Grain Brain: The Surprising Truth About Wheat, Carbs and Sugar – Your Brain’s Silent Killers


Dr. Perlmutter argues that excessive carbs, especially modern, gluten-containing grains and other sugars, are wreaking havoc on our health and our cognitive performance and can lead to increased risks of neurological and age-related diseases

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Key Takeaways
  1. Gluten and modern grains are destroying your brain
  2. Recommendations - eat more veggies, brush your teeth, sweat and exercise regularly, rest a lot, don't smoke, laugh more, avoid all gluten, limit carbs to less than 60g per day where most of your calories are coming from high-quality fats and proteins (grass-fed, local, etc)
  3. Believes shift from high-fat, low-carb to low-fat, high-carb diet is causing many of our modern diseases such as chronic headaches, insomnia, anxiety, depression, epilepsy, schizophrenia and ADHD
  4. Much more intricate and intertwined relationship between what we eat and the health of our brain than recently thought
  5. Brain disorders often reflect poor nutrition and other lifestyle habits
  6. Inflammation a key indicator of disease throughout the body
  7. Often don't realize the negative effects gluten and carbs can have on the brain as there is no direct physical manifestation and often takes a long time to show up
  8. Two biggest myths today - low-fat, high-carb diet is good and cholesterol is bad
    • Cholesterol is one of the most important players to reduce brain disease, increase longevity and maintain brain health and function
    • Higher cholesterol levels linked with higher performance in verbal fluency, attention/concentration and abstract reasoning
  9. Interestingly, the human dietary requirement for carbs is virtually zero; we can survive on a minimal amount of carbs, which can be furnished by the liver as needed. But we can't go long without fat."
  10. Key Brain Supplements - DHA, resveratrol, turmeric, probiotics, coconut oil, alpha--lipoic acid, vitamin D
  11. Exercise spurs the generation of new brain cells as well as build new networks. Makes neurons more nimble and able to multitask
  12. Deep and consistent sleep extremely important
  13. Outlines a 4 week program in order to institute a gluten-free diet and other healthy habits
What I got out of it
  1. Not that I ate a lot of gluten before, but this has cemented it for me. Dr. Perlmutter advocates for <60g of carbs per day, no gluten, as many veggies as possible, majority of calories from high quality fats and protein and repeat. Certainly not always easy, but definitely simple
Introduction - Against the Grain
  • More than in our past, people are dying from specific diseases as opposed to just old age
  • Author argues that it starts with the food you eat - mainly, modern grains are destroying your brain
    • Not just refined white flours and sugars but multigrain, wholegrain, live grain, stone-ground, etc. too
    • Fruits and other carbs are to blame as well - accelerating body's aging process
  • Brain disease can largely be prevented through daily life and diet choices
  • Our genes determine not just how we process food but, more important, how we respond to the foods we eat
  • Introduction of wheat grain into human diet has had the most wide-reaching decline of brain health
  • Today we are simply eating foods that we are not physiologically made to eat
  • The food we eat can change our DNA
  • Hopes that this book will shift how we eat and understand the connection between our food and our health and wellness
  • Book broken down into 3 sections - healthy habits as well as a list of brain enemies and friends, science behind the healthy habits (nutrition and supplements, exercise and sleep), and finally a month long program to help you build healthy habits
Self-Assessment - What Are Your Risk Factors?
  • By eating right and exercising we can stave off brain disease
  • Brain disorders often reflect poor nutrition and other lifestyle habits
  • Lab tests that should be done to test your risk factors for brain disease
    • Fasting blood glucose - common test for diabetes (between 70-100 mg/dL) is normal
    • Hemoglobin A1C - average blood sugar over 90 day period, great predictor of brain atrophy
    • Fructosamine - average blood sugar over 2-3 weeks
    • Fasting insulin - early warning system to get ahead of possibility of diabetes and preventing brain disease
    • Homocysteine - higher levels of this amino acid linked with many bad conditions
    • Vitamin D - critical brain hormone
    • C-reactive protein - marker of inflammation
    • Cyrex array 3 - most comprehensive marker of gluten sensitivity
    • Cyrex array 4 - measures sensitivity to 24 cross-reactive foods to which a gluten-sensitive person may also react
      • Amaranth, buckwheat, chocolate, coffee, dairy, eggs, hemp, millet, oats, quinoa, rice, sesame, sorghum, soy, spelt, tapioca, teff, whey, yeast
Part 1 - The Whole Grain Truth
Chapter 1 - The Cornerstone of Brain Disease: What You Don't Know About Inflammation
  • The origin of brain disease is in many cases predominately dietary
  • Inflammation a key indicator of disease throughout the body
  • Increased blood sugar (insulin resistance) leads to inflammation throughout the body and manifests in blindness, nerve damage, heart disease and Alzheimer's
  • Diabetes, dementia and Alzheimer's have a lot more in common than previously thought and are intricately linked
  • Gluten isn't just an issue for those with celiac disease. As many as 40% of people can't properly process gluten. Research is increasingly showing a strong link between gluten sensitivity and neurological dysfunction
  • Often don't realize the negative effects gluten and carbs can have on the brain as there is no direct physical manifestation and often takes a long time to show up
  • Two biggest myths today - low-fat, high-carb diet is good and cholesterol is bad
    • Cholesterol is one of the most important players to reduce brain disease, increase longevity and maintain brain health and function
    • Higher cholesterol levels linked with higher performance in verbal fluency, attention/concentration and abstract reasoning
  • Want to switch body to run on fats and proteins rather than carbs as this will help with effortless weight loss, more energy, better sleep, more productivity and creativity, sharper memory, faster brain, better sex life
  • Body's natural response to stress is swelling and inflammation. A great survival strategy as it lets us know when something is wrong. However, chronic inflammation is where you get into trouble and can lead to long-term health issues. Diet and exercise top ways to fight and reduce inflammation
  • Antioxidants, such as Vitamins A, C and E, are important to lower oxidation which lowers inflammation
    • Turmeric, omega-3 DHA, berries, nuts great sources of antioxidants
  • LDL has been termed "bad cholesterol" but it is absolutely vital as it transports cholesterol to the neurons where it performs important functions
    • Oxidized LDL is what causes a lot of issues and this is caused through physical modification by glucose
Chapter 2 - The Sticky Protein: Gluten's Role in Brain Inflammation (It's Not Just About Your Belly)
  • Gluten is a protein that binds together materials such as flour to make bread products and is what gets bread to rise when wheat mixes with yeast
    • Found in wheat, rye, barley, spelt, kamut and bulgur
    • In food of course but also beauty care products such as shampoo, hand creams, etc
  • People of northern European ancestry as particularly susceptible to celiac disease but a lot more people are gluten sensitive and fall along a spectrum
    • Most people don't realize they are sensitive as there often aren't physical manifestations but can be having brain inflammation or other silent effects elsewhere in the nervous system
  • A wide range of symptoms from chronic migraines to early onset dementia have shown to improved through a gluten-free diet
  • Gluten sensitivity, with or without the presence of celiac, increases inflammatory cytokines which are pivotal in neurodegenerative conditions
  • Gluten can bind to morphine receptors which are the same ones which opiate drugs bind to, creating pleasurable effects. Many of us know this feeling of happiness when we finish a croissant or bagel. This feeling is also addicting which is why food manufacturers pack gluten into as many foods as possible
  • A slice of whole wheat bread has a Glylcemic Index (GI) score higher than a tablespoon of sugar. GI is a measure of how quickly blood sugar levels rise after consuming something
Chapter 3 - Attention, Carboholics and Fat Phobics: Surprising Truths About Your Brain's Real Enemies and Lovers
  • Consuming excess carbs, even if gluten free, can have very negative effects on your system
  • "Interestingly, the human dietary requirement for carbs is virtually zero; we can survive on a minimal amount of carbs, which can be furnished by the liver as needed. But we can't go long without fat."
