Brain Health, Food and the Gut Interview with Marc David and Dr. David Perlmutter

Marc: Welcome, everybody. I’m Marc David, Founder of the Institute for the Psychology of Eating. Here we are in the Future of Healing Online Conference. I have the wonderful honor of being with truly an amazing human being, Dr. David Perlmutter. Welcome, Doctor David Perlmutter.

David: Marc, I am delighted to be here. Thank you.

Marc: Yay, thank you. Let me say a few words about you and what you’ve been up to to give you, the listeners, caught up. Dr. Perlmutter is a Board certified neurologist and Fellow of the American College of Nutrition. He’s the author of the number one New York Times bestselling book Brain Grain: The Surprising Truth About Wheat, Carbs and Sugar, Your Brain’s Silent Killers. This book has appeared for more than 33  consecutive weeks on the New York Times bestseller list.

Dr. Perlmutter is a frequent lecturer at symposia sponsored by such medical institutions as Columbia University, University of Arizona, Scripps Institute, NYU and Harvard. He’s contributed extensively to the world medical literature and is the author of seven books, Editor in Chief of the peer­reviewed medical journal Brain and Gut.

Dr. Perlmutter has been on numerous national broadcast programs. In addition he’s a recipient of the Linus Pauling Award, Humanitarian of the Year award from the American College of Nutrition, lots of others. He also serves on the medical advisory board the for Doctor Oz show. His newest book is The Brain Maker. I like that title.

David, why don’t we start from the big picture. You’ve said that many of our most feared brain conditions are preventable. Can you explain?

David: I can. We live in a society where it’s pretty much, at least as it relates to brain disorders, a situation of diagnosis and adios. Meaning we make the diagnosis, name the disease and then you’re pretty much on your own.

As it relates to Alzheimer’s disease affecting 5.6 million Americans, costing us about

$200 billion a year, twice what we’re spending on treating heart patients, there is no treatment. As you and I have this conversation, Marc, right at this moment that disease has no treatment and certainly no cure.

Yet we now fully understanding that wonderfully researched publications have demonstrated that to a very significant degree Alzheimer’s, for example, is a preventable disorder and a reversible disorder. Doctor Dale Bredesen at UCLA has recently published his results actually demonstrating reversal of the symptoms of Alzheimer’s. People regaining cognitive function by making some very significant lifestyle changes which really center upon actually working on the causes of inflammation in human physiology.

We now recognize that the cornerstone in neurodegenerative conditions like Alzheimer’s, multiple sclerosis, autism, even Parkinson’s and to some degree ADHD, that inflammation really acts as a pivotal, mechanistic player related to all of those conditions.

Your viewers of this podcast may be surprised because they may think of inflammation as getting bitten by a mosquito and your arm gets inflamed, but inflammation is a cornerstone mechanism in heart disease, diabetes, cancer and now we know in brain degenerative disorders as well.

What is so powerful is the notion that we now understand that at least with respect to these systemic issue like I’ve mentioned, that the gut and the bacteria contained within the gut play a pivotal role in determining how much inflammation is in your body.

We therefore turn to the gut as an opportunity to give us tools to really for the first time have an opportunity to really make changes and reducing inflammation. I think it is dramatically blowing the doors wide open in terms of our ability to now for the first time in history have a meaningful impact not only in treating these devastating conditions   but actually in their prevention.

Marc: Let me ask you this question. When did you as a neurologist first start to realize that on so many levels ground zero for neurology is the gut? When did that occur to you and how has that been rolling out for you?

David: I’m going to tell you, Marc, I’m not going to tell you there was an epiphany moment,   that I can tell you that on that specific date it hit me like a thunderbolt. It didn’t. I think I’ve always initially in my career as being trained as a neurologist felt very shorthanded coming to the job with very few tools in the toolbox. That basically I was instructed

during my residency in terms of treating symptoms with drug remedies, and very poorly at that.

We treat headaches by giving headache pills, etcetera, much as you might treat high blood pressure by giving blood pressure medications. If you pay attention to certain lifestyle issues that lead to these problems, that are causal, that becomes the powerful leverage point.

I came to this understanding with a desire to open up the toolbox and gain more tools. More and more it became clear that the notion of the brain being over here and the gut being over here was really not founded ever in the history of medicine. This call it holistic, if you will, but a unified approach to dealing with human health and illness is really the most comprehensive approach that we have ever had. It’s always been this way.

The reductionist mentality purported and brought into the field of medicine and health really from the early work of Descartes, looking at the body as basically a machine, has not served us well in any way.

