How Your Diet Affects Your Behavior, Risk Of Disease & What You Should Do About It w/Dr. David Perlmutter EP 1211

Today’s guest is Dr. David Perlmutter, who is a Board-Certified Neurologist and five-time New York Times bestselling author. He received his M. D. degree from the University of Miami School of Medicine where he was awarded the Leonard G. Rowntree Research Award and he currently serves on the Board of Directors and is a Fellow of the American College of Nutrition. He’s written a new book Drop Acid: The Surprising New Science of Uric Acid―The Key to Losing Weight, Controlling Blood Sugar, and Achieving Extraordinary Health. In this episode we discuss how your diet can contribute to your behavior, the real reason most people are addicted to sugar, how to reduce the risk of Alzheimers and other diseases, the emerging science behind uric acid and everything you need to know about its effects on the body, and so much more! For more go to: www.lewishowes.com/1211Check out Perlmutter's website - www.drperlmutter.comRead his new book - www.dropacidbook.comThe Wim Hof Experience: Mindset Training, Power Breathing, and Brotherhood: https://link.chtbl.com/910-podA Scientific Guide to Living Longer, Feeling Happier & Eating Healthier with Dr. Rhonda Patrick: https://link.chtbl.com/967-podThe Science of Sleep for Ultimate Success with Shawn Stevenson: https://link.chtbl.com/896-pod 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.

• 0:00Lewis Howes?

  This is episode number 1,211 with New York Times bestselling author Dr. David Perlmutter.

• 0:08Lewis Howes?

  Welcome to the School of Greatness. My name is Lewis Howes, former pro athlete turned lifestyle entrepreneur. And each week, we bring you an inspiring person or message to help you discover how to unlock your inner greatness. Thanks for spending some time with me today. Now let the class begin.

• 0:31Lewis Howes?

  Welcome back, my friend. Today's guest is Dr. David Perlmutter, who is a board certified neurologist and five-time New York Times bestselling author. He received his MD degree from the University of Miami School of Medicine, where he was awarded the Leonard G. Rowntree Research Award. And he currently serves on the Board of Directors and is a Fellow of the American College of Nutrition. He's written a new book called Drop Acid: The Surprising New Science of Uric Acid, The Key to Losing Weight, Controlling Blood Sugar, and Achieving Extraordinary Health. In this episode, we dive deep about how your diet can contribute to your behavior, the real reason most people are addicted to sugar,

• 1:14Lewis Howes?

  how to reduce the risk of Alzheimer's and other diseases, the emerging science behind uric acid, and everything you need to know about its effects on the body, and so much more. I'm excited about this one. I hope you really enjoy it. Make sure to share this with someone that you think would be inspired by this message as well, as we are all about helping improve the quality as many people's lives as possible. So please share this message if you find it helpful. And a quick reminder, if this is your first time here, please subscribe over on Apple Podcasts or Spotify to the School of Greatness to stay up to date. We've got over 1,200 episodes from some of the biggest minds in the world, some of the greatest athletes, doctors, nutritionists, scientists, leaders, all about how to improve your life. So make sure to subscribe and stay up to date on this podcast.

• 1:59Lewis Howes?

  And I want to give a shout out to the Fan of the Week from Ro, who said, "Lewis highlights all self-help topics and more in this can't-miss podcast. He and his guest experts offer insightful advice and information that is helpful to anyone that listens." So a big thank you to Ro for being a Fan of the Week and leaving us a review over on Apple Podcasts, and I'm very excited about this one. So in just a moment, I bring you the one and only Dr. David Perlmutter.

• 2:28Lewis Howes?

  I definitely have my favorite type of workouts, but I think we can all agree that changing them up often makes it easier to stay excited for our fitness goals each day. Of course, it can be hard to always come up with new types of workout routines, which is why I love Peloton. They're always coming out with new stuff to help switch up your exercises, especially right now to ring in the new year. The Peloton Bike and Bike Plus are releasing new classes, new music, and new ways to keep your workouts fun and motivating. And guess what? I'm super pumped about this. Peloton is adding boxing to their workout lineup. No gloves needed. I've recently gotten into boxing and let me tell you, it's an incredible and super fun way to get your exercise in. Even if you've never boxed before, these classes will have you working up a sweat

• 3:13Lewis Howes?

  while working on the fundamentals of form, footwork, and fun combos that will keep you on your toes. For a limited time, try the Peloton app free for two months, then $12.99 per month after. New members only. Visit onepeloton.com/app to learn more. That's two months free at O-N-E-P-E-L-O-T-O-N.com. Offer expires January 31, 2022. Terms apply.

• 3:42Lewis Howes?

  What are those main foods or ingredients that keep us in fear-based brain activity as opposed to the...

• 3:48David Perlmutter?

  Excellent question. So it's really foods that threaten metabolism. In other words, refined carbohydrates, foods to which you may be sensitive as a unique individual, and foods that tend to elevate uric acid. So, and these are the foods of the day. By and large, the biggest issue for us is fructose. Leads to uric acid and turns on inflammation, turns on oxidative stress, does other things that we'll talk about. But beyond that... Through the lens of what that's doing to our thinking process and locking us into amygdala-based behavior, it's a big deal. It's, uh, and we're watching it play out around the world.

• 4:32Lewis Howes?

  Yes.

• 4:32David Perlmutter?

  I mean, you know, you feel the shift. Yeah, there was always, you know, conflict in the world, but there's never been the polarization like we're seeing, we're seeing now.

• 4:41Lewis Howes?

  I know.

• 4:42David Perlmutter?

  And the lack of compassion for your fellow human. Now, the Dalai Lama said that if you want others to be happy, practice compassion. But if you want to be happy, practice compassion.

• 4:54Lewis Howes?

  Hmm.

• 4:55David Perlmutter?

  So it works. That's tapping into your prefrontal cortex.

• 4:59Lewis Howes?

  It's funny, I was just interviewing a therapist psychologist, Dr. Ramani Navrasila, who is the, the leading expert on narcissism and narcissism, personality disorders and all things narcissists. And I'm curious if part of narcissism or these fear-based, you know, reactive thoughts and emotions could be diminished by the things people eat and be less narcissistic because most narcissists aren't compassionate.

• 5:29David Perlmutter?

  We have two chapters on that exact topic.

• 5:31Lewis Howes?

  Really?

• 5:32David Perlmutter?

  Oh, yeah.

• 5:32Lewis Howes?

  In the book?

• 5:33David Perlmutter?

  Not in that book.

• 5:34Lewis Howes?

  Okay.

• 5:34David Perlmutter?

  In the book, I'm going to send you, brainwash.

• 5:36Lewis Howes?

  Wow.

• 5:37David Perlmutter?

  Uh, but you are correct. Uh, so narcissism is really just the amygdala doing its thing, that it's all about me, it's all about ultimately my fears. So it's, it's a very fear-based, uh, program from which the brain and reality, the brain operates and reality is seen and doesn't, uh, really have the door open in any way for other, the feelings of others and how I'm, what I might do to be helpful for that other person.

• 6:08Lewis Howes?

  Really?

• 6:09David Perlmutter?

  And so, as I described, food, because it separates, it segregates the prefrontal cortex from the amygdala.

• 6:17Lewis Howes?

  The amygdala is the fear-based part of the brain, right?

• 6:19David Perlmutter?

  But it dictates behavior.

• 6:21Lewis Howes?

  The amygdala dictates behavior.

• 6:23David Perlmutter?

  That's right.

• 6:23Lewis Howes?

  So if it's turned on and fear-based all the time, you're, it's pretty hard to have a compassionate, calm behavior.

• 6:29David Perlmutter?

  You're locked out from that. You're kept out of God's kingdom.

• 6:33Lewis Howes?

  Wow.

• 6:33David Perlmutter?

  Yeah. So, this prefrontal cortex is, exercises the control, reins that in and says, "Hey, you know, I know you want to eat this food now. I know you want to do this. I know you want to be a bully and hit somebody. But we're gonna rein that in because there's a, there's a better purpose here in life, you know, and that's what we, that's our gift as humans. The opposable thumb and this prefrontal cortex, right?

• 6:56Lewis Howes?

  Yes.

• 6:57David Perlmutter?

  And that, so that superhighway, that communication that's bidirectional, we really depend upon to get the job done, as humans living together on this planet. When that is compromised, for any number of reasons, we don't have that ability and we're locked into that other mentality, clearly a mentality that's based on a reptilian brain, that is, you know, feasting, it's fear-based, and reproduction, basically, that's it. It's all about my needs and...

• 7:28Lewis Howes?

  What I want.

• 7:29David Perlmutter?

  What I want, and right now.

• 7:31Lewis Howes?

  That's the amygdala.

• 7:33David Perlmutter?

  Yeah, and what threatens this disconnection, one of the most powerful threats is the process of inflammation. And that takes us to, as, you know, back to your question, the foods we eat, which fan the flames of inflammation by disrupting our metabolism, separate us from the input of the adult in the room, and lock us in. And it's a feed-forward cycle, meaning that the more then, that you've locked out the prefrontal cortex, the worse decisions you make, as it relates, for example, to the foods you eat. You continue to eat those bad foods, inflammation is augmented...

• 8:10Lewis Howes?

  You keep making bad choices in your life.

• 8:11David Perlmutter?

  You're locked in.

• 8:12Lewis Howes?

  You're reactive.

• 8:13David Perlmutter?

  You spiral down, and now you're in a...

• 8:15Lewis Howes?

  So how do you get out of that?

• 8:17David Perlmutter?

  Well, so we offered up, what are the off-ramps? A whole program based upon what you can do to choose to meditate for a few minutes a day. We'll expand that with time. Getting out in nature, getting enough restorative sleep. Perhaps, you know, being a little bit more proactive about following your blood sugar. In that book, we didn't talk about continuous glucose a lot, and we have a whole section in this book about that. But talked about those foods, if you could give us one week, we're gonna help you redirect.

• 8:47Lewis Howes?

  So in Brainwash, you have a couple of chapters on narcissism specifically?

• 8:51David Perlmutter?

  Well, actually, when you really read the book, you're gonna realize that it's throughout the book. It's a commentary about where we are, how we got there, and what you can do now to get us away from that.

• 9:05Lewis Howes?

  Well, I mean, with social media and using, I think everything's a tool. I think everything's a tool. You can use social media to benefit people, or you can use social media to benefit yourself with the selfie culture, right, of me, me, me, look at me, me, me. And I'm curious how that plays in with our eating habits and nutrition habits based on, I guess, the psychological seeing yourself all the time and getting attention for how you look all the time on social media from random strangers. As opposed to when you just used to walk out in the street and get attention, but now it's just like, in a moment, you can get this dopamine hit.

• 9:42David Perlmutter?

  The original term for that was Snapchat dysmorphia, where you had to cultivate your social media appearance, not so much your real appearance of what people will experience face-to-face in terms of not just what you look like, but what do you got underneath it? Which is truly what matters, right? It's really less about what you look like. It's about what, you know, what you portray, what you are, how you interact. What is your message? What is the message? What is your contribution? That's what, to me, I think, really seems to matter, but, you know, that stuff is so underrated now. It's all about what you look like. And it has to be within the first three or four seconds, and that's end of story.

• 10:24Lewis Howes?

  So in Brainwash, you're talking about social media narcissism and all these different things. How are those affecting us in what we choose to eat as well? Is it part of the cycle when we get these dopamine hits for looking good or our social media? Do we then choose to eat certain foods from that? Or what is that?

• 10:42David Perlmutter?

  No, I think that that's an excellent question. And I think that the answer is no. Because I think we either eat what we want to eat, or we eat what we know is good for us. Now, what we want to eat, what's deep in our brains, is sugar.

• 11:00Lewis Howes?

  Yes.

• 11:01David Perlmutter?

  So we are deeply programmed. Every person walking in the plan, you're laughing because you know exactly what I'm talking about.

• 11:06Lewis Howes?

  That's my vice. You know, I don't drink. I've never been drunk in my life. I don't drink alcohol. I don't smoke. I don't do drugs. But sugar is a thing that when I'm disciplined, I can be completely off of it.

• 11:17David Perlmutter?

  When the prefrontal cortex is in the driver's seat. When the adult is in the room.

• 11:20Lewis Howes?

  But when I'm not disciplined, I can just be like, oh, let's just eat as much as you want, you know? So it's always been a, an opportunity for growth for me. Let's say, you know, where there's seasons of life where I'm extremely clean and other seasons where it's like, ah, you know, just have as much as you want. And it always affects me.

• 11:37David Perlmutter?

  Yeah, yeah.

• 11:38Lewis Howes?

  What are the main risks of sugar in the first place? And why should we be aware of it before figuring out how to get it under control?

• 11:46David Perlmutter?

  Well, let me go back to just the notion of your sugar

• 11:49Lewis Howes?

  Yes.

• 11:50David Perlmutter?

  desire. You are like, I would say, seven plus billion people. Meaning, it's what led us to survive. Our desire for sweet. We're deeply programmed. It's not learned. It's not an app that we picked up along the way. It came when you bought that computer. It was built into the hard drive that we will seek out sweet. Why? Because sweet tells us that a food is safe. It tells us that it is ripe, meaning highest in nutrients. It's good for the fruit because that's when the seeds of that fruit need to be dispersed. So everything works together. But it also tells us that winter's coming.

• 12:31David Perlmutter?

  Which means it tells our bodies to shift metabolism and start making and storing fat. And it turns out that the danger signal that winter's coming, the signal that tells your body to make that happen involves uric acid. And this is something that happened to our ancestors around 14 to 17 million years ago, when the earth became cool. And certain primates who developed mutations in the genes that dealt with an enzyme called uricase that breaks down uric acid, they developed mutations that turned that enzyme off, so they couldn't break down uric acid. So uric acid levels would elevate, they survived. Not that they got fat.

• 13:16David Perlmutter?

  Right. But they stored just a little bit more fat, so they might survive, whereas the other primate might not, and then they would pass the genes on. And that comes to us. That's why we make fat when we're exposed, for example, to fructose. It was a powerful survival mechanism, and we carry it today. The problem is now fructose is everywhere, in every food we eat, so we're suffering from this evolutionary environmental mismatch. I mean, that's the premise of the paleo movement. Let's try to emulate an environment that our paleolithic ancestors must have experienced in terms of lifestyle, exercise, activity, and certainly food and sleep.

• 14:00David Perlmutter?

  So it's not that the gene is necessarily bad, it's the context of today bombarding that gene pathway with this signal that says, "You better make fat and make it fast, because winter's coming, and you need to be ready. You need to lay down some fat. You need to raise your blood sugar to power your brain, because there's not going to be any food. You need your brain so that you can forage and find some food." That's our ace in the hole, that's our high card. So that's why there's all this excitement then about the relationship between fructose, the downstream metabolite, which is uric acid, making more sugar, making more fat, and really a central player in our metabolic mayhem. And how much does sugar affect the brain?

• 14:45David Perlmutter?

  Well, the brain does run on a form of sugar called glucose. There is even some suggestion that the brain can metabolize a small amount of fructose. That's really kind of recent data, but how it, uh, the brain is not tolerant to any significant degree of disruption of our metabolism. This is what I call metabolic mayhem. Because this disturbance of our metabolism sets the stage then for inflammation. And that is the underlying cornerstone of brain degeneration. Alzheimer's is an inflammatory disease, like coronary artery disease, type 2 diabetes, obesity, these are inflammatory conditions.

• 15:26David Perlmutter?

  So, you know, Alzheimer's is very much the brain on fire, which is what the word inflame, inflammation means, to be on fire. So we've got to do everything we can to put the fire out as, you know, an intervention.

• 15:40Lewis Howes?

  And to prevent it as well.

• 15:41David Perlmutter?

  Yeah.

• 15:42Lewis Howes?

  And to, uh... Have there been cases, not to go off topic here, but have there been cases of people...

• 15:47David Perlmutter?

  We're, we're deep into the woods, we're good.

• 15:49Lewis Howes?

  Have there been cases where people have had Alzheimer's that have reversed it? Is that possible?

• 15:55David Perlmutter?

  Yes.

• 15:55Lewis Howes?

  Really?

• 15:56David Perlmutter?

  There are. It's, uh, there are books written about it. In fact, I wrote the foreword to a book by Dr. Dale Bredesen, who is here in LA, um, at UCLA. And he has reversed it now in over 100 patients.

• 16:10Lewis Howes?

  Come on.

• 16:11David Perlmutter?

  Who have, oh, absolutely.

• 16:12Lewis Howes?

  Early stage or is this like...

• 16:14David Perlmutter?

  Early to moderate, yeah.

• 16:15Lewis Howes?

  Wow.

• 16:16David Perlmutter?

  Yeah. He's gotten people back to work. So, we live in a world, Western medicine, of monotherapy and, you know, we're going to create a magic pill for you that will take your diabetes away, for example. I was giving a talk in New Jersey to, I had 500 mainstream doctors, why they chose me, I don't know. But I said, "How do you treat diabetes?" And people would raise their hand and say, "Oh, I use such and such a drug, I use this or that." And then I said, "Well, what happens when you stop using that medication?" And they said, "Well, you know, within a day or two, the blood sugars go up." So I asked the question, "Did you really treat the diabetes?" And then I presented data from a Dr. Sarah Hallberg where using a ketogenic diet

• 16:59David Perlmutter?

  reestablishes insulin sensitivity and people don't eat medication. Published research, that's treatment.

• 17:06Lewis Howes?

  Yeah.

• 17:06David Perlmutter?

  So, again, we're not treating diabetes with the drug and we don't have a drug for Alzheimer's. Doesn't exist. I wish there were such a thing.

• 17:16Lewis Howes?

  Right.

• 17:16David Perlmutter?

  We know what happened with this Aduhelm drug that was put out in February of this past year. And finally mainstream neurology said, you know what, this isn't working. And challenges the notion that this accumulation of beta amyloid is the cause of Alzheimer's. Getting back to Dr. Bredesen, he's identified 36 different inputs that can affect the brain in different ways. And identifies in each patient, what is disrupted? Is it brain energetics, meaning the brain's inability to use glucose as a fuel? Is it inflammation? Is it toxic? Is it infectious? Is it previous trauma? What is going on in the brain? Let's work on that rather than one size fits all.

• 17:59David Perlmutter?

  You're gonna take this pill and lo and behold, you're gonna get better. So it's a paradigm shift. And I was, in the intro to his book, or the foreword, I said, you know, this is on par with washing your hands before delivering a baby. You know, it's that big of a deal.

• 18:14Lewis Howes?

  What would you say, based on all the research you've done and also with these other doctors you've worked with, would be the three or four or five key things to eliminate or to do to prevent Alzheimer's or to start reversing it in the early stages?

• 18:31David Perlmutter?

  So, again, I think the most important thing is to realize that it begins a lot earlier than you think.

• 18:38Lewis Howes?

  How early?

• 18:39David Perlmutter?

  30 years before clinical symptoms, at least. That's what, you know, our peer reviewed literature is telling us.

• 18:44Lewis Howes?

  Wow.

• 18:45David Perlmutter?

  And I'll tell you why. Because a study that appeared in the journal, Neurology, looked at, created what's called an inflammatory composite score. And they looked at people, they did blood work and they created a marker of their level of inflammation. And then they went back and evaluated them 28 years later. And they perfectly correlated who got Alzheimer's with how high their inflammation score was 28 years before.

• 19:15Lewis Howes?

  Oh my gosh.

• 19:16David Perlmutter?

  Now, we've seen the same thing with waist circumference. Three decades. We've seen the same thing with brain scans that look at glucose utilization are predictive long before people began to forget their grandchildren's names. So the point is, when does it begin? Does it begin in the 30s? And I would submit, it begins a lot earlier. That when we see adolescents now that are diabetic, that are obese, or significantly overweight, when we see teenagers in high school experiencing head trauma from contact sports, these are issues that are profound. We know that inflammation, the set point of inflammation,

• 19:57David Perlmutter?

  to some degree is determined before a child is even born, based upon the gut bacteria

• 20:04Lewis Howes?

  Oh my gosh.

• 20:05David Perlmutter?

  of the mother. And we know that, for example, how a child is even born, vaginal birth versus cesarean birth plays a huge role in determining that child's level of inflammation, immune function, risk for autoimmunity, and even risk for obesity later in life.

• 20:23Lewis Howes?

  Based on how they're delivered?

• 20:25David Perlmutter?

  How they're delivered. If a child is born by C-section, doesn't pass through the vaginal birth canal, doesn't get those bacteria that are there to anoint that child. Passing through the birth canal puts bacteria in the mouth, in the nose, in the eyes, throughout the body of that child that then are the seeds to create that microbiome for that living being.

• 20:47Lewis Howes?

  Wow.

• 20:48David Perlmutter?

  As opposed to picking up bacteria in the operating room because mom had to have a C-section. There is a time and a place for a C-section, but a third of American births are C-section right now.

• 20:59Lewis Howes?

  Right.

• 20:59David Perlmutter?

  So.

• 21:00Lewis Howes?

  So you're saying that there's like, this is an extreme complication. We've got to do a C-section. That's when you say, hey, yeah, we want everyone safe.

• 21:07David Perlmutter?

  The umbilical cord's wrapped around the child, whatever it might be. But as a matter of convenience, or not wanting to, whatever.

• 21:15Lewis Howes?

  Not dealing with a certain amount of pain, or whatever it is.

• 21:17David Perlmutter?

  And I think that the narrative that's given to mother and father-to-be is,

• 21:23David Perlmutter?

  You know, you can either deliver or we'll do a C-section, let's say Thursday at 11 a.m. How does that, how does that work through your schedule?

• 21:29Lewis Howes?

  Yeah, convenience.

• 21:30David Perlmutter?

  Yeah, and how big will my scar be? Well, we need to have the discussion that C-section delivery has lifelong implication for your child. Significant increased risk for autoimmune conditions like type 1 diabetes, for autism, for celiac disease, all increased in kids born via C-section. And, you know, that's published literature.

• 21:52Lewis Howes?

  Is there a way to, let's say, you know, there was an extreme complication and, you know, there was going to be an issue if there was not a C-section for whatever reason? Is there a way to get that bacteria into the child?

• 22:04David Perlmutter?

  How would you do it?

• 22:06Lewis Howes?

  I'm asking, I don't know, is there a way to do that? Is there a way to, I have no idea.

• 22:11David Perlmutter?

  There, in fact, it's wonderful question, I like where you're thinking. So if you're a research clinician, you'd be, you'd fall asleep tonight thinking, what could we do? The child should get this array of bacteria from passing through the birth canal, but they're bypassing that, what can we do? So.

• 22:31Lewis Howes?

  Maybe they would, yeah, I don't know.

• 22:32David Perlmutter?

  Go ahead.

• 22:33Lewis Howes?

  I was thinking, well, let's inject them with something.

• 22:35David Perlmutter?

  Close, so here's what the research at NYU has, has looked at, and that is taking a cotton swab, swabbing the vaginal canal, and then when the baby's born, covering their face with it. So that's already being done.

• 22:49Lewis Howes?

  Does that work?

• 22:50David Perlmutter?

  It's in the early stages of, you know, people want to play it out for a few years and see what it does. But that's exactly what's going on.

• 22:57Lewis Howes?

  Right, right, yeah, swab it around and put it on their whole body and put in their mouth a little bit?

• 23:00David Perlmutter?

  Exactly, definitely in the mouth and the nose.

• 23:02Lewis Howes?

  Yeah, see if it works, I guess.

• 23:04David Perlmutter?

  And the reason they're doing this is because, you know, the, the gut bacteria, and in fact, the microbiome in, in the entire body, not just in the gut, is really central. We have this relationship with, with these trillions of bacteria that are involved in our mood, in our immune function, in our set point of inflammation in our bodies. It's really quite profound when we humble ourselves and recognize that our day-to-day thought process is highly influenced by the gut bacteria, that, you know, the bacteria that live within us, that the array of bacteria living within us change our gene expression moment to moment, they're changing our life code, they're altering which parts of our genes are turned on and which are turned off.

• 23:49David Perlmutter?

  To suit their needs. And in turn, they create an environment for us to be healthier or not, depending on how we treat them. When we bombard our gut bacteria with unnecessary medications, with eating the foods that destabilize them, they're not able to do their job. Our guts become leaky. We increase inflammation, and that's, as we've talked about, what we don't want to do. So, you know, I'll send you a book, called Brain Maker. It's all about the microbiome and the brain.

• 24:19Lewis Howes?

  Please. What would be, this is all fascinating, because I was asking about the things that we could do to prevent or start to reverse Alzheimer's. And you said, well, it all goes back to actually childbirth and making sure we have the right,

• 24:35Lewis Howes?

  I guess, bacteria for the gut and the body and the brain and the immune system to be aligned so we don't so we don't have these issues later. And you were saying thirty years before, you can you can tell based on the the waist circumference and based on the foods you're eating and things like that. So, what would you say are those? Let's talk about the things you should eliminate. If you could eliminate three to five things to set yourself up for the best possible of prevention. Without having head trauma and all these other things, but food, environment, you know.

• 25:08David Perlmutter?

  I wrote an article about this this morning. I got pinged by a national magazine wondering exactly this article, so I got up extra early to write it.

• 25:20David Perlmutter?

  But if we understand that the worst thing for the brain is chronic inflammation, anything we can do to target that is going to help. So that's where diet comes in. A diet with lower levels of refined carbohydrates, things to add to the diet like good fat. We know that there are some all-stars out there that really are really important for brain health, like the omega-3 DHA, docosahexaenoic acid, generally from fish oil, although there's a vegetarian form of that. But I think that the biggest lever that can be pulled, provided a diet is reasonable, would be aerobic exercise.

• 26:01Lewis Howes?

  Really?

• 26:01David Perlmutter?

  So this is profound. So this is a, an epigenetic player. This turns on the genes that make something called BDNF, brain-derived neurotrophic factor, which is fundamental for healing damaged neurons, but also for nurturing them, allowing them to do what they can do and should do, but also stimulates what is called synaptogenesis, where brain cells connect to each other, and even allows the human brain to grow new brain cells. Who knew?

• 26:34Lewis Howes?

  When you're doing aerobic exercise.

• 26:36David Perlmutter?

  Yes.

• 26:36Lewis Howes?

  So even if you have, let's say, not the cleanest diet, and you have some sugar here and there, maybe you have some wine or some alcohol or whatever it is, you're saying doing consistent aerobic exercise will help defend against all those things as well. Could help.

• 26:52David Perlmutter?

  Well, again, it's not that your guest today is, is saying that. That's what the literature shows. It's profound. So the work, the original work is done by Dr. Erickson at University of Pittsburgh.

• 27:03Lewis Howes?

  Okay.

• 27:04David Perlmutter?

  And fascinating research, looking at two groups of individuals, several hundred in each group, one group got a stretching program and one group got an aerobics program. Now, I'm not knocking stretching. I mean, that's very important, but the aerobics part, you know, pushing up your heart rate is what seems to be very important for augmenting this production of this BDNF.

• 27:27Lewis Howes?

  How long is the, the heart rate up for or how long is the program, like 20, 30 minutes?

• 27:30David Perlmutter?

  It was variable, but my recommendation is minimum of 20 minutes.

• 27:34Lewis Howes?

  Okay.

• 27:35David Perlmutter?

  What should that heart rate be? Depends obviously on the person. I typically say 180 minus your age as a ballpark. Now, that might be too low for some people, too high for some people, but you know, that's where you use a wearable and you see where you're comfortable. I typically say you should be breathing hard, but not hard enough that you can't have a conversation with somebody.

• 27:57Lewis Howes?

  Okay.

• 27:58David Perlmutter?

  I mean, these are kind of, you know.

• 28:00Lewis Howes?

  A hard jog?

• 28:02David Perlmutter?

  Yeah.

• 28:02Lewis Howes?

  A leg run?

• 28:03David Perlmutter?

  Depending on what, you know, it may be walking for somebody. It may be, you know, maybe an elliptical machine at a certain rate. Who knows? But.

• 28:11David Perlmutter?

  Once that happens after a period of time, so this B D N F starts to get produced. And what did the study show that I'm quoting? They followed these people for a year. Those who did the aerobics had, instead of declining size of their brain's memory center, called the hippocampus, it actually increased during the course of one year. I mean, we expect everything's gonna be on the skids, but here it actually increased and memory function improved. Wow. It is a wow. I mean, that's not supposed to happen. Is that daily? Is that three times a week? What is that? This was five days a week. Five days a week. But interestingly, in 2017, in the journal Neurology, the Green Journal Neurology,

• 28:55David Perlmutter?

  which is put out by the American Academy of Neurology, they're the group that says that you're a board-certified neurologist, they do the, you know. So it's our most revered neurology journal. They had a practice guidelines section, asking the question, what can, what does science validate us being able to recommend to, for patients who have what's called MCI, mild cognitive impairment? That is one step beyond what's called subjective cognitive impairment. Subjective cognitive impairment is, you know, I can't remember the Wi-Fi code or whatever, the gate code, you know, I can't remember where I put my phone. Who does that, right? That's why Apple now makes those things, right?

• 29:40David Perlmutter?

  Anyway, that's subjective. You go to the doctor's office and they administer a test and everything's okay. So you just have subjective issues, senior moments, if you will. Mild cognitive impairment means you've gone to the doctor's office, they test you, and you're already showing some areas that are not dementia-like, but they're not, on the other hand, normal. So you're starting to decline, and that's when the intervention needs to happen. So the question that was asked in the journal, what can we recommend? They went through, I think, fourteen different interventions. This drug, that drug, you know, the approved drugs for Alzheimer's. They made one recommend, it said only one thing. This is a mainstream journal.

• 30:22David Perlmutter?

  There's only one thing that has any scientific support that you can recommend for your patient. And it's a drug called exercise. Wow. They said that's the only thing that stands the test of scrutiny. Yeah. That can actually slow the decline in patients who've established mild cognitive impairment. That's where that new drug, Aduhelm, was targeting. Patients with mild cognitive impairment, and it's, it failed. So, yet, how many neurologists will say, "You've got to exercise." Where's the ad on television saying, you know, "I'm glad my dad is taking this drug or that drug because he has Alzheimer's." But the drugs aren't working.

• 31:06David Perlmutter?

  We've got to recommend lifestyle changes. Get enough sleep. Sleep issues are related to profound increased risk for Alzheimer's for a number of reasons, including increasing inflammation, including problems with increasing blood sugar and dramatically increasing your risk for type 2 diabetes, just because you're not sleeping well. If you get type 2 diabetes, you have quadrupled your risk for becoming an Alzheimer's patient, a disease for which there is no simple treatment. So, we've got to focus on metabolism. We've got to keep people from becoming diabetic. We've got to get the willies when we know that the prediction is that by 2030, 50% of American adults will be obese.

• 31:51David Perlmutter?

  Come on. 2030 is eight years from now. You used to think, "Oh, 2030, you know, the glaciers are melting, that's sometime in the distant future, thank you, Al Gore." It's eight years from now. Think about that. So, they're predicting 50% of the US population will be obese. Adults. It's already one-third of American adults that have high blood pressure. It's already 10% of children between the ages of 12 and 18 that have high blood pressure, that require medication. What was it like 30 years ago? Things were better, but that's just about when things changed. And what happened? What happened was, we were all told, not just doctors, but the lay population as well, that fat was the enemy, right? Low-fat everything.

• 32:32Lewis Howes?

  Yeah, fat-free, fat-free this, yeah.

• 32:35David Perlmutter?

  Low-fat Oreos with that white stuff in the middle that we all loved, right? Who wouldn't? And what happened was, because we all went fat-free or low-fat as much, as best we could, there was far more carbohydrates and, um, simple carbohydrates in the diet. Sugar consumption skyrocketed. So, uh, between 1970 and 1990, fructose consumption went up a thousand percent. Now, fructose was, uh, looked upon as being a safer sugar than table sugar per se, or certainly than glucose, because fructose, in its metabolism, doesn't require insulin, doesn't mess with the insulin issue. So, it was looked upon, it was even recommended by the American Diabetes Association.

• 33:20David Perlmutter?

  And yet, fructose consumption directly leads to insulin resistance. That's the harbinger for future diabetes. So, it is about the worst sugar we could be consuming. And yet, we're consuming it, you know, left, right, and center these days.

• 33:37Lewis Howes?

  Wait a minute, so the American Diabetes Association, is that what you said?

• 33:40David Perlmutter?

  Said fructose.

• 33:41Lewis Howes?

  They recommended that fructose was a way to prevent type 2 diabetes?

• 33:46David Perlmutter?

  No, that if you needed a sweetener, fructose is a better choice. In other words, high-fructose corn syrup, which is 55% fructose and only 42% glucose, because glucose was the problem, right? Your blood glucose goes up with diabetes, so we've got to limit that, eat more fructose. Bad idea, bad recommendation. So, our government to this day supports the growth of corn to make fructose to the tune of $500 billion a year. And our USDA food nutrition recommendations that are issued every five years have continued to say, when, when they were just released, uh, last year, that we can get up to 10% of our calories per day from sugar.

• 34:33David Perlmutter?

  Despite the fact that over 99% of the scientists who weighed in and gave the USDA information said, "That's way too much." So, I wrote, along with another doctor, an open letter in MedPage to President Biden, saying, "Look, that's not what the science is telling us. It's going to break the bank to take care of these people with the obesity, the diabetes, the hypertension, the dyslipidemia, and all the downstream issues. The coronary artery disease, the Alzheimer's, the cancer, and again, type 2 diabetes, that are the consequences of these dietary recommendations. We've got to rein in our sugar consumption, and we all have a sweet tooth.

• 35:17David Perlmutter?

  And it's good business to sell a lot of sugar. Close to 70% of the prepackaged, the labeled foods, or the ones that carry a barcode, of the 2 million foods sold in America's grocery stores have added sweetener. And by and large, it's high fructose corn syrup. It's super sweet, and it's really cheap. Tastes good, it's cheap. Yeah, tastes great, and less filling. And it is, it's less filling. Which means you keep eating more and more of it to fill yourself up. So, fructose, as a survival mechanism for our ancestors, didn't tell them to stop eating. In fact, it played with this satiety hormone called leptin, and blocked how leptin works in the brain.

• 36:02David Perlmutter?

  So, we would eat, and then want to eat some more, and then keep eating. And then help us store fat. You bet, we would survive. But now it's making us sick. Very much making us sick. And we're supporting it, and it's, you know, clarion cries from a few of us out there, you know, the Robert Lustigs, the Gary Taubses, you know, those of us who are really recognizing what is going on here, that, you know, the sweetening of our foods, and the sense that it's natural. Did you used to eat a lot of sugar yourself? Growing up, or as an adult? I think, as a kid, we always had soda. Yeah.

• 36:44David Perlmutter?

  We had black cherry soda, and so we ate a lot, drank a lot of that. That would be the primary source. And we did drink a lot of orange juice, growing up in Florida. So, that's about the worst thing you could do. It's just so, such a high load, quickly, of fructose in your system. So, I said, from that perspective, yes.

• 37:03Lewis Howes?

  But you weren't big on sweets and candy and cakes and cookies and?

• 37:06David Perlmutter?

  I would say no more than anybody else.

• 37:08Lewis Howes?

  Yeah.

• 37:09David Perlmutter?

  Uh, do I still want it and desire it? Absolutely.

• 37:12Lewis Howes?

  Really?

• 37:12David Perlmutter?

  Oh, yeah.

• 37:13Lewis Howes?

  How do you manage it?

• 37:15David Perlmutter?

  I, I, uh.

• 37:16Lewis Howes?

  Do you have it some? Do you have it, you know, seasonally?

• 37:19David Perlmutter?

  Oh, there, I definitely eat some fruit. I can't tell you when I had a glass of juice. It's not even in my memory anymore. Um, I will say that, uh, I had some gingerbread and loved every bit of it. I don't know how much sugar it contained recently, uh, but it's generally off the table for me. I mean, I don't want to become diabetic. My father died of Alzheimer's. Um, I have a continuous glucose monitor. I know darn well moment to moment what my foods are doing to me. And I'm keeping my blood sugar under control.

• 37:51Lewis Howes?

  You have a blood, uh, monitor on your?

• 37:52David Perlmutter?

  I'm traveling right now, so I don't have it on.

• 37:54Lewis Howes?

  Okay, I got you, but you usually have it on your shoulder.

• 37:56David Perlmutter?

  Left shoulder, yeah. I usually have it right here, CGM.

• 37:58Lewis Howes?

  And so you check?

• 37:59David Perlmutter?

  Oh, you need to get that. We'll, we'll get you set up.

• 38:01Lewis Howes?

  Oh, I know, like Asprey and all these other guys have them and Sergey Young and all these people. I'm like, ah, do I want this in my body? Do you feel it a lot? Is it, it's not painful?

• 38:09David Perlmutter?

  So this is not a needle in your body.

• 38:11Lewis Howes?

  Okay, what is it?

• 38:12David Perlmutter?

  It's measuring it in what's called the interstitial fluid, which is right in the top layer of your skin.

• 38:16Lewis Howes?

  Okay.

• 38:17David Perlmutter?

  You put the patch on, you don't know.

• 38:19Lewis Howes?

  It's just the patch, it's not the bulky plastic thing or is it like?

• 38:22David Perlmutter?

  No, it's a tiny little patch, but then you put a patch over it to keep it there. That way you can get it wet and you can shower.

• 38:27Lewis Howes?

  Wow.

• 38:28David Perlmutter?

  In fact, I think I arranged Sergey to get his.

• 38:30Lewis Howes?

  Really?

• 38:31David Perlmutter?

  Uh, yeah.

• 38:31Lewis Howes?

  Okay, cool. Yeah, we had Sergey on here as well. So what does that do for you to know like?

• 38:37David Perlmutter?

  Well, it, it tells Louis specifically what foods will make you.

• 38:44David Perlmutter?

  And then you have to tell me.

• 38:45Lewis Howes?

  Oh, man.

• 38:45David Perlmutter?

  No, no, you're going to post it.

• 38:47Lewis Howes?

  Oh, man.

• 38:48David Perlmutter?

  But you'll become a part of a, the tribe, you know, that's monitoring your blood sugar level. And, you know, you've mentioned people that you probably respect.

• 38:55Lewis Howes?

  Yes.

• 38:56David Perlmutter?

  Uh, they're both close friends of mine. I respect them both and. What's really valuable is they know how important this is. And others. So there's a Dr. Casey Means, who I'm hoping you get on your program.

• 39:08Lewis Howes?

  Okay.

• 39:08David Perlmutter?

  I'm gonna have dinner with her on Saturday night. And she is the founder of a company called Levels.

• 39:13Lewis Howes?

  Okay, yeah, I've heard of Levels, yeah.

• 39:15David Perlmutter?

  And Levels is the software for understanding what this CGM continuous glucose monitor is telling you. How important is CGM? It's so important that I put it in the new book, actually. I put a whole chapter, actually Casey Means helped create that chapter. It's really important. And, you know, moving forward, there may well be a day when that same patch is gonna give you other information, like your uric acid levels. So you can know how the foods you're eating are affecting uric acid, because it's equally valuable.

• 39:47Lewis Howes?

  So you kinda shifted your identity to just saying like juice and certain sugary foods are off the table.

• 39:54David Perlmutter?

  Yes.

• 39:54Lewis Howes?

  You're not even like tempted. You might be tempted, but you're like, there's no chance I will have this.

• 39:59David Perlmutter?

  Professionally and personally, I've seen what Alzheimer's does. And that's the big threat for me. I mean, I have a family history of it, so I'm at increased risk. Generally, not as much risk. It would have been, if my mother would have had Alzheimer's, it would have been a much greater risk. And I don't carry one of the risk markers called the APOE4 allele. I don't carry that.

• 40:22David Perlmutter?

  But is to say, that is an allele of predisposition, not determinant. It doesn't mean if you have APOE4, or you have two APOE4, that you're definitely going to get it. Your risk is increased dramatically, as much as 12-fold, if you have both 4 and 4. But again, you know, in that situation, you do everything you can to chart your destiny, change your destiny, and say that that the APOE4 allele works in concert with other things over which you do have control. You know, you don't you don't have control over your genetic legacy. It's a gift from all of those who came before. And there may be some upside to carrying the APOE4 allele. If there weren't, then why would it persist? If it was always a bad thing,

• 41:06David Perlmutter?

  then why would it still be present in our population? You know, some populations, and you know, 20, 30% of the population carries at least one APOE4 allele. It's gotta do something positive. Maybe not in today's world, but maybe, you know, in our paleolithic ancestors, or even more recently, it was protective, maybe because it has a role to play in inflammation, which can be a good thing. Inflammation can be life-saving. Right. But excessive inflammation. Chronic inflammation. Chronic or acute severe inflammation. In COVID, there's something called, you know, this storm, the cytokine storm, where the body is basically on fire from these inflammatory chemicals that destroys tissue, the lungs, the heart, the brain.

• 41:51David Perlmutter?

  But we have to consider a notion of another term, the cytokine drizzle, where you have just a slight uptick of these cytokines floating around your body all the time. You know, the Grand Canyon wasn't formed by one huge flood cytokine storm. It's that slow river going through it for hundreds of thousands of years, and look what you get. Right. So we've got to rein in inflammation through our diets, through conscious awareness of the role of our gut bacteria, keeping in mind the notion of gut permeability or leakiness, how lack of sleep augments inflammation, all of these things. And I don't want this to sound too compelling, right? I mean, you've talked to really wonderful people whose focus has been reining in inflammation,

• 42:36David Perlmutter?

  whether it's getting into really cold water or doing the things Sergey Yan talks about. And certainly, you've talked a lot about diet and how important that is. But diet is more than just macro and micronutrients. It's information. The foods that you eat are speaking right now to your DNA, changing your gene expression. That's heady. I mean, when I was in medical school, DNA was locked in a glass case, and it determined everything about you. You know, what your body would be like, what you'd be allergic to, you know, your destiny was there. And now we know that we interact with our DNA aggressively, that, you know, more than 90% of the genes

• 43:21David Perlmutter?

  that code for health and longevity are under our control to some degree, based upon what we choose to do. I mean, the moment you... Want to binge watch something and you stay up really late to watch the 12th episodes of Suits or whatever it is. And you didn't get up, you had to get up in the morning and you're not right. That changes gene expression. Obviously not for the better. Increases, does other things. Increases your body's production of cortisol, a stress hormone. That's toxic to your hippocampal neurons. You know, increasing inflammation, decreasing your ability to detoxify so much of what's around us. And yet, we have the data, we can use our prefrontal cortex to say, maybe that wasn't a good idea.

• 44:06David Perlmutter?

  And no one is perfect. I mean, no one can be perfect because no one fully understands the exact program for them through what is called personalized medicine. That would be the right thing for you, for me. You know, what's right for me at my age, in my body type, based upon my previous experiences, is clearly going to be different from what would be best for you. That said, there are the broad strokes, which, you know, we can challenge, and I know 10 years from now, when I come back on your podcast, we may have a different story. And that's a good thing.

• 44:41Lewis Howes?

  Really?

• 44:42David Perlmutter?

  Oh, yeah. I mean, I was parroting the low-fat narrative 30 years ago.

• 44:46Lewis Howes?

  Really?

• 44:47David Perlmutter?

  Oh, yeah, absolutely.

• 44:48Lewis Howes?

  What do you think will change in 10 years? Based on historical evidence, based on trends, based on the new science and research that's coming out?

• 44:56David Perlmutter?

  Well, I think that, you know, the exciting thing for me is something called genetic reprogramming. And I think you mentioned that you've interviewed David Sinclair.

• 45:08Lewis Howes?

  Yep, yep. Jason Fong and Sinclair and all the...

• 45:11David Perlmutter?

  Yeah, so that's what his research is all about. It's the ability that is being developed to revert cells back to a more primitive, less defined phenotype or how they look, and then allow them to start over again. And he is demonstrating it in rodents, where he has crushed their optic nerve.

• 45:36David Perlmutter?

  And then uses this technique of genetic reprogramming, they regain their vision. That's crazy. It is crazy. But you know, until that time, I think, looking at how we're understanding this epigenetic control that we have, how we can harness that to reduce inflammation, to increase our detoxification functionality, to allow brain cells to replicate and to connect better. That's something we talked about earlier. This control over the BDNF that I mentioned via exercise is an epigenetic intervention. You're changing the epi over genetic control, over that genome, that part of the genome

• 46:19David Perlmutter?

  that regulates our production of this chemical, brain-derived neurotrophic factor. But important that, yeah, BDNF's a player, but as a trophic hormone in the brain, but so is insulin. And everybody, you know, is talking about insulin in terms of, well, we need insulin and adequate amount and functionality to keep our blood sugar in check, no argument. But insulin does other things in the body. Just because we learned about its role in blood sugar doesn't mean that's all it does. Insulin, like BDNF, is a trophic hormone for brain neurons. So we need insulin to do its job, to be around. And we control how our bodies and our brains are able to interact with insulin based upon our lifestyle choices.

• 47:04David Perlmutter?

  So when we become insulin resistant by eating the wrong foods, not exercising, not getting enough sleep, the brain doesn't like that at all. Because fundamental to brain degeneration is what is called the bioenergetic theory, which means how do brain cells use energy? That is the most predictive measurement of brain degeneration. Okay. We talked about earlier when we should begin thinking about the Alzheimer's Prevention Program. You can do a brain scan using what's called fluorodeoxyglucose, which is a radioactive, transiently radioactive glucose, inject it into a person and do a brain scan, a PET scan.

• 47:48David Perlmutter?

  And that will show glucose utilization in the brain. And you can see areas in the brain that are not up to speed, the temporal parietal regions, if you must, that are not using glucose. That predicts brain function decline two decades, three decades in the future. Even more exciting is you can now image the brain in people with ketones and demonstrate that the very same areas that are dysfunctional, as it relates to their ability to use glucose, the brain neurons are perfectly fine when they're using ketones as fuel. Meaning that these neurons,

• 48:28David Perlmutter?

  it's not that they're not using glucose because they're no longer functional. They are no longer functional because they're not using glucose. Give me another fuel and I'll come right back into the game.

• 48:40Lewis Howes?

  Right.

• 48:41David Perlmutter?

  Put me in, coach. Just give me the right fuel, right?

• 48:43Lewis Howes?

  Yeah.

• 48:44David Perlmutter?

  So give them ketones. The brain scan looks great. Those temporal parietal areas are now lit up. And you know, that is the reason that there's so much research looking at ketogenic diet as an intervention for Alzheimer's treatment. There's a Matthew Phillips in New Zealand who has published reports now of improving brain functionality.

• 49:07Lewis Howes?

  With the keto diet?

• 49:08David Perlmutter?

  Ketogenic diet in Alzheimer's patients who are well along and also Parkinson's patients.

• 49:14Lewis Howes?

  Wow.

• 49:15David Perlmutter?

  Same kind of thing. That there's improvement putting patients on a keto diet in Alzheimer's patients. Who knew?

• 49:22Lewis Howes?

  Is it because of the things that are are added in a keto diet or the things that are eliminated in a keto diet?

• 49:28David Perlmutter?

  I think it's both. But one thing I would say, this is an important point, kind of one of those bullet points, is if you're keto and therefore you're limiting carbs, don't eliminate fiber. So that's a huge issue because you know, plant foods, fiber itself is a carb, right? That's what fiber is. So you don't want to eliminate that. So this is, you know, this groundbreaking work done by on keto and the body, keto, the brain, people like Dominic D'Agostino, and then this Dr. Matthew Phillips, you know, really groundbreaking. I mean, there's a sense that, you know, in our primate and certainly

• 50:09David Perlmutter?

  paleolithic past, when we didn't have foods, and you know, now we like to fast for a couple of days, you know, we want to trigger those things, but our ancestors didn't necessarily choose to fast. That was what happened.

• 50:22Lewis Howes?

  They were forced to fast.

• 50:23David Perlmutter?

  Yeah, when they didn't have a grocery store nearby, you know, and, you know, hunting and gathering didn't mean hunting down a convenience store, gathering up the Doritos. So that's what their physiologies allowed them to do is to shift, you know, they were metabolically flexible, which we can become easily enough, and they could shift over to ketones and power the brain and do those things, and then tap into their fat reserves quite readily and, you know, create those ADP molecules with less free radical production and survive.

• 50:52Lewis Howes?

  If someone's trying to fast now, will the body actually, will the metabolism change? Or will they store the, keep the fat because the body's saying, well, you're, you're not eating, so I'm going to keep the fat here and not burn it as quickly?

• 51:06David Perlmutter?

  Actually, they'll burn the fat.

• 51:09Lewis Howes?

  They will.

• 51:10David Perlmutter?

  And they'll burn it readily once, once glycogen stores have been depleted.

• 51:15Lewis Howes?

  How long does that take?

• 51:16David Perlmutter?

  It depends, but it actually happens fairly quickly. You begin generating those ketones within, early on, within 12 hours.

• 51:24Lewis Howes?

  Okay.

• 51:25David Perlmutter?

  So it depends, of course, on your level of physical activity. So, you know, it's generally said that if you're a runner, around 13 miles is when glycogen stores are depleted. Then you need the sports drink or whatever it is to give you more sugar, or if you're keto-adapted or, and metabolically flexible, then you can begin to tap into a huge resource of calories and energy.

• 51:48Lewis Howes?

  We've had a lot of fasting experts on. We just had Dr. Walter Longo on, and he was just saying... Doing a consistent 12 hours a day fast, like consistently every day is what his research suggests is the best approach. There's other people that say the 16 and 8 and there's other people that say go 24 hour day, you know, fast. What have you seen based on fasting research?

• 52:10David Perlmutter?

  Well, I think his work is really very powerful and, you know, he's certainly done a lot more than simply talk about what's great for you from a metabolic perspective. I mean, he is deep into the role of fasting and immune function as it relates to cancer.

• 52:26Lewis Howes?

  Yes.

• 52:27David Perlmutter?

  So, doing some breathtaking work. So, I would say that the notion of time restricted eating, perhaps more popularized by Dr. Satish and Panda, would tend to indicate that a little bit longer in terms of the fast and then compressing the feeding window might be a little bit more appropriate.

• 52:43Lewis Howes?

  So like a 16, 8, 16 fast.

• 52:46David Perlmutter?

  There's really nothing, well, I shouldn't say that. I think for some people, maybe it would be, but that's more of a behavioral modification. Because, you know, early on, let's say you do 12 and 12, you'll adapt very quickly and especially as you shift over to more fat and less carbs. Fat is incredibly satisfying in terms of hunger.

• 53:05Lewis Howes?

  Right.

• 53:06David Perlmutter?

  And, you know, people say, well, you know, mom said breakfast is the most important meal, you shouldn't skip breakfast. I'm fine with that, I think mom was right. But mom sort of emphasized what you had for breakfast.

• 53:18Lewis Howes?

  Yeah, don't eat some sugary cereals.

• 53:20David Perlmutter?

  Yeah.

• 53:21Lewis Howes?

  And some Pop Tarts.

• 53:22David Perlmutter?

  I think, yeah, which we love.

• 53:23Lewis Howes?

  Yeah, so good.

• 53:24David Perlmutter?

  But, so maybe there were some more sweets in my youth than I'm talking to. But it's really not just about what you eat, it's when you eat. And you say, well, I skip breakfast. Well, no you don't. Nobody on the planet skips breakfast, ever, because we all break fast, eventually. Whether it's 40 days and 40 nights, or it's, you know, a two day fast, or whatever it may be, we all break fast, we all end up having our break fast. So, you know, for me, that's usually one or two in the afternoon, so.

• 53:56Lewis Howes?

  That's when you start to eat.

• 53:57David Perlmutter?

  Yeah, that works for me. I do have coffee in the morning, so technically, Rhonda Patrick would argue that that might not be necessarily fasting, but.

• 54:05Lewis Howes?

  Right, right, right. She's great.

• 54:07David Perlmutter?

  Yeah, I know darn well that, you know, I'm producing ketones, I measure, I see what's going on, I check my blood sugar, so I'm getting some benefit. If I didn't have anything but water in the morning. Uh, two things would happen. It would be a more truthful fast, uh, but I'd be not the most pleasant. I'll tell the world I need that, uh, that lift in the morning. It, uh, it does great things for me. And knowing that coffee consumption is associated with reduced risk of Alzheimer's, I think is a real plus.

• 54:34Lewis Howes?

  Right.

• 54:35David Perlmutter?

  And, uh, also the fact that it lowers uric acid is also something I'm

• 54:39Lewis Howes?

  Yeah.

• 54:39David Perlmutter?

  Into.

• 54:39Lewis Howes?

  Uh, Rhonda, I think a week ago talked about some new research about coffee, the benefits of coffee, which has been researched for a while, but something around, I can't remember specifically what it was based on, but she, she loves that research as well. And I think she's got the levels, the monitor.

• 54:55David Perlmutter?

  Oh, I think she has a level, the, uh, the patch, but, uh,

• 54:58Lewis Howes?

  Yeah. She said, when she, when I interviewed her, she was said that, I said, what's one food you would eliminate from a child's diet? She said grapes. And I go, huh, interesting. She goes, cause I, my kid had like a bag of grapes and then I ate one when I had the monitor on. I can't remember if she had the monitor here or here, but, and she was like, it just skyrocketed something, her glucose levels or whatever it is. And she was like,

• 55:21David Perlmutter?

  Kids shouldn't be eating grapes anyway.

• 55:22Lewis Howes?

  Yeah.

• 55:23David Perlmutter?

  Because they'll choke on them.

• 55:24Lewis Howes?

  Right, right.

• 55:25David Perlmutter?

  Sorry, Rhonda.

• 55:26Lewis Howes?

  But she was like a sugar bomb. Um, so that was her, her recommendation. But do you think this, these wearables, for some people listening or watching might be like, gosh, this is just so much to every day, check something and see the levels. Can I just live a natural life and just, you know,

• 55:43David Perlmutter?

  Yeah, sure.

• 55:44Lewis Howes?

  Eat sensibly? Do I need to measure all these things?

• 55:46David Perlmutter?

  I don't know what that means.

• 55:46Lewis Howes?

  Yeah.

• 55:47David Perlmutter?

  So it, it, you know, it's back to where we started and that is, what does that mean? More importantly, what does it mean for Lewis?

• 55:54Lewis Howes?

  Right.

• 55:55David Perlmutter?

  To eat sensibly?

• 55:56Lewis Howes?

  Right.

• 55:56David Perlmutter?

  And so how do you define sensible? Well, sensible would be a diet that's not spiking your blood sugar, as an example, or doesn't, uh, have a dramatic effect on the area under the curve of what your glucose levels are over time, more important. And I don't know what sensible is for you. I know some broad strokes that are pretty likely going to affect your blood sugar. I think we all know those, but, um, should you be compulsive about it? Yep, you should be.

• 56:21Lewis Howes?

  Because we, you want to prevent it sooner than later.

• 56:24David Perlmutter?

  Yeah. I mean, we live in a world of reactive medicine and I would prefer to be proactive. And preventive.

• 56:31Lewis Howes?

  Yeah.

• 56:32David Perlmutter?

  You know, there's a great quote from John Kennedy. It's that the time to fix the roof is when the sun is shining. And for, you know, you're in great health right now and I want to keep it.

• 56:42Lewis Howes?

  Now's the time.

• 56:42David Perlmutter?

  I want to come back in 10 years and do your show again.

• 56:44Lewis Howes?

  Yes.

• 56:45David Perlmutter?

  And, and you'll be healthy still.

• 56:47Lewis Howes?

  Yeah.

• 56:47David Perlmutter?

  You've done all the right things. But how would you know? Would you know because you went to your doctor? And every year she checks your blood sugar and says, well, it's okay. You're not diabetic yet, or maybe it's trending upward. You need a lot more information than that. Now, in, there was an op ed in Journal of the American Medical Association several months ago that said, you know, people shouldn't, non-diabetics shouldn't be checking their fast, their blood sugars with CGM because they're just going to become compulsive and neurotic and all that. Maybe that's true. But I would prefer to recommend erring on that side where people have information

• 57:27David Perlmutter?

  and at least have the opportunity to choose whether they're going to do something about it or not.

• 57:33Lewis Howes?

  Right.

• 57:33David Perlmutter?

  And how would you know?

• 57:35Lewis Howes?

  The more information, more frequent information, the better. At least you have the knowledge, okay, I'm doing something that's affecting my body, my blood type, everything else, right?

• 57:45David Perlmutter?

  Yeah, I mean, even sleep. I wear an Oura ring.

• 57:49Lewis Howes?

  Yeah.

• 57:49David Perlmutter?

  And I, I learned a lot about, I'm generally, that's one thing I do pretty well, sleep. But I.

• 57:56Lewis Howes?

  Do you usually wear it out throughout the day or just at sleep?

• 57:57David Perlmutter?

  No, I use my Apple Watch during the day.

• 57:59Lewis Howes?

  Yeah, to track everything else.

• 58:01David Perlmutter?

  Yeah. But Oura ring at night, just because I like it. And, you know, I've learned that a real benefit for me in terms of the restorative aspect of sleep, because I get a good night's sleep, but the restorative parameters that are measured is walking after dinner. We never did that before. And it's a, you know, my wife and I, you know, we exercise in the morning pretty aggressively. And then, but the idea of taking a walk after dinner, it's a great thing. I mean, we see people out walking, their dogs are just walking. So it's a nice thing to do anyway, but it really helped me with the, with my. Pulse very, uh, heart rate variability, which is a, which is tied into how well you recover during sleep.

• 58:46David Perlmutter?

  And so my heart rate variability went up quite a bit. Now, I think, I'm fearful that viewers are thinking, what is all this crap? You know, what are these guys talking about? And I don't want to do any of that. What's, give me some bullet points. So, uh, you know, I would say that it's time to avail yourself of this biotechnology. I think it's really great. But the broad strokes are again back to the simple things that you've got to exercise. You've got to make every effort to get a good night's sleep.

• 59:16Lewis Howes?

  It's so important. Matthew Walker, when we had him on, talking about sleep and just how one hour less of sleep can, can change so much. Both focus and attention and memory loss and all these things. And if you couple that every day more and more, it's just going to hurt you long term. So really.

• 59:35David Perlmutter?

  Well, that's right. And, and what his research has more recently demonstrated, you know, getting back to the whole notion of brain health is that, uh, is lack of sleep and it, and how it increases the presence of beta amyloid. Which is if you buy into the amyloid hypothesis of Alzheimer's, and I think it plays a role. I don't think it's the end all. As we talked about, Dr. Bredesen has looked at a lot of different parameters that are influential in terms of brain health and risk for decline. But, uh, you know, who wants to have a, a brain load of amyloid? Not me. And therefore yet another reason with lack of sleep, increasing your insulin resistance, increasing your blood sugar,

• 1:00:19David Perlmutter?

  increasing your cortisol, threatening your hippocampus, uh, increasing your risk of obesity or at least significant weight gain, increasing your uric acid as a powerful metabolic marker. So, yeah, and, you know, it's important to look at the, the parameters that you can, uh, you can modify.

• 1:00:40David Perlmutter?

  To help you get a better night's sleep. But you may not know. You may, next morning you wake up. Gosh, I went to sleep at 10 o'clock. Now I'm waking up and I, I slept all night. You might not have. You might have awakened four or five times, you didn't know it. Well, you remember the one time you got up to pee. But what about the other four times when you didn't fully awaken, but you dropped out of those restorative levels of sleep? You won't know that. You won't know how much time you spent in REM or deep restorative sleep, unless you're using a wearable. And it's the ticket.

• 1:01:11Lewis Howes?

  Yeah.

• 1:01:11David Perlmutter?

  So, try it out, you know? What, what is there to lose? You wake up in the morning, and you download the information into your smartphone.

• 1:01:19Lewis Howes?

  It's already in your phone, you just open the app.

• 1:01:21David Perlmutter?

  I have it in my phone, right here. I can look and tell you what my sleep is like. And, uh, did you do well? And if you did well, you say, gee. Uh, not that, oh, now I'm gonna have a great day. Or I had a, I got a crappy score, I'm gonna have a crummy day. You know, that's the risk. But if you had a crappy score, you say to yourself, maybe it was that glass of wine, or maybe I shouldn't have had dessert, or we ate too late, or I, um, or I didn't exercise at all. Yeah, the cappuccino at 4 o'clock in the afternoon.

• 1:01:50Lewis Howes?

  Yeah.

• 1:01:50David Perlmutter?

  Uh, for me, I can do that. And it doesn't seem to affect my sleep, gratefully. But, um, for others it may. Um, kombucha, which I think, you know, I like kombucha, but it's made from tea. So you have kombucha to drink with dinner? Maybe that's a factor. You just don't know. And it's good to be thinking about what your choices are. And lovingly and slowly, you modify things until, you know, you get a solid eight hours and you're killing it on the deep sleep and the REM sleep. And the latency, how long it takes you to, you know, drop in. And your, you know, other things, your heart rate variability. And then, you know, you've got that checked off. You, uh, you know, and, and can you be, become neurotic about it?

• 1:02:33David Perlmutter?

  I guess so, but I'm willing to take that risk.

• 1:02:36Lewis Howes?

  Right, yeah. It's better to be neurotic than to have no information.

• 1:02:39David Perlmutter?

  Yeah, and just, and to do what modern medicine wants you to do, and that is come to us when you're having a problem, then we'll talk about it. But meanwhile, do whatever you want. Live your life, come what may, eat whatever the heck you want. You know? You have that big dessert and then you take your diabetes pill. You know, you didn't cure your diabetes with that pill, as I mentioned earlier. So it's... We've got to be our own advocates. It's very clear. Uh, mainstream medicine again is, is gonna be there if you need them. Uh, in an accident or to have surgery, great. But in terms of keeping you healthy, you've got to be your own advocate. And the only way you can do it is by getting at least a modicum of information.

• 1:03:22Lewis Howes?

  So what would you say are the foods or the liquids that are off limits for you? Or maybe that are like very rare, that you'll consume something? Whether it's a gingerbread.

• 1:03:32David Perlmutter?

  So we were watching Rick Steves on public television. And it was obviously a couple of years ago, cause no one was wearing masks. He was in Europe and uh, he, they had, it was for Christmas and he ate gingerbread. And it was, uh, we, my wife and I, we went, we gotta get some gingerbread. So I, I was able to, to find some, but um. So that's, so from time to time, having something that's sensible, that's not really, you know, killing it. But uh, I think this, the high fructose foods and the high sugar foods. You know, understand that table sugar is 50% fructose.

• 1:04:07Lewis Howes?

  Okay.

• 1:04:07David Perlmutter?

  Sucrose, this table sugar, that is the ingredient, you know, that two uh, tablespoons of, of sugar, along with the refined flour and some vanilla and next thing you know, you've got dessert. Um, and somehow it, you know, it's alchemy. It creates something new, de novo, out of these ingredients. Pizza, the same way.

• 1:04:25Lewis Howes?

  Yeah.

• 1:04:25David Perlmutter?

  Somehow, well, it's pizza, but no, it's made from flour, highly refined carb uh, flour dough, refined flour, and then you would put tomato sauce in the mushrooms. It's now not bad anymore. It's new thing, it's pizza, therefore it's good. But um.

• 1:04:41Lewis Howes?

  What's off limits for you then? What's like, you don't have?

• 1:04:44David Perlmutter?

  Well, one thing I, I don't ever eat is liver. Not, I'm not saying it's bad food, I just can't eat it. I hate it. Uh, off limits are soda, uh, fructose containing uh, sauces, uh, condiments, uh, fruit juice, that's for sure. Anything that's, that's got a lot of sugar is off the table.

• 1:05:00Lewis Howes?

  Sweets, candy and all that stuff?

• 1:05:02David Perlmutter?

  Uh, that's not for me.

• 1:05:03Lewis Howes?

  You don't eat it?

• 1:05:04David Perlmutter?

  No.

• 1:05:04Lewis Howes?

  It's completely out of your?

• 1:05:06David Perlmutter?

  No, I, I won't say completely. I might have a mint.

• 1:05:08Lewis Howes?

  You might have, okay.

• 1:05:09David Perlmutter?

  In fact, uh, there was a, and so I remember them. I had a mint, uh, that was in the, our rental car that the, uh, that Hertz put there for me. I ate that, but generally that's not who I am. I don't eat, uh, I don't need it and um. Do I feel guilty afterwards? Probably not. Maybe I could feel more guilty. After eating a mint, you mean, or what? No, I don't. I don't feel guilty. Well, because you have it once a year or something. I know. I mean. You remember the last. So I don't, you know, I don't obsess that I had a mint or that I tasted somebody's key lime pie. Right. But sodas are gone, that's for sure. And sugar in the coffee and all that. I will say that I had a post on Instagram recently. And it was, honey, I'm sorry, will you forgive me? Oh, you can't have honey?

• 1:05:54David Perlmutter?

  Well, here's the thing. Oh, no. People thought I had messed up with my wife and I was asking for her forgiveness. That's funny. And it was the biggest Instagram post I think I've ever had. And I'm not taking credit for it. One of our team members, Jonathan Jacobs, if you're watching this, he created it. And it was because there is evidence that honey actually can help lower uric acid. And that, but beyond that, it may, more importantly, be not a huge metabolic threat, though it contains fructose. Doesn't mean that agave is on the table. It is not. Agave is something I would never touch. I would never go near agave. No, and I also would not be ever consuming artificial sweeteners like aspartame, for example,

• 1:06:39David Perlmutter?

  because of the threat for gut bacteria. The other thing that I'm super careful about would be any medication that might be prescribed for me, like an antibiotic. I really go through a lot of cogitation if I'm injured, you know, and or had an operation, for example, and there's a need for an antibiotic. That just, I break the doctor's orders generally. Now, I don't want your viewers to say, oh, I'm never taking antibiotic. But these are weapons of mass microbial destruction in your gut. And you know, every time a child has a sniffle, goes to pediatrician, they prescribe the, you know, the liquid, whatever it is, antibiotic, that's just inappropriate, in

• 1:07:24David Perlmutter?

  my opinion.

• 1:07:25Lewis Howes?

  Really?

• 1:07:25David Perlmutter?

  Yeah, it really is. Ear infections can oftentimes get what's called tincture of time, meaning wait it out. Now, I'm not, you know, the, there's gotta be a disclaimer here. People make their own decisions. Talk to your healthcare provider. But that's one of the biggest issues of our time. The effects of medications on the gut bacteria, like proton pump inhibitors taken by 14 million Americans profoundly disrupt the gut bacteria and are associated in the journal stroke with an increased risk of dementia and a dramatic increased risk of stroke.

• 1:08:02Lewis Howes?

  Wow.

• 1:08:03David Perlmutter?

  By taking these acid blocking drugs. They also raise uric acid and they are over the counter. And you, you think you, you ate something you shouldn't have, you go into a store and you buy this acid blocking drug, you take it all the time because you just think you need it, you know? And I'd say change your diet, first of all, if you're not tolerating certain foods.

• 1:08:22Lewis Howes?

  Right. And this surprising new science of uric acid.

• 1:08:26David Perlmutter?

  We haven't talked about that, but I think we're gonna do a virtual or need to talk about it later. But I wanna say one other thing as it relates to foods that are really important to be aware of, and it's fat. And therein lies a, an important discussion because the good fats are a blessing. Eat all the extra virgin olive oil you can put your hands on, organic fats like good sources of omega threes. But by all means, you really want to avoid the processed vegetable oils, canola, corn oil, soybean oil, these, soy especially, these need to be avoided.

• 1:09:08David Perlmutter?

  These are used structurally in your body to create cell membranes that is where all the action is in terms of how cells work, even brain cells, importantly, how they are able to transmit information from one brain cell to the next. Those receivers and transmitters are built by the fats that they have access to, which are the fats that you consume. They don't come from the air. So being really careful about the fats you consume, I think, is fundamentally important.

• 1:09:38Lewis Howes?

  What are the good oils, then?

• 1:09:40David Perlmutter?

  Well, there are a lot. I think coconut oil to some degree, extra virgin olive oil. Strange as it may sound, we travel with a bottle of extra virgin olive oil.

• 1:09:52Lewis Howes?

  Extra virgin olive oil based on

• 1:09:54David Perlmutter?

  Organic.

• 1:09:54Lewis Howes?

  Which is different than what other type of olive oil?

• 1:09:58David Perlmutter?

  Well, there are more, there are olives that aren't necessarily extra virgin.

• 1:10:01Lewis Howes?

  Okay, gotcha.

• 1:10:02David Perlmutter?

  So are heated in the processing and there are plenty, you know, if you ask for olive oil in a restaurant, oftentimes they're allowed to call it olive oil if it's 51% olive oil. What is the other 49? Is it canola? What is it? You don't know.

• 1:10:15Lewis Howes?

  Gotcha.

• 1:10:16David Perlmutter?

  You know, I've, I can taste the canola oil now. Interesting, Italy is the largest importer of olive oil. So they import olive oil and then they manufacture what passes as olive oil by this 51% rule. So you really want to be super careful where you're getting your olive oil, making sure that it's treated appropriately, that it's not been heated, that you keep it closed in a cool, dark place if you can. That sounds a little bit compulsive, but we did. So we live in Florida. Here we are in California, right? First thing, went to a health food store, bought a bottle of olive oil. We take it to the restaurant when we go to dinner. Nobody seems to care.

• 1:10:56Lewis Howes?

  Right.

• 1:10:56David Perlmutter?

  And if they did care, that would be interesting. I wouldn't, wouldn't bother me in the least. We have a bottle of olive oil. I mean, it's not, they don't charge you a corking fee like they would charge if you bought a bottle of wine, right? So, and, and that's a really, and just pour it on. You know, I try to have a liter of olive oil myself a week.

• 1:11:15Lewis Howes?

  Really?

• 1:11:15David Perlmutter?

  Yeah.

• 1:11:16Lewis Howes?

  Dr. Gundry talked about that too. He says have a liter a week of olive oil for the gut bacteria, the microbiome or

• 1:11:22David Perlmutter?

  Well, he's talking about it, you know, his, he too focuses a lot on inflammation.

• 1:11:27Lewis Howes?

  Yes.

• 1:11:28David Perlmutter?

  You know, his idea that lectins are a powerful cause of inflammation because of, through the mechanism of disrupting the gut lining and other, even to some degree, blood brain barrier. But his call for Eau Vuitton, extra virgin olive oil, again, deals with its role in helping tamp down inflammation, but also helping allow our bodies to build parts of the body that are made from fat, like cell membranes, from good things. So supplying raw materials.

• 1:11:56Lewis Howes?

  What are you pouring it on? If you're not pouring on the breads and the...

• 1:11:59David Perlmutter?

  Oh, you wouldn't believe it. I pour it on everything. I mean, I have it on... I do it on my eggs, which I have most days. I often have salad for breakfast, or I'll have avocados and have extra virgin olive oil.

• 1:12:11Lewis Howes?

  Just pour it all there?

• 1:12:12David Perlmutter?

  Yeah, I mean, if I'm... You know, that's usually like around noon or 1:00, so you can get away with having salads. No one's gonna say, "Well, you're having that for breakfast?" And who does that, right? I do it at the restaurant, I mean, at the hotel. That's what I want for breakfast. They have it. Well, it's not on the menu, but you'll manage. I know you will.

• 1:12:28Lewis Howes?

  You can get some lettuce out there, yeah.

• 1:12:29David Perlmutter?

  Yeah, I mean, sometimes if I'm busy, I'll have an avocado, take the seed out, and fill that little reservoir with olive oil. Problem solved.

• 1:12:38Lewis Howes?

  There you go.

• 1:12:39David Perlmutter?

  Wow. And maybe use a plate. But that's about as aggressive as I get sometimes.

• 1:12:46Lewis Howes?

  I wanna go over this a little bit.

• 1:12:48David Perlmutter?

  Oh, that's why we're here today.

• 1:12:50Lewis Howes?

  Yes. Because a lot of people, since a third of Americans are obese, and it sounds like in 10 years, half

• 1:12:57David Perlmutter?

  That's right.

• 1:12:57Lewis Howes?

  is the predictions. Most people today wanna learn how to lose weight, but they don't wanna do the work. They don't wanna give up the things that they really enjoy, and they don't wanna work out as much as they probably should.

• 1:13:09David Perlmutter?

  Right.

• 1:13:10Lewis Howes?

  And they probably don't wanna go to bed earlier to sleep so that they can burn more fat. They're sleeping, all these different things. So what is this surprising new science of uric acid? What is uric acid? What do we need to know about it? And how do we use it to lose weight?

• 1:13:25David Perlmutter?

  Uric acid is the downstream end metabolite of fructose.

• 1:13:31David Perlmutter?

  What does that mean? So it means when you eat fructose, it goes into your body, it's absorbed through your testicle lining. It undergoes a series of changes until it reaches uric acid. At which point, that uric acid, some of it stays in the bloodstream, some of it is excreted. So sugar turns into uric acid at some point? Fructose turns into uric acid. What other, okay, so not sugar. Right. Well, fructose is sugar, but this is unique. Fructose and glucose are totally different. I would say apples and orange, that's confusing. Apples and candy bars, yeah. So where is fructose and where is glucose? For those that aren't sure. That's right. So fructose, the name comes from fruit, sugar, fructose.

• 1:14:15David Perlmutter?

  Ose in biochemistry means, or in chemistry means, sugar. And, you know, this is what is found in fruit, and this was what allowed some of our ancestors to survive. Okay. Who could eat fruit in the late summer, early fall. And had a little advantage that they would make more fat. Such that when food was unavailable, they would survive. And those who didn't make that little bit more fat would perish. Yeah. We didn't get their genes. We got the genes from the ones who survived. Who could produce a little more fat. A little bit more fat, and became a little bit more insulin resistant. So their blood sugar would go up just a little bit.

• 1:14:57David Perlmutter?

  Allowing their brains to help them avoid the two things that were their biggest threats. Starvation and predation. Starvation, not having enough food. Predation, getting eaten. Mm-hmm. You know, not, both of which are not really threats to most of us these days. Right. It's not like we're gonna be walking down the street and a lion's gonna come and eat you. No. In which case, you'd wanna have a smart, be smart so you could do what you need to do to get away from the lion. And then glucose comes from?

• 1:15:26David Perlmutter?

  Glucose is also found in foods and certainly table sugar. Glucose and fructose bound together is what is called sucrose. That is, is table sugar in a 50 50 ratio. I'm not going to say that is the natural way, but I would like to say it in the context of this unnatural combination where the fructose is unnaturally increased to create what's called high fructose corn syrup, which is incredibly pervasive in our world today. Yes. That's 55% fructose. That 5% makes a big difference. Okay. So we as Americans are consuming 17 teaspoons of sugar a day. How many sugar we have? I don't know.

• 1:16:10David Perlmutter?

  We don't need sugar. We don't need sugar. We need zero. Zero sugar. The human requirement is zero. So how much sugar do you have a day? Um, hard to say, not very much. Uh, you know, where is there sugar? You know, I, I don't know. I mean, I have, I have very little. You don't eat fruit? No, they're, uh, oh, I do eat fruit. So there's going to be some sugar in fruit. And there is a modicum of sugar in my kombucha, but I dilute it down usually with about two parts water and then one part kombucha. Um, I don't use sweeteners, uh, except occasionally. I've been trying a little bit of Alulose as of late. Alulose is a new sweetener

• 1:16:55David Perlmutter?

  that actually has been demonstrated to improve your blood sugar. So has positive metabolic activities. And, uh, if somebody is making something for me that's using monk fruit, I, I will think that's acceptable. But, you know, there's fruit, there's sugar in vegetables. Um, so there is definitely going to be sugar in my diet, but. Not 71 grams per day, which is what the typical American gets. So, you know, and this is a relatively recent phenomenon.

• 1:17:29Lewis Howes?

  So you can eliminate, I mean, you'll have minimal doses of sugar, but very little.

• 1:17:34David Perlmutter?

  In the 1920s, we would consume about 15 grams of fructose a day. Now it's 55.

• 1:17:40Lewis Howes?

  So what does that do to burning fat?

• 1:17:44David Perlmutter?

  Okay, so fructose says, don't burn fat. Fructose tells your body, winter is coming. Get ready. Make fat, store fat, lock it up. That's the signaling mechanism. So when we look at this metabolism, we have to look at it in the, through the eyes of our evolution. And again, we never had fructose like we have now. We had it in small amounts, or if we would gorge on the blueberries, whatever we found, which we should have done, only in a small window of the year, when we would make enough fat that would allow us to get through. Animals that hibernate just gorge on fruit.

• 1:18:25Lewis Howes?

  Yes.

• 1:18:26David Perlmutter?

  I mean, what does a hummingbird consume prior to, you know, flying across North America? Nectar.

• 1:18:33Lewis Howes?

  Yeah.

• 1:18:33David Perlmutter?

  Sugar water. If you want to have a hummingbird in your backyard, you put out sugar water. They will hone in on that like nobody's business. And the hummingbird might be one of the fattest animals on the planet.

• 1:18:46David Perlmutter?

  One, you know, when they are storing fat for their long journey, 40% of their body weight can be fat. You know, we think of whales as having a lot of fat, and of course they do, they're, you know, obviously. But, you know, whales use body fat, a little off topic, sure for energy, but also as their source of fresh water. So when they, and you metabolize fat, you're creating gram for gram, water, when you metabolize one gram of fat, you make one gram of water. So for our ancestors, what a powerful tool.

• 1:19:20David Perlmutter?

  To survive, not just in food scarcity, but water scarcity as well. To keep from becoming dehydrated. That little bit of body fat would help them make water as it was metabolized.

• 1:19:32Lewis Howes?

  Right.

• 1:19:32David Perlmutter?

  They could survive.

• 1:19:33Lewis Howes?

  So what does uric acid tell us then? As the key to losing weight? What is, is it, because it's linked to sugar.

• 1:19:40David Perlmutter?

  Yeah, so this person that you described who's not gonna exercise, gonna not get enough sleep, gonna eat garbage, all this stuff. Keeping their uric acid level under control, first of all, is not really gonna be possible. Because a high level of fructose is gonna keep your uric acid level elevated, number one. Number two, they have overridden all the benefits of uric acid. We're targeting people who are trying and not really hitting the mark. They're doing their best to eat right, they are getting some exercise, and they're still not losing the weight they wanna lose.

• 1:20:11Lewis Howes?

  Okay.

• 1:20:11David Perlmutter?

  Blood pressure's still a little bit elevated, still, um, blood sugar might be a little elevated. This is another tool, a brand new tool, a powerful tool in the toolbox. Know your uric acid level.

• 1:20:24Lewis Howes?

  How do you know it?

• 1:20:25David Perlmutter?

  You go to the doctor and get it checked, or you get a monitor.

• 1:20:28Lewis Howes?

  Is this a blood?

• 1:20:29David Perlmutter?

  It's a finger stick.

• 1:20:30Lewis Howes?

  A finger stick.

• 1:20:31David Perlmutter?

  Oh, at the doctor's office, it's a blood draw, but for you, and the monitor I will send you, it's a finger stick.

• 1:20:36Lewis Howes?

  The levels monitor or a different monitor?

• 1:20:37David Perlmutter?

  It's a, like a blood sugar monitor.

• 1:20:39Lewis Howes?

  Okay, got you, got you. So you prick it, and then it tells you your uric acid levels, is that right?

• 1:20:45David Perlmutter?

  That's right.

• 1:20:46Lewis Howes?

  And so do we, what is, what does that information do for us? Or how do we optimize it?

• 1:20:51David Perlmutter?

  Much like you, you optimize it by going on a specific diet to help lower your uric values, L U V, the Love Diet.

• 1:20:59Lewis Howes?

  Ooh, I like the Love Diet.

• 1:21:01David Perlmutter?

  Love Diet's right on the cover.

• 1:21:02Lewis Howes?

  Yeah.

• 1:21:03David Perlmutter?

  Uh, and that is a diet specifically designed to help you accomplish the task, lowering uric values. You will take quercetin 500 milligrams a day, which targets an enzyme that's involved in uric acid production. You'll pay attention to your sleep. You will reduce fructose and be conscious of other two inputs to uric acid, which are alcohol and purines. Purines are found a lot in organ meat, for example, in small fish like sardines and anchovies. Doesn't mean you can't have them, but you're now gonna start to see how they affect your uric acid level.

• 1:21:40Lewis Howes?

  Interesting.

• 1:21:41David Perlmutter?

  And you wanna get your uric acid level below 5.5. And you're gonna have this next week and you'll

• 1:21:47Lewis Howes?

  Okay, I will. Get it below, and what if it's, what's, what's high level then?

• 1:21:53David Perlmutter?

  Above 5.5.

• 1:21:55Lewis Howes?

  That's high.

• 1:21:55David Perlmutter?

  When you go to the doctor and they, you ask what's normal, they're gonna tell you 7. But that's a uric acid value that relates to something called gout, which is really the context that they look at uric acid.

• 1:22:07Lewis Howes?

  Oh my gosh.

• 1:22:08David Perlmutter?

  Yeah, that's, it's only looked at by mainstream medicine in terms of gout. Uh, there is 20 years of robust medical research, we have 400 references in this book, looking at uric acid as the central player in, in metabolic dysfunction.

• 1:22:24Lewis Howes?

  So if you get it below 5.5, that tells you what? That this person has the ability to burn more fat, to lose more weight?

• 1:22:30David Perlmutter?

  You're gonna shift more towards burning and less storing of fat. It can help you get your blood sugar under control. It will very likely help you rein in your blood pressure. Uh, it, um, may even help you with your lipids, your, uh, HDL, LDL, triglycerides as well. So these things are all influenced by having an elevated uric acid. So is it the end all? No, but is it yet another powerful, uh,

• 1:22:58Lewis Howes?

  Tool.

• 1:22:58David Perlmutter?

  Arrow in your quiver, you bet.

• 1:22:59Lewis Howes?

  Wow.

• 1:23:00David Perlmutter?

  And these days, you know, when you're, you think you're, you know, you're working out however many times a week, you're eating what you, the best you can, you know, no one's perfect. Um, and, you know, this is, this is just another piece to that puzzle, but it's a powerful piece. And, you know, the science is taking off. This is not the last time you're gonna hear about uric acid.

• 1:23:19Lewis Howes?

  Really?

• 1:23:20David Perlmutter?

  Oh my gosh.

• 1:23:21Lewis Howes?

  And this is what, you, to check this, you, you prick your finger once every week or once a month, or you do this?

• 1:23:26David Perlmutter?

  Well, it depends. Uh, you know, for me, it's every couple of weeks, two to three weeks, I run around 4.5, 4.6.

• 1:23:32Lewis Howes?

  Can you be too low?

• 1:23:34David Perlmutter?

  Uh, probably not. I mean, we do see very low values in, uh, elderly people with very little muscle mass. Because they're not breaking down, uh, uh, any more muscle. They don't have muscle to break down, therefore they don't liberate what are called pyrenes. Um, so, you know, there is some discussion that uric acid may have some antioxidant properties. Uh, but I think that we're moving past that. It's not really, uh, setting up for, for scrutiny. And, uh, I, I think keeping it, you know, below 5.5 should be the goal. Again, You know, a doctor may say, hey, below seven is what we're looking for because of gout. But I would say that's a, you know, a situation to be kind of people being down on what they're not up on.

• 1:24:17Lewis Howes?

  Right. Well, I know a lot of people want to have extraordinary health. And so I'm so grateful that you decided to create the book on this and create a process with a plan, the diet, everything in here, the love diet, which I think is really cool.

• 1:24:33Lewis Howes?

  We'll have to do more, we'll have to do another episode sometime in the future.

• 1:24:35David Perlmutter?

  Yeah, we didn't really get to the book, but that's okay, because we were into some, into some good areas.

• 1:24:40Lewis Howes?

  I think it's beautiful, yeah.

• 1:24:41David Perlmutter?

  Yeah.

• 1:24:42Lewis Howes?

  I have a couple of final questions for you. This is called the three truths. I ask everyone this question at the end of the interview. And it's a hypothetical scenario. So imagine it's many years away, but it's your last day, last day on earth. And you get to choose the day, you get to live as long as you want. But eventually you gotta turn the lights off for this world. And you have accomplished every dream you could think of. You can, you've lived a life that you want to, you have the relationships, you have the, you know, the accomplishments, the impact, it's all there. But for whatever reason, every piece of work or piece of content you've put out into the world has to go with you or go to another place. We don't have access to this information anymore. So this book, everything you've created, for whatever reason, it's gone. Again, hypothetical world.

• 1:25:27Lewis Howes?

  But you have a piece of paper and a pen, and you get to write down three things you know to be true about life, about your experiences, about what you've learned that you would want to share with the world. And this is all we would have to be reminded by your message. What would you say are those three truths for you?

• 1:25:44David Perlmutter?

  Number one, and I'm not going to rank them, but number one that comes to mind is there is nothing constant except change.

• 1:25:53David Perlmutter?

  Number two is the golden rule. Do unto others as you would have them do unto you.

• 1:26:00David Perlmutter?

  And number three would be don't sweat the small stuff.

• 1:26:03Lewis Howes?

  Yeah.

• 1:26:04David Perlmutter?

  I remember who said that to me the very first time, it was freshman in college. And oddly enough, his name was John Kennedy. Not John Kennedy, but that was his name. And it was very meaningful. I didn't get it at first.

• 1:26:16Lewis Howes?

  Said, don't sweat the small stuff.

• 1:26:17David Perlmutter?

  But over the years, I've gotten it.

• 1:26:18Lewis Howes?

  Right. Isn't the book, Don't Sweat the Small Stuff, and it's all small stuff? Doesn't that the?

• 1:26:22David Perlmutter?

  Oh, yeah, you're right. But that's, uh, it's not worth it.

• 1:26:26Lewis Howes?

  Yeah.

• 1:26:27David Perlmutter?

  It isn't worth it.

• 1:26:28Lewis Howes?

  What do you wish you'd have learned? And implemented 30 years ago for yourself that maybe you didn't implement yet? But now you know.

• 1:26:35David Perlmutter?

  From a practical point of view, I would have said, uh, don't get as much sun.

• 1:26:41Lewis Howes?

  Really?

• 1:26:42David Perlmutter?

  Oh, man, I really overdid it and paying the price now. Number two, floss more regularly.

• 1:26:46Lewis Howes?

  Yeah.

• 1:26:47David Perlmutter?

  Number three, I would say, don't sweat the small stuff.

• 1:26:50Lewis Howes?

  Yeah, interesting.

• 1:26:51David Perlmutter?

  Cause it took, it took a while to learn that. I mean.

• 1:26:53Lewis Howes?

  Yeah. obsessing over every little thing that was like.

• 1:26:55David Perlmutter?

  I'm, I know I'm a driven individual. I, I know that. It's just who I am. Uh, and when that starts to, you know, bleed out into relationships and other things.

• 1:27:04Lewis Howes?

  And sleep and health.

• 1:27:05David Perlmutter?

  Everything. So, uh, it, you know, it, it's about, you know, focusing on what really matters. And the older you get, the more you realize, uh, A, what really matters? And why did you invest so much into things that?

• 1:27:18Lewis Howes?

  Meaningless things, whatever. What really matters to you now?

• 1:27:22David Perlmutter?

  Uh, I have a gift and I'm not trying to be, um, bombastic with that. And, um, my gift is, uh, to be able, to have the ability to take complex information and present it to many people who may not have a, uh, ability to access that information by virtue of its complexity.

• 1:27:44Lewis Howes?

  Right. Like everything in the back of the book that's just, you know, citations of research papers, really like, I'm never gonna read this.

• 1:27:50David Perlmutter?

  Yeah. I mean, everybody has a, a gift. I, I feel very fortunate that I'm able to identify mine and exploit the heck out of it. Because, um, the word doctor doesn't mean healer, it means teacher.

• 1:28:03David Perlmutter?

  And that's, at this stage in my life, what I'm doing, and that is getting out information that I think is going to be helpful.

• 1:28:09Lewis Howes?

  Yes.

• 1:28:10David Perlmutter?

  Because there's a lot of misinformation out there. We've talked about a lot of that today, about, you know, that you can eat sugar and fat is the, all the things that we've been told. And I think it's important for people to hear the other side, the science validated, scientific validated truths for us, that may change, things may change, rule number one.

• 1:28:31Lewis Howes?

  Yeah.

• 1:28:32David Perlmutter?

  So that's the mission, and I think it's very comforting to be on mission, for me, day to day.

• 1:28:38Lewis Howes?

  Yeah. So, you wish you would've flossed more, and you wish you would've got less sun?

• 1:28:44David Perlmutter?

  Yeah. I mean, I'm not saying getting some sun is a bad thing, but...

• 1:28:46Lewis Howes?

  Sun's good, but it's not...

• 1:28:47David Perlmutter?

  Oh my gosh.

• 1:28:48Lewis Howes?

  Did you have just some skin issues or challenges?

• 1:28:49David Perlmutter?

  Oh yeah, I mean, uh...

• 1:28:50Lewis Howes?

  Really?

• 1:28:51David Perlmutter?

  Well...

• 1:28:52Lewis Howes?

  Well, being in Florida every day, too, Gus, growing up is...

• 1:28:54David Perlmutter?

  Yeah, I mean, in my last year of high school and then early in college, I built houses in Florida Keys.

• 1:28:59Lewis Howes?

  Oh, man.

• 1:29:00David Perlmutter?

  You know, the whole thing, no shirt...

• 1:29:01Lewis Howes?

  Shirtless, yeah.

• 1:29:02David Perlmutter?

  Yeah, I'm Mr. Tough Guy, right? So, you know, I think getting some sun is a good thing, but, you know, you gotta be careful. Nowadays, I'm being much more careful, of course, making sure my vitamin D level's where it needs to be, but as a general rule, if you don't want to have your face acid washed, which was no fun, yes, because of all the skin, you know, things, be careful in the sun.

• 1:29:25Lewis Howes?

  Wow.

• 1:29:26David Perlmutter?

  Yeah.

• 1:29:27Lewis Howes?

  Uh, your book is coming out, Drop Acid, The Surprising New Science of Uric Acid The Key to Losing Weight, Controlling Blood Sugar, and Achieving Extraordinary Health, which I believe is something a lot of people want, extraordinary health. So I highly recommend you guys all get a copy of this book. It's gonna give you some powerful tools. And for me, I love that you say that you, you make the complex simple, or at least simple to understand. Maybe some of these things are challenging, changes to make for people, but easy to understand, so you are at least with the right wisdom and the knowledge to take action in an easier way, hopefully.

• 1:30:02David Perlmutter?

  That's right.

• 1:30:03Lewis Howes?

  People can get this everywhere. Where else can we go to support you? Social media, website?

• 1:30:09David Perlmutter?

  Well, I think the clearinghouse is drperlmutter.com, D-R-PrelMutter.com. And that's sort of the launchpad for everything else that I do. I mean, the book has a dedicated URL, Drop Acid Book. But I think drpromoter.com is home base.

• 1:30:22Lewis Howes?

  Yes, home base. It's got all the links to everything, all your other previous books, which I gotta check out. Brainwash, I think that one's gonna be fascinating for me as well.

• 1:30:29David Perlmutter?

  I'll get your copy.

• 1:30:30Lewis Howes?

  Brainwash. Now, the more people that have these wearables on, I'm gonna have to start getting this stuff, I'm sure now. So, I'll talk to Dr., what's her name again?

• 1:30:41David Perlmutter?

  Casey Means.

• 1:30:43Lewis Howes?

  With Levels, you recommend that wearable?

• 1:30:45David Perlmutter?

  We'll talk to her later today.

• 1:30:46Lewis Howes?

  Okay, you'll connect me, I'll get the text intro. Before we go to the final question, I want to acknowledge you, David, for showing up vulnerably, for showing up and being true, authentic, honest. And I think it's beautiful to see someone who is as intelligent and accomplished as you, still connected to your heart and caring about people so deeply, and so compassionate about helping people and serving people at a high level to not have to experience the type of pains and sadness and challenges that you went through and that so many of your clients went through for many years and a lot of people are going through. So, I really acknowledge you for being honest and authentic and vulnerable with me. And one final question for you.

• 1:31:29David Perlmutter?

  Okay.

• 1:31:30Lewis Howes?

  What's your definition of greatness?

• 1:31:31David Perlmutter?

  I think greatness is recognition and exploiting your gift.

• 1:31:37Lewis Howes?

  There you go.

• 1:31:38David Perlmutter?

  What is your gift? And then, you know, doing your very best to get as much out of it as you possibly can.

• 1:31:45Lewis Howes?

  Yeah, awesome, David. Thanks, man, I appreciate you.

• 1:31:47David Perlmutter?

  Thank you.

• 1:31:48Lewis Howes?

  Appreciate it, man. Thank you so much for listening. 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 show with all the important links. And also make sure to share this with a friend and subscribe over on Apple Podcasts as well. I really love hearing feedback from you guys, so share a review over on Apple and let me know what part of this episode resonated with you the most. And if no one's told you lately, I want to remind you that you are loved, you are worthy, and you matter. And now, it's time to go out there and do something great.