinary body activities can “free” an electron from a molecule, which will cause it to try to steal an electron from another molecule. – This is the oxidation process, itself, a chain of events that creates more free radicals and stirs inflammation.  High levels of oxidation correlate to high levels of inflammation which correlate with an extensive list of health challenges such as low resistance to infection, joint pain, digestive disorders, anxiety, headaches, depression and allergies.  Antioxidants such as vitamins A, C and E donate electrons to free radical and interrupt the chain reaction.”

This chapter contains a brief discussion of using statins to control inflammation:

Perlmutter tells us that statins are now being used to reduce overall inflammation even though new research reveals that the use of statins may lessen brain function and increase risk for heart disease.  The reason:  the brain needs cholesterol to thrive.  Cholesterol is a critical brain nutrient essential for the function of neurons and a fundamental building block of the cell membrane.  Cholesterol acts as an antioxidant and a precursor to important brain-supporting elements like vitamin D, as well as hormones like testosterone and estrogen.  (Note – I had to look up what “precursor” means in this sentence.  Here is the definition of “precursor” - a chemical that is transformed into another compound, as in the course of a chemical reaction and therefore precedes that compound in the synthetic pathway: Cholesterol is a precursor of testosterone.”)  Cholesterol is an essential fuel for neurons.  We are informed here that LDL is not a cholesterol molecule, it is the carrier protein (low-density lipoprotein) that brings cholesterol to the brain.  Therefore, there is nothing inherently bad about LDL.  When cholesterol levels are low, the brain does not work well.  Perlmutter insists that we need to change our attitudes about cholesterol and LDL.  They are our friends, not our foes.

Perlmutter addresses the issue of cholesterol and coronary artery disease in detail in a later chapter, but here he introduces the concepts that:

• cholesterol is good
• coronary artery disease is not caused by LDLs, but by oxidized LDL
• Basically, in a high-sugar environment, LDL gets so damaged by sugar that it can longer deliver cholesterol to the brain. Sugar molecules attach themselves to LDL and change the molecule’s shape, which makes LDLs less useful, and at the same time damaged LDLs increase the production of free radicals.

In summary, the first chapter was dense, but it was meant to cause us to ask these three questions:

1. “Have we accelerated our brain’s decline by following a low-fat, high carb diet with fruit on the side?
2. Can we really control the fate of our brains through lifestyle alone despite the DNA we’ve inherited?
3. Is there too much invested interest in Big Pharma to consider the fact we can naturally prevent, treat, and sometimes cure – without drugs – a spectrum of brain-based aliments such as ADHD, depression, anxiety, insomnia, autism, Tourette’s syndrome, headaches, and Alzheimer’s disease?”

The rest of the book is intended to prove that the answer to all three of these questions is, Yes!”

More to follow – again, I am writing about this for two reasons:  So it will stick and to hear your thoughts.  I am very interested in your comments.