When we look upon the brain as being completely disassociated from the gut it   isolates the powerful approaches that we could take because it’s very narrow­minded, it’s myopic. Gastroenterologists are interested in the gut and don’t pay any attention to the brain. Neurologists think that really there’s nothing below the foramen magnum   that they’re interested in and as such they are cutting themselves off from a very rich potential in terms of leverage points to really have a powerfully meaning impact in  some of our most devastating conditions.

For example, we now fully recognize that there is a unique fingerprint of the gut   bacteria that defines autism, for example. When you look at the gut microbes and you  do an analysis of those bacteria that live within the gut you find that the autistic gut, the autistic stool specimens that you look at have a unique signature.

When you look at those bacteria that are found characteristically in the autistic patient what you find is, for example, an overgrowth of one species or one type of organism called clostridia. Now, we’re now seeing a dramatic increase in clostridia infections in humans causing a disease called clostridium difficile. Thirty to forth thousand Americans are hospitalized each year with what is called C. diff.

Interestingly enough, it’s now been demonstrated that the most powerful approach to treating C. diff has been what’s called a fecal transplantation, meaning taking fecal material from a healthy person and transplanting that into the C. diff patient to reestablish balance. That’s about 92 to 96% effective in treating C. diff, now being done in more than 150 hospitals here in America.

Much less effective is the standard treatment that has been used for a long time, antibiotics, which is about 28% effective. Think about that. By restoring balance to the gut, that’s become the most powerful approach to treating this imbalance which leads to overgrowth of C. diff.

Now, I mentioned a moment ago that we’re also seeing overgrowth of clostridial species, a different type of clostridia called clostridia histolyticum in the autistic patient. The idea is what can we do as a possible treatment in autism to reestablish gut health and hope that we get some benefit from a neurological perspective.

It’s heartening to see. In fact, in Brain Maker I actually reported a case of a child, a ten year old child with autism, whose mother was able to arrange for him to undergo fecal transplantation. He regained almost perfect fluency of speech, became almost completely socially interactive. She has agreed to allow me to place a video of him on our website, which we will do when Brain Maker is published. I don’t know when this is going to air, but probably by that time. We now recognize that the University of Arizona is recruiting autistic patients for fecal transplant as a treatment for that disease by reestablishing gut health.

Over the years and as you and I have been having these conversations we’ve talked about things like gluten and high carbohydrate diets and their damaging effects upon the brain through the mechanism of inflammation. Now we’ve taken it to another level. We’ve taken it to a level where it’s not just the foods that we eat but how those foods that we consume influence the balance of gut bacteria and how that then influences brain health function and disease.

When you recognize that for example 95% of the neurotransmitter serotonin is manufactured in the gut and there’s a relationship between serotonin and something like depression, we begin to understand that the balance of gut bacteria has a role to play in depression. The balance of gut bacteria, because it has a role to play in

inflammation, influences our risk for any number of brain degenerative conditions as well as things like obesity, diabetes and even cancer.

Again, this is an intervention. This is a leverage point then for us that opens up the door to vast possibilities well beyond the brain. Certainly I’m not saying that the only available opportunity to reprogram the gut comes from a fecal transplantation, but looking at foods that are probiotic in and of themselves, like fermented foods. Like kombucha and kimchi and yogurt and kefir, for example. Prebiotic foods, foods that contain things like inulin, that will enhance the growth of good bacteria, foods like jicama or Mexican yam, dandelion greens, chicory root, garlic, onions. These are foods that tend to enhance the growth of good bacteria.

Then again, from a preventive perspective, recognizing that we in America are dramatically overusing antibiotics and that is having a devastating effect upon the balance and the diversity of organisms, of bacterial organisms that live within the gut.

Marc, you have in your body ten times more bacteria than you have Marc cells. You  are 90% bacteria and only 10% you. Your body is the vessel, the repository for this organ that we now call the human microbiome. Ninety­nine percent of the DNA in your body is bacterial. Your DNA, your 22,000 genes that everyone is so excited about that were sequenced, if you think that’s a lot of genes the rice plant has twice as much   DNA as you do. It’s not as if the number of genes that we carry is somehow related to our complexity.

We have offloaded our genetics. You don’t carry around every picture that you own on your iPhone. You carry around some but you know you have access to them because they’re downloaded to the cloud. You can always refer back to the cloud for more information. In much the same way we refer to the cloud of genetic information that is stored within the genome of the bacteria that live within us, the microbiome.

This is a revolutionary time in human understanding what really is underlying human health and illness. Of course, from my perspective finally some very powerful information that’s giving us great tools to really in a very powerful way treat brain disorders.

Marc: As you’re speaking I’m taken by in part this amazing metaphor that we’re home for trillions of these bacteria that are essential for us. Part of me wants to start charging rent. This could be another income stream here.

