Detox your mind with Dr. David Perlmutter.
Dr. Michael Ruscio: Hi everyone. In today’s episode, we speak with Dr. David Perlmutter and discuss his new book Brain Wash. There are a few concepts in this book that I think could really help anyone who is either a healthcare provider or any type of clinician or health coach or even someone who is personally trying to figure out how to be more motivated to make healthy changes.
He discusses fascinating neuroanatomy and neurobiology about how modern-day unhealthy choices will create this over-reliance on the amygdala in the brain at the expense of the prefrontal cortex. The amygdala is more emotionally based and the prefrontal cortex is more logic- or reason-based. What the research discusses and he outlines in his book, “Brain Wash” is that for those of us who are stuck in this cycle of making bad choices, going to bed too late, drinking too much, eating unhealthy food, not exercising, there may be this unhealthy habit related stimulus in which inflammation may be the main driver that causes this skewing of what parts of the brain are activated.
This can lock someone in this cycle of poor decision making. This is a very timely book, especially if you’ve ever struggled with those who you work with, those you love or even yourself. This read is empowering and motivational because it helps one better understand the source of some of these bad habits and what one can do to change them.
I hope you’ll stick around and listen to the conversation with Dr. David Perlmutter on his new book, Brain Wash.
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DrMR: Hi, everyone. Welcome back to another episode of Dr. Ruscio Radio. This is Dr. Ruscio. Today, I’m here with my highly respected colleague and friend and also a phenomenal public speaker, Dr. David Perlmutter. David, welcome back to the show.
Dr. David Perlmutter: Michael, I’m always delighted to be back. This is great.
DrMR: It’s been so interesting following your work over the past several years, and I have to give you a virtual pat on the back here. We were both at the IHS Symposium in New York City in 2019 together, and my parents are nearby in Massachusetts, so they came out and they sat through your keynote lecture.
DrDP: Oh, how nice. I’m very excited to hear that.
DrMR: I saw their eyes open to the stuff I harp on them about all the time, and not to say that they’re not receptive, but I saw their eyes open to a degree I had not yet seen.
DrDP: Oh, my goodness.
DrMR: It was phenomenal, so thank you so much.
DrDP: I’m totally happy to hear that. That’s really great.
DrMR: Yeah, and your presentation was absolutely magnificent, and you mentioned a new book that’s launching, and we’re going to be talking about this book today, and I have not had a chance to read this book, although I am very curious too, but give us the summary first, and then we can dig into some of the details.
DrDP: I’d be delighted. Over the years, I’ve been writing a lot of books about what choices we should make, so have you, so have so many people, and, by and large, when we look at what everybody’s been telling everybody, it’s pretty darn good information, but, unfortunately, my work included, it’s useless to each and every person unless they are able to implement what we’re talking about.
Disconnection between Inflammation and Action
What we’ve realized is there’s this huge disconnection between inflammation and action. Getting the information is not the issue. Giving the information is no longer the issue. The issue seems to be, and I’m sure you’ve found this to be very frustrating with your patients, is implementation. What do we do when we know what to do, and yet we suffer through the inability to make those changes, make those good decisions.
My son and I, he’s a board-certified internal medicine MD, set about to explore this. We came together one evening, and we were talking about our frustration and all the outreach that we do either individually to people or to groups, all the education that we put ourselves through to learn as much as we can, the outreach, and yet the failure of the population to really carry this out certainly transcends our experience. We know that, by and large, this is something across healthcare, that about 70 to 80% of the information we give to patients is not really followed through on as it relates to these important concepts that you have spoken about for so many years, that many of us have been talking about the food we eat, the exercise we get, the sleep, meditation, nature exposure, relationships.
Prefrontal Cortex vs. Amygdala
All these things and their value have been just neglected, so we decided in Brain Wash to look at the actual process involved in making decisions and realized that this is a function of the part of the brain called the prefrontal cortex, that we really have two important decision-making areas, the prefrontal cortex that allows us to look at information, take apart and ultimately make a decision, and then a more impulsive part of the brain called the amygdala that just acts. It doesn’t really think things through. It’s like what we see in children, and they just do things, don’t think about the long term consequences. Everything that we need to do that we talked about in Brain Wash is allowing people to reconnect to the prefrontal cortex.
- Two important decision-making parts of the brain: Prefrontal cortex and amygdala
- The prefrontal cortex allows us to take in information, take it apart, and ultimately make a decision
- The amygdala is the more impulsive part of the brain
We call our lack of connection to the prefrontal cortex disconnection syndrome, and it certainly has wider implications than that, but it involves disconnecting from each other, disconnecting from ourselves, disconnecting from the messaging of our genome, disconnecting from the interaction we should be having with our microbiome, disconnecting with caring for the planet. Fundamentally, we’re talking about disconnecting from the adult in the room from the prefrontal cortex, the area of the brain that lets us really embrace the long term consequences of what we decide to do today, the area of the brain that allows us to participate in empathy and compassion and allows us to experience what it’s like to look at something from another person’s point of view. It’s the area of the brain that embraces other people as opposed to areas like the amygdala that tend to foster both impulsivity and also an us-versus-them mentality.
What we discovered was a really robust amount of scientific literature that reveals how, for example, the modern American diet is keeping us from connecting to the prefrontal cortex. How this diet that we generally see spreading around the globe is so pro-inflammatory and how inflammation severs our relationship with the prefrontal cortex and, therefore, severs our relationship with other people and severs our consideration of making good choices moving forward. It’s certainly more than the foods we eat. It’s our lack of sleep, the susceptibility we have to advertisers, the amount of time that we spend in front of a screen.
42% of the time Americans are awake their eyes are fixed on a screen of one sort or another, be it a tablet, phone, television or computer. That is more than six hours a day, and, in a lifetime, that’s 22 years spent on screen time. That has implications in and of itself, but it’s been said that when you’re doing one thing, you’re not doing something else. We really want to create a scenario whereby people can regain the ability to connect to the prefrontal cortex and then be able to make these choices that they’re learning about. We want to finally give people the tools to bridge between information and action.
DrMR: I mean, you make a number of poignant points, and I think one of the things many of us, maybe all of us, struggle with is knowing about health ourselves and having the knowledge to help ourselves and our patients and being frustrated when the people we care about and we love are unable to act upon that knowledge. Maybe my parents were a good example to open up with, and they do a good job, but I think we always want more for our loved ones, and so I very much appreciate what you’re trying to do in the sense that you’re trying to help people discover why they may not be able to make the behavioral changes that they want to make because, just as you said, with all the information that we have, but without the ability to be able to apply it, it’s like having a Ferrari with no gas in the tank.
DrDP: You bet. You’ve got all this incredible information and, like the Ferrari, it’s not going to take you anywhere. It’s so challenging because people are not going to realize their goals. I mean, it’s New Year’s resolutions, or whatever they are, every year they come and go without any action, and there’s a lot of blame here because I think that we as healthcare providers can slip into a place of blaming patients for not doing what we’ve said. They come back to the office time after time. They’re gaining weight. They’re not exercising. They’re not doing the things that we know are important, and there’s a tendency to at least consider that they ought to be doing better, and, certainly, these people are generally feeling not fulfilled themselves and are wondering why it is that they’re not doing the things that they know are good for them, so it’s very frustrating. There’s a lot of self-blame out there as well. I think what we’ve identified is it’s not necessarily people’s fault that the deck is absolutely stacked against each and every one of us because of the way our decision-making is so highly hacked in our modern world.
These are keeping us from connecting to the prefrontal cortex
- American diet – Pro-inflammatory
- Lack of sleep
- Time on screens – 42% of the rime we are awake, our eyes are on screens
Why it’s Us Against Food
DrDP: Let me give you an example. Each and every one of us walking the planet right now has a sweet tooth. You might want to deny it, but the fact is we all love sweet, and it’s a good thing because that is a powerful survival mechanism. Sweet told our hunter-gatherer forebears that the fruit was ripe, that it was at its highest level of nutritional content, though they probably didn’t think about that, and it also signals some very important biochemical pathways to enhance the ability of the body to make and store fat. So we had sweet things that were found in nature at the end of the summer and the fall that stimulated insulin, caused us to lay down a layer of body fat, and we would then survive the winter when there was caloric scarcity. But that hard-wired desire that we have is absolutely hacked into by the foods we eat. When you recognize that 68% of the 1.2 million foods sold in America’s grocery stores have added sweetener.
Why is it added? It’s added because it hacks into this primitive desire that we have for sweet. Therefore, people eat more and more sweet. It raises their blood sugar. It increases inflammation, severs their ability to the prefrontal cortex so they don’t make good choices anymore and, guess what, that leads to making even more bad choices as it relates to food. So it creates this really unending and worsening, vicious cycle with time. What does it do? People end up gaining weight, and, as such, that compromises their sleep and, as such, that also feeds into inflammation and increases cortisol that further damages our connection to the prefrontal cortex. All these things worsen what we are calling disconnection syndrome.
- Inflammation reduces prefrontal cortex activity = Poor decision making
- 68% of the 1.2 million foods sold in America’s grocery stores have added sweetener
We’re Being Tricked Into our Own Bad Health
DrDP: 70% of American adults are now overweight or obese, and 60% of American adults have at least one chronic degenerative condition. By and large, brought on by making bad choices and which will feed into continued bad choices. This hacking into our desire for sweet is really pervasive, and it’s so troublesome, and there are many different hacks into who we are that are going on. We are social animals, and we need to be interconnected with each other. That’s been a powerful aid to our survival as we’ve evolved. Now, we’re hacked into this thing called social media that makes us think that we’re connecting to other people when, in reality, that’s not happening, and the more time we spend on social media and the more time we spend in front of the computer, the more damaging it really is.
To be clear, Brain Wash is not anti-technology, it’s anything but. We wrote the book using the Internet which gave us the ability to have unlimited access to information from around the world. Christian Lange, the Nobel Prize winner in 1921 told us that technology is a useful servant, but a dangerous master. Now we are seeing, through clickbait, popup ads, queued-up YouTube videos how we are being targeted and manipulated to spend time online. What our eyeballs see is very valuable to individuals for their gain, but certainly not for our gain. We’ve created a program that helps people, first of all, and most importantly, recognize what’s going on through their mental manipulation and through their choices. It then ultimately provides them a framework whereby they can regain back the ability to make good choices and, finally, carry out these resolutions that are so challenging for people.
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DrMR: It sounds to me like there’s almost this repudiation of the concept of laziness because if one can discover how to sever these negative inflammatory-based connections, they can discover where their lack of motivation is coming from and then ostensibly discover the motivation that they need to effectuate these changes. It makes me wonder if there can be, using this term very loosely, this IBS of the mind. Some people may manifest poor food and lifestyle choices as inflammation in the gut, and, perhaps, some people don’t see the digestive manifestation, but rather they’ll manifest more neurologically and more motivationally. Is that something? Is that a positive thing?
DrDP: Without a doubt. First, when we disconnect from the prefrontal cortex, there are many implications here. I mean, we become impulsive, we become self-centered, we become aggressive, fearful, we enhance an us-versus-them mentality, we value our lives less, we value other people less, we value our future selves less. We become less compassionate, less empathetic, so wide-ranging implications of this disconnection syndrome that we talk about. The upside here is that, as you mentioned, so many things can feed into it like inappropriate diet, like having non-restorative sleep, disconnection from nature, disconnection from people, lack of meditation, lack of exercise.
All of these feed into fostering disconnection and then creating these feed-forward loops whereby these things worsen with time. If we can get people to jump on this carousel at any point, it will then enhance their decision-making, and that will then serve them to allow more strength to make better decisions moving forward and then incorporate other aspects of our plan. Whether a person focuses on his or her sleep, ability to gain restorative sleep, maybe measuring the quality of their sleep with a polysomnogram or maybe just getting an Oura ring or other wearable device or maybe just begin an exercise program that you’ve been putting off for a long, long time. That might start with 15 minutes a day. Perhaps it’s engaged mindfulness or a meditation program or change your diet or whatever it may be that you can jump on. It’s going to be feeding forward and allowing better decision-making that will then enhance the ability to make better decisions moving forward.
- 70% of American adults are now overweight or obese
- 60% of American adults have at least one chronic degenerative condition
- When we become disconnected to the prefrontal cortex we become impulsive, self-centered, aggressive, fearful, value our lives less, etc.
Sleep is Critical
DrDP: That said, so many don’t recognize that sleep is such an important part of this whole paradigm. We should sleep one-third of our lives, and we certainly don’t need to spend a third of our lives eating or exercising, and yet sleep is so undervalued, and we know that even one night of non-restorative sleep makes an individual far more impulsive the very next day, far more likely to make bad food choices. Chronically not getting enough sleep is associated with about a 350 daily caloric increase without any change in energy expenditure, and when you consider that it only takes 3,500 calories to equal a pound of fat, that means a pound of fat is added in a person who’s not sleeping well every 10 days. Play that out over six weeks. What does that look like?
The problem is that body fat is pro-inflammatory and increases ghrelin, the hungry hormone as it were, so that is a feed-forward cycle. Further, we know that obesity and even being overweight is associated with sleep disorders. Making the situation worse and compromising mood, increasing inflammation, inflammation related to depression, increasing impulsivity as it relates to your very food choices, increasing your lack of consideration for your future self. Therefore, who cares what I do today in terms of my choice?
It’s a big problem, and it’s a global problem. As our western diet becomes the global standard, we know that we’re increasing inflammation globally. We know that we’re severing the relationship to the prefrontal cortex globally, and what is that doing? It’s fostering fear, anger, us-versus-them and short-term decision making. In a very real way, this global spread of our western diet is absolutely having existential implications.
DrMR: Obviously, anything that can help someone better act on their health seems to have broad applicability in terms of the audience that it’s suited for. Would you say there’s an ideal reader here? I’m thinking about patients in the office who are not very compliant. This could be a good thing to hand to them, but what would you comment in terms of is there an ideal reader or some subset of the population you’re trying to focus on with this writing?
- 1 night of non-restorative sleep makes an individual far more impulsive
- Chronic lack of sleep is associated with about a 350 daily caloric increase
- Obesity and being overweight is associated with sleep disorders
Who Should Read This Book?
DrDP: I’d say that, originally, the genesis of this book which I wrote with my son was trying to answer the question of why don’t our patients do what they’re told? I don’t mean to sound so paternalistic here or maternalistic, but why is it that, we do so much to learn as much as we can. You know we do. I see it at every conference. We’re studying. We’re day and night learning as much information we can and then we’re imparting it as best we can through whatever means we can. I’m big on doing slides, et cetera, whatever it takes, and yet the ball gets dropped. So we were targeting that and then we realized that this is a much broader message because it’s well beyond sick people. It’s well people who are at risk. It’s adolescents who are making bad decisions because of reasons that are not necessarily theirs. Events that are not necessarily of their making, of their choosing, the foods that they eat, for example. So it’s a book with a broad application, and I’ll tell you something really interesting and so your listeners will know that you and I are having this conversation before the book is actually published.
I’ve never experienced this before, but this book has been bought by 14 countries around the world in advance of its publication here in America. We’re certainly over the top honored and excited about that because, again, this is a global message, and the fact that it’s starting to get traction around the world is a great thing. We need to take a step back and recognize that we’re all in this together, and this polarization that we are seeing in our country and around the world these days will not serve us well. We can see that in this idea that we’re all different, and our lack of ability to embrace diversity is threatening to our existence.