  • Eating fat does not mean being fat
  • Fish, olive oil, flaxseed and other sources of high omega-3 foods are very beneficial. Unfortunately, the typical American diet is very high in omega-6's and the imbalance between 3 and 6 can lead to dementia and other brain diseases
  • Higher levels of cholesterol are also correlated with lower levels of neurodegenerative diseases
    • Key to avoid oxidation of LDL and not the overall level of it. Do this by limiting the amount of glucose consumed
  • Many overweight people cannot lose weight while still eating carbs because their insulin insensitivity won't allow it
  • Vitamins A, D, E and K are extremely important for overall health and can't be absorbed and transported without fats
  • Cholesterol is vital because it serves as a facilitator for the brain to communicate and function properly
  • Vitamin D is an important antioxidant and anti-inflammatory. Vitamin D deficiency is common and can lead to soft bones, increased chances of dementia, diabetes, depression, and cardiovascular disease
  • Brain burns fat much more easily than glucose and can be considered a "super fuel" for the brain
  • Statins are dangerous because they handicap liver's ability to produce cholesterol
    • Other side effects include memory loss
  • Can reprogram body to be mentally sharp and a fat burning machine by limiting carbs to the minimum and substituting with high quality fats and proteins
  • Cholesterol is a very poor predictor of heart attack risk even though modern medicine touts it so highly
  • Smoking, excess alcohol, lack of exercise, being overweight and a diet high in carbs can lead to elevated heart attack risks
  • The type of diet prescribed here, of high fat and protein and limited carbs, also has tremendous effects on your libido and overall sex life
Chapter 4 - Not a Fruitful Union: This is Your Brain on Sugar (Natural or Not)
  • Consuming both fructose (fruit and honey) and glucose (simplest form of sugar) at the same time means your liver has to work harder than if you ate the same number of calories from glucose alone
  • Fructose tastes the sweetest but has the lowest Glycemic Index score because liver metabolizes most of the fructose quickly
  • The carbs that trigger the biggest surge in blood sugar are typically the most fattening since it increases production of insulin from the pancreas
    • Refined flour (bread, cereal, pasta), starches (rice, potatoes, corn), liquid carbs (soda, fruit juice, beer)
  • The link between oxidative stress and sugar cannot be overstated - as free radicals increase it leads to loss of cellular function and eventually cell death (premature aging and increased risk of diseases)
  • Visceral fat (fat surrounding internal organs) is uniquely capable of triggering inflammatory pathways in the body which disrupt the body's normal course of hormonal actions
  • Have proven that increased weight leads to decreased brain size
  • To lose weight and improve insulin sensitivity, diet is most important and then exercise. Exercise alone without changing a poor diet has little to no effects on improving insulin sensitivity
    • High fat and protein and very limited (gluten-free) carbs
Chapter 5 - The Gift of Neurogenesis and Controlling Master Switches: How to Change Your Genetic Destiny
  • Your brain is supposed to stay sharp until your last breath - that age comes with cognitive decline is a myth
  • We have a direct effect on our genes - our food choices, stress we experience or avoid, exercise we get or avoid, quality of our sleep and even relationships all effect which genes are active and which get suppressed. We can change the expression of more than 70% of the genes directly affecting our health and longevity
  • Physical exercise is one of the most potent ways of changing your genes
  • Caloric restriction (calorie reduced diets by 30%) has many positive health benefits such as reduced incidents of neurodegenerative diseases
    • Intermittent fasting also very beneficial (see Dave Asprey's Bulletproof Diet and infographic)
    • Can help initiate apoptosis (death of cells) which sounds bad but is a critical cellular function where healthy cells replace old or damaged cells
  • Going on a ketogenic diet is very helpful too. Ketones are a special type of fat (medium chain tryglicerides or MCT oil) and helps with cognitive function and decreases risks of cognitive diseases
    • Coconut oil a very rich source and is where MCT oil is derived from (again, see Asprey's Bulletproof coffee)
  • Meditation has numerous health and mind benefits
  • Curcumin (main active ingredient in turmeric) and DHA (found in fish and fish oils) are both extremely important for their anti-inflammatory, antioxidant and antifungal properties. Also help the production, connectivity and viability of brain cells while also enhancing their function
    • Need to consume at least 200-300 mg daily of DHA and it is often difficult to come by simply through food
  • Challenging the mind through reading, crosswords, new challenges and experiences all help fortify and build new neural networks
  • Internal antioxidant system much more powerful than anything we can consume. Turn on and power up internal system by
  • Glutathione is an important antioxidant and major player in detoxification
  • Natural compounds that help turn on antioxidant and detoxification pathways - curcumin (turmeric), green tea extract, silymarin (milk thistle), bacopa extract, DHA, sulforaphane (in broccoli), coffee and ashwagandha)
Chapter 6 - Brain Drain: How Gluten Robs You and Your Children's Peace of Mind
  • Sugars and gluten-laden foods can trigger disorders, mood conditions like depression, chronic headaches, and lack of focus and concentration
  • Mouth breathing is a very clear sign of inflammation. Should be able to breathe freely through the nose
  • ADHD has become one of the most frequently diagnosed conditions in kids today and Dr. Perlmutter explains how many of the symptoms are tied to and can be alleviated through gluten-free diets
    • Gluten has been linked to developmental delay, learning difficulties, depression and anxiety
  • Finding more and more that natural events are often very beneficial - natural birth and breastfeeding can help keep people healthy for life
  • Even signs of autism have improved after implementing a gluten-free and/or dairy free diet. Since many of these neurological diseases are linked to inflammation, reduced symptoms after adopting these types of diets seems to make sense
  • Low cholesterol and celiac are correlated with higher rates of depression. Celiac causes intestinal damage and this can lead to malabsorption of key nutrients which help boost mood
  • Often takes 3-6 months of going on a gluten-free diet to truly experience the full range of benefits
  • Gluten-free diets can have tremendous impact on those with consistent headaches or migraines. Also, obesity a strong indicator of how often you'll have headaches
    • The following help eliminate headaches - consistent sleep/wake cycle, lose fat, be active, limit caffeine and alcohol, don't skip meals, manage stress, eliminate gluten/preservatives/additives and processed foods (especially aged cheese, cured meats and MSG), track the headache patterns
Part 2 - Grain Brain Rehab
  • Discusses 3 key habits to support ideal health - diet exercise and sleep
Chapter 7 - Dietary Habits for an Optimal Brain: Hello, Fasting, Fats and Essential Supplements
  • Fasting and intermittent fasting can have very beneficial side effects as they secrete ketones, improves antioxidant function, increases the number of mitochondria and stimulates the growth of new brain cells
  • Key Brain Supplements
    • DHA - one of the most important supplements and found in salmon, cod-liver, anchovies, flaxseed and avocados. Richest source is human breast milk which is why this is so important for new borns
      • 1,000 mg daily (fish, krill oil or from algae)
    • Resveratrol - found in red wine but not enough which is why you need to supplement
      • 100 mg twice daily
    • Turmeric - helps activate genes which are important sources of antioxidants
      • 350 mg twice daily
    • Probiotics - support intestine's rich bacteria population and can help alleviate stress, anxiety and depression. New research is showing that gut health has much more profound impact on our overall wellbeing than ever thought before
      • Look for products that contain Lactobacillus acidophilus and bifidobacterium and have at least 10B active bacteria per serving. Avoid sugary yogurt though
      • 1 capsule on empty stomach up to 3x daily
    • Coconut oil - help prevent and treat neurodegenerative disease states, is a superfuel for the brain and reduces inflammation
      • 1 TBS daily
    • Alpha-lipoic acid - needed to produce the energy for the body's normal functions
      • 600 mg daily
    • Vitamin D - maybe the most important supplement. Helps with everything from improving cognitive function to reducing the risk of developing Alzheimer's, MS, depression, chronic fatigue
      • 5,000IU per day
Chapter 8 - Genetic Medicine: Jog Your Genes to Build a Better Brain
  • Simply moving your body will do more for your brain than any riddle or brain teaser
  • Running has forever been part of our history and it has been linked to overall health and well being as well as better cognitive functioning
  • Exercise helps with controlling inflammation, increasing insulin sensitivity, influencing better blood sugar control, expanding the size of the memory center and boosting levels of brain derived neurotrophic factor (BDNF, encourages new neurons and synapses to form)
  • Exercise spurs the generation of new brain cells as well as build new networks. Makes neurons more nimble and able to multitask
  • Exercise need not be extremely intense - simple, everyday activities such as cooking and cleaning can have tremendous positive impacts
Chapter 9 - Good Night, Brain: Leverage Your Leptin to Rule Your Hormonal Kingdom
  • Restful and deep sleep is vital for good overall health and wellbeing
  • Sleep affects our metabolism, how much we eat, how fat/thin we get, how well we fight off infections, how well we can cope with stress, how quickly we learn new things and how well we store memories
  • The average person needs a solid and deep 7 hours of sleep
  • Sleep is still very mysterious and research into it is growing rapidly
  • Leptin helps coordinate the body's metabolic, hormonal and behavioral response to starvation and helps determine whether or not we crave carbs and is highly reliant on sleep
    • The less we sleep, the more likely we are to overeat
  • Continuously high levels of carbs makes the body leptin resistant which leads to further overeating and other detrimental health risks
  • Ghrelin is secreted by the stomach when it's empty and increases your appetite. With a diet too high in carbs, ghrelin soars and leads your stomach to essentially be disconnected from your brain which leads to overeating
Part 3 - Say Good-bye to Grain Brain
  • Outlines a 4 week program for better overall health and happiness
Chapter 10 - A New Way of Life: The 4 Week Plan of Action
  • Benefits - clearer thoughts, better sleep, improved energy, fewer headaches, better stress management, weight loss, overall happier and those with neurological disease may begin to notice reduced symptoms
  • 4 goals - shift body from relying on carbs for fuel and add brain-boosting supplements, incorporate a fitness routine, work on getting great sleep and establish new, healthy habits for life
  • Pre-week 1 - determine your baseline
    • Fasting blood glucose - less than 95 mg/dL
    • Fasting insulin - below 3 microIU/mL
    • Hemoglobin A1C - 4.8-5.4%
    • Fructosamine - 188 to 223 micromol/L
    • Homocysteine - 8micromol/L
    • Vitamin D - 80 ng/mL
    • C-reactive protein - 0 to 3 mg/L
    • Gluten sensitivity test with Cyrex array 3 test
    • Remove all sources of gluten, processed foods/carbs/starch, packaged foods, margarine, vegetable shortening, tofu, soymilk from kitchen
    • Be wary that "gluten-free" has no legal meaning at the moment
    • Buy - healthy fats (coconut oil, EVOO, grass-fed butter, avocados, olives, nuts), herbs/seasonings/condiments (but no ketchup), low sugar fruit (avocado, peppers, cucumbers, tomatoes, eggplant), protein (pasture raised eggs, wild fish, shellfish, grass-fed meats), veggies (leafy greens mainly, sauerkraut, brussels sprouts).
    • Pair with Bulletproof infographic which has all this information summarized in an easy to digest form
    • In moderation - milk, stevia, dark chocolate, glass of red wine, legumes
    • Ideal to start week 1 after a full, one-day fast. Nothing but water for 24 hours - recommends a Sunday and start program on a Monday
    • Recommends fasting 4 times per year - last weeks of September, December, March and June
  • Week 1 - focus on food
    • See supplement list above
    • No focus on calories and is self-regulating in that you'll naturally stop and feel sated for hours
    • Lower carbs to 30-40 grams per day for the 4 weeks and after can raise to 60g per day
    • Avoid eating out
  • Week 2 - focus on exercise
    • Aim to sweat once per day
    • Make it something fun and sustainable. Can be as easy as a brisk 20 minute walk
    • Recommends trying to get around 30 minutes per day for at least 5 days per week
    • Limit sitting as much as possible, take stairs, incorporate as much movement into everyday activities
  • Week 3 - focus on sleep
    • Sleep at least 7 hours per night
    • Maintain a regular sleep cycle and establish a routine
    • Identify ingredients hostile to sleep (medicine, caffeine, alcohol, screens, light, nicotine, etc.)
    • Try to eat dinner 3 hours before sleep
    • Eat on a regular schedule
    • Try a bedtime snack (cottage cheese, turkey, chicken, eggs, almonds) but make it light
    • Reduce screen time
    • Minimize sleep aids such as PM medicine formulas
    • Be aware of your toiletries and beauty products as often they contain gluten
  • Week 4  - put it all together
    • Tips - plan each week in advance to avoid pitfalls and to make good choices routine, prepare shopping lists, be flexible but consistent (don't let a small slip derail your efforts), find a motivator (vacation, hike up Mt. Kilimanjaro, etc.)
    • Can eat out successfully if stick to these tips but should be minimized
  • Post week 4 - repeat baseline tests to see results
    • Try to adhere to an 80/20 rule or even 90/10 rule. Can't be perfect but don't want to fall off the wagon too much
Chapter 11 - Eating Your Way to a Healthy Brain: Meal Plans and Recipes
  • Look for local foods that are in season and for proteins look for organic, local and grass-fed
  • Won't tell you how much to eat, simply what to eat. Your body will know when to stop
  • Stick to mainly water - half of body weight in oz (150 pounds drinks 75 oz of water) but can also have moderate amounts of coffee and tea (don't drink after 2pm) and a glass of red wine at night
  • Save fruit as dessert, can mix with coconut milk and stevia
  • Can use olive oil freely and can interchange coconut oil and olive oil
  • Have snacks ready at all times - nuts, chicken, hard boiled eggs, salad, raw veggies, avocados
    • Travels with avocados and cans of wild-caught sockeye salmon

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