David: They’re paying. They’re giving you your health and your life. That’s what they’re paying for the warm, moist environment and the foods that you are providing to these organisms. Without them you’d have no immune function. You wouldn’t be able to respond to your environment.

You have to understand that the lining of your gut, if you opened it up, is a size of a tennis court. That is the relationship that you have with your external environment. Everything that goes on within your gut profoundly influences moment to moment your health in very way. Your absorption of nutrients, your levels of immune function, your levels of inflammation, the production of various vitamins and even the production of  the neurotransmitters.

It’s all based upon the array of bacteria that live within us. We, in Western cultures, when you look at the array of gut bacteria we find that our level of diversity is dramatically reduced in comparison to cultures that have less obsession with hygiene.

We have a hand sanitizers at the end cap of every aisle in the grocery store, God forbid we should be exposed to germs. Our children are not allowed to play in the dirt and our environments are very, very sterile. As mentioned, we are grossly overusing antibiotics. Seventy­five percent in America of the antibiotics we are using actually go into livestock and then become another part of our food chain.

Interestingly, as Doctor Martin Blaser has written in the book Missing Microbes, he believes that this incredible exposure to antibiotics that we have and the changes that have occurred in our gut bacteria because of our misplaced faith in antibiotics may be related to our obesity epidemic.

One of the reasons that antibiotics are given to cattle is because it immediately fattens them up. That was discovered in the early 1950s. That’s why we continue to use antibiotics in animal husbandry, or in growing of these animals, because it makes them fat. It makes them more valuable. We’re now seeing governmental involvement in that with the hopes of reducing that or hopefully eliminating antibiotic exposure in that  regard.

Keep in mind that you go to the walk in clinic with the sniffles or cough and if you don’t walk out with a prescription for an antibiotic you’re going to ask yourself, “What did I   just do? Why did I waste my time? They didn’t give me an antibiotic, a bacterial antibiotic, for a viral illness.” I tell my patients two things. That’s like having your gallbladder removed if you have appendicitis. It makes no sense. Also, I say if you   have a cold and you go to the doctor for an antibiotic and get an antibiotic your cold is only going to last a week. If you don’t take the antibiotic it’s going to last seven days. Is usually takes them a few moments to process that. That’s a joke, Marc, stay with me   on this.

The point is it makes no sense to take an antibiotic when you have a cold. We now    see literature in very well­respected, peer­reviewed journals that indicates that the idea of, for example, taking an antibiotic when you go to the dentist to have your teeth cleaned because you have an artificial hip or you have an artificial knee doesn’t make any sense. The risk of infecting that prosthesis is not increased if you don’t take an antibiotic.

People are finally coming to the realization that this very profound over usage of antibiotics is clearly having a potential serious downside. Not just in changing the microbiome but also in creating antibiotic resistant organisms, which I’m sure all of the viewers of this podcast will realize is becoming a very real issue indeed.

People now know the term MRSA. Everybody has heard of MRSA, methicillin­resistant staph infection, staph which makes treating these infections very, very challenging. We never had that growing up. We didn’t have infections for which we had no antibiotics.

That prediction has come home to roost.

To get back to the original part of our discussion, we’ve got to welcome dirt back into our lives. We’ve got to be dirty. Let our kids play in the dirt and don’t be so overly concerned with sanitization of everything.

I might just take a step back and talk about for a moment where we get the   microbiome. How did we get these bugs first as we enter the world into our intestines, into our mouths, onto our skin? We get them through a very profound mechanism. It’s called birth. When we are born we pass through mother’s birth canal. The bacteria that live in the birth canal are absolutely perfectly ready to inoculate the newborn with a

microbiome that will allow him or her to respond to his environment, to be able to process the lactose sugar in mother’s milk, to be able to respond to those immunoglobulins that are presented in human breast milk, to be able to respond to the bacteria that are on the skin of the mother on the breast to, again, further develop that microbiome.

When a child is born by C­section, Cesarean section, and let me say that this is not mommy bashing. This discussion that we’ll have now is really first to be prefaced by the idea that C­sections save lives. They’re fundamentally a wonderful procedure to save the life of mother or newborn or infant being born.

That said, the idea that a third of all births in America have to be created by C­section is certainly an interesting statistic. That would mean that a third of al pregnancies are complicated and require a C­section. We know that not to be true. With all due  respect, some C­sections are performed out of a matter of convenience.

When a child is born by C­section he does not pass through the birth canal and is therefore deprived of that perfect array of bacteria that so fosters the creation of a highly functional microbiome, a highly functional array of bacteria in his or her gut. Because the gut bacteria plays such a fundamental role in immune function, being born by C­section is associated with a significant increase in immune and inflammatory issues.

For example, being born by C­section is associated with an 80% increased risk for developing celiac disease. It’s associated with a three­fold increase in developing ADHD. It’s associated with a doubling of the risk of having a child with autism. It’s associated with a 70% increased risk of type one diabetes. These are illnesses which are serious and which are predicated on immune disregulation and inflammation.

Again, I want to be so clear that C­sections are an important tool that we have to save lives. I’m making these correlations because I think it’s very important to strengthen   this understanding of the role of the microbiome and the creation of that microbiome in terms of immunity and inflammation and how that may have effects later in life.

The 50% increased risk of obesity being born by C­section, that’s something that occurs later in life. There’s a direct correlation between obesity and risk for

Alzheimer’s. This becomes a very germane discussion as it relates to the notion of preventive medicine with reference to brain health. I think that’s very important.

Marc: Really what’s happened is we’ve opened up this door called brain health. It leads us in part into the gut. Which leads us in part to the birthing process, for goodness sakes.

There’s such a return here to I think just some of the primal aspects of being a human being alive on planet Earth. You’ve talked about letting your kids play in the dirt, for goodness sakes.

There’s something about our nature it seems like we’ve lost a little bit. As per your discussion, we’re starting to circle back now because clinical experience tells us so, because science tells us so. I think that’s amazing.

David: Well, look, we’ve been here for two million years so it works. The whole thing works.

We can talk about the Paleo diet, and I think the Paleo diet is an idea that is really very important. We look at the idea of eating foods that to some degree emulate what our forbearers consumed because it worked for them. It’s well beyond that.

It’s understanding that we are a modern day organism functioning on a Paleolithic set  of instructions. To look at the birthing process, for example, as a way of effecting the newborn from well beyond the fact that she or he inherited mom and dad’s genes, but  in more importantly how that individual is programmed with respect to the microbiome, being born through the birth canal, is I think fundamental. Here is the transfer of 99%   of genetic material, far more than mom and dad’s gametes coming together to form   this perfect union.

Now, this is what we call vertical transfer of genetic information, this process of giving the child at birth his or her final set of walking orders. The last minute, most up to date information about what that child should expect from an environmental perspective is transmitted at the moment of birth by passing through the birth canal.

Now, those bacteria, the array of bacteria in the birth canal change during the course    of a year. If a child’s born at one time of the year it’s going to look different than born at another time of the year. If a child is born to a mother who is living in an environment where she doesn’t have adequate nutritional status, that will be reflected in the change of bacteria. That changes in such a way to make that child more adaptable to this

environment where food sources may not be readily available. Really it’s a breathtakingly beautiful paradigm.

It’s not limited to mammals who deliver their children through the birth canal. We see it in birds. We see it in reptiles. It is seen in mollusks or clams or oysters, shellfish. It is seen even in sponges, the transfer, this vertical transfer of material, of genetic   bacterial information at the time of birth. This goes back hundreds of millions of years  as a very fundamental mechanism of informing the newborn and giving that newborn the best chance at survival, which is what transferring genetic material is really all about.

The Paleo diet is one aspect of honoring our heritage in terms of treating human physiology in a way that it has evolved over millions of years to be in complete harmony with the environment. It’s a very deep but on the upside it’s a very empowering discussion.

When we recognize that there are ways to reestablish gut health by taking probiotics, by consuming prebiotic foods, probiotic foods that I mentioned, by limiting our exposure to damaging things that change the gut bacteria this is health at an all new level.

We have to take a step back and understand that there are many environmental issues these days that are very relevant in terms of this discussion. For example, the discussion of genetically modified foods, the role of GMO in terms of changing the human microbiome is only just being explored at a time when the genie is very much out of the bottle. Just recently genetically modified apples have now been approved. Down here in Florida they are about to release genetically modified mosquitos in the Everglades so that mosquitos don’t replicate. They’re an important part of the food chain.

I think also, more importantly, is the fact that here in America most of the GMO  mentality has been geared at creating what is called Round­Up resistant crops, crops that are created so that we can use ­ I don’t want to say we, I don’t want to be included in that group. So that glyphosate or Round Up can be sprayed on our food and it’ll kill the weeds but won’t kill the crops. It won’t kill the corn and it won’t kill the soy.

The problem with that mentality is beyond the fact that the corn and soy have been genetically modified, there are residues of glyphosate or Round Up in the food chain to s a significant degree. We know that glyphosate, the active ingredient in Round Up, is   in fact a significant modifier of the human microbiome.

Now, the role of that in terms of a long­term health consequence is not being explored to any significant degree. This represents a clear and present danger that we really need to have discussions about. Glyