Neurologist: The Shocking ROOT CAUSE of Alzheimer’s - How To Prevent & REVERSE Damage To Your Brain | Dr. David Perlmutter

In today’s episode of The School of Greatness, I sit down with renowned neurologist and bestselling author Dr. David Perlmutter to explore the critical connection between metabolism and brain health. Dr. Perlmutter shares groundbreaking insights on preventing and potentially reversing Alzheimer's disease through metabolic health. As someone whose father suffered from Alzheimer's, he brings both scientific expertise and personal experience to this crucial conversation. We dive deep into how modern dietary habits are impacting our brain health, the promising research around GLP-1 agonists, and practical steps everyone can take to protect their cognitive function. Get ready for an eye-opening discussion that could change how you think about brain health and aging. Dr. Perlmutter's websiteIN THIS EPISODE YOU WILL LEARN:Why metabolism is the key driver of brain health and how mitochondrial function impacts cognitive declineThe surprising truth about fructose consumption and its effects on brain healthHow continuous glucose monitoring can help optimize your metabolic healthThe critical role of microglial cells in brain function and how to support their healthThe unexpected connection between birth delivery method and long-term health outcomesFor more information go to https://www.lewishowes.com/1698For more Greatness text PODCAST to +1 (614) 350-3960More SOG episodes we think you’ll love:Dr. Charan Ranganath – greatness.lnk.to/1632SCDr. William Li – greatness.lnk.to/1410SCGlucose Goddess – greatness.lnk.to/1575SC Get more from Lewis! Get my New York Times Bestselling book, Make Money Easy! Get The Greatness Mindset audiobook on SpotifyText Lewis AIYouTubeInstagramWebsiteTiktokFacebookX

Speaker names marked ? are inferred from speaking time and the show’s known hosts — they are not voice-verified.

• 0:00David Perlmutter?

  I think it's really important that people understand that Alzheimer's itself is the number three cause of death in America. It kills people. The rate of increase of Alzheimer's is far beyond the fact that our population is aging. One would expect that as the population ages, we would see an increase, but the rate of increase far exceeds that.

• 0:18Speaker 01

  One of the most sought-after minds on the planet in the fields of nutrition and brain health, four-time New York Times bestselling author, David Perlmutter.

• 0:28David Perlmutter?

  One study demonstrated that there's a profound relationship between the number of sugary beverages and Alzheimer's risk and actual shrinkage of the brain. Really? The reality is that the metabolic defects of the brain begin 20 to 30 years prior to the clinical manifestations.

• 0:48Lewis Howes?

  Is it possible to reverse dementia or Alzheimer's with newer mitochondria to create a more present, memory-functioning brain?

• 0:58David Perlmutter?

  The answer is absolutely.

• 1:01Lewis Howes?

  Welcome back, everyone, to School of Greatness. Very excited about our guest. We have the inspiring Dr. David Perlmutter in the house. So good to see you, David. Thanks for being here again. Thanks for having me. Very excited about this because there's a massive health crisis in the world, specifically in America. It just seems to be growing, and there's a stat, according to the Alzheimer Association, the number of Americans living with Alzheimer's is growing and growing fast. Nearly 7 million Americans have Alzheimer's, and by 2050, the number of people aged 65 and older with Alzheimer's may grow to a projected 12.7 million, barring the development of medical breakthroughs to prevent or cure Alzheimer's disease.

• 1:44Lewis Howes?

  Now, you've written six New York Times bestselling books, 15 books in total. You're a neurologist, medical doctor specializing in the diagnosis and treating diseases of the brain, the spinal cord, and nerves. And I'm curious, what has been, in your opinion, or with the research that you've seen, the biggest cause of this spike in Alzheimer's over the last 20, 30 years? And the fact that it just seems like it's just going to keep growing? What is the main causes of this? And is it bigger in America versus the rest of the world? Or is it kind of equal around the world?

• 2:21David Perlmutter?

  Lots of good questions, and let's take a step back. Those statistics are worrisome, they are staggering, and they don't encompass, you know, the real issue, which is well beyond that Alzheimer's patient. And that is, what does this incredible increase in Alzheimer's do to family members and loved ones and caregivers? What is the economic impact of the loss of brain function of the population in general? And the fact that the rate of increase of Alzheimer's is far beyond the fact that our population is aging. One would expect that as the population ages, we would see an increase, but the rate of increase far exceeds that.

• 3:05David Perlmutter?

  So we know that there's something operating in the background, and the fact that it's changing, i.e. increasing, indicates that it is not genetic. If it were genetic, it'd be static. The genes wouldn't suddenly become more prevalent in the population. So we take a step back and ask ourselves, well, what is really going on? Where are we in the understanding of what in the heck is going on? And let's look at health in general, and then we'll focus on Alzheimer's, because general health and Alzheimer's are not disparate issues. The same issues that are affecting the general health of the global population are at play in terms of undermining what's going on in the brain, making a good brain go bad.

• 3:49David Perlmutter?

  And it is, in a word, metabolism. Metabolism is the main thing making a brain go bad. That's right, and it's not, it is not, I'll say it maybe three times, the accumulation of this protein called beta amyloid. So. So what makes up of a metabolism for a human being? How cells use energy, and the progressive problems with our metabolic health are the number one cause of death on planet Earth. Really? Not COVID, not any other infectious disease, not war. It is the progressive loss of metabolic function that underlies our chronic degenerative conditions like diabetes and various forms of cancer

• 4:33David Perlmutter?

  and heart disease, and yes, Alzheimer's as well.

• 4:36Lewis Howes?

  Before you go on, if you could, we hear the word metabolism a lot. You say, "I've got a slow metabolism," or "His metabolism is really fast," or whatever it might be. If I'm hearing the word metabolism for the first time and I'm nine years old or something, or 12 years old, could you explain it to me like I'm 12 and say, "This is what a metabolism is, and here's how it works," as if I've never understood it before? How do you break it down in simple terms?

• 5:03David Perlmutter?

  Totally glad that you asked that question. I feel like I scripted you to ask it. And I'm gonna respond to the nine-year-old. Because we all know that our cells are doing things. They're making proteins, they're clearing away waste products, etc. Every cell does something different in the human body, but to carry out any work, we have to have a fuel source and use that fuel to power the engine that allows the cell to do its thing. A car goes nowhere unless it has a battery pack or it uses gasoline. So it's the process of using fuel to carry out the various functions of the cell that we call metabolism. Now, if your car's metabolism is not working well,

• 5:48David Perlmutter?

  if for some reason, for example, you mixed your fuel with water or something, then the car is gonna sputter and come to a screeching halt, because it's metabolically compromised. That's what we are doing to the human brain. We are giving threats to the human brain that are compromising its ability to use fuel appropriately. Now, by and large, the fuel is glucose, which is a good thing. Can the brain use fats? Can it use ketones for fuel? Yes, it can. So we really need to drill down on what's going on that allows the brain to use glucose. And where is the furnace? Where is it burning this glucose to produce energy?

• 6:31David Perlmutter?

  And it's doing so in parts of the cell, organelles that are called mitochondria.

• 6:38Lewis Howes?

  So metabolism is connected to mitochondria?

• 6:42David Perlmutter?

  To a significant degree, yes. There is... And mitochondria is in the brain? So mitochondria are little tiny organelles that live within the brain cells. Each brain cell may have, even though you see a diagram, here's the mitochondria, here are the ribosomes, here's the nucleus. Typically, a brain cell may have as many as a thousand mitochondria, each cell. One cell. One cell. So how many mitochondria do we have in our brain? It's a number that is incalculable. Billions, trillions, millions? Trillions. Trillions of mitochondria? Throughout the human body as well. In fact, virtually every cell in the body does contain mitochondria, with the exception, for example, the red blood cell.

• 7:25David Perlmutter?

  So the issue then is recognizing the brain as a hugely energy-hungry organ, using a lot of energy day in and day out. The brain, truthfully, never rests. When we sleep, the brain isn't going to sleep. It's actually diverting its tasks to cleaning things up and getting ready for the next day, while other parts of your body, your muscles, etc., are resting at night. Your heart is resting at night. But that said, the brain is very energy-hungry, and as such, problems with metabolism, how it creates the energy, would be very obvious then in the brain. And it's really the first place to suffer.

• 8:06David Perlmutter?

  The reality is that the metabolic defects of the brain that presage to the development of Alzheimer's disease begin 20 to 30 years prior to the clinical manifestations. In other words, the changing in memory, the issues with carrying out purposeful activities, where suddenly now, though the problem began two decades ago, when we could have paid attention. Now that mom, or dad, or husband, or wife is beginning to have issues remembering the grandchildren's name, the Wi-Fi codes, how to use their iPhone, getting lost, now we take notice and begin to think about,

• 8:49David Perlmutter?

  well, what drug can we use now that it's forth and long? The point I'm trying to make is, an important mission is to emphasize that our brain function, our health of the brain, the brain's ability to resist degeneration is dependent upon metabolism, and we need to begin paying attention to that metabolism 20, 30, 40 years prior to when the typical medical intervention is then implemented to deal with a problem.

• 9:22Lewis Howes?

  Wow.

• 9:22David Perlmutter?

  You know, as John Kennedy said, "The time to fix a roof is when the sun is shining." So we really need to start getting the word out that our brain depends upon good metabolism.

• 9:33Lewis Howes?

  What would you say then are the things that cause someone to hurt their brain or break their brain the most? From, is it emotional? Is it the way they think? Is it what they eat? Is it an environmental thing? Is it? What are the things that hurt a brain the most?

• 9:50David Perlmutter?

  Well, anything that threatens the mitochondria, then, is going to threaten not only how the brain works moment to moment, but set that up for, set that brain up for future decay.

• 10:05Lewis Howes?

  So if you hurt the mitochondria, that hurts the brain?

• 10:07David Perlmutter?

  Yes. So to answer your question, then, what hurts the mitochondria? Well, we know that a powerful threat to mitochondria, a direct, clear, and present danger to mitochondria, are certain foods, like ultra-processed foods. We know that fructose is a dramatic threat to mitochondrial function. We put a paper out on that topic in February of 2021. Certainly, many environmental issues need to be considered. Anything that increases inflammation in the human body increases the threat to the mitochondria and, as such, sets the stage for brain decline.

• 10:50David Perlmutter?

  So with that understanding, then, the idea of developing therapies for people in whom Alzheimer's is now beginning to raise its ugly head, focusing simply on the accumulation of this protein, beta amyloid, is myopic and has proven ineffective and beyond that, has proven threatening. Fascinating.

• 11:18David Perlmutter?

  A study appeared in the New York Times yesterday, it was reviewed in the New York Times yesterday, talking about how the most popular drug that targets this beta amyloid that accumulates in the brain is quite threatening, that about 28% of people given the drug have small brain hemorrhages, but that people who carry a certain genetic predisposition for Alzheimer's are at a significantly increased risk for these bleeds in their brain. And what the New York Times article reported yesterday is that the company knew it.

• 11:54Lewis Howes?

  Wow.

• 11:55David Perlmutter?

  And went ahead with the research.

• 11:56Lewis Howes?

  Interesting.

• 11:57David Perlmutter?

  So, you know, it, to me, violates the most important doctrine of medicine, above all, do no harm.

• 12:04Lewis Howes?

  I mean, all these companies, though, when you, I mean, whenever I watch sports and there's a commercial, I don't really watch much TV, but I do watch sports, half the commercials are medical, drug-related commercials. And they talk about, you know, fixing one thing, but then causing, I don't know, 30 different side effects that seem pretty extreme, some of these side effects.

• 12:25David Perlmutter?

  That's right.

• 12:26Lewis Howes?

  We're gonna solve one thing, your, I don't know what it is, your eczema.

• 12:30David Perlmutter?

  Psoriatic.

• 12:31Lewis Howes?

  Yeah, yeah, it's like arthritis, eczema, but then it's like, but you might die. You know, it's like the extreme.

• 12:35David Perlmutter?

  But they don't say it like that.

• 12:36Lewis Howes?

  But it's like dancing people and songs and sunshine.

• 12:39David Perlmutter?

  That's right. So you were distracted by all of those graphics, all the video that's really showing this person now resuming their life, they can wear a bathing suit because their skin is cleared up, and it lowers your risk of, I mean, increases your risk of infection, including tuberculosis, and in fact, you may even die. You're right. But you're looking at this person who could finally take off his shirt, and, you know, it looks great to me.

• 13:05Lewis Howes?

  But how do these, these medical companies get away with it if their whole mission is to do no harm? I understand that the intention is, we're gonna try to solve one problem, the eczema, the heart palpitations, whatever it might be, I don't know, all those different things. But if you're solving or helping, and it really doesn't fix one thing, it seems like it... Helps one thing, but if it hurts you in a lot of other things, isn't that doing harm?

• 13:31David Perlmutter?

  Louis, that it may respectfully may not be the mission. I mean, I think oftentimes what we see is more interest in shareholders than stakeholders. Basically that, you know, focus on the bottom line. And with the, there was a resounding rejection of the approval process of a certain Alzheimer's, so-called Alzheimer's drug called Leqembi, still being, you know, editorials are written, why was this drug approved? Because its clinical effectiveness after 18 months is minimal at best. And the side effect profile is very scary. So as we look at the risk benefit ratio, it doesn't add up.

• 14:13Lewis Howes?

  You mentioned processed fruits, fructose, things that cause inflammation in the body. You know, obesity is one of the main, I guess, is something that's happening. I don't know what it is, 30 or 40% of America is kind of obese now? Or is that what the calculation is?

• 14:29David Perlmutter?

  I'd say it's close to 70 to 80% are either overweight or obese.

• 14:33Lewis Howes?

  Really?

• 14:33David Perlmutter?

  In fact, north of 90% of Americans have at least one component of metabolic dysfunction.

• 14:41Lewis Howes?

  And obesity is a big...

• 14:43David Perlmutter?

  Obesity, overweight obesity is one of them. You know, certainly hypertension, elevated blood sugar, insulin resistance. These are all things that we consider. I add elevated uric acid to the equation as well. This lipidemia or problems, abnormal lab studies as relates to our blood lipids. But, but having said that, and only one or less than one in 10 individuals is metabolically intact in America today. And it's these metabolic issues that set the stage for all the things we don't want to get, including Alzheimer's disease.

• 15:17Lewis Howes?

  And so, you know, a lot of these weight loss drugs, weight loss drugs are taking off because they have been effective in losing the weight, it seems like for some people. And I haven't studied this enough to know the side effects or the harms of those. But you see cases of people losing a lot of weight quickly, it seems like.

• 15:37Lewis Howes?

  What is more harmful, and maybe we don't have the research yet, but what is more harmful? Being obese to our brain health? Or using a drug like an Ozempic to lose the inflammation on our body and the excess weight? But is there side effects that are causing more harm to the brain long term than the obesity?

• 15:58David Perlmutter?

  You mean of using the drug?

• 16:00Lewis Howes?

  Yeah, like losing the weight, but staying on the drug? Or having obesity and not being on the drug? What is more harmful to the brain health?

• 16:10David Perlmutter?

  So I'm gonna, I'm gonna challenge you a little bit here.

• 16:12Lewis Howes?

  Okay.

• 16:12David Perlmutter?

  And because it challenged me quite a bit as well. So. You know, obesity is not just an accumulation of body fat. There's a lot going on with obesity in terms of. Uh, letting us understand that metabolism is really in disarray. Obesity is really kind of the outward manifestation of what I call metabolic mayhem. There's a lot going on with obesity beyond just in the, uh, the, the presence of body fat. We know that mitochondria are threatened. We know that, uh, inflammation markers are skyrocketing. We know that there's an increased leakiness of the bowel. We know that risk for neurodegenerative conditions is going up. Uh, diabetes, of course.

• 16:57David Perlmutter?

  So. It all dates, it all dates back to, or gets back to the issue with metabolic and the threat. Uh, that is, uh, evident when someone is obese or hypertensive or has, uh, elevated blood sugar because they're insulin resistant. It's an indication that their metabolism is dysfunctional. That is a clear and present danger to the brain. So. What happens if you take one of these GLP-1 agonist drugs? Uh, like semaglutide, like Ozempic or a liraglutide? Uh, and lose the weight? What's happening? Is that a good thing or is it a bad thing? That's what your question is, isn't it? And you're expecting a particular answer from you.

• 17:39Lewis Howes?

  I'm not expecting any answer. I'm curious your response.

• 17:41David Perlmutter?

  And I think you're gonna be surprised by where we go with this because. What these drugs have been shown to do is.

• 17:51David Perlmutter?

  Nothing short of remarkable in terms of metabolism. So they were originally developed to help people lower their blood sugar, to improve the way we're able to control our blood sugar. And it was almost as a side effect initially that people were noticed that their weight was going down. And now, of course, they've been repurposed and subsequently approved for weight loss. But there is a lot going on with metabolism as a consequence of GLP-1 agonist drugs. In a good way or a bad way? In a good way. Okay. And I am not, you know, generally my mission in life is not pharmacocentric. You know, I want to allow people, and we're going to morph back to that in just a moment.

• 18:36David Perlmutter?

  But the reason we're going to unpack this GLP-1 agonist drug and why it's having positive effects in the brain is because it will subsequently, again, allow us to circle back to the primacy of metabolic issues as it relates to brain health. Here's a powerful validation. So the GLP-1 drugs do far more than help us control our blood sugar and lose weight. They focus on metabolism. They actually enhance mitochondrial function. Really? Can you believe it? I mean, the most of the work has been done in diabetic patients, but showing reduced

• 19:17David Perlmutter?

  free radical formation, increased oxygen consumption. In other words, an improvement in mitochondrial function, which requires oxygen for the burning of the fuel, and various other metabolic markers that are improved in diabetic patients who are, have been prescribed these medications. In the New England Journal of Medicine in the spring of this year. Well, let me, let me go back a little bit.

• 19:45David Perlmutter?

  So Alzheimer's, as I've indicated, is primarily a metabolic issue. It's a mitochondrial issue. As I

• 19:52Lewis Howes?

  You fix the mitochondria, you fix the brain health.

• 19:54David Perlmutter?

  Yes, and if you damage the mitochondria, you set the stage for Alzheimer's. You set the stage for neurons to undergo suicide.

• 20:02Lewis Howes?

  And is there a way to go back if you've hurt the mitochondria so much for so long? Is there a way to reverse it?

• 20:09David Perlmutter?

  Absolutely.

• 20:10Lewis Howes?

  There is.

• 20:10David Perlmutter?

  Yes. There's a lot we're gonna have to

• 20:14Lewis Howes?

  Yeah, we're done back here, yeah.

• 20:15David Perlmutter?

  So we'll do this maybe in the fourth hour.

• 20:17Lewis Howes?

  Sure.

• 20:20David Perlmutter?

  But to sidetrack on that answer real quick, I will say that yes, we have a huge opportunity to replace defective mitochondria with fully functioned, better functioning mitochondria. We do that through scavenging dysfunctional mitochondria through a process called mitophagy. And we can grow new mitochondria through mitochondrial biogenesis. And we'll talk about how we can make that happen. But therapy for the brain and improvement in Alzheimer's patients toward at least slowing their decline and Parkinson's as well focuses on dealing with the dysfunction of the mitochondria.

• 21:00David Perlmutter?

  That's where we need to be in this epidemic that you opened our discussion with today. So I do want to tease the audience a little bit with the notion that we've always focused on the brain cell. One would think that's where the action is, the neuron. Because it's so active from an energy perspective, i.e. the mitochondria. I indicated earlier that a neuron may have as many as 1,000 mitochondria.

• 21:31David Perlmutter?

  But it turns out where we are in the latest research is really exciting because it's shining the spotlight not on the neuron itself, but on the caretakers of the neuron. We're going upstream of the neuron. The neuron's a worker bee, doing what it can do. Hopefully, the environment's going to be one that is salubrious in terms of how the neuron does what it needs to do. Transmit information, connect to another neuron through a synapse, and allow the networks to function. But the caretakers of the neurons are the brain's immune cells called the microglia. So these microglia make up about 10 to 12% of all the cells in the brain.

• 22:15David Perlmutter?

  And they are immune cells, they're part of the innate immune system. But they do a heck of a lot more. So when you think of immune cells, you think of, well, you know, how it's able to fight off bacteria, viruses, fungi, et cetera, how it protects us. We think of immunity in terms of our body's ability to take care of these confrontations. People are interested in a robust immune-ish function. Now that COVID has, you know, let us recognize that those individuals whose immune systems are not at the snuff were and remain at higher risk for complications from COVID, and even long COVID. Who are those individuals?

• 22:56David Perlmutter?

  These are individuals with diabetes, obesity, hypertension, three of the big players in metabolic diseases. So what I'm saying then is there's this powerful then relationship between our metabolic health and our immune health. To the extent that there's now been defined an area of medicine called immunometabolism, immunometabolism. In my area of interest, the immunometabolism conversation takes us to the brain's immune cells called the microglia. The microglia are wholly dependent

• 23:38David Perlmutter?

  upon their mitochondrial energy-producing function. The ability of the mitochondria in these microglia to do their job and allow the microglia to nurture our brain cells, to nurture our synapses, to create chemicals that allow us to grow new brain cells, and to shore up what is called the blood-brain barrier, is fully dependent upon their metabolism, their mitochondrial function. When mitochondrial function is threatened...

• 24:13David Perlmutter?

  These wonderful, loving, nurturing cells shift to become the evil twin. The same cell now destroys our neurons, activates pathways in neurons to undergo apoptosis or pre-programmed cell death. It threatens and damages and destroys ultimately the synapses where communication takes place. It reduces the formation of this chemical to grow new brain cells. It increases the production of beta amyloid and ultimately threatens the integrity of the blood-brain barrier. Same cell, two types, the nurturing M2 phenotype and the evil twin, the M1 phenotype.

• 24:57David Perlmutter?

  And the microglia can go back and forth and their ability to go back and forth and what motivates them to change from being the helpful twin to the evil twin are changes in their mitochondrial function and it is reversible.

• 25:12Lewis Howes?

  Really?

• 25:13David Perlmutter?

  So we can go back to a wonderful nurturing brain that allows more synapses to form, that allows new brain cells to generate in the brain. Who wouldn't want that?

• 25:24Lewis Howes?

  Sure.

• 25:25David Perlmutter?

  Especially in the brain's memory center and really creates an environment that's nurturing for your brain.

• 25:31Lewis Howes?

  Wow. But is it possible if dementia has gone too far into Alzheimer's and is it possible to reverse that dementia or Alzheimer's with newer mitochondria to create a more present memory functioning brain?

• 25:51David Perlmutter?

  The answer is absolutely.

• 25:53Lewis Howes?

  Really?

• 25:54David Perlmutter?

  Yes.

• 25:55Lewis Howes?

  Even if it's like they've had dementia for a decade or five, 10 years or Alzheimer's for a while?

• 26:00David Perlmutter?

  Well, the duration of the issue is less important as the how aggressive it is. So as one would expect, you know, as one would see with other degenerative condition or even cancer, some people get attacked more aggressively and decline more quickly based upon their metabolic health and others don't. So.

• 26:24David Perlmutter?

  Can it be reversed? Yes. Are there new studies demonstrating that targeting metabolism has a dramatic effect on the brain in an existing Alzheimer's patient? Yes. And this gets back to our GLP-1 agonist story.

• 26:39Lewis Howes?

  Interesting. Okay. And so you're seeing that the GLP-1 drugs are having a huge benefit to mitochondria health, which has a huge benefit to brain health.

• 26:51David Perlmutter?

  Yes. So let me run through the dots, because this will be on the quiz. Why we want to target metabolism? Why the GLP-1 drugs have such an opportunity to be game changers? And again, you know, my focus has never been medication, but my commitment has been to never take anything off the table. Under the doctrine of above all, do no harm, and looking at things like risk benefit ratio. What I'm saying is that metabolism is the central focus. This is one avenue that seems to target metabolism and does so aggressively. Long term, how might that play out? We don't know yet.

• 27:32David Perlmutter?

  But a poster presentation that was at the American, rather, the Alzheimer's Association International Conference about two and a half months ago, revealed a one-year study in which the actual Alzheimer's patients, over a one-year period compared to control, their rate of brain shrinkage, receiving a GLP-1 agonist drug, was reduced by 50%, the rate of shrinkage of their brain. Their cognitive decline was dramatically reduced in comparison to control. Published in the New England Journal of Medicine in, I believe, March of this year.

• 28:17David Perlmutter?

  Was a three-year study giving a GLP-1 agonist drug to patients who already had Parkinson's disease, a disease for which we have no treatment whatsoever. Some of your viewers are going to raise their eyebrows saying, "Well, I know of drugs that treat Parkinson's and I, as a neurologist, have treated patients with drugs for 30 years." But they didn't, you know, solve something. They just kind of minimized something, right? Exactly. These are symptomatic, this is symptomatic management. And I'm not derogating it. I mean, there's really a very important benefit to patients to reducing their tremor, to improving their ability to walk and reducing their rigidity. That's for sure.

• 29:01David Perlmutter?

  Any Parkinson's patient or family member right now watching this will recognize that the drugs that their mother or father may be taking are really designed to treat symptoms, which I think is very valuable, but we're treating the smoke, but not the fire. Treat the smoke, that's important. The root cause. But let's look at the fire. There's a 41% increased risk of Parkinson's in diabetics, a metabolic challenge. Oh, man. Because of that, a study was undertaken to determine, well, if we treat Parkinson's patients with a diabetes drug, in this case, a GLP-1 agonist drug, how might that affect

• 29:45David Perlmutter?

  their time course? So Parkinson's patients are rated on a functionality score called the Unified Parkinson's Disease Rating Scale, kind of a common way that we look at Parkinson's patients over time. How quickly are you deteriorating? And we expect over a three-year period to be a moderate decline in functionality. And in the control group of this study, indeed, there was a decline, a worsening, a higher number on that scale. The patients treated with the GLP-1 Ozempic-like drug not only stabilized in terms of that scale, but had a small improvement. Really? Can you imagine?

• 30:30David Perlmutter?

  I've never seen that before, but that is finally treating the fire. Wow. That's big. Yeah, and it's a game changer. Now, with every, I mean...

• 32:35David Perlmutter?

  That's what was observed in the Alzheimer's patients. That their rate of decline, they continue to decline, but their rate of decline was markedly reduced, far more so than in the drugs that have become FDA-approved that target beta amyloid.

• 32:52Lewis Howes?

  What was the stat you said, was it 40% of diabetics or diabetics had a 40% chance of?

• 32:59David Perlmutter?

  Increased risk of Parkinson's.

• 33:01Lewis Howes?

  Increased risk of Parkinson's.

• 33:03David Perlmutter?

  Yes.

• 33:03Lewis Howes?

  And how many people in America are diabetic or prediabetic right now?

• 33:07David Perlmutter?

  That number is probably around 75%.

• 33:11Lewis Howes?

  Wow, is that diabetic or prediabetic?

• 33:13David Perlmutter?

  Both.

• 33:14Lewis Howes?

  What is the difference between pre and diabetic?

• 33:17David Perlmutter?

  Really, it depends on the blood sugar measurement, where the cutoff is specifically for diabetes, which is a marker, not only measures blood sugar, but also looks at something called the hemoglobin A1C.

• 33:28Lewis Howes?

  So 70% of Americans are pre or diabetic.

• 33:32David Perlmutter?

  Prediabetic or diabetic. And I think that it's unfortunate that we use that terminology, because we get to the discussion of, you know, when you go to the doctor and look at your blood sugar, or look at it yourself, if you have a continuous glucose monitor, you know what your blood sugar is, and you're going to ask yourself, well, what's normal? And I think in healthcare, we've been looking at what's so-called normal range, what's in the normal range, for a long time, and I think that doesn't really serve the notion of optimal health very well.

• 34:07Lewis Howes?

  Right, normal may not be healthy still.

• 34:09David Perlmutter?

  Normal is what's common, basically. You take a large number of people, you see what is normal, you know, what is, our population isn't normal, our population, as we discussed earlier, is not healthy. We should define what is optimal. And so, you know, typically, a doctor would say, well, your blood sugar is 100 or 105, and everything's fine, we'll see you next year, and check again, a very static measurement of your blood sugar fasting, that you'll probably train for a little bit, so you can get a good number. And I really want to know, what is your worst blood sugar? What is the level of blood sugar at its worst? And how long does it stay elevated? After carbohydrate challenge? What is, as we talked about off-camera?

• 34:51David Perlmutter?

  What is, over time, the area under the curve? In other words, when we look at the level of blood sugar over time, it defines an area. And that's really a very valuable metric in terms of understanding the dynamics of blood sugar and how insulin is working in your body, which is one of the fundamentals for medical health.

• 35:13Lewis Howes?

  Wow.

• 35:13David Perlmutter?

  Because the brain, by and large, powers itself with glucose. The higher the glucose over time, the less the brain is able to use it, because the brain becomes many parts of the brain depend upon insulin to allow the glucose to be used as fuel. As we threaten the function of insulin by virtue of the fact that our blood sugar remains elevated over time, we threaten the brain. We threaten the mitochondria. We get back to the change between the good and the bad microglia, and that threatens neurons.

• 35:48Lewis Howes?

  I was at a summit recently where there was a panel on longevity with Dr. Rhonda Patrick, Peter Diamandis, and Dr. Walter Longo. I think you know all three of them, I'm assuming. And Walter Longo was talking about the fasting window research has shifted in the last year. I'm not sure if this is 100% accurate, what he said, from my memory. But he said something like, you know, we used to think it was 16-hour, you know, fasting, 8-hour eating windows, feeding windows. But the research is showing more of a 12-hour fasting window. Unless you're doing like a 24-hour, two-day fast or something, but more of a 12-hour window.

• 36:33Lewis Howes?

  He's saying the research is showing more of that now. I don't know if that's 100% what he was talking about, or something has shifted there.

• 36:39David Perlmutter?

  Well, I think that what he's saying is that there's more research coming out indicating that the period of fasting doesn't need to be as great. So, this is, you know, not I would say that this is really more of a discussion of what is called time-restricted eating, as opposed to specifically fasting. You know, those are kind of a bit nebulous terms. When you say "time-restricted eating," how much time? When you say fasting, is it three days? Is it 12 hours? And I think it's kind of an analog scale. I

• 37:09David Perlmutter?

  Probably 16 to 18 hours is going to be better than 12 hours, but there's benefit to a 12-hour fast. And that is, or at least restricting your consumption of calorie or other types or other parameters as it relates to food, anything but water. There's been a discussion, well, is the morning coffee, even if it's black, did you break your fast?

• 37:31Lewis Howes?

  Coffee lovers like to say, no, you didn't break it.

• 37:33David Perlmutter?

  No, nothing. We're still, I'm still on the clock.

• 37:36Lewis Howes?

  Yeah.

• 37:38David Perlmutter?

  But that said, this remains, you know, in evolution and I think that there's more to come. And it's, it's really quite exciting that we have researchers like Valter Longo who are looking at the implications of these types of interventions, which are fairly simple to employ, not only as it relates to longevity parameters, but also in his work as it relates to even the immune system vis a vis cancer. So we're learning a lot that immunometabolism relates not only to

• 38:14David Perlmutter?

  these chronic metabolic diseases, Alzheimer's, but the, the function of the immune system as it relates to its ability to seek out and destroy cancer cells, for example.

• 38:27Lewis Howes?

  So I want to go back to the GLP-1 drugs because again, I haven't heard someone clearly define beyond weight loss, the, the power of these drugs for brain health. And like I'm hearing you say now, based on the research, right? So I'm, I'm happy to hear that. And I'm happy to hear that people who have dementia or family members who have dementia or Alzheimer's now have some type of hope, hopefully, that they can start testing this for themselves to see either a reduce in decline or a potential increase in cognitive function, right?

• 39:05David Perlmutter?

  Well, let me take a step back then, Lewis, if I could, because let's, let's ask ourselves, how did we get to the GLP-1 discussion in the first place?

• 39:14Lewis Howes?

  Right. And is there a way to prevent even getting there?

• 39:16David Perlmutter?

  Yeah, and it was through the lens of wanting to really unpack the fundamental role of metabolism.

• 39:24David Perlmutter?

  In brain health.

• 39:25Lewis Howes?

  Yes, which metabolism is linked to mitochondria health, right?

• 39:29David Perlmutter?

  Mitochondria health, and I use the GLP-1 drugs as a way of really kind of supporting the notion that it's all about metabolic health. Because these results are, you know, for me, being at this for quite some time, I use the word astounding because they are. It is really the first time we're targeting the fire and not just the smoke.

• 39:53Lewis Howes?

  But it sounds like if we just target the fire on a daily basis, 10, 20, 30 years beforehand, and do our best to not put ourselves in a situation of prediabetic, diabetes, obesity, inflammation, eating processed foods, having a lot of high blood sugar spikes continually throughout the day, that is treating the fire by preventing the fire, correct?

• 40:20David Perlmutter?

  Yeah. What a notion. I mean, people don't talk about it, but Alzheimer's prevention. I mean, we are led to believe, to get back to the various commercials that you watch when you're watching the evening news, pretty much, and look at the people in those commercials. Just look at the actors and who they are designed to target. So we're kind of led to believe that we should live our lives however we want, come what may, and that modern medical science will fix our ails.

• 40:51Lewis Howes?

  Yeah, there's no one with a six-pack and like shredded on these commercials or just super, you know, healthy looking. Like a little bit overweight or really overweight?

• 40:59David Perlmutter?

  Yeah, and I'm not being disparaging. I'm simply saying this is a marketing ploy. But again, I want to get to the belief part of it, that we believe that, hey, you know, modern science is going to fix my, fill in the blank.

• 41:11Lewis Howes?

  Take a drug and it's fixed.

• 41:13David Perlmutter?

  My Ozempic for my obesity, my Alzheimer's now that we've heard this new exciting research, so what the heck? Why should I worry? I'm going to do whatever I want, eat whatever I want, stay up late. I don't really like to exercise, do all the things that feel good. I mean, you know, truthfully, they're called comfort foods for a reason because we all love them. They taste great. Brains are programmed to seek out sweet and fat and salt. And these are things that threaten metabolic health. As relates to fat, we know there are good fats and bad fats. But by and large, we're programmed to seek out foods that are fatty. Why? Because they're calorie dense. They are survival mechanistic that allows, that causes us to seek them out. Sweet, what does it mean? It means a food is ripe.

• 41:57David Perlmutter?

  It means it is safe. And when does fruit ripen? It ripens at the end of the summer and the early fall as a clue to our physiology to make our body make more fat to allow us to survive winter, a time of caloric scarcity when we were hunter-gatherers. So we are deeply programmed to love sweet. You know, when I lecture, I say, and I ask the audience, how many of you think you have a sweet tooth? Don't raise your hands. Answer is every one of you. We do. We all have a sweet tooth. So, but these are, you know, deeply seeded mechanisms that did us good, allowed us to survive so we could have a conversation today. The issue, though, is that when we gravitate now to those foods in excess, there's hell to pay.

• 42:41David Perlmutter?

  There's a downside and that's what is leading to these metabolic challenges that are really quite central to not only what you described at the, at the opening of our time together, you know, these incredible rates of increase of neurodegenerative conditions well beyond Alzheimer's, but the other metabolic conditions as well. Rates of diabetes soaring well beyond what was predicted in 1990. Obesity becoming a global problem, you know, it's, as the global diet has, we used to say, people adopt the American diet, it became then the Western diet. Faces now.

• 43:17Lewis Howes?

  Globally.

• 43:18David Perlmutter?

  The global diet. Even in the Mediterranean, we talk about the Mediterranean diet. People around the Mediterranean basin are eating this same stuff.

• 43:25Lewis Howes?

  They're getting bigger, right?

• 43:27David Perlmutter?

  They're getting bigger. They're getting diabetes at ever-increasing rates. Happening globally.

• 43:31Lewis Howes?

  Even all the, the blue zones, you hear about, you know, I think the blue zone of Japan, it's like, it's not becoming a blue zone anymore because there's so many fast food restaurants, the conveniences around those places seem to be excessive. And people naturally lean into convenience over discipline when it comes to food and decision-making, unless, I don't know, they're just so disciplined. Why is it so hard for human beings to go against temptation? And conveniences to stay healthy.

• 44:06David Perlmutter?

  I'm gonna give you the the short answer and then I'm gonna unpack it.

• 44:09Lewis Howes?

  Yes.

• 44:12David Perlmutter?

  It's because of the food they eat in the first place. The very foods that we are eating are rewiring our brains away from making better decisions.

• 44:25Lewis Howes?

  And causing us to want more of it.

• 44:26David Perlmutter?

  Yes. So, let me simplify. We may have touched upon this before, I think we did, a couple of years ago. And that is that, let's say we have two main decision-making parts of our brain. The five-year-old and the adult in the room. The five-year-old, the amygdala, I want the cake now, I'm staying up late.

• 44:49David Perlmutter?

  I'm not doing my homework.

• 44:51Lewis Howes?

  I deserve it.

• 44:51David Perlmutter?

  All the things. The adult says, you know, this is what you should be eating. And I think you need to go to bed now. And, you know, these are your instructions. This is what is good for you in the long run. That's the prefrontal cortex. So we have these two important decision-making parts of the brain that influence what we ultimately do. The amygdala, the short-term gratification part of the brain.

• 45:20Lewis Howes?

  That's in the front?

• 45:21David Perlmutter?

  And, which is the short-term gratification. And then the prefrontal cortex, the adult in the room. When the amygdala is in charge, we think only of ourselves. We don't think of other people. We think of immediate gratification. We do not think of long-term consequences.

• 45:35Lewis Howes?

  And that's in the back?

• 45:36David Perlmutter?

  It's inside.

• 45:38Lewis Howes?

  Got you, okay, got you.

• 45:40David Perlmutter?

  So, what happens as we mature is that with time, we establish a connection, a better connection, whereby the adult in the room can be more influential. So these areas are are interacting. And we call this top-down control, where the adult says to the amygdala, yeah, I know you wanna do what you wanna do, but here's what you should do, and here's why. So you're able to recruit all of this wonderful information that is now part of your experience base and explains to your decision-making process why you don't want to eat what you think you want to eat.

• 46:19Lewis Howes?

  As an expert in this field, someone leading the research and been doing this for many decades, where's the biggest challenge you face personally?

• 46:29Lewis Howes?

  Where you might lean into something that you know is bad for you. Even if it's like a little thing here and there, what's the temptation that you lean into? Is there food? Is there something you do that you eat a certain way sometimes? Or drink something, whatever it might be that you're like, I know this isn't gonna help my future brain health, but I do it anyways?

• 46:51David Perlmutter?

  Well, I'm a lot older than you, so I've had to tighten up quite a bit.

• 46:55Lewis Howes?

  Really?

• 46:55David Perlmutter?

  Oh, of course. I mean, you know, I think you asked me last time if I could have my 30-year-old self inform me, what would I, I think the answer was stay out of the sun as much as I did and floss, floss my teeth more often. But having said that, what are my biggest challenges, I think?

• 47:13Lewis Howes?

  Yeah.

• 47:13David Perlmutter?

  And I don't really labor over sweets. I think I could drink less. I think that, you know, I've been saying one to two glasses of wine a day and I might have more. And I have to admit that I should be more probably disciplined in that regard, but I don't mind how I feel. And so, what can I say?

• 47:38Lewis Howes?

  But there's a lot of negative effects with alcohol to the brain, right?

• 47:42David Perlmutter?

  There are.

• 47:42Lewis Howes?

  There's no benefit to brain health with...

• 47:45David Perlmutter?

  There's no benefit to brain health chemically. But as my son pointed out on a podcast to me, he said, there may be a benefit to the socialization that then happens when you're with people and you have that third glass of wine, which I'm guilty of.

• 48:01Lewis Howes?

  Sure, sure, sure. But it doesn't help mitochondria.

• 48:04David Perlmutter?

  It does help mitochondria. No, it doesn't.

• 48:06Lewis Howes?

  And so you have to kind of do everything else to, I guess, benefit the mitochondria and kind of minimize that potential risk, right?

• 48:14David Perlmutter?

  Yeah. And I would say that on occasion, I stay up too late. When I, when I get to a place of being deeply involved in, in research, I can't turn it off.

• 48:28Lewis Howes?

  Yeah.

• 48:29David Perlmutter?

  I cannot turn it off. And I know I should go to bed and my wife tells me I need to go to bed because she usually, remember you just said this on a podcast?

• 48:39Lewis Howes?

  Yeah, it's like...

• 48:40David Perlmutter?

  I know, but sometimes I'm so close to discovering something.

• 48:44Lewis Howes?

  Yeah.

• 48:44David Perlmutter?

  And pulling things in, I, I just can't lose the thread.

• 48:47Lewis Howes?

  What are the negative side effects to brain health and to the mitochondria or to metabolism?

• 48:54Lewis Howes?

  When you get five to six hours of sleep versus seven to eight hours of sleep, is there a big difference to brain health?

• 49:02David Perlmutter?

  Well, I think that tends to generalize. We do know that there are some individuals who are able to sleep five to six hours and do quite well. And again, there's no magic of the eight hours. We know that Alzheimer's risk is increasing in people who have shorter duration of sleep and who have longer duration of sleep as well. That once we get north of nine hours of sleep, Alzheimer's risk goes back up. So it's a bit of a U-shaped curve. But I think that, you know, what the data, what Matthew Walker has talked about in his really wonderful book, Why We Sleep, is there are a variety of issues. I mean, one thing that we see when we don't sleep enough, that I think is really fundamental, is that inflammatory chemicals, cytokines, seem to increase.

• 49:46David Perlmutter?

  The very next morning, we've lit up the amygdala, the impulsive fear mongering part of the brain, the child in the room, the poor decision maker, and as such, our decision making is threatened dramatically.

• 50:01Lewis Howes?

  Wow.

• 50:02David Perlmutter?

  Such that when you look at the type of food choices a person will make when he or she is deprived of sleep for a night, it's dramatic. The caloric consumption that happens and the quality of the food that people will consume and even other measurements of decision making quality in studies, which are correlated, interestingly, with functional MRI evaluation of the activity of their brain's amygdala, the fear center, the poor decision maker. So that's something people don't really talk, I mean, what people are really talking about these days is the activation in the brain, and this is important, I don't mean to minimize it, of basically the ability of the brain to clear itself out.

• 50:48David Perlmutter?

  You know, the brain has a lymphatic system as well called the glymphatic system, and it's during sleep, during deep sleep, that our brains are able to rid themselves of accumulated things that happened during the course of the day or through our exposure. So that's certainly very important. So, you know, the other thing that happens, I think that's really very relevant, gets back to Dead Senator, our conversation, is with

• 51:14David Perlmutter?

  Repeated lack of restorative sleep, it's a powerful threat to metabolism and mitochondrial function.

• 51:20Lewis Howes?

  Interesting. Gotcha.

• 51:21David Perlmutter?

  And this then

• 51:22Lewis Howes?

  Causes obesity, inflammation.

• 51:24David Perlmutter?

  And directly threatens the mitochondria and therefore allows us to understand why people who chronically don't get enough quality sleep, i.e. length and quality are important, are at a significantly increased risk for Alzheimer's.

• 51:41Lewis Howes?

  How risky is it to have a night job? And to be off on the natural, I guess, circadian rhythm of when the sun comes up and goes down?

• 51:53David Perlmutter?

  Significant. And, you know, it is what the science is saying and it is something that night shift workers need to be aware of. I mean, by and large, they don't get as much sleep if you were to measure the quantity as people who have a daytime job, number one. Number two-

• 52:10Lewis Howes?

  And probably not quality either, right?

• 52:11David Perlmutter?

  It's not as, you know, good luck getting your room to be dark and quiet during the day, you know, especially if you live in a city. So they are at significant increase for a variety of issues, including neurocognitive decline and including various forms of cancer. So it's anything but ideal.

• 52:28Lewis Howes?

  Wow. There's something, I don't know if you have the information to be able to comment on this, but there's something I saw about a month ago, online. And it was talking about the negative side effects of kind of like botox and fillers and things like that in men and women. Is there any research around excessive use, or even just normal use of botox, fillers, or other things that, cosmetic injections, that directly link to either brain health or gut-brain connection, or mitochondria, or metabolism health? Because there was a video I saw that talked about how- You know, if you're getting fillers in your face, it's not really draining out.

• 53:13Lewis Howes?

  It's kind of just migrating in different places around the head. And I'm wondering, is that entering the brain in any way? I have no clue if it does or not.

• 53:23David Perlmutter?

  Well, these are very separate issues. First, let's talk about Botox. There is evidence that this botulinum toxin is able to migrate down nerve pathways and may in fact make its way into the brain.

• 53:37Lewis Howes?

  Really?

• 53:38David Perlmutter?

  Well, that's been well described.

• 53:40Lewis Howes?

  And that's a toxin, so when a toxin that goes in the face somehow goes through the blood barrier into the brain, what is that doing to the brain?

• 53:49David Perlmutter?

  Unclear.

• 53:50Lewis Howes?

  We don't have the research yet.

• 53:51David Perlmutter?

  The notion of that happening, I think, a toxin is something that we should be considering. Now, gosh, I was, I think, the second person neurologist in Florida to undergo botulinum, Botox training. And I was using...

• 54:10Lewis Howes?

  Really?

• 54:11David Perlmutter?

  Yeah, so I was using Botox not for a cosmetic reason, but to treat people who had various types of facial spasms, neck spasms, eye closures, et cetera.

• 54:21Lewis Howes?

  To relax the space.

• 54:23David Perlmutter?

  Yeah, people would have what's called blephrospasm, where the eye would close and we could inject the orbicularis oculus muscle so that their eye would relax a little bit. And it was very helpful. And inject, when they had spasmodic torticolis and their neck would turn, we would inject the sternocleidomastoid muscle and they would get benefit for a period of a couple of months.

• 54:42Lewis Howes?

  When was this, when you got trained in?

• 54:44David Perlmutter?

  Gosh, this must have been at least 25 years ago. Yeah.

• 54:49Lewis Howes?

  But then it started being used for cosmetic reasons.

• 54:51David Perlmutter?

  Oh, it was already being used for cosmetic reasons in my office because in those days, the many members of my office staff would notice if I had any Botox left over after I treated a patient.

• 55:03Lewis Howes?

  Do a little on their forehead.

• 55:05David Perlmutter?

  No, and I would, I have to admit. But having said that, I think we have to watch this data. And I think that, you know, the scientific community, medical community is well aware of that as a potential risk.

• 55:18Lewis Howes?

  Really?

• 55:19David Perlmutter?

  As it relates to the fillers, I think the biggest issue would be... That this is a foreign chemical put in the body by and large. You know, some of the collagen-based injections are really not that foreign. But I think what you can see are allergic reactions. And whenever there's an allergic reaction, it's amping up the immune system, creating inflammatory chemicals. What that does in the long term may not be good.

• 55:46Lewis Howes?

  Do we have the research yet in the last 20 years of kind of what's, what happens to the immune system, to the metabolism, to the brain function with fillers?

• 55:56David Perlmutter?

  Yeah, I think it's an interesting area to explore. I'm not sure even that, you know, I can't quote you research that's ongoing as it relates to that.

• 56:06Lewis Howes?

  Gotcha.

• 56:06David Perlmutter?

  But I think it's interesting.

• 56:07Lewis Howes?

  Interesting. I just worry about any type of drug, toxin injections that people do excessively. You know, if there's some other way to prevent or optimize, I guess, without injection of toxins, you know what I mean?

• 56:25David Perlmutter?

  Well, Lewis, let me.

• 56:26Lewis Howes?

  Like, I guess there's difference between like a peptide versus like collagen versus toxins, right? And it's like, okay, where do you, I guess, go with all this?

• 56:35David Perlmutter?

  Well, here's where I'm going to go with it, and that is it doesn't need to be injected. So that opens the door to topicals and the risk of toxicity in the human body from what we are exposing ourselves to with anything that's put on topically, whether we think we're doing the right thing by using sunscreen or moisturizers. This is well beyond the notion of hair dye and all of that type of stuff, which, you know, clearly represented a danger. In fact.

• 57:09Lewis Howes?

  How dangerous is hair dye?

• 57:10David Perlmutter?

  Well, originally, the original work on hair dye was done by Dr. Bruce Ames. So Dr. Ames, decades ago, was able to identify certain chemicals in hair dyes that were carcinogenic and developed a bacterial test using a type of bacteria, I think it was streptococcal, that could be used globally to evaluate various chemicals in terms of their carcinogenicity. Could they? Cause cancer and so he was able to identify certain components of hair dye that were indeed quite threatening.

• 57:44Lewis Howes?

  Really?

• 57:45David Perlmutter?

  Yes.

• 57:46Lewis Howes?

  Are there innovative hair dyes that are less threatening and that are more organic or natural in nature?

• 57:52David Perlmutter?

  Question then arises in terms of have they been thoroughly vetted and that is worrisome because most of these products haven't really undergone rigorous human trials or even animal trials that are still sold in stores that may well be threatening.

• 58:12Lewis Howes?

  When you dye-

• 58:13David Perlmutter?

  There's really no review process for these products.

• 58:16Lewis Howes?

  Interesting. When you dye your hair, what is happening, I mean, it's, is the hair dead? Is it like a dead cell? Is it still connected to living cells?

• 58:26David Perlmutter?

  Well, hair is dead. Hair is not living.

• 58:28Lewis Howes?

  So if you dye it though, is it entering through the cells from that chemical?

• 58:34David Perlmutter?

  It's entering through the skin.

• 58:35Lewis Howes?

  Right.

• 58:36David Perlmutter?

  Your scalp. But it, interestingly, the part of the system that is alive is of course, of course, the cells in the skin that manufacture and color your hair. So the cells, the melanocytes that are involved in giving your hair color, decline in function over time as their mitochondria begin to fail.

• 59:01Lewis Howes?

  Really?

• 59:02David Perlmutter?

  So as their mitochondria begin to fail, they are less able to create the color of your hair and your hair turns gray.

• 59:08Lewis Howes?

  So the more you color your hair, you're weakening the mitochondria-

• 59:12David Perlmutter?

  No, no, I didn't say that.

• 59:13Lewis Howes?

  Okay.

• 59:14David Perlmutter?

  What I'm saying is the more these cells that are involved in keeping your hair colored are declining in terms of their functionality, the less able they are to impart color into the hair and your hair turns gray.

• 59:28Lewis Howes?

  And that's your total health, that's your environment, the foods you're eating, your sleep.

• 59:31David Perlmutter?

  To some degree, there's certainly a lot of heredity involved in it as well. But these cells become what's called senescent, which means they lose their ability to divide, they lose their ability to function and the fact that they are senescent oftentimes allows them to create certain chemicals that causes the next cell adjacent to them to also become senescent and less functional. It's why, you know, people develop a patch of gray hair in certain areas and it tends to spread.

• 1:00:02Lewis Howes?

  Yeah, I've got a little bit, a little bit of hair. I got a, how do you, can you reverse gray hair?

• 1:00:07David Perlmutter?

  It's a good question. I've wondered, and this is not a pit, but I've wondered if either NAD or urolithin might help reverse gray hair.

• 1:00:19Lewis Howes?

  NAD.

• 1:00:20David Perlmutter?

  NAD, perhaps.

• 1:00:21Lewis Howes?

  We don't have any research.

• 1:00:22David Perlmutter?

  Not NAD per se, but NAD, NMN, or NR, nicotinamide mononucleotide, or nicotinamide riboside, the precursors for NAD in the human body. I wonder if that, or perhaps urolithin A, may contribute to less, rather lessening of gray hair.

• 1:00:39Lewis Howes?

  We don't have the research on this yet?

• 1:00:41David Perlmutter?

  I've not seen it, but I've experienced it.

• 1:00:43Lewis Howes?

  You've taken this and you've seen like a reversal, or just a stop?

• 1:00:47David Perlmutter?

  Suddenly over here, all growing black hair.

• 1:00:50Lewis Howes?

  Come on.

• 1:00:51David Perlmutter?

  Yeah, yeah. And I pointed out to my wife, I said, you know, I'm not using, just for men, what is that stuff?

• 1:00:57Lewis Howes?

  Yeah, yeah, you're not dying your hair.

• 1:00:58David Perlmutter?

  And look, now I'm getting these black hairs, or dark hairs.

• 1:01:00Lewis Howes?

  Really?

• 1:01:00David Perlmutter?

  So who knows?

• 1:01:01Lewis Howes?

  Interesting.

• 1:01:02David Perlmutter?

  But I think that if you target mitochondrial function, and there are so many things that we could be talking about, that that might happen. I don't know for sure. But next time I come on your show.

• 1:01:11Lewis Howes?

  Let me know if you have all black hair over here, I'll be like, yeah.

• 1:01:14David Perlmutter?

  Just for men.

• 1:01:16Lewis Howes?

  If you, so what is the research around people that dye their hair continuously, or a couple times a year? Is there research around how it impacts mitochondria, metabolism, brain health?

• 1:01:27David Perlmutter?

  It's tough to say, because there are, you know, how many types of hair dye that are out there. So that's not a, that's not how science works.

• 1:01:34Lewis Howes?

  Sure.

• 1:01:35David Perlmutter?

  Science works at one variable, generally assessing one variable that's now being challenged, which I'm grateful for. So it might be one hair dye, or more importantly, one chemical in a hair dye. Let's see what that does over a period of time in laboratory animals, and then perhaps in an interventional trial.

• 1:01:51Lewis Howes?

  Okay. So if someone, if someone...

• 1:01:53David Perlmutter?

  We've covered a lot of water fun.

• 1:01:55Lewis Howes?

  I know.

• 1:01:55David Perlmutter?

  This is good, though.

• 1:01:56Lewis Howes?

  If someone dyes their hair, I guess you don't have the answer to this, but if someone dyes their hair with over the counter, normal hair dye, I guess.

• 1:02:09Lewis Howes?

  Are they hurting the functionality of their hair? Quality, strengths, and color by doing that? Or is it not hurting that in the research that we have so far?

• 1:02:20David Perlmutter?

  Hard to say, because inherent in the ability to dye hair is first stripping it and allowing so that the dye then is more able to penetrate the hair. Is that necessarily good for hair? I tend to think that it is not.

• 1:02:34Lewis Howes?

  Got it, okay.

• 1:02:35David Perlmutter?

  So, you know, we've gone from inside the head to outside the head.

• 1:02:40Lewis Howes?

  Yeah, well, I don't know which ones, how it's impacting, I'm just curious, yeah.

• 1:02:44David Perlmutter?

  Yet it's exceedingly common. I think that...

• 1:02:48Lewis Howes?

  Did you used to dye your hair ever?

• 1:02:50David Perlmutter?

  Never have.

• 1:02:50Lewis Howes?

  Never have?

• 1:02:51David Perlmutter?

  No.

• 1:02:51Lewis Howes?

  Not even a little like just for men on the sides or something?

• 1:02:54David Perlmutter?

  Never went with it. I'm, you know, I'm okay with it. I'm just fine with it.

• 1:03:00Lewis Howes?

  Yeah, yeah. There was a, there was a clip that we posted the last time we had you on that went crazy on Facebook. My team told me that it was...

• 1:03:11David Perlmutter?

  Last thing I remember to tell you, go ahead.

• 1:03:13Lewis Howes?

  Okay. My team told me that it was our most watched clip on all of our Facebook videos that, from you. And I wanted to follow up and see if there's more research from what we talked about. And the clip that we talked about that went crazy online was around the pros and cons of having a vaginal birth for mothers versus a cesarean C-section for mothers. And you mentioned something about kind of the pros and cons of the immune health of the child, however they're being birthed. And I don't know if you remember this?

• 1:03:52David Perlmutter?

  Oh, I believe me, I do.

• 1:03:54Lewis Howes?

  And if you can elaborate on the pros and cons of a C-section versus a vaginal birth? And I understand there's certain complications these days for women needing to have a C-section for whatever reason. But is there research on the pros and cons of vaginal versus cesarean section births? And if someone has to do a C-section for whatever complicational reasons, is there a way that you can still benefit the child so that they get the optimal immune capacity from that birth?

• 1:04:31David Perlmutter?

  Yes, so...

• 1:04:33David Perlmutter?

  Does the child enter the world through the vagina or through an incision in the mother's belly, basically? A cesarean section. And those are very different experiences for that newborn. We have to recognize that a cesarean section is a life-saving, wonderful procedure, now done in a hospital sterile environment, such that, quasi-sterile environment, we'll get to that in just a moment, such that a child can be saved and mother can be saved as well if, in fact, this pregnancy is threatening to mother. So there's a time and a place, that's for sure. As we sit here right now, about 30% of births in America

• 1:05:17David Perlmutter?

  is delivered via a C-section, which is an exceedingly high number. What was that 30 years ago? It's been pretty consistent over the past 30 years. And I'm going to say that some of the reason it happens, with all due respect, it's not because there's a threat in terms of the newborn, or the fetus, rather, or mother's health, but because of convenience. I think to be fair to mothers and fathers, parents-to-be, that a full explanation as to potential downside risks of a C-section, aside from a scar or any other complication to the mother in terms of a general anesthetic and surgery

• 1:06:02David Perlmutter?

  and an antibiotic being administered, should include what are now the well-understood risks to that newborn. And here is what they are. When a child passes through the birth canal in a normal vaginal delivery, that child is anointed, anointed with the seeds, the bacterial seeds, the viral seeds, of his or her future microbiome. The bacteria, the viruses, the other organisms that invest that child and determine various functions of that child when he's an adult or she's an adult. Really? The set point of immune reactivity, for example.

• 1:06:45David Perlmutter?

  That the immune system receives a significant degree of programming from the gut bacteria.

• 1:06:54David Perlmutter?

  And the differences in the bacteria in the gut between a C-section born child and a vaginally delivered child are significant. Really? We know that changes in the array, the functionality and diversity of the gut organisms relate to things like diabetes, obesity, and even risk for autoimmune conditions. Having said that, what the science reveals is there's a pretty significant increased risk of autoimmune conditions in children born by cesarean section. There's a dramatic increased risk of autism, ADHD, and autoimmune conditions like celiac

• 1:07:37David Perlmutter?

  disease and type 1 diabetes in C-section born children as opposed to children born vaginally. And the research is out there on this? Research has been published for at least 15 years. Now, are there other things that happen in terms of physical compression of that child at the time it passes through a tight canal versus being just liberated in the C-section? Perhaps it's playing a role, but I think much of the research, most of it, is focused on the anointing of that child with a specific type of bacterial array, viral array, in the birth canal that invests that child's eyes, ears, nose, mouth especially, and then

• 1:08:18David Perlmutter?

  serves as the seed for his or her upcoming gut microbiome, as opposed to forming that gut microbiome based upon whatever bacteria happens to be on the surgeon's glove, gown, or in the operating room. The good news, in fact, there's two bits of good news. First, that there is a pretty significant normalization of the toddler's gut microbiome with time as he or she is exposed to the world, the similar world as the other child. But the other bit of research I think is really very exciting, being done mostly at NYU, is the idea of prior to doing a C-section.

• 1:09:02David Perlmutter?

  Taking a vaginal swab, keeping that swab in a warm, moist environment, deliver the child by C-section, and then implant that bacterial component into the child's mouth, nose, and face.

• 1:09:16Lewis Howes?

  Ears, eyes, kind of all in place, right?

• 1:09:19David Perlmutter?

  Basically wipe the face of that child. That research is early, but it's being done. And I think that we will see that the results will probably be related to an intermediate benefit somewhere between vaginal birth and C-section, but in a better place than C-section.

• 1:09:40Lewis Howes?

  Because you hear about, I mean, you hear about the rise in autism, ADHD, like you mentioned, autoimmune diseases, skin irritations, nut allergies, all these different things that I don't know if those were around when you were growing up. Were they, was that a common thing in children?

• 1:10:01David Perlmutter?

  No, they were around. And autoimmune conditions, again, type 1 diabetes, celiac disease, lupus, all the various autoimmune conditions were around, but we're seeing that they're skyrocketing, and why? It gets back to one single term that we've talked about today called immunometabolism. The relationship between the balanced response of the immune system and our metabolic health. The control of our blood sugar, our blood pressure, whether we're obese or not. Those things are skyrocketing and threatening the balance of the immune system. Beyond that, though, the array and diversity and functionality of the gut bacteria

• 1:10:46David Perlmutter?

  is changing quite rapidly over time, primarily based upon the change in the human diet. That has a direct role to play in the balance of the response of the immune system. It should be not too high, not too low, the Goldilocks zone. Not enough immune function, we develop risk for infection. Too much immune function, we react to things, even react against ourselves. Hence explaining, in providing the answer to your question, why are we seeing such a rise in allergies to nuts and other things, and autoimmune conditions as well?

• 1:11:21David Perlmutter?

  Let me tell you something before I forget.

• 1:11:22Lewis Howes?

  Yes. Is this what you're gonna tell me before I ask you?

• 1:11:25David Perlmutter?

  Yeah. My wife and I are in a lodge in, just in the northern part of Patagonia in Chile. And I'm watching TV. It's in Spanish, of course. And there's my interview, your interview with me.

• 1:11:43Lewis Howes?

  Really?

• 1:11:43David Perlmutter?

  On Chilean television in really good Spanish that was lining up with our mouths. It was perfect.

• 1:11:50Lewis Howes?

  That's great. Yeah, yeah. We dub our content. We have, you know, the whole AI dubbing the whole thing. So we have over a million subscribers in Spanish on our Spanish channel. And somewhere around five or seven million views, I think, a month in our Spanish content. We have Portuguese channel as well.

• 1:12:06David Perlmutter?

  Wow.

• 1:12:07Lewis Howes?

  So our mission is to serve humanity in the biggest way possible with this information. And so I go to Mexico a lot. My fiance is from Mexico. And we go there a lot for her work. And I'll be walking down the street and people come up to me and playing the Spanish content.

• 1:12:21David Perlmutter?

  Can we stop?

• 1:12:22Lewis Howes?

  Exactly. And they're like, watching the content in Spanish.

• 1:12:25David Perlmutter?

  Yeah, yeah.

• 1:12:26Lewis Howes?

  And they're so grateful because they don't have access to you if they can't, you know, understand English with your English content unless you're both translating in Spanish. But the video content is really helpful for them to listen and watch at the same time. Not just subtitles in Spanish, but actually hearing it. And I don't think more people are starting to get into that dubbing their content. It's a big investment, but it's been worth it for us for the impact.

• 1:12:50David Perlmutter?

  Yeah. Well, I will explore that with you further off camera because

• 1:12:54Lewis Howes?

  For sure.

• 1:12:54David Perlmutter?

  I think I would love to do that with my podcast because, again, you know, the mission is to get the information out. So.

• 1:13:00Lewis Howes?

  Yeah, it's, I mean, it's investment. So it's like, it took a couple of years for us to kind of break even, I guess, on the ad return on YouTube or whatever. But it's, for me, it's more about changing lives, helping people, service.

• 1:13:11David Perlmutter?

  Understood.

• 1:13:12Lewis Howes?

  And it's worth the investment in my mind to help more people. But that's cool that you got to see your content. It was on TV, huh?

• 1:13:18David Perlmutter?

  It was on TV. Now, it may have been on YouTube, but I think it was, it might have been on network.

• 1:13:23Lewis Howes?

  Maybe they took a clip. Well, we also, we're on PBS as well, so in America, so probably not in Chile. But that's, that's awesome. Something that's been a hot topic lately in culture and society around sugar and glucose spikes. How? How related is the amount of sugar we eat, the amount of glucose spikes we have in a day to dementia or Alzheimer's? And is there a way to understand our glucose spikes better? Or to cut out sugar in a way to support us in this process?

• 1:13:59David Perlmutter?

  Well, I think the relationship of our consumption of sugar, and I'll need to kind of define what that means. What is sugar? Is profoundly related to Alzheimer's risk and Alzheimer's progression. You know, one study demonstrated that there's a profound relationship between the number of sugary beverages each day and Alzheimer's risk and actual shrinkage of the brain, even more profound. And sugary beverages, we're thinking soda, et cetera, includes fruit juice. So let's be clear.

• 1:14:32Lewis Howes?

  Orange juice, lemonade, apple juice.

• 1:14:34David Perlmutter?

  Cranberry juice. That the sugar content of these juices is equal to drinking a Coke or Pepsi. Perhaps not Mountain Dew's really got a lot of sugar, but you know, we're talking 36 grams of sugar in a 12 ounce or 16 ounce can, so, or glass. So having said that, it's a clear and present danger. And you know, mechanistically, we've already covered why it happens because we're threatening mitochondria. We're threatening to change those wonderful supportive immune cells to becoming the evil twin and destroying brain cells. And you know, it all comes together. We are now connecting these dots.

• 1:15:16David Perlmutter?

  My colleague, Dr. Robert Lustig, has really gone a long way to really defining the biochemistry in terms of how this is happening. And then what are then these relationships between these dietary trends and, and brain health decline?

• 1:15:34David Perlmutter?

  But yet, we're seeing ever increasing amounts of other information kind of leading us to believe that, well, you know, there are bad sugars and good sugars. And, you know, the reality is that the most threatening sugar of all is not glucose. What is it? It is fructose, by far and away. What's the difference between glucose and fructose? So they are totally different molecules in terms of the number of carbon atoms. And importantly, in table sugar, it's both. It's 50% fructose and 50% glucose. They are bonded together. We consume that table sugar and then we, in the intestine with an enzyme

• 1:16:13David Perlmutter?

  called sucrase, we break it up into fructose and glucose. Fructose is, doesn't require insulin for its metabolism, and as we may have talked about before, immediately is metabolized into something called uric acid, which is a profound threat to our metabolism. Wow. Glucose is absorbed and is used as fuel. Fructose is a powerful mitochondrial toxin. Toxin. Mitochondrial toxin. Fructose. Fruit sugar, fructose. Now, having said that table sugar is 50% fructose, recognize that there exists something out there called high-fructose corn syrup, which has an even

• 1:16:53David Perlmutter?

  higher percentage of fructose that is cheap and really, really sweet, which is why it's the go-to sweetener for, you know, about 60 to 70% of grocery store shelf packaged products contain at least some added sweetener. By and large, it's high-fructose corn syrup or a derivative thereof. Fructose is a powerful threat to our immune function, a powerful threat to mitochondrial health. That's why it threatens our immune function, and clearly, clear and present danger as it relates to brain health and Alzheimer's risk.

• 1:17:31David Perlmutter?

  So let me take us back, let me wind the clock back a little bit to when we started today. You presented some very sobering statistics about not just where we are in Alzheimer's, but where we're going.

• 1:17:43Lewis Howes?

  Yes.

• 1:17:44David Perlmutter?

  I think you talked about 2050 with tripling of the prevalence of Alzheimer's at that time, far outstripping the aging of our population. And I think the query was, why is it happening? And my response to you was, because of the changes in our metabolic health. The number one threat to our metabolic health, and I believe I've said it before, is our fructose consumption.

• 1:18:06Lewis Howes?

  So how much fructose consumption can we have where it doesn't threaten our metabolic health and brain health?

• 1:18:13David Perlmutter?

  Wonderful question. And indeed, humans consume fruit sugar, goes by the name of fructose. That's where the name comes from. And we can handle at any given time about five grams of fructose. That's an apple.

• 1:18:28Lewis Howes?

  One apple a day?

• 1:18:29David Perlmutter?

  No, at a time. You can have a couple of apples in a day, but you don't want to load your body, you don't want to load your digestive system quickly with any more than about five grams of fructose.

• 1:18:40Lewis Howes?

  Now-- So one apple is about five grams of fructose?

• 1:18:44David Perlmutter?

  That's right.

• 1:18:45Lewis Howes?

  And what is that, like bananas, five grams as well, or a similar range?

• 1:18:49David Perlmutter?

  So the issue isn't necessarily the amount of fructose that a particular fruit contains. Bananas are about midway, melons are higher, watermelon, honeydew melon, cantaloupe are higher. You know, there's a scale in terms of fructose consumption. One doesn't eat as many by mass, wouldn't eat as many blueberries perhaps as a big apple. But having said that, our small intestine can handle about five grams of fructose at a time. Time is an important operative word. Why? Because when you're chugging a glass of orange juice, or Dr. Pibb, or whatever it may be,

• 1:19:30David Perlmutter?

  you're bombarding your digestive system with a huge fructose load, far more than it can handle.

• 1:19:36Lewis Howes?

  Like a rush of it.

• 1:19:37David Perlmutter?

  That's right, a rush. And it's far more than your small intestine can process, which is about five grams at any given moment. You don't eat all the fructose, or consume all the fructose in an apple. You don't chug an apple.

• 1:19:51Lewis Howes?

  Right. It takes time. You gotta chew it, you gotta, you know, swallow it.

• 1:19:54David Perlmutter?

  But you do drink a glass of orange juice or apple juice quickly. Not only that, but an apple contains fiber that slows the release, the absorption of fructose. It also contains vitamin C, which is relevant because the downstream consequence of ingesting higher dose, higher amounts of fructose is the creation of uric acid, which affects your metabolic state in a negative way. But vitamin C helps to offset that by augmenting your ability to excrete uric acid. So eat the apple, or two a day. Keep the doctor away, but don't drink the apple juice. Or if you do, water it down.

• 1:20:33Lewis Howes?

  Interesting. So have less concentrated apple. A little bit and pour more water.

• 1:20:37David Perlmutter?

  And you won't notice a difference.

• 1:20:38Lewis Howes?

  Yeah, exactly. So what about people that just love to have, you know, a fruit diet? They eat tons of fruit, a big bowl of fruit. They, they believe it's very healthy for them. It's got fiber, it's got nutrients, it's got vitamin C. And it's a big bowl of fruit. Is something wrong with that?

• 1:20:55David Perlmutter?

  Well, it's not, it's not ideal. I mean, if you're gonna pace.

• 1:20:58Lewis Howes?

  Is it better than processed fruit or sugars, though? Is it better?

• 1:21:02David Perlmutter?

  I would say yes, for the reasons that you delineated. The fiber, the vitamin C, the other nutrients, the bioflavonins, the polyphenols, you name it. But if you're going to do that, then pace yourself, eat it slowly. This morning, with my breakfast, I asked for a bowl of fruit. And the hotel brought. It was massive, this bowl of fruit. And at the end, the waiter asked me, well, do you want to box this up? Because you left two thirds of it. I said, no, I didn't really want to do that. So what did I have for breakfast this morning? I had three eggs, over easy. A garden salad for breakfast, who knew? With a side order of olive oil.

• 1:21:45Lewis Howes?

  Lot of fiber.

• 1:21:46David Perlmutter?

  A lot of fiber, a lot of good fat. And a what turned out to be a very small bowl of fruit, because I didn't eat it. And two cups of of black coffee with allulose sugar in it. Which acts as a GLP one agonist.

• 1:22:03Lewis Howes?

  So the allulose sugar, which you're on the board of a brand called RX Sugar, is that right?

• 1:22:11David Perlmutter?

  That is correct.

• 1:22:12Lewis Howes?

  That creates this allulose sugar, which is a GLP one.

• 1:22:18David Perlmutter?

  Agonist.

• 1:22:18Lewis Howes?

  Agonist, what does that mean?

• 1:22:20David Perlmutter?

  It means it stimulates the GLP one receptor in a positive way. As the natural GLP one produced in the body from the L cells in the small intestine would do. Actually, in a similar way as the GLP one Ozempic like drugs. They're all considered GLP one agonists.

• 1:22:42Lewis Howes?

  What is GLP one?

• 1:22:44David Perlmutter?

  So this is a hormone that regulates things like appetite, regulates the emptying of the stomach, essentially in the brain to regulate how much food we consume. And even has a role in terms of how insulin does its job in the body as well.

• 1:23:01Lewis Howes?

  We all produce this.

• 1:23:02David Perlmutter?

  We all produce this, to varying degrees.

• 1:23:04Lewis Howes?

  But some of us produce less of it over time if we're eating too much sugar or processed foods, is that part of it?

• 1:23:11David Perlmutter?

  That may happen, but I think that eating sugar actually immediately stimulates the body to produce GLP one, as does fat and fiber.

• 1:23:21Lewis Howes?

  Interesting. So GLP one is something that helps us to process food better? Or to have less, what does it help us do specifically?

• 1:23:31David Perlmutter?

  So this glucagon like peptide.

• 1:23:36David Perlmutter?

  Is, you know, when we're eating, there's a lot of signaling going on in the body that, you know, suddenly, there's a big change about to occur. We're going to load the body up with who knows what, and how are we going to deal with it, and how much should we be consuming, and why don't we just keep eating? So, this is a way of regulating appetite, that's built into our physiology, that now starts to metricize what we're eating, in terms of quantity and quality, in terms of calories, derived from fat versus carbohydrate, so that we're going to eat an appropriate amount of food. Other hormones are involved, like ghrelin and leptin as well. With time, we can become less sensitive to these chemicals.

• 1:24:19David Perlmutter?

  We certainly become less sensitive to leptin, which also regulates our appetite, such that we become, like we can become insulin resistant, we can become leptin resistant, as we constantly bombard our bodies with foods that challenge the production of leptin, we become resistant. So, we become less sensitive to the signaling of leptin, and therefore, we might eat too much. I mean, there was an attempt in the past to give people leptin as a way of curbing their appetites, didn't seem to work. But, clearly, the GLP-1 agonists are working. I mean, people aren't just taking these drugs because they're, you know, they're being,

• 1:25:03David Perlmutter?

  the celebrities are talking about them. They're working extremely effectively, in terms of weight loss, and in control of blood sugar as well. In the New York Times this morning was a fascinating article, talking about addiction, and the effectiveness of GLP-1 agonist drugs in terms of addiction, even things like alcohol consumption.

• 1:25:27Lewis Howes?

  So, are these drugs helping you essentially?

• 1:25:32Lewis Howes?

  Not eat more? Or they're helping you digest the foods you're eating faster?

• 1:25:38David Perlmutter?

  Actually, they they slow gastric emptying so that that food will be around longer and will then be available for digestion perhaps longer. But I think the the former is probably much more a reason that we just our appetites are are curbed and we're eating less food.

• 1:25:56Lewis Howes?

  So you feel fuller because the food is inside of you longer?

• 1:25:59David Perlmutter?

  Yeah, and the the stomach, because it's not emptying, becomes more distended. And that is an electrical event. We sense that the stomach is becoming distended. And as such, it sends a signal to the brain that we should stop eating. It's, you know, in the in days gone by, a procedure was done called a gastric sleeve, where the outflow of the stomach was compressed with a device to and as such, the stomach would then distend more. And that would send signals to the brain, doing the same type of thing.

• 1:26:29Lewis Howes?

  Wow, what about people that do, I guess, like a shrink their stomach? They do a surgery to, I guess, shrink? I don't know what that's called, but.

• 1:26:38David Perlmutter?

  Yeah.

• 1:26:38Lewis Howes?

  What is that called when they they open the stomach? They they cut it in half, shrink it or something?

• 1:26:42David Perlmutter?

  Well, that what's been done is called gastric bypass operation, whereby the outflow of the stomach is diverted, such that, again, and the stomach is is is made smaller as well, really with the same goal in mind. And interesting, there are some pretty profound metabolic changes that happen from that, like better insulin functionality.

• 1:27:06Lewis Howes?

  Really?

• 1:27:07David Perlmutter?

  Yeah, I mean, you don't, in my.

• 1:27:10Lewis Howes?

  You don't want to go there.

• 1:27:11David Perlmutter?

  I don't want to, you know, it's kind of hard to admit because, you know, I think it's an aggressive procedure. But that's what the that's what the data shows. And, you know, similarly, you know, again, I I didn't want to spend, you know, an ordinary amount of time talking about these drugs, but I think people are really interested. I think they need it needs to be talked about.

• 1:27:31Lewis Howes?

  That's interesting.

• 1:27:32David Perlmutter?

  Because I think we should look at upsides and downsides of everything that's available.

• 1:27:36Lewis Howes?

  I guess the one thing that you mentioned that was a a red flag for me, I guess, is like if the food is not digesting and it's sitting there and it's like, I guess, just kind of blocked up, does that mean you have more constipation? Or is it just OK, your stomach is bigger for a period of time because it's the food's still in there? Shouldn't the flow want to have like a natural flow as opposed to a blockage like Madame?

• 1:28:00David Perlmutter?

  I think that is correct. I think, you know, the more physiologic we can be in terms of interventions and recommendations, the better. You know, one of the feared complications of these GLP-1 agonist drugs is something called gastroparesis, or paresis, which means basically a total paralysis of the stomach, and that can be life-threatening. So it's not common. It is described as, you know, one of the concerns of using these types of medications. And, you know, as we talked about earlier, in the interventional trial for Parkinson's patients, gastrointestinal issues were very, very common.

• 1:28:41Lewis Howes?

  Interesting. So what would be the three to five natural interventions, or environmental or food interventions, that we can take today to prevent us from getting Alzheimer's, or help us optimize the longevity of our health and our brain health for the future without medical interventions?

• 1:29:04David Perlmutter?

  Let me first characterize the use of a continuous glucose monitor. Let's maybe not call it a medical intervention, okay?

• 1:29:14Lewis Howes?

  But it's a, it's a, it's an assessment tool.

• 1:29:17David Perlmutter?

  Yeah, that I am very grateful is now not, you know, is now available non-prescription, i.e., it's a way that people can, can really gain a fundamentally important metric about their physiology. And the reason, you know, again, if, it's like a bathroom scale to me, which anyone can have and should have. You're learning about your body weight, you should learn about your blood sugar. So what then is this ideal diet that Dr. Perlmutter is now going to describe to your audience? And I think that we should consider the question as more along the lines of what's the ideal diet for you?

• 1:29:59Lewis Howes?

  For you, personalized, yeah.

• 1:30:01David Perlmutter?

  Right? And I don't know how to answer that question. I do know the broad strokes, and we can talk about the broad strokes, but I think ultimately, to me, an ideal diet is one that keeps your blood sugar under tight control.

• 1:30:14Lewis Howes?

  And what? How high do you want your blood sugar to be if you're using a glucose monitor? What's like the parameter for you?

• 1:30:21David Perlmutter?

  Well, if your blood sugar spikes to 160 after a carbohydrate meal, you might think that's a high number, 160, 180. But it's not really that important because it's going to. And I think that what we look at in looking at these measurements, it's not the spike, but how quickly it returns to baseline, how long it stays elevated. And again, gets back to if it comes back to baseline very quickly, then the area under that curve is pretty reduced. If it spikes and stays elevated for a longer period of time, then we have a larger area under the curve that translates to poor control of blood sugar, threatens insulin sensitivity. That becomes a powerful threat to brain health.

• 1:31:04Lewis Howes?

  So you think having a glucose monitor, at least for a couple of weeks of time, is something that people should consider so that they just have more information about their own health?

• 1:31:14David Perlmutter?

  That's right.

• 1:31:16Lewis Howes?

  But you were pretty healthy before you used a glucose monitor yourself, right?

• 1:31:20David Perlmutter?

  Well, when I started using the glucose monitor, I was very pleased with my results. But you know, I can't be one of those do as I say, not as I do individual. A, B, my dad died of Alzheimer's and it was awful.

• 1:31:32Lewis Howes?

  Yeah.

• 1:31:33David Perlmutter?

  And I don't want that to happen to me, but more importantly, I don't want my family to go through that again. So I think it's important for me to stand as an individual who practices what he preaches.

• 1:31:49Lewis Howes?

  Yeah.

• 1:31:50David Perlmutter?

  And so therefore, when I started using a CGM, the continuous glucose monitor, I was happy with the results. But I think, you know, this isn't something you have to do day in and day out for the rest of your life. You begin to develop a sense as to what your blood sugar does when you do or don't exercise, when you do or don't get a good night's sleep. And fundamentally, how do your food choices relate? And how do your supplements relate, as a matter of fact?

• 1:32:12Lewis Howes?

  Interesting.

• 1:32:13David Perlmutter?

  As well. And how do other things? You mentioned, we talked about alulose relate to blood sugar. And I think people using a CGM are going to be surprised by what they learn about themselves. The broad strokes, avoiding ultra-processed foods would be on the top of the list. Number two on that list would be avoid ultra-processed foods. Probably going to be three through five.

• 1:32:34Lewis Howes?

  Really?

• 1:32:35David Perlmutter?

  Yeah, beyond that is...

• 1:32:36Lewis Howes?

  Ultra-processed foods.

• 1:32:37David Perlmutter?

  It's such an issue. Packaged foods, processed carbs, grains, processed grains.

• 1:32:44David Perlmutter?

  Are ubiquitous and I don't care if you know they're organic, they were made by this or that, you know, company that has a great

• 1:32:52Lewis Howes?

  Vegan, non-GMO, everything.

• 1:32:53David Perlmutter?

  Yeah, a great startup, I want to be supportive of these people. It's the processing of these foods that leads to the fact that they're predigested basically and when they are consumed, your blood sugar goes up.

• 1:33:05Lewis Howes?

  So what about like protein bars and things like that as well?

• 1:33:09David Perlmutter?

  It's not a natural food and I think that for me, I've done my best to avoid those types of packaged foods. I mean, you know, is there a time if you're at a conference, sitting in a conference all day? Yeah, not really, you know, the truth of the matter is

• 1:33:27Lewis Howes?

  Just fast a little bit, yeah.

• 1:33:29David Perlmutter?

  And your brain's gonna work pretty well. Have a good breakfast, go to the conference, you know, maybe there's a good luncheon or not. So I don't really see a time and a place. If you're, you know, gonna be on the trail, hiking in the, you know, and you need to have something in your backpack, oh, you could put an apple in your backpack and a bag of mixed nuts just as easily as you can put a protein bar. Is there, could there be a protein bar that is acceptable? Yeah, there are and there are a few of them out there that are not too bad. You gotta watch the sugar component. You really gotta watch what kinds of fats go into it and because they're good, again,

• 1:34:09David Perlmutter?

  processed fats that are threatening and good fats that are not just good for you, but fundamental for your health.

• 1:34:18Lewis Howes?

  What about like dried meats or like kind of a jerky with no sugar or something? It's just salt and meat dried or smoked, something like that?

• 1:34:25David Perlmutter?

  Well, dried versus smoked, I think is really important. I think the process of smoking may introduce chemicals that are not necessarily going to be good for you. Dried, basically dehydrated, I don't think is a significant risk. You know, they do contain, that does contain a lot of purines ounce for ounce. Purines are metabolized into uric acid, which is something else we can monitor and we can monitor our own uric acid with going on online and buying a uric acid monitor. That requires a finger stick, unlike the continuous glucose monitor, but we'll see what the future holds.

• 1:35:02Lewis Howes?

  Is there any processed foods that you think could

• 1:35:07Lewis Howes?

  Benefit in any way that are out there that are like, okay, these are minimally processed. These are in a package or in a bag where they're not that harmful.

• 1:35:17David Perlmutter?

  Yeah, there are, in fact. You know, there's a couple that really stand out. There's one minimally processed type of buckwheat called Himalayan Tartary Buckwheat, HTB.

• 1:35:27Lewis Howes?

  Yeah. Who's the person who works on that?

• 1:35:29David Perlmutter?

  Dr. Jeffrey Bland.

• 1:35:31Lewis Howes?

  Oh, man, I can't remember.

• 1:35:32David Perlmutter?

  Yeah, Dr. Jeffrey Bland, oddly enough, Dr. Austin Perlmutter, who knew?

• 1:35:37Lewis Howes?

  There you go.

• 1:35:38David Perlmutter?

  So they have just published a report looking at changes in what are called methylation patterns, looking at the changes in the markers on human trial, human DNA over time in people who are consuming this HTB, Himalayan Tartary Buckwheat. And really, some phenomenal results.

• 1:36:01Lewis Howes?

  Interesting. Now, you mentioned briefly that your father passed away with Alzheimer's. Was that one of the main reasons you wanted to get into the medical field and study this?

• 1:36:13David Perlmutter?

  No, my father was one of the main reasons, without question. I mean, I think pretty much in the book that I was going to be a physician. And for a number of reasons. I mean, my first choice was meteorologist,

• 1:36:32David Perlmutter?

  specifically a hurricane specialist. When I was in fifth grade, I used to ride my bike to the National Hurricane Center in Coral Gables. And they had all these displays about how does a hurricane form? And I used to chart hurricanes when they would give the... They used to give lat and lon, the latitude and longitude of the hurricane, so that you at home could chart the progress of this hurricane on your home hurricane map. They don't use that anymore. But anyway, I decided I wouldn't do that because as I got older, I realized, oh, you had to study chemistry and math, which turned out to be, you know, my favorite subject, but anyway, so to become a doctor.

• 1:37:13David Perlmutter?

  But I think the main thing, that two main things that spurred me on were his compassion.

• 1:37:22David Perlmutter?

  Towards his patients and my curiosity with just medicine and how the human body works. Was he studying Alzheimer as well? No, he was a brain, he was a neurosurgeon, so, but it was always about the brain. I mean, when I was 11 years old at the dinner table, he would say, "Well, David, what is fascio, what is Marcio Fava Bignami Syndrome?" Marcio Fava Bignami Syndrome, and I'd say, "Well, I don't know," he said, "That's what Italian men get who drink too much red wine." And I would never forget, and when you're young, you can remember stuff like that. Sure, sure. Wow. Yeah, it was, and then as I became, like, in my early teens, 13, 14, I used to be able

• 1:38:05David Perlmutter?

  to go in those days, you know, less of a risk, I'd go into the operating room. I would scrub in. Wow, with your dad? With my dad, yeah. Wow, what was that like? What, he was doing like, brain surgeries? Doing brain surgery. When I was 14 years old, I was in the operating room, holding retractors while my dad was taking out brain tumors. Come on, really? Yeah. How many brain surgeries did your dad do? Oh, my gosh, you know, several a week. But he did a lot of back work, too, a lot of- Hundreds or thousands? Thousands, yeah. He was a wonderful surgeon. And when you couple that ability with compassion, you know, because it was not always good news after the fact. Sure.

• 1:38:46David Perlmutter?

  And I watched him do that, you know, I watched him interface with families, and I remember in particular, one night, he woke me up, he said, "I gotta go out to the emergency room at South Miami Hospital." And we went out, it was 1 o'clock in the morning. And a man had dove off a wall drunk in the Keys, Florida Keys, broken his neck. Brought him up to South Miami Hospital. And my dad had to put tongs, like ice tongs, in his skull, ice tongs connected to a rope, connected to a pulley, connected to a weight, to pull the neck up, to keep him from moving

• 1:39:29David Perlmutter?

  his neck further, prior to him being able to go in and then stabilize the fracture. Wow. So, I watched him do that in the emergency room, and then the man's mother and father showed up.

• 1:39:46David Perlmutter?

  And I'll never forget the interaction that he had with that mother and father. I was, you know, in my early teens. And he explained that he had broken his neck. And I remember the mother literally almost fell over to the extent that my dad had to help her into a chair. And she grabbed her heart. But the way he dealt with that situation was a horrible situation for the parents to find out. And then his son was still drunk, so he was kind of still out of it. I won't forget that. And I won't forget one other moment of compassion.

• 1:40:28David Perlmutter?

  We were fishing and he caught a small fish that we weren't fishing for. And he unhucked it and threw it back in the water and the fish was not doing well. And he watched that fish for probably 20 minutes and kept talking to it and saying, "You can do it, you know, go back down." Sometimes when you catch a fish, it doesn't do well. And I stopped fishing and watched him and heard him. And finally, the fish fluttered and went down. And just that level of compassion, you know, really just had an imprint on me at a, you know, at a time in life when you are imprintable.

• 1:41:08David Perlmutter?

  And I've, I think it's a Dan Fogelberg song that I quoted at his eulogy. I want to go off just for a second. Go ahead. Sorry. Go ahead. So the Dan Fogelberg song in it, it's called "The Leader of the Band." And he says, "My life has been a poor attempt to imitate the man. I'm just a living legacy to the leader of the band." And I let that one hang on the audience.

• 1:41:52David Perlmutter?

  Because, you know, I've kind of lived my life trying to live up to that.

• 1:41:56Lewis Howes?

  Really?

• 1:41:56David Perlmutter?

  Yeah, I really have.

• 1:41:57Lewis Howes?

  Wow.

• 1:41:59David Perlmutter?

  You know, he wasn't perfect, nobody was, but like your father, as you describe in your book, set the bar pretty high. Luckily for us, they did. And that wasn't their mission, but they did by example.

• 1:42:15Lewis Howes?

  Uh huh. What was the biggest lesson he taught you beyond compassion?

• 1:42:22David Perlmutter?

  That, uh...

• 1:42:28David Perlmutter?

  The notion of noblesse oblige.

• 1:42:30Lewis Howes?

  What's that?

• 1:42:31David Perlmutter?

  That John Kennedy talked about. And it basically means that if you're gifted, and we all are, whatever that gift is, you're obligated to use that gift in a way that serves humanity. You know, I get the message that I'm pretty clever about certain things. I know that at this stage of life. I'm gonna be 70, so I can say that I've understood that over the years, that I have a pretty good brain. And it's allowed me to do the things that I've done, to accomplish the things I have accomplished. But to accomplish things for accomplishment's sake is one thing, but to accomplish things that

• 1:43:13David Perlmutter?

  fulfill your noblesse, your obligation to others, we are obligated. I think it's a task that he charged me with by letting me know about that notion. And that stands right up there with, that is part of compassion. To be compassionate to others is to use your skill set to benefit them like you do with this podcast. I mean, it's all about giving back. And we talked about, you know, why do you have your podcast translated in Spanish? Because they need the wonderful information that you're giving them. It's not a moneymaker, face it. But that's our obligation.

• 1:43:51Lewis Howes?

  Absolutely.

• 1:43:54Lewis Howes?

  How long, you say your dad died of Alzheimer's, is that right?

• 1:43:58David Perlmutter?

  Alzheimer's killed him, and I think it's really important that people understand that Alzheimer's itself is the number three cause of death in America. It kills people. Now, to be clear, Alzheimer's patients generally have, you know, quite a few other diseases going on because they're metabolically compromised, heart disease, diabetes, etc. And becoming a type 2 diabetic is associated with about a fourfold increased risk of Alzheimer's. So these things ride together, but it was clearly the Alzheimer's that took his life.

• 1:44:33Lewis Howes?

  How long did he have the Alzheimer's for, before his death?

• 1:44:37David Perlmutter?

  Well, how long had he had the clinical manifestations? Probably about seven years. But vis a vis our earlier discussions, it's, you know, likely started 20, 25 years earlier than that.

• 1:44:50Lewis Howes?

  But you started to see the symptoms for the last seven years, is it most?

• 1:44:54David Perlmutter?

  Well, I diagnosed it.

• 1:44:55Lewis Howes?

  Wow.

• 1:44:56David Perlmutter?

  And I remember the moment I diagnosed it. And at the moment, at that moment, I said to myself, how could I have ignored this as a neurologist? And of course I would ignore it, it's my father for crying out loud.

• 1:45:12Lewis Howes?

  Of course.

• 1:45:12David Perlmutter?

  But it's, you know, my work, I did it every day. I made that diagnosis countless times, every single day in my medical practice.

• 1:45:21Lewis Howes?

  You don't want to see that with your father, so maybe you're not looking.

• 1:45:23David Perlmutter?

  I didn't want to see it, I couldn't see it, I kept myself from seeing it. But finally, in one statement that he made, I was about to argue with him that he was wrong, that dad, no, as a matter of fact, it was a different way, when I finally got it and I said, wow, this is where we are. Put your seatbelt on because you know what's going to, I know better than anyone what's going to happen. This has been, you know, my work for decades, I knew very well. And then I had to tell my other family members, five kids, I had to tell my four siblings, what's going on here, what to expect.

• 1:46:02Lewis Howes?

  Are you the oldest?

• 1:46:03David Perlmutter?

  I'm the youngest.

• 1:46:04Lewis Howes?

  Wow.

• 1:46:07David Perlmutter?

  You'd think I was the oldest. I get that all the time. You know, you must be.

• 1:46:11Lewis Howes?

  Either the oldest or the youngest. You get Alzheimer's either one.

• 1:46:16Lewis Howes?

  What were the biggest lessons you learned in that seven years with your father?

• 1:46:21David Perlmutter?

  Compassion and get to work. Get to work.

• 1:46:26David Perlmutter?

  So, you know, I've devoted myself to this notion. And we are living in a world that again wants us to believe that our lifestyle choices don't matter. They are everything. They are everything. This disease is not caused primarily by an accumulation of beta amyloid. It's the targeting of beta amyloid that is the focus of all these wonderful new drugs that are being FDA approved. They aren't working. It's a metabolic issue. That's what I yell from the mountaintop. And we've got to rein in our metabolism to help keep the brain healthy and resistant to the problem in the first place. And also as a therapeutic intervention.

• 1:47:09Lewis Howes?

  It sounds like a glucose monitor could be the first step to understanding your own personal data of how your foods, your environments, your workouts, your supplements are impacting you in a positive or negative way. So that you have better data to make better decisions.

• 1:47:26David Perlmutter?

  Yeah, and I think it really, it stems from our beliefs.

• 1:47:32David Perlmutter?

  There's a long, difficult quote from Mahatma Gandhi that says, "Our beliefs become our thoughts. Our thoughts become our words. Our words become our actions. Our actions become our habits. Our actions, our habits ultimately become our destiny." And i.e. our beliefs become our destiny. Our beliefs, if we believe that we can live our lives and that medicine is going to save us, will be our destiny.

• 1:48:08David Perlmutter?

  That we will be destined to these diseases that we so fear. People fear Alzheimer's more than any other situation at the end of their lives.

• 1:48:18Lewis Howes?

  Really?

• 1:48:18David Perlmutter?

  The ability... Or the lack of variability for self-care and becoming a burden to others.

• 1:48:25Lewis Howes?

  And relying on other people or everything, yeah.

• 1:48:29David Perlmutter?

  You know, Robert Kennedy said, "Some men see things as they are and say, 'Why others see things as it could be and say, 'Why not?'" I think these days, it should be some people, let's make it politically correct. The point is, how it could be is no Alzheimer's. It could be eradicated.

• 1:48:50David Perlmutter?

  Or we could cut it in half. We could absolutely cut it in half if this messaging could be worked into a policy. So...

• 1:49:01Lewis Howes?

  We used to have a much fitter country and world, though, didn't we?

• 1:49:05David Perlmutter?

  Yeah.

• 1:49:06Lewis Howes?

  Fitter. Like, we used to move more and not eat as much processed foods.

• 1:49:11David Perlmutter?

  Well, we've gotten really away from our paleolithic ancestry, which is basically genetically who we are. We're still paleolithic individuals and we are still, you know, our whole physiology via our genetics is designed to express itself in a way that keeps us healthy, provided it receives the external environmental signaling, i.e. food, etc., that is in alignment with our genetics, and it is not.

• 1:49:44Lewis Howes?

  But also, I mean, I say that with the caveat that the lifespan 100 years ago was a lot shorter than it is now. Isn't that correct? Even though we have more diseases and obesity and struggles now, we still have a longer lifespan than 100 years ago when we were eating less and less processed foods, I guess.

• 1:50:03David Perlmutter?

  Well, what is lifespan? And when you talk about the lifespan of our population, if you were to determine the lifespan of the population, you'd look at, in 1900, you'd take 1,000 people and ask yourself, "How long did they live?" And then you'd make the average. Well, in those days... There was a lot of childhood death, there was a lot of infant mortality. There was a lot of deaths around, you know, childbirth. And that shortened lifespan. There's a lot of death from trauma, a lot of death from infection. And those things, paying attention to those things, improved our lifespan. And you're right, lifespan did increase over time. But interestingly now, in the past four years, for the first time in human history,

• 1:50:47David Perlmutter?

  lifespan is declining.

• 1:50:49Lewis Howes?

  Really?

• 1:50:49David Perlmutter?

  So it's finally caught up with us.

• 1:50:51Lewis Howes?

  Really?

• 1:50:52David Perlmutter?

  We've really kind of...

• 1:50:53Lewis Howes?

  What is the lifespan for men and women in America currently?

• 1:50:56David Perlmutter?

  So we're in the mid 70s now for men and late 70s for women. And we can do so much better than that.

• 1:51:05Lewis Howes?

  Is that, I mean...

• 1:51:06David Perlmutter?

  And what's killing people now? It's not, it's not as much, you know, the infectious diseases. What's killing people, I mentioned it earlier. According to World Health Organization, number one cause are chronic degenerative conditions that rob us of our ability not just to live a long life, but to have a longer health span so we live a healthier life. And these are conditions caused by disruption of our metabolism. We've closed the circle. And these are influenced by our lifestyle choices, moment to moment.

• 1:51:43Lewis Howes?

  When you hear that the lifespan is 77 or whatever in men, how does that affect you mentally or emotionally as you get closer to 70? You know, it's not something I like talking about, but how does, how do you approach life with that information? Not saying that like, oh, my life is over in a certain amount of years, but how do you think about it then? And I'm assuming that you have a lot of friends and colleagues and people in your life that have, you've lost as well as they've gotten older. And you've seen people...

• 1:52:16Lewis Howes?

  Die.

• 1:52:17David Perlmutter?

  Yeah.

• 1:52:17Lewis Howes?

  How does that impact you at this season?

• 1:52:20David Perlmutter?

  Well, I have to, I certainly don't dwell on the fact that I'm where I am, you know, on the chronological clock. I do know that my biological clock is, it puts me in the low sixties. That's certainly a good thing.

• 1:52:35Lewis Howes?

  That's great. Yeah, you look very healthy. If you'd have said seventy, I didn't think you were seventy.

• 1:52:39David Perlmutter?

  Well, I'm not there yet. I've got a couple of months to go. But, you know, I'm not middle aged. I mean, if we're gonna die at seventy-five, so thirty-seven and a half is the peak, right? So that's middle, I'm well beyond middle age. I have to admit, I don't think about it. But, you know, James Taylor wrote a song called "The Secret of Life," "The Secret of Life." And the secret of life is enjoying the passage of time. Any fool can do it, there ain't nothing to it. Einstein said he could never understand it all. The planets are spinning through space, the smile upon your face. So I think it's

• 1:53:18David Perlmutter?

  just really enjoying, recognizing that time is passing and enjoying the various phases of the moment.

• 1:53:27Lewis Howes?

  It's a good way to live.

• 1:53:29David Perlmutter?

  I, you know, I play a lot of pickleball and the people I play pickleball with, or that are playing pickleball, where I play pickleball, I'm about the middle of the age of those individuals. So there are people

• 1:53:41Lewis Howes?

  Wow.

• 1:53:42David Perlmutter?

  A lot older than I am playing pickleball. So that's encouraging.

• 1:53:45Lewis Howes?

  I hear paddle sports are some of the best ways to improve your brain function and your, extend your lifespan, too.

• 1:53:52David Perlmutter?

  That's right. And especially, and I'm really excited that outside your studio, there's a table

• 1:54:00Lewis Howes?

  Big box.

• 1:54:01David Perlmutter?

  Which is great because things happen so quickly and you've got to think very, very quickly. And pickleball is the same thing.

• 1:54:07Lewis Howes?

  Yeah.

• 1:54:08David Perlmutter?

  But, you know, you're moving a lot and

• 1:54:10Lewis Howes?

  So you play a lot more doubles then, huh?

• 1:54:11David Perlmutter?

  It's all doubles. Yeah, that we play. And I think that's becoming much more popular. But, you know, I have been, you have to be a little bit more careful at this stage of the game. You don't want to hurt yourself. A, you don't want to have the injury. And B, if you're injured, then you can't exercise. You don't want to stop exercise.

• 1:54:28Lewis Howes?

  Exactly.

• 1:54:29David Perlmutter?

  Exercising is, I think, the most important tonic for the brain.

• 1:54:35David Perlmutter?

  In multiple studies, if you want to enhance the growth of new brain cells and nurture those good-sided microglial cells that are there to help you and love you, that's what exercise does. So rein in your diet and make sure that you exercise every single day.

• 1:54:51Lewis Howes?

  Yeah. This is powerful, David. I appreciate you coming here. So much information in this. I want to send people to your site, DrPearlMutter.com. You're all over social media, David Pearl Mutter, or David Pearl Mutter M.D. in certain places. We'll have all this linked up as well. You've got 15 books. You've got more on the way. How can we be of service to you today? What can we do to support you?

• 1:55:17David Perlmutter?

  Gee, that's a good question. I'd say, yeah, look at the information I'm putting out. Think about it. And, you know, recognize that there are two sides to every story. And be open-minded that some of the things you may be hearing referenced your health may not necessarily have your interest at heart. How does it serve me? It makes me happy to think that, you know, there are some people who are going to hear my message and become and will be better off for that. And that's the goal. I appreciate that very much.

• 1:55:58Lewis Howes?

  That's great. Is there a recent book we should send people to, to check out?

• 1:56:04David Perlmutter?

  My last book was called Drop Acid. That has to do with uric acid. My next book is tentatively called Brain Wars. And Brain Wars deals with the war in your brain between the good and the bad microglial cells, and how we can absolutely affect the outcome of this confrontation.

• 1:56:22Lewis Howes?

  Brain Wars. I like it. I asked you this question last time, three truths. I'm curious if you have different truths this time. If you could only leave three lessons behind to the world. At the end of your life, you get to continue to create what you want, achieve, live the life you want, but for whatever reason, you gotta take all of your content with you, or it's erased from our existence. But you get to leave behind three lessons, three things you know to be true. What would you leave behind? What three truths?

• 1:56:53David Perlmutter?

  Well, I don't know what I answered last time, but what resonates with me right now is be as compassionate as you can to everyone in your life, everyone you interact with. We need that more than ever.

• 1:57:08David Perlmutter?

  Number two is be a good listener.

• 1:57:13David Perlmutter?

  And number three is express your gratitude.

• 1:57:18Lewis Howes?

  I'm grateful for you, David. I appreciate your, your, your consistent research and wisdom and bringing this information to people. And I appreciate you letting me ask you questions that are like, can you explain this like I'm nine, so that I can understand this? Because I think we hear these big words and terminology, and I don't fully understand them. And I'm interviewing experts like you all the time, but I still like want to simplify these things. So I appreciate you simplifying the complex for me and our audience. Appreciate you being committed to finding solutions, whether it be through organic interventions or medical interventions and being open to all possibilities on how you can help people with Alzheimer's or other things to support their brain health and their body health.

• 1:58:03Lewis Howes?

  And I'm just grateful that you're still on a mission to improving your health. And I hope that we see you around for a long time, because I know your wisdom, we need more of it. So I'm grateful for your research.

• 1:58:14David Perlmutter?

  Well, thank you for that.

• 1:58:15Lewis Howes?

  Your commitment, your dedication to serving humanity at the highest level.

• 1:58:20David Perlmutter?

  Well, and I want to say to you that I, that I think we have a very special connection. And the reason I say that is because I don't know how many years ago it was that I sat in this chair and we, we spoke, but I feel like I never left. I feel like we're just continuing on where we left off.

• 1:58:38Lewis Howes?

  Yeah.

• 1:58:39David Perlmutter?

  And that's very, very special. And I'm grateful for that.

• 1:58:42Lewis Howes?

  I appreciate it. Yeah. Well, we'll do it again.

• 1:58:44David Perlmutter?

  You bet.

• 1:58:45Lewis Howes?

  We'll do it again. I'm excited. When your next book's out, we'll have you back on. Final question for you, David. What is your current definition of greatness?

• 1:58:54David Perlmutter?

  Greatness is using the gifts that you have for the betterment of our planet.

• 1:59:03David Perlmutter?

  And I believe that's pretty similar to what I said last time. I don't know.

• 1:59:07Lewis Howes?

  We'll check.

• 1:59:08David Perlmutter?

  Oh, you're gonna check.

• 1:59:09Lewis Howes?

  We'll check, make sure.

• 1:59:10David Perlmutter?

  You can run that through the chat, J P T.

• 1:59:12Lewis Howes?

  Exactly.

• 1:59:12David Perlmutter?

  What did you say last time?

• 1:59:14Lewis Howes?

  I don't know. I'll look and see what it said. David, thanks so much for being here. I appreciate it.

• 1:59:18David Perlmutter?

  Thank you, Lewis. My pleasure.

• 1:59:19Lewis Howes?

  Amazing. I hope you enjoyed today's episode and it inspired you on your journey towards greatness. Make sure to check out the show notes in the description for a full rundown of today's episode with all the important links. And if you want weekly exclusive bonus episodes with me personally, as well as ad free listening, then make sure to subscribe to our Greatness Plus channel exclusively on Apple Podcasts. Share this with a friend on social media and leave us a review on Apple Podcasts as well. Let me know what you enjoyed about this episode in that review. I really love hearing feedback from you and it helps us figure out how we can support and serve you moving forward. And I want to remind you, if no one has told you lately, that you are loved, you are worthy, and you matter.

• 2:00:04Lewis Howes?

  And now it's time to go out there and do something great.