Well people who are at risk
This is a Global Issue that Affects Humanity
DrDP: Diversity begets resilience. You and I have talked about that in the past as it relates to the gut bacteria. The more diverse the gut bacteria, the more resilient it is. The more diverse the flora and fauna in the Amazon basin are, the more resilient that environment is to environmental threats. The same thing goes with human beings. The more diversity we have, the more ideas are vetted and the more people can make progress by looking at other people’s ideas, so it’s not a Democratic issue or a Republican issue or a Muslim-versus-Jewish-versus-Christian-versus-you-name-it, issue. We all are in this together. We’re on the same planet here, and I think it’s really important to foster the idea that we start to communicate and look at things from another person’s perspective and vet that. See how it feels. So, to answer your question, when you look at it from that perspective, I think it has a pretty wide-ranging appeal.
DrMR: I also want to just endorse you here. You have this broad base of knowledge, this clear erudition, but you have this unbelievable way of translating the message into something that’s appealing and not overwhelming. I really do 100% just want to give you that commendation because when I listened to your lectures, I often find myself shaking my head and going, “Gosh, he is very good at taking what could be a complicated concept and putting it up there on two or three slides and making it so appealing.”
The reason why I share that is so for people in the audience who are thinking, “Is this the right book to try to use to motivate someone or to motivate myself or to help them in X, Y or Z way?” I really do feel that you’re a fantastic messenger for this task because you have the way of, again, really making these things simple and appealing to someone.
Just like what I was saying with my parents, they were nodding their heads in agreement, their eyes were wide open, and, even on the train out of New York, my mom was like, “Oh, boy, Michael, I think I’ve got to cut back on X, Y, or Z.”
DrDP: That’s so good. Let me say also thank you for your comments. I’m deeply appreciative, and that happens to be one of my skill sets, and I think it’s so important for each of us to recognize what our skills are and to really exploit them as much as we can with the goal in mind that somehow you exploit that skill set for the benefit of others. I don’t play guitar that well. I don’t snow ski that well, but I think I do what you say, and that’s the area that I enjoy. There’s nothing more appealing for me than standing up there and giving that lecture, I will tell you, and connecting. I live for that. I really do.
DrMR: It certainly shows. We’ve hit on a number of concepts, diet, connectivity, sleep, reduction of screen time, so I think we’ve hit some key pillars, and I think the more important thing perhaps for the audience to keep in mind. David, if you want to modify or add to this, please, please do. These concepts are probably not terribly new especially to an educated audience as our own. I’m sure you’ve heard the importance of sleep and diet, but the point seems to be, if there is a struggle with compliance, this book can help get people over that hump.
DrDP: You bet, and the first part of Brain Wash is all about calling it out, recognizing that this stuff is going on around you day and night, that those popup ads aren’t random, that that clickbait is not random, that the next thing queued up on YouTube isn’t random, that the adding of the sugar to your food isn’t just something that is there to act as a preservative. No, the hacking of your brain is very, very real and very premeditated not for your benefit. Job one is to get a sense and your arms around the fact that it’s happening.
Once you get that, I think a lot of people recoil and say, “I’m not playing into this anymore. Okay, let’s read the rest of the book and figure out how I can offload this stuff,” so that was our task, and it was such a great moment for me to be able to write a book with my son and to collaborate. I look at him as such a mentor for me, and it’s been an amazing experience.
DrMR: It sounds, of course, like a very empowering message where someone is not going to be chastised, but, rather, hey, there are forces at play here that are not working in your favor, and the first step on this journey of empowerment is just understanding them so you can stop doing them.
DrDP: That’s right, and I think that’s actually very important that, for so long, the fingers have been pointed to these individuals and… to everyone and pointed at them, and they certainly blame themselves, so that’s why we opened with this, really, review of what the heck has been going on. I used to be able to do the right thing. I can’t do it anymore. I’m locked out. I’m locked out of that part of my brain that allows me to do those things I know are good for me. It’s a bit sobering, but, at the same time, it’s extremely empowering to distance ourselves from this momentary pleasure, from impulsivity and really be able to look at the future and how our decisions are going to play out in the future. Having empathy that we normally consider as to how you treat or feel about another person, having empathy for your future self, who that person will be in the future.
There’s a great quote by Henry David Thoreau, and it says, “Discrimination is the precious capacity to see the difference between what is pleasant for the moment and what is fulfilling always. Today, we are surrounded by a bewildering array of glittering lifestyles and models of behavior, most of which deliver just the opposite of what they promise.”
Just spend five minutes on the internet and you see all the promises and the glitter and what the world looks like for those people who seem to be succeeding and are tweeting or Instagramming about their wonderful lives. But when you get to know these people and you’ll realize that we’re all in the same boat. We’re all having to make the right decisions, and it’s important that we recognize our long term decisions affect our future selves and, in addition, affect those people around us and the planet on which we live. Environmental concerns are much higher in individuals who have a greater connection, again, to this prefrontal cortex, and we need to pay attention to the health of the planet upon which we live. That’s for sure.
DrMR: Full agreement there. As you were making those remarks, a question popped into my mind, though I’m not sure if there’s a great answer to this, I figure who better to maybe answer it than the guy who just got them wrote in the book on this topic.
There is this technique, as I understand it, it’s known is motivational interviewing or essentially when you’re trying to coax someone into compliance, frame the benefit of the intervention around, “I want to be able to run down the beach with my kids or dance at my daughter’s wedding”. I’m wondering if, perhaps, with the information you’re uncovering, it’s not so much that we have to hold the carrot of benefit in front of someone, but, rather, clear the issues that are thwarting their ability to allow the correct brain centers, the prefrontal cortex to activate.
DrDP: I couldn’t say it better. The notion of motivational interviewing is exactly right. It’s being able to allow the people who are ambivalent about making a decision and committing to something or being insecure to ultimately be able to carry these things out. That’s the big hangup. Motivational interviewing deals with acceptance, compassion, evocation, and partnership. Those are support ideas that can then strengthen an individual’s connection to that behavior, connection to the ability to carry out that positive behavior, whatever that behavior may be. It may have nothing to do with health. It may have to do with financial success. Who knows?
It’s about making choices. I would like to insinuate what we’re talking about ahead of that. I’d like to get to the place where people say, look, this motivational interviewing idea is really great, so let’s get you to change in such a way that you can make a decision to engage in that work with somebody who happens to practice that technique. That’s the hump that we got to get over with. Every journey begins with the first step. But when your feet are stuck in the mud, you can’t even make that first step. That’s what we have to push through because, once that journey begins, then there is a recognition that the goal is getting closer day by day, and that tends to be feed-forward enhancing in terms of the motivation and committing to making further changes.
- The hacking of your brain is very real and premeditated not for your benefit
- Our long term decisions affect our future selves and, in addition, affect those people around us and affect the planet
DrMR: Where can people learn more about the book?
DrDP: The book is called Brain Wash, and it is available everywhere. The website is oddly enough, brainwashbook.com. Lots of information is already appearing there. We’re going to load that website up with all kinds of videos and blogs and… you name it. We’re really excited that there’s so much attention to the book even now, so I appreciate the time I could share this information with you today.
DrMR: I’m deeply appreciative of the time, David, and, again, I want to encourage our audience that, if you’re looking for this message, I think you will find no better messenger than Dr. Perlmutter. Honestly, I’ve watched his work, and I think I’m halfway decent at public speaking, but when I watch you, I feel like I’m a JV soccer player next to a field of professional World Cup soccer players, so let’s put it on that kind of scale. I think it’s a great message, the right messenger, and I just want to thank you for all that you’ve done not only with this book, but also the personal assistance you’ve given me in some of my speakings, in my career, so I would highly encourage our audience, give the book a look, and, again, David, thank you for being you and all your work.
DrDP: My pleasure. Thank you, my friend. We’ll talk soon.
DrMR: Sounds good. Talk to you soon.
Where to find the book
- Dr. Perlmutter’s book, Brain Wash is available at
What do you think? I would like to hear your thoughts or experience with this.