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The Melanie Avalon Podcast Episode #52 -  Dr. David Perlmutter

Dr. Perlmutter is a Board-Certified Neurologist and five-time New York Times bestselling author. He serves on the Board of Directors and is a Fellow of the American College of Nutrition.
Dr. Perlmutter received his M.D. degree from the University of Miami School of Medicine where he was awarded the Leonard G. Rowntree Research Award. He serves as a member of the Editorial Board for the Journal of Alzheimer’s Disease and has published extensively in peer-reviewed scientific journals including Archives of Neurology, Neurosurgery, and The Journal of Applied Nutrition. In addition, he is a frequent lecturer at symposia sponsored by institutions such as the World Bank and IMF, Columbia University, Scripps Institute, New York University, and Harvard University and serves as an Associate Professor at the University of Miami Miller School of Medicine.
Dr. Perlmutter’s books have been published in 36 languages
and include the #1 New York Times bestseller Grain Brain, The Surprising Truth About Wheat, Carbs and Sugar, with over 1 million copies in print. Other New York Times bestsellers include Brain Maker, The Grain Brain Cookbook, The Grain Brain Whole Life Plan, and Brain Wash, co-written with Austin Perlmutter, MD. He is the editor of The Microbiome and the Brain authored by top experts in the field and published in December 2019 by CRC Press.




1:45 - IF Biohackers: Intermittent Fasting + Real Foods + Life: Join Melanie's Facebook Group For A Weekly Episode GIVEAWAY, And To Discuss And Learn About All Things Biohacking! All Conversations Welcome!

2:15 - Apollo Neuro: Get 15% Off Apollo Neuro At  Apolloneuro.com/melanieavalon

The Melanie Avalon Podcast Episode #50 - Dave Rabin (ApolloNeuro)

6:30 - How Covid/Quarantine Relate To The Decisions We Make

9:10 - On Wearing Masks: Self Centered and Narcissistic Decisions  

11:10 - Parts Of the Brain: The Amygdala

14:00 - The Role Of The Prefrontal Cortex

15:30 - Beneficial Roles Of The Amygdala 

17:00 - Threat And Learned Reflexive Responses 

19:30 - Tribalism, Social Media, And Other Viewpoints 

23:15 - Are We Born Empathetic? The Role Of Empathy In Happiness

26:40 - Emotional Vs Cognitive Empathy  And Being Open To Other Ideas

30:10 -  BEAUTYCOUNTER: Non-Toxic Beauty Products Tested For Heavy Metals, Which Support Skin Health And Look Amazing! Shop At Beautycounter.Com/MelanieAvalon For Something Magical! For Exclusive Offers And Discounts, And More On The Science Of Skincare, Get On Melanie's Private Beauty Counter Email List At MelanieAvalon.Com/CleanBeauty!

32:15 - Amygdala, The Immune System, Covid Risk And Stress

35:20 - Babies Born During Covid

36:30 - The Fundamental Role Of Emojis

38:25 - Digital Faces 

39:20 - The Problem With Seeing Others As Threats

40:20 - Animated Films And Perspectives Of Reality 

43:25 - Being Wrong, Embarrassment, And Identity  

44:15 - Why You Should Change Your Mind

47:00 - Evaluating Healthy Relationship with Social Media: The Test Of TIME 

50:30 - How Social Media Hacks Our Yearning To Be Social

50:40 - Exploiting Our Sweet Taste

53:40 - Liking Things Other People Like And Dopamine 

54:30 - The Role Of Sweet, Safety, And Stress 

57:05 - Keto And Reactive Hypoglycemia 

59:40 - Engaging With FB Groups

1:04:20 - BIOPTIMIZERS: Full Spectrum Magnesium Supplement To Fix Your Magnesium Status, Containing All 7 Versions Of Magnesium! Get 10% Off At www.magbreakthrough.com/melanieavalon With The Code Melanie10

1:06:45 - Social Media At Night 

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1:08:25 - The Role Of Dopamine In The Addiction Reward Pathway 

1:10:10 - Dopamine Fasts And Meditation 

1:10:45 - 10 Day Detox Program 

1:14:00 - Biohacking Overwhelm And The State Of Enlightenment 

1:20:30 - Fructose and Human Health


Melanie Avalon: Hi friends, welcome back to the show. If you could see me right now, the amount of smiles on my face is just insane. I am here with a guest who honestly when I first started this show, a while back now, I made a dream list of everybody I wanted to bring on, and this man was at the top of the list. Of course, at that time, it was for one of his other books. Today's conversation will be about his newest book. But let me introduce today's guest, I am here with none other than Dr. David Perlmutter. He's the author of five New York Times best-selling books, including Grain Brain, which I feel everybody has read, which is really foundational work. Also, Brain Maker, which is amazing. And his newest book is called Brain Wash and we're going to be diving deep into that today.

Again, most of you are probably familiar with Dr. Perlmutter, but I will tell you a little bit more about him. He is a board-certified neurologist. He serves on the board of directors and is a Fellow of the American College of Nutrition. He has been published extensively in peer-reviewed scientific journals, which is incredible. He's a member of the Editorial Board for the Journal of Alzheimer's Disease. And he's just a really well-known, respected man in the whole health biohacking everything sphere. So, Dr. Perlmutter, thank you so much for being here.

David Perlmutter: Well, Melanie, I'm very thrilled to be with you today. Thank you.

Melanie Avalon: Yeah, actually, your book, Grain Brain, was one of the first books that I probably read in the whole “paleo world, low-carb world." It's been near and dear to my heart for quite a while, but then tackling your newest book, Brain Wash, it's a subject that, even before our current situation with the whole COVID and quarantine thing, is definitely something that I have so many questions about, I think really resonates with people which is common feelings of isolation, alienation, social media, the need for likes, how this all affects our brain, how it affects our relationships. But even more now today, I'm sure you didn't time this with the timing of the book, but it's so relevant today with the whole COVID and quarantine situation.

Actually, yeah, that's a question to start things off, because I don't know what the timeline was of writing the book. Did you ever have this moment after the book's release when you're like, “Wow, this is really relatable with COVID"?

David Perlmutter: Oh, I can tell you that you're not the first to point this out. The real difference this time around, there were a couple, I think, major differences. First, that this was a book cowritten with another doctor, Austin Perlmutter, MD, our son, which was just a momentous event for me in life. The other thing is all of the other books, Grain Brain, Brain Maker, etc., really dealt with making specific choices. In other words, what are the best choices to make. Brain Wash doesn't do that. It is about how and why we make the choices that we do.

In other words, allowing us then to have the ability to make the good choices when we happen to run into good information. Whether the information is telling us to eat low carb, get some exercise, get out in nature, pay attention to how well you sleep, make better relationships, express gratitude, you name it. So, it's really about our decision-making. You are right that I am not trying to pat myself on the back, but it was very prescient because so much about what is happening with COVID is related to the decisions that we make. Let me give you several important examples.

First, the decisions that people have made in their lifetimes, up until the current time have really paved the way for them to either be healthy or not, that decisions with respect to food and other lifestyle choices, exercise, sleep, etc., either allowed people to be healthy or paved the way for illness for things like obesity, diabetes, coronary artery disease, etc. As it turns out, related to COVID-19, those choices that translated into those disease states ultimately sets the stage for bad outcome. We know that these are the people who've been making bad choices over the years are the ones who are having the worst experience when they become infected with COVID.

Beyond that, even our day-to-day choices to date, if they're impulsive, if they're based on what I want for myself today, then that is ultimately not necessarily the good framework for making decisions as it relates to our own health and even beyond that as it relates to the health of other people who are around us. Simple example. Will I wear a mask or not? If I choose to not wear a mask, and say, “You know what? I'm young and healthy, I'll be fine even if I get this crazy infection.” Well, that is decision-making based upon only thinking of myself. It is a very self-centered, narcissistic, non-forward-thinking, non-empathetic way of making a decision, as opposed to, “I'm going to wear this mask. I think, even if I get the infection, I'll probably do really well. But I could be infected, not know it, and I certainly don't want to infect other people who may not come out as well as I will on the other side.” Older people, people with underlying health conditions.

And that is a decision that more involves the area of the brain that we call the prefrontal cortex, the adult in the room, if you will. That is the real fundamental of what Brain Wash is all about. It's how over recent times our brains have become more wired into the impulsivity, narcissistic centers of the brain, and away from those parts of the brain that allow us to think about how our decisions that we make right now will play out over time, how will they impact us personally, and also importantly, especially during these times, how they might impact other people living around us and even the planet itself. So, our decision making is front and center right now. Do we decide to do the things that we're told might be good ideas like social distancing, hand washing, wearing a mask, etc.? Or do we say the heck with that, I want to go out and party with my friends and act impulsively, and really foster the connection to the amygdala, that impulsive, self-centered part of the brain and just do what I want to do right now?

Melanie Avalon: Listeners, you can see now why this is so enlightening and so relevant. So, you dropped some keywords in there, the amygdala, the prefrontal cortex, different parts of the brain, because I do have a lot of situation-specific question with COVID, for example, but maybe to start things off, we can paint a picture of what actually happens in the brain and the three different types of the brain. You talk about our reptilian brain, the limbic brain, and the cerebral cortex. I'm trying to get away from the irony of we're using our brain to analyze the brain. But I guess that's a whole esoteric conversation that we can save for another time. But would you like to tell the listeners a little bit about the actual makeup of the brain and how we do come to form decisions and make choices?

David Perlmutter: Well, even to make it simpler, let’s just define two areas, and that would be, as mentioned, the very primitive part of the brain, which is called the amygdala. The amygdala is involved in things like fight or flight. That's actually a good thing. When we are suddenly threatened and have to make an instantaneous decision, that could be life saving. So, God bless the fact that we have this amygdala, but it's not the area of the brain that needs to be activated all the time because we certainly know there are significant downsides to being in a fight-or-flight mentality, if you will, or frame of reference, if you will, day in and day out. That is a stress situation. Ultimately, vis-à-vis our discussion five minutes ago, that kind of mentality being involved with activation of the amygdala day in and day out does something very important that I think your listeners should know. And that is, it's compromising to our immunity. The higher levels of activity of the amygdala translate to impaired immune function.

There's a big take-home message there in these so-called troubled times. The more that we activate our amygdala by engaging in a lifestyle that caters to what the amygdala thrives on, like fear-inducing situations, spending a lot of time watching the news that's uniformly aggressive and bad, that activates the amygdala, the more it keeps us away from the other part of the brain, the calming part of the brain, the prefrontal cortex. The more we activate the amygdala, the more impulsive our decisions, the more we're likely to make bad food choices, not exercise, not engage in nature, and certainly, very importantly, not make sure that we get a good night's sleep. All of those choices feed back to amplifying our connection to the amygdala and also down-regulate or damage our immune function. So, I think the overriding theme of our entire time together today needs to be, what do we do to help reconnect to this prefrontal cortex, the area of the brain that's a better decision-maker that is not involved as much in impulsivity, that makes decisions based on looking at a lot of inputs, looking at maybe more of the science, if you will. It's making decisions based upon how we consider the outcome maybe in terms of helping ourselves, for sure, in terms of helping other people, and in terms of what the decision might be, how that decision might look a week from now or a year from now.

You're not going to feel any worse to any significant degree if you suddenly start eating glazed doughnuts day in and day out, but you know what? A year from now, you will have gained weight and your blood sugar will be elevated, your insulin resistance will be higher, you will have increased your risk for diabetes and as such. Hey, you will have increased your risk for bad outcome from COVID. But moment to moment, in the short term, who cares? You don't notice that. But your prefrontal cortex, the non-impulsive area says, “Hmm, I read somewhere that eating glazed doughnuts day in and day out might be bad for me for these following 10 reasons, and therefore I choose not to do it.”

So, not to exonerate the idea that impulsivity from the amygdala is uniformly bad, it is not. When, for example, we are backing out of the driveway, and our vision in the rearview camera sees a child on his tricycle, we impulsively, suddenly, instantaneously put our foot on the brake. That's not a decision that we need our prefrontal cortex to make, gratefully. It's not something we think about, well what's the outcome going to be? Is it a good idea? How would it play out 10 years from now? You need at times to have instantaneous responses to challenges like that. But we don't want those to be our responses day in and day out to all the incredible number of decisions that we have to make during our waking hours. We need to be able to bring our higher-order brain to bear on thinking about our decisions as it relates to things like the foods we eat, the mask we choose to wear or not. The social distancing that we engage, the amount of exercise we get, our choice to do meditation or not, whether we prepare ourselves for a good night's sleep.

All of the countless day-to-day lifestyle choices that we make that have a bearing, not just on our health, not just on our measurable parameters, like our waist to hip ratio, our blood sugar, our vitamin D levels, etc. But even the levels of compassion and empathy that we are able to engage based upon the decisions that we make.

Melanie Avalon: It's so incredible. I've so many follow up questions. I wonder if I can articulate this correctly. You gave the example of we automatically put our foot on the brake without even needing to think about it. It's automatic. So, in that situation-- because what I'm trying to understand is, is that being enacted by the reptilian part of our brain, not the prefrontal cortex? My question for that is, if so, was it our prefrontal cortex, which first-- because putting the foot on the brake is not something like an animal would know how to do, they wouldn't know how to drive a car. So, is it like we learn these things through the prefrontal cortex, but then they get registered in a different part of our brain? These responses that we have in life that are so abrupt and so instantaneous, I feel like we had to have learned them at one point with the prefrontal cortex. What determines our daily actions, whether or not they're being mediated continuously through the prefrontal cortex or through the amygdala?

David Perlmutter: Very, very good question. I would say in a word, "threat." If a situation is processed instantaneously as being threatening, that becomes-- it's a very quick circuit involving the amygdala to an engram that you learn in this case, moving your foot from the gas to the brake and that happens with, we call it, reflexively. Well, you can learn various reflexes, whether it's to-- say martial arts, how you block an incoming punch, you can't think about, “Well, I'm going to use a particular type of block to block this punch coming in," because it's very, very fast. So, we learn these almost reflexive responses that become instantaneous. The problem is that sort of impulsive decision-making that it just happens instantly can become translated to our day-to-day decision-making that isn't thoughtful, that doesn't involve bringing to bear all of the great information that we're exposed to on a daily basis to help make a better decision.

We all do it. Call it what you will, flying off the handle, reacting to a comment, a look that somebody gave us. We're seeing a lot of that type of behavior play out when we see the division between groups of people and how they're treating each other play out in terms of various protests, you name it. That divisiveness, it's a representation of something that we call tribalism. I'm right, you're wrong. Our group is right, your group is wrong. And this tribalism, flames are fanned based on our social media interaction, for example. People lock into a frame of mind. That is the only way, that the world is flat or the world is round, whichever choice you make is the way that it is and we won't ever consider interacting with those other people.

Now, are these people who have views about various things that we're seeing play out on-- Well, wear a mask or not wear a mask. These people are digging their feet and confronting each other and lacking what we call cognitive empathy. Cognitive empathy is the ability that we have to try on. We don't have to agree with it, but to try on somebody else's perspective. Their viewpoint, how they feel about a particular topic. Somebody may, for example, think that there is merit to eating particular diet, and we don't think so, but we have to be able to try on their viewpoint. That way, hopefully, in a perfect world, then we come together with these people and we come up with somewhere in the middle of an idea, whatever it may be, that actually is novel. And that's how we make progress.

I used to dig my feet in thinking that dietary fat was a bad thing. Based upon the science that we were seeing 25, 30 years ago, my goodness, if you ate dietary fat, the world would come to an end. You'd get heart disease and all your children will be born naked. So, it was a horrible thing. Now with time, I began interacting with people who began to make it clear to me as an example that humans have been eating lots and lots of fat, because it's a dense source of calories which are coveted, at least from an evolutionary perspective, and maybe it's not the amount of fat that we eat, maybe, just maybe it's the quality of fat that we eat.

Listening to these people, trying on their perspective, engaging in cognitive empathy, activating my prefrontal cortex, sharing the agora, the marketplace, and sharing ideas led me to believe that, you know what? Maybe they have a point, maybe they have something there. I just, in fact, wrote a blog, in fact, that was the title of it, because we sure need more and more of that these days, because of the incredible polarization that we're seeing where I'm right and you are wrong, and I'm not even going to engage with you. Those darn Democrats! Those terrible Republicans! More independence! How could you ever talk to them?

And we talk about politicians saying that they're going to reach across the aisle and help to bridge ideologies. My vote would be that we don't have an aisle as a matter of fact that everybody just sits down, and we have a conversation. But we're seeing this partisanship that is doing nothing more than making things worse, tearing us apart, people digging in their heels. That is activity based upon more the amygdala than it is the prefrontal cortex. As we become disconnected then from the influence of the prefrontal cortex, that is what we defined in Brain Wash as disconnection syndrome, where we lock into partisanship, lacking empathy, narcissistic impulsive behavior, and, gosh, certainly in these days, that's not what we need, in my opinion.

Melanie Avalon: I could not agree more. I personally come from the perspective of, I always want to engage in other viewpoints and I'm always looking for why I'm wrong, rather than why I'm right. So, I just love engaging in all different viewpoints and trying to understand why people think certain things. To that point, you spoke about narcissism, for example, and how this relates to the prefrontal cortex or not. Are we born with a certain state of empathy and our ability to see things from other people's perspective? Is there some sort of level of that that we all have? And then what affects that? Are there some people, like clinical narcissists, can they literally not understand the other person's opinion, like they just can't because of their brain?

David Perlmutter: First, are we born with it? I would say there may be some degree of wiring. We learn that there are other people in the world. We are born focused only on our desires and our needs. That's actually, from an evolutionary perspective, a very good thing. Because newborns are needy, they get taken care of because they need to be taken care of. They certainly can't survive on their own. But with time, we increase our levels of impulsivity and narcissism and self-centeredness based upon the choices that we make. The more we engage in that behavior, the more hardwired it becomes, through the process of neuroplasticity. Similarly, the more we engage in empathy, the more empathetic we become. The Dalai Lama famously said, “If you want others to be happy, practice empathy. If you want to be happy, practice empathy. I think that raises some interesting ideas that we would first derive happiness for ourselves by being empathetic towards others. So, in a way, it's self-serving. Call it like it is, there's nothing wrong with that. But beyond that, I think that looking at our modern world, we live in a very narcissistic promoting type of world. It's really all about me, and my Instagram posts and what I do on social media.

I ran into somebody recently in a parking lot and we were talking about this COVID-19 experience. He said, “The truth of the matter is, I don't know what all the excitement is about this COVID infection, because if I get it, I'm healthy, I'll be fine.” Okay, well, I guess that's his frame of reference, that if he gets it, he'll be fine. But if he gets it and I'm near him at age 65, which I am, I might not be fine, just by virtue of the outcome prediction based upon my age. So, it's a really very glowing example of empathy or lack thereof to say, “If I get it, I'll be fine. What's the big hoot?” You see it on the news where they are interviewing college kids at bars saying, “Hey, you know what? I'm healthy, I'll be fine.” Realize that these kids go home eventually to their parents and their grandparents and where is the concern for the possible threat to their health, i.e., empathy?

Melanie Avalon: If empathy is understanding other people's viewpoints-- like if you said, “Oh, if I get it, I'll be fine.” Am I being empathetic if I understand, okay, from his perspective, if he gets it, he'll be fine, so that makes sense from his perspective? When you engage with empathy, do you need to necessarily encourage empathy in other people? I don't know if I'm explaining myself. If a person has something that makes sense to them, even if it's not empathetic, I feel for me to be empathetic, I would have to accept their non-empathetic stance. Does that make sense? I've been thinking about this a lot recently.

David Perlmutter: First, let's define two types of empathy. First is, I think the empathy that more people are aware of, it's called emotional empathy, means I feel your pain. Somebody's going through something that's very challenging, and we feel sad with not just for them, but we feel sad with them. That's emotional empathy. Cognitive empathy is, again, this notion of perspective-taking that we can see their viewpoint. I think that it is, again, this question of being heard and hearing. I find that a lot of times in my interactions with people that there isn't much of the former, that they don't hear you. They close their minds to the idea that you might offer up a different explanation. For example, well, it's not the same as the flu, and here's why. I do my best to listen to and we should do our best to listen to their points of view. You've got to vet that idea. You've got to vet the conspiracy theories. This is how I see it, but maybe there is something to the dangers of 5G. Maybe there is some reality to the idea that COVID-19 was developed as a bioterrorist weapon in a laboratory. Could be. Be open to it. I tend not to believe those things, but I'm willing to listen.

But getting back to the example that I chose. I think it's a very obvious demonstration. Very front and center, that the individual with whom I was communicating, was clearly focused on seeing the world as it related to him. End of story. We're seeing a lot of that play out in terms of-- I think this COVID-19 is a very interesting study for us in terms of human behavior. I think we're learning an awful lot, for example, about who we are as Americans in this situation. It's not I think who we were, but it's I think more who we've become.

When we think back about the sacrifices that our parents and grandparents made, for example, during World War II, that was a four-year commitment to doing what was ultimately thought to be the best for the herd, not just for the individual. Of course, there were outliers. But now what we're seeing is every man for himself. We're not really interested in what's good for the group, but really what's good for our own personal gain, be it financial or otherwise. That level of commitment to the best outcome for everyone mediated by the prefrontal cortex seems to be quite lacking as we watch the behaviors that people choose when faced with these current challenges.

Melanie Avalon: Yeah, and then also to that point, you were speaking earlier about what activates the amygdala and it's this feeling of threat or fear. So, I'm assuming on the flip side of that, we would have the feeling of safety. I'm so fascinated what you were saying about how the amygdala relates to the immune system. Before I ask my main question, do you know does activating the amygdala hamper the immune system? Is it because it's just not devoting resources to the immune system because resources are being spent elsewhere? Or is there actually chronic damage to the immune system from the stress of it all? Or maybe it's both?

David Perlmutter: Getting back to our original description of the amygdala, it is the brain's fight-or-flight region. When it is activated, we perceive that we are under threat, and that is stress-inducing. So, this is real threat, which happens at times, or perceived threat, which is a cognitive involvement of the stress response. But based upon what we're seeing, what we're hearing that, “Oh my gosh, the situation is really threatening.”

Now, that stress elevates the production of-- mechanistically elevates cortisol, for example, the fight or flight hormone, one of them, stress hormone. And cortisol specifically compromises the immune function. It actually increases inflammation. It changes the array of bacteria within the gut. It increases the permeability of the gut lining, which further amplifies inflammation. So, at multiple levels being exposed to stress is highly compromising of immune function. It's the reason, for example, that stressed laboratory animals have poor development of their brains, have compromised immune systems, are at much higher risk for developing diabetes and cancer as well. Cancer being a reflection of a compromised immune system. So, if you stress a laboratory animal and then expose it to an infectious agent, those animals that are stressed are far more likely, A, to become infected and, B, to have a worse outcome in comparison to the exact same animal that hasn't been stressed.

Now, we're watching that play out in humans as well. The more people think about it, the more people accept this incredible onslaught of stress-inducing information via the news and what they're getting on social media, the more it's compromising their immune function and the worse outcome they may have, should they become infected. So, it's good to be informed. But the more you open your mind to the fear-inducing nature of what's going on around you, the more you will be at risk for having a bad outcome.

Melanie Avalon: So basically, the situation that we're in is really the perfect storm of situation to further perpetuate susceptibility to the virus, the potential to recover from it. So, it sounds like now more than ever is the time to really be engaging in practices which you've discussed all throughout your book, things which do cultivate-- bring back that feeling of safety, that feeling of trust, meditation, mindfulness, breathing, how we're engaging with social media, which we can go into. Before we get to that, two quick COVID questions. What do you think are the implications of babies being born right now during COVID? I don't know if the touch aspect is being interplayed with mothers and babies, but at least seeing masks and not seeing faces when they're born, do you think there's going to be like generational effects from that?

David Perlmutter: 100%. I think that newborns are probably handled and touched and get olfactory or synth stimulation as much as ever if not more, because mom and dad are home now all the time. But I think in the toddler and early childhood, that is a fundamental time that children develop-- even newborns as well, develop the ability to understand the meaning of facial expression. This is a fundamental tool that we as humans use to understand the nuances of communication. The absence of that induced by masks, I think, could have very significant implications in terms of children and future adults, not having as much of that ability. It is a critical part of our skill in terms of communication.

For example, when we text somebody, they have our words, but they might not fully embrace what the meaning of those words are until you look at the emoji that somebody attached to the text message. Then that person has the ability to communicate the subtle meaning of those words, with the addition of a facial expression. That's what emojis are all about. They emote an emotional response.

So, I would strongly agree with the idea that certainly does represent a threat but recognizes that young children are at home with whomever is at home and there's plenty of non-mask time available in that environment. Hopefully, that'll be enough for them to develop these skills.

Melanie Avalon: I'm so glad you brought that up about the emojis, that explains so much now. I'm communicating with a lot of people every day, writing a lot of emails, and I have to overdo the emojis all the time, because I feel with just words, I don't know that my message will be received the way it would be received if I was talking to them. I've just known that about me and I did not really know why but now it all makes so much sense.

David Perlmutter: When the emojis pop up for you to choose one, look at all the different expressions that you have access to and I would tell you that humans have many fold more subtle expressions that communicate a lot of information.

Melanie Avalon: I actually just took one of those tests where you are looking at faces and facial expressions to evaluate your emotional strength of your brain and gives you a score. But doing it, I was really starting to realize the nuance of facial expressions and all of these things that we have attached to it. You're speaking about toddlers or kids growing up right now and not having that normal exposure to faces. Seeing faces on TV or the computer, does that provide a benefit?

David Perlmutter: It does. I would say that in-person interactions are the best. But there is still lots of value to a digital interaction. We recently interviewed two Oxford researchers exactly on this topic. The title of our interview was “Social Distancing Shouldn't Mean Social Isolation.” In fact, they wrote a blog about that we shouldn't not socially isolate. We should socially distance, of course, but we need to remain engaged with other people. Like you and I are connecting right now. It's totally audio, but even with the audio, there are nuances in your inflection, of course, that carry important meaning in terms of the context and the meaning of what you're trying to transmit.

That said, I think that it is not as ideal, it is the way of the world, but I would say that there are plenty of other notions of reality that are being imparted into the developing mind about which we will learn in the coming years. This notion that being near another person is a threat. It's very powerful if a mother and child are in public transportation and the child happens to be too close to another person who's wearing a mask and mother pulls on that child's arms and telling them they need to be further away. This stranger danger has become much more amplified and that does what, it amplifies the way that child perceives the world around him or her and sets them up for more of an amygdala-based reality, which as mentioned, is involved with less thoughtful decision-making, perceiving the world as being more threatening than it maybe is and responding in that way to the challenges of the day.

Melanie Avalon: One more last very random question, but it relates to all this and it's something I've wondered for forever. I don't know who else I would ask. I remember growing up watching animated TV like Disney movies and stuff. There's only been a few times in my life when a parent or an authority figure told me something and I was certain they were lying straight to my face. And I remember when I was little, watching Disney movies and my mom saying that Aladdin was not a real person. I just remember thinking, “But he is a real person.” He looks like the 2D, animated, looked like real people to me. I’ve talked to other people, and they said they remember that as well, not knowing the difference between reality from 2D versus real life. Is that something in the brain when we start to see the difference between pictures and flat presentations of humans to real life?

David Perlmutter: Absolutely. It begins to take shape around five years of age, but never fully. There is always a time when things that are seemingly real that are not real, that may stick with us. Whether it's believing in Santa Claus and suddenly being told that Santa Claus doesn't exist, and you just can't embrace that at first. And then, after multiple exposures to that reality, you change your view. And it's a wonderful quality of the human brain to have that malleability that it can adapt and accept things. You look at something and it's definitely one way until somebody suggests another explanation. And then, suddenly it becomes that explanation and you say, “Oh, now I get it.” But you have to be open to that, you have to be open to those alternative views, alternative explanations to have that resilience and plasticity of brain function to allow that to happen. A lot of that is what we talked about earlier, this ability to share or at least participate in other points of view, that Aladdin is not real, but maybe Jafar is real, whatever it was. There is no Santa Claus. The world is not flat. This particular political party, they're not all bad people. They have their viewpoint, and we have our viewpoint, and it's maybe we should be listening to each other.

Melanie Avalon: The second thing I remember was when the music teacher told us in probably kindergarten that on the weather channel, that there wasn't actually a map behind them. And I was like, “But there is a map.”

David Perlmutter: But I'm seeing it. I'm actually seeing the map. How can you tell me it's not there? Categorically, what you're telling me can't be true until you take a field trip to the studio and you realize it's a green screen, and they're actually looking to a monitor off set, then you say, “Ah, now I get it. Gee, you were right all along. I'm able to participate in your frame of reference."

Melanie Avalon: Normally, I feel I really try to empathize with other people's viewpoints, but on the occasion when I do you feel I'm right about something and then I'm maybe debating something with somebody else, if I find out that they were in fact right and I was wrong, I feel really embarrassed. Do you know why we would get a sense of embarrassment or shame when we find out we're wrong?

David Perlmutter: Because your thoughts and your frame of reference have until that time to find who you are, and now that was threatened. So, who you are is threatened, is challenged. And that's actually a part of maturity, I think is the ability to accept that and move forward. To be able to change your views and your discussion about a point, I think is a very, very good thing.

There was interesting, to be nice, magazine article written about me in a national magazine a couple of years back. To call it like it is, it was scathing. I was attacked from every perspective. I think the biggest attack that was levied upon me was that I had changed my messaging, that Dr. Perlmutter used to tell us that we should be on a low-fat diet. And now, he's totally gone against that by telling us that we should eat things like olive oil and avocados. Yeah, that's what you'd like your scientists to do. And certainly, healthcare provider to be up to date and be able to have that ability to change messaging based upon current science.

Melanie Avalon: I will say I empathize with you completely on that one. I don't like to qualify things as pet peeves but the one thing I always say is, I reserve the right to change my mind because we learn new things, and how can we not change our minds when presented with new evidence? So, I always think it's sad that people get attacked for changing their message if it's because they challenged their preexisting beliefs and have a different idea now.

David Perlmutter: Yeah, the people who challenge you are those people who want to lock in and they are behaving again, from an amygdala perspective, that one way is right, and never will we embrace the ideas of another because we're definitely right. Our team is the winning team, end of story. I don’t want to discuss anything further because we are always right, and you are always wrong. You know what, whether you watch CNN or you watch Fox News, one side is right and one side is wrong. I say if you're going to watch news, watch them both. If one side is more in tune with your ideology, then make sure to watch the other one just so you can maybe gain a different perspective in terms of what you read. It's worthwhile to, again, read things and learn about other perspectives. It's how we visit the agora, the marketplace, as humans and share ideas and ultimately come up with novelty in terms of ideas and solutions to problems.

We are seeing an incredible demonstration of this right now in the scientific community, where researchers have really dropped their guard and are openly sharing information and ideas about coming up with novel approaches to dealing with COVID-19, and that's helping to move the ball down the field. It's only this isolationist patent-protecting behavior focused on profit that doesn't lead anywhere, that doesn't embrace the idea of sharing of information for the common good.

Melanie Avalon: And then, also to go a little bit deeper into social media and all of that, because you make a very strong case throughout Brain Wash that there are a lot of negative effects on our brains, how we engage with the world, our social connections, our health, just all across the board. Do you think there was a timeline on that? Like when the internet first started or when instant messaging first started. Do you think when we first had social media, did it get exponentially more problematic? Is it getting exponentially more problematic? Is there a healthy way to engage with social media?

David Perlmutter: Yes, and what we talk about in the book is we use what's called the test of TIME, and that's an acronym, T-I-M-E, for your online experience. T, how much time are you going to dedicate to the task. Whether it's looking at your high school group or learning about the different types of seashells, how much time today are you going to allot for the task at hand? Researching to write a book, whatever it may be. I do remain intentional throughout that experience, what is your goal? What do you hope to accomplish? Again, you want to reconnect with your long-lost boyfriend or girlfriend from the class of whatever, or you want to learn about interplanetary dust, whatever. What is your intention, and do you remain validating that intention throughout your time online, being therefore not taken away from your task by pop-up ads and clickbaits?

M, are you mindful while you're involved in the task at hand? You remain with the program focused on what you're trying to accomplish? Finally, E, is it enriching? Is it net positive? When it's all said and done, you're feeling like that was time well spent? Or you allotted 20 minutes, and two and a half hours later, and you say, “Gee, why did I do that?” So, staying with the test of time I think is very important.

To your point about the role of social media in locking us into ideology, I think that it just played upon human nature that we have that our tribe has viewpoints that need to be the viewpoint of everybody because they're right and they're better. That characterizes the human experience. It's what wars are fought over because they don't believe what we believe. They have a different set of morality or they have a different-- their religions are different, whatever it may be. So, that has been a definition of humanity. There may certainly be some upsides to that, to this notion that ideology defines the herd and we're going to stick to that because it's what's worked for us. Throughout the past 100,000 or 200,000 years, our group has done this, it's worked for us because we're still here. Let's keep doing it.

So, there's an upside to that. And that is a powerful hack then by the social media that we experience. The hack into our sense that we want to belong to a group that sees things in a particular way. That's what underscores the development of these particular sites that cater to particular ideology. There are many ways that some of our most primitive emotions and things that we are drawn to are hacked into.

Let me give another example. When I lecture, I say to the group, “Look, I don't need a show of hands to determine how many of you, what percentage of you, have a sweet tooth?" Because the answer to the question is 100%, means everyone, whether they want to raise their hand or not. Everybody likes sweet. I'm not pointing fingers. So, do I. We all. We're hardwired for sweet. Why? Because that's in our hardwiring to tell us a couple of things, to speak to our genome, to tell us that winter's coming, to amplify our body's production of insulin so we lay down fat so that we will survive. It tells us that fruit is ripe. So, it's the best time to eat fruit. When it is the sweetest, it has the highest level of phytonutrients. We have sweet desire, hardwired into our brains to seek out sweet because it's almost never available. It's only available in the very late summer, early fall, when the fruit that our hunter-gatherer forebearers might have discovered, and perhaps a little honey here and there if they're willing to climb the tree. But that said, sweet foods are something we didn't have year-round, but yet, we're still having this sense that sweet is good and we crave sweet and that's like the social media hacking into our desire to be socially involved with others.

The sweet tooth is hacked in by the addition of sugar to 68% of more than two million foods sold in our grocery stores. More than 68% have added sweetener. Why? Well, it's not to preserve the food, it's not to make them any cheaper. It's because we'll eat more of it and buy more of it, better for the bottom line of that company if you add sugar to things that you would never expect. Tomato soup, I think it's the second ingredient after water, even before the tomatoes.

So, these are hacks that are being exploited into our very deep operating system, our very deepest nature. Being a social animal is hacked into by the various social media sites. Being social was very powerful for us in terms of letting us survive. We would survive better in a group when we could cooperate, when we could have segregation of jobs, where some people would hunt, some people would gather, whatever. But that's important for us as a survival mechanism, like the sweet tooth, a survival mechanism. Like our desire to have things, which we see people these days just unable to control their online buying. Those primitive, deep-laden desires that we have, which are part of the hardwiring, are being powerfully exploited. So, yes, social media is making that situation worse and that's really why it's so effective and pervasive because it hacks into this primitive desire that we have.

Melanie Avalon: Is that a reason you feel good when you like something that lots of other people are liking because you're engaging with the tribe?

David Perlmutter: Exactly. You like and you are liked in return, and through this dopaminergic pathway, you get a little stroke, you're part of something. And being part of something is like the sweet tooth. It's the sugar. It's the same reward. Because they liked my picture, I'm accepted. I'm part of a group. And you don't get likes all of a sudden with a post, then that is-- you're thinking you're being cast out of the group. That is stressful. What does that do? Amplifies cortisol, amplifies inflammation, amplifies impulsivity, what happens you make bad decisions.

Melanie Avalon: Quick question about the sweet tooth because that was fascinating when I read that in your book about how the sweet taste actually does correlate to our sense of safety. Do you think that's a reason people on low-carb or ketogenic diets-- some people don't do well and it's too stressful for them? Does it somehow relate in part to the feeling of safety that we get from the sweet taste and some people never getting that, maybe it's a problem, maybe for women especially?

David Perlmutter: I think that's an interesting consideration. But I think there are some more low-hanging fruit-- not to get back to this sweet analogy, but low-hanging fruit, that might explain why, let's say, a ketogenic diet is not tolerated by everybody. I would say, first of all, we know that there are various genetic polymorphisms or subtle variances in genetics that have a role to play in terms of how well people are able to create ketones and use them as fuel, number one.

Number two, we also know that in engaging that diet, the onramp, in other words, what we call keto-adapting, becoming keto-adapted, is somewhat difficult in some people, especially in those whose diets have been really focused on carbohydrates for a long period of time. So, there is a period of time called keto-adaptation that's a little rough for some people more than others. So, that's really also very important to recognize.

Finally, I think that-- and I don't mean to be too mechanistic here, but when you are now in ketosis, you're creating these ketone bodies that float around in your bloodstream and in the urine as well. With ketone bodies, call them particles in the urine, it tends to induce what we call a diuresis. Meaning, basically, in ketosis, you tend to pee more. That makes it very easy for people to understand that. When you pee more, you lose things like electrolytes, potassium especially, and magnesium. Another reason people have difficulty tolerating keto diet is because they become electrolyte depleted. This is a handful of things people should think about in terms of why they might not be necessarily loving a ketogenic diet.

Lastly, I'd say that there's a lot of good literature lately that is starting to put value on cycling between a good low-carb diet, as well as a full-on ketogenic diet from time to time.

Melanie Avalon: I was just thinking about some people do keto and low-carb diets and advocate no sweet taste. No things like Stevia. I would not personally advocate artificial sweeteners. Really something like Stevia. I was just wondering if maybe some people if adding Stevia to their low-carb meal, maybe could they instigate a feeling of safety with the meal, assuming they don't get like a reactive hypoglycemia-type situation. That's tangents for another day.

David Perlmutter: Well, again, if it's an artificial sweetener or if it's something natural like Stevia, it won't induce a reactive hypoglycemia. So, what a reactive hypoglycemia really is, is reacting to carbs, reacting to sugar. What happens is, you overcompensate with respect to your insulin secretion and then your blood sugar is driven really low. So, it's actually strangely not a response to the ketones. It's a response to carbs and sugar specifically, it's a response to elevated blood sugar.

Melanie Avalon: The mechanism of action I was thinking was, I feel like some people, if they're doing low-carb, their blood sugar is low, and then if they add in Stevia, it could perpetuate an insulin response, drop their blood sugar lower, and they get a reactive hypoglycemia, even though there was never sugar present.

David Perlmutter: I hear what you're saying, but I don't think you're going to see much insulin response to Stevia. It's the reason that Stevia and monk fruit as a couple of natural sweeteners, they don't have that glycemic response. So, that's why people seem to like them.

Just to go a little further, as far as the artificial sweeteners go, there is plenty of data to indicate that through multiple mechanisms, it's not a good choice, not the least of which are the changes that have been well described in French and Israeli literature to the gut bacteria, to the microbiome, actually leading to a situation that amplifies your risk for type 2 diabetes, because you're using a yellow packet or a pink packet or paisley packet, whatever packet is on the table, oddly enough being associated with increased risk of the very thing you're trying to avoid.

Melanie Avalon: 100%. I remember when I was first doing research on artificial sweeteners. Initially, I was doing the research on insulin and blood sugar and things like that. But now exactly what you said, I think the effects on the gut microbiome are potentially very, very dangerous and not wanted. Few more quick questions about the groups that we were talking about with the social media. So, we have Facebook groups, for example, which seems like they are us creating a virtual representation of our normal groups that we would have in real life and so all of the implications of what would happen in a normal group may extend to the social media form. So, that's why we're getting all of these effects on our amygdala, our sense of connection, our sense of loneliness. What about for people whose social media is part of their job or part of--

For example, I have a Facebook group. It's not super huge. It has around 5000 members, and I say it's not super huge because my cohost, Gin, of The Intermittent Fasting Podcast, her groups have like 100,000 members, which is insane. But I'm personally struggling because I love that group. And it does feel in a way my safe place and everybody they're so kind, so supportive. We discuss all different things. We have all different viewpoints. But I'm struggling to figure out still what is a healthy relationship with virtual engagement with social media and things like Facebook groups.

For example, when I was reading about your TIME test in the book, I was going through it and I was applying it to my engagement with these groups, like time restricted, the max amount of time for accomplishing the goal. The goal is growing the group, so in a way the time would be-- I don’t know, in a way it could never end. I could just keep doing it. I, intentional, does it benefit me? It does. M, mindful, awareness to how I'm using it and how it's affecting me. I discuss all of these biohacking things, all the stuff about helping other people. It is really wonderful and then enriching. Is it providing knowledge? It is. So, my engagement, for example, in that group-- and hopefully this can apply to other people who feel like they are engaging in some sort of social media where they do feel it's really benefiting them. But it's a thing where you could do it all day, or you could not. So, I struggle with this. I'm like, how do I best engage? How do you best engage with a virtual world when it could just always keep going?

David Perlmutter: No, I think you brought up some very, very good points. But I would say, keep in mind, the notion that when you're doing one thing, you're not doing something else. The average American spends more than six hours a day in front of one screen or another, whether it's your computer, your tablet, your smartphone, you name it. Through the lens of doing one thing and not doing something else, it means that there's less time available for the other important things that we need to be both physically and emotionally healthy. The exercise, nature exposure, interacting with others, practicing compassion, planning our meals, cooking our meals, and making sure that we're going to get a good night's sleep. Those are all equally important, they're on the top of the list as well.

When you recognize that those things are up for being compromised by the fact that you're spending an awful lot of time fanning the flames of this particular social media group. It would, I think, tend to reframe it, number one. And number two, simply already as has happened with you, you're aware of the fact that this is, I don't mean to be judgmental, but it's insular. There's a messaging within your group, there are guidelines within your group, there is a mentality within your group. I'm not saying good or bad. I'm simply saying it's insular. By its very nature, you're either in it or you're not. And if you're in it, this is what we will talk about.

Now that you recognize that, and your other participants, your other Facebook followers recognize that, hopefully you'll explain this to them, that it is healthy to engage other groups. It's healthy to see what the next-door neighbors are doing online, visit another group, become a part of another group, and try that on. That's the cognitive empathy that we spoke of earlier. What you're doing right now, you're doing your best to build out the group. But I would caution you to look at it through the lens of, if you're doing one thing, you're not doing something else. So, there are other things in your day that are valuable that need to be considered.

Melanie Avalon: Okay, that's really practical. Two things-- because there's like group rules on Facebook groups. Our only rule is you have to be kind and you can talk about whatever you want, as long as you're nice about it. So, physically be empathetic, I think it says something about understanding other people's viewpoints. And then the other rule is don't judge other groups. But, yeah, I guess that's very practical what you said. If it's interfering with other aspects of life that should be honored, then that's probably an issue. Do you know if there is an indication or something around social media at certain times of the day-- for example, like in the evening, when I want to go to bed, I have to turn off social media before and I can't-- I have to turn off Facebook, I have to turn off everything, and I can't let myself even check to see if somebody has reached out to me because it just wakes me up. I wonder if that has something to do with in the natural world we wouldn't have been engaging with people at night when we were sleeping.

David Perlmutter: Well, and I mean this from my heart, I think that you are getting this positive reinforcement from what you see with your social engagement. Much as eating sugar, you're getting this positive feedback that is hard to pull yourself away from. I think that it's valuable, we talked about in the book, to try to derive enjoyment and validation from other sources, A. B, why would you not want to be engaged in anything online after dinner in the evening is because of two reasons. There's blue light exposure that's going to compromise your production of melatonin and therefore not help you get a good night's sleep, which is really important. There's a lot of information that you may be exposed to through this digital interaction that maybe challenging or stimulating in such a way that it again could compromise your sleep. So, to be doing this before you go to bed at night is not what I would recommend.

Melanie Avalon: Agreed. Yep, shut it off. The blue-block glasses go on. Really quick questions about dopamine because we're talking about the addiction-reward pathway. You discuss in the book how dopamine is-- Well, I guess we can talk about what dopamine is. But a lot of people think that we are addicted to dopamine when really dopamine is not the actual reward itself. It's the thing driving you to get the reward. I was wondering, is it possible, though, to be addicted to the drive to get the reward?

David Perlmutter: Oh, without question. I think that makes a lot of sense. Dopamine is not the ultimate goal. Dopamine is really the craving kind of neurotransmitter. Ultimately, there are a lot of different neurotransmitters, not the least of which are endorphins that are involved in this pathway. So, in a way when we recognize that constantly feeding into these pathways that ultimately stimulate us by stimulating our endogenous morphine, that's what an endorphin is, endogenous morphine receptors, offers up an understanding how there's such a big problem in our society with opiate dependence. Because our society is gearing our brains to need that opiate hit, day in and day out. Certainly, the availability of the opiates, the fact that they were really pushed on doctors to use them, etc., played into it, but we, by our nature, of wanting to satisfy ourselves day in and day out, I think, set the stage through enhancing the requirement of our receptors to be stimulated, these endogenous morphine receptors. We set the stage for a quick fix by taking opiates.

Melanie Avalon: Do you have thoughts on a dopamine fast? I know that's like a thing in Silicon Valley, apparently.

David Perlmutter: Well, no, I think that we do that. We're distancing ourselves from this catering to our reward systems when we are involved in, for example, meditation. When we're not thinking about our next post, of what we're going to eat, who we're going to hang out with, the fact that we're going to succeed at one thing or another, meditation is very much a way of helping to calm that whole system down. And those effects last well beyond the time of meditation.

Melanie Avalon: To that point, so how did you decide to develop because you have your 10-day detox program? It was interesting to me because I feel each day with the different things that be it meditation or diet or social connection, these are things that we could spend, like we could write a whole book alone on each individual one. How do you find people when they go through the program? Is it like you learn a little bit about how each of these feel and then you can further implement all of them into your life? What does that practically look like, like taking charge of our brain?

David Perlmutter: Sure. Just take a little bit of time just to set the stage. Meaning, it's all about gaining the ability to make better decisions. However, we find an onramp to better decision-making will serve us well. For some people, making a better decision will happen when they dedicate to getting a better night's sleep. Not getting a good restorative night's sleep is associated with as much as a 60% increased activity of the amygdala. Meaning, don't sleep well, make bad decisions. Eat bad food, don't exercise, etc. So, we go through all of the entrance ramps onto the highway of better decision-making and it turns out that some people will gravitate towards something finding it a lot easier, and frankly, it doesn't really matter to us what onramp you get because then the other decisions become easier.

So, let's say-- it happens to be for you, let's concentrate on a better night's sleep. Now you're getting more sleep. The next day, you're able to make better decisions. Now, you are primed for making a better decision as it relates to getting 20 minutes of exercise or beginning a meditation program, or getting out into nature, or keeping a gratitude journal, whatever it may be, the other aspects of our program. While they're linear in terms of how they're described, it may well be as we mentioned in the book that people want to use one particular day as their onramp, that this is something they can do. Maybe somebody just says, “I am not in a place where I am going to exercise.” That is just not going to happen. Fine. Why don't we start with you with a gratitude journal? You can do that, can't you? Get a little journaling each day, write down five things that you are grateful for. That's it. That's where we're going to start. What is that do?

That strengthens this connection to this better decision-maker part of the brain, the prefrontal cortex, then moving forward. Yeah, they say, “Well, now that I've been keeping that gratitude journal for the past week, I think maybe I could just walk around the block one time.” It's just all about for each person to find out where he or she is comfortable in making that first step. That's what puts the foot in the door. And once the door is open, then we've got access to the entire decision-making process.

Melanie Avalon: I love this so much. It speaks to something that resonates with me a lot, which is, I feel like on the one hand, I have all these tools and all these techniques and all these things I'm constantly trying to do to create a certain state within my mind. So, the meditation, the mindfulness, the gratitude, the [unintelligible [01:05:57], the journaling, and then with sleep, the blue blocks, the red light. There's all these different things that every single day that I go through. So, I'm torn in a way because I'm like, “Oh, there's so many things that are wonderful.” And they're wonderful tools moving towards this, I guess, the state of safety or feeling of wholeness. But I think if my brain did just feel safe and whole, I feel I wouldn't need any of these. How do I interpret all of these things in doing as warranted and worthy and not signs that they're bandages or they're something that I need?

David Perlmutter: I'll tell you why it, with all due respect, will probably never happen. And if it does happen, we call that the state of enlightenment. That is a place where you are totally content and you're feeling totally at peace, putting your guard down. Truthfully, that's not necessarily a good state to be in. We have to have a guard. We have to be able to recognize danger. There is a particular syndrome, I think it's called Williams Syndrome, where these individuals just produce an overabundance in their brain of oxytocin, and they trust everybody, and everything's wonderful. They get abused, they get taken advantage of. So, I think that there is a place in our world for understanding and responding to things, I wouldn't say negatively, but I think with some caution and that things are not all perfect around us. But, on the other hand, we want to do our best to be as trusting as we can to be as forgiving and compassionate as we can be. And recognize that sometimes we respond in ways that we don't like and that you would say, “It's not like me, why did I do that?” But we move forward because we're human.

Melanie Avalon: I love that. I will keep doing all the things and not stress about doing all the things. I guess it's that secondary emotion that comes in that is not necessarily helpful. Well, this has been absolutely amazing. Listeners, I cannot recommend enough that you get Dr. Perlmutter’s new book, Brain Wash. We've just barely graced the surface. There's so much in there. There's science, practicality, details. It's just a really, really wonderful book and I really, really applaud you for it. And like I said, coming full circle, especially right now with everything that's going on, I feel like it can really, really, really benefit us.

David Perlmutter: Well, I appreciate, just the ability to spend time with you to make a new friend, even though it's virtual. And I appreciate those comments about Brain Wash. Again, we had no prescience about why it would be needed. But since it was launched a few months ago, now that it's in 18 languages around the world, like you say, it really is showing some application to what's going on in the world. We're living in a world that is very much divisive and tribalistic in terms of one grouping right, one grouping wrong. I think we'll move past that. I think that goodness will prevail. As we are all challenged by this, this is a world war that we're in right now. I think we will rise and figure things out and be better off in the long run.

Melanie Avalon: This is truly incredible. Just quickly to that point, I always find it really interesting when you're first exposed to some information and you learn something, but for whatever reason, you don't have a personal reason to really let it resonate with you. I actually live in Atlanta. I read your book before a lot of the political unrest, racial and social unrest happened. When that all happened, I was like, “Wow, I really need to reread the parts of this book that are talking about conflict and empathy and understanding other people's viewpoints and what a healthy version is of that.” It's been a really wonderful resource.

For listeners, the show notes will be at melanieavalon.com/brainwash. I will put a link to everything there. The last question that I ask every single guest on this podcast and it's just something you will probably appreciate, it's just because I've started to realize more and more each day how important mindset is, how important gratitude is, for not just our mindset, but our health and all of our wellbeing. What is something that you're grateful for?

David Perlmutter: Oh, I already have a big smile on my face. I'd say that I'm grateful from a personal perspective that I've been able to identify my skill set, and my skill set is to be able to take information and make it understandable to others. So, I'm grateful that I identify that. I hope I can go more than one. Keep the timer going. I'm grateful for all the wonderful relationships I have, beginning with my family that we’ve such an understanding relationship with so many people, and it's so enriching for me to have relationships with others. And so, beginning with my wife and children, and then moving out from there, that has always been a very, very big source of gratitude in my life. So, there you go.

Melanie Avalon: I love it. Well, thank you so much. I really mean that. I just want to take a moment and be grateful for this moment because you're such an amazing human being, your work, like I said, it's been-- because I just looked up when Grain Brain was released, because I really fell into the whole paleo-type world-ish around 2012 or so. It was 2012-2013, which is around when you released that book, and pretty sure that's when I first read it. So, you've been like a mentor to me even though I don't realize such a figure and I've just been so in awe of all the work that you've been doing. So, having this moment to thank you for taking the time to have this conversation, answer my question, share it with my listeners. And I really look forward to your next book. Do you have one in the works?

David Perlmutter: It's interesting. I'm probably going to go back to basic science for the next book. There's something I've for whatever reason become really enamored with in terms of understanding. And I'll just tell you that it's the role of fructose. The type of sugar called fructose in human health and illness.

Melanie Avalon: I'm obsessed with this.

David Perlmutter: Really?

Melanie Avalon: This is what I think about every day.

David Perlmutter: Oh my gosh, well, what do you know? Great minds think alike. Anyway, you have a great mind. I don't know about me. But that said, I'm really taken by the mechanisms by the interaction, for example, with dietary salt, by the role that fructose plays in metabolism, in the creation of metabolic syndrome, in terms of weight gain, and really as such then as a pivot point for most of these chronic degenerative conditions that are crippling humanity. So, I'm going to do a deep dive into the science of fructose. I'm really fascinated by it.

Melanie Avalon: I literally have on my to-do list, have an episode about fructose because I'm just torn because there does seem to be two actually very at-conflict viewpoints, which is one reason I am so fascinated by it. I don't know if you're familiar with the whole work of Ray Peat. Are you familiar with his work?

David Perlmutter: Absolutely.

Melanie Avalon: Yeah. They love fruit which is not isolated fructose, but that tribe is very much of the opinion of a glycogen-fueled body, fructose being actually very healthy fuel for the body, liver glycogen being something we really want to boost. On the other side, we get that's the last thing we should be focusing on or that we should be avoiding that. So, I'm haunted by this question. That's why I think about it all the time. So, yeah.

David Perlmutter: I'm going to tell you I will certainly have an opinion. But I think it's going to be fair, as I've always tried to be, to vet both sides of the story, so that people realize I've seen both sides of the literature and therefore here's what I've come up with. But when I wrote Grain Brain, I thought that having a lot of carbs and sugars was not necessarily good for your brain and your body. I feel that pretty much since 2013 that most of the science has lined up supporting that notion, in light of the global epidemic of obesity and Alzheimer's. So, we'll see, but I'd like to raise fructose to a level of conversation. I think a book is a way of doing that.

Melanie Avalon: I am really excited. Talk about an exciting teaser.

David Perlmutter: You're the first to know.

Melanie Avalon: Oh, really? [gasps]

David Perlmutter: I haven't mentioned that on any podcast. So, there you go.

Melanie Avalon: Oh, my goodness. I just got really excited.

David Perlmutter: In fact, my publisher doesn't even know it yet.

Melanie Avalon: Oh, man. Well, your secret's safe with me, and whoever listens to this. [laughs] Well, thank you so much. This has been absolutely incredible. Hopefully, we can talk again soon. Maybe it'll be about that topic, fructose.

David Perlmutter: There you go. I hope so. All right.

Melanie Avalon: That'd be wonderful.

David Perlmutter: Well, bye for now. Thanks again for having me.

Melanie Avalon: Thank you so much. Bye.

David Perlmutter: Bye-bye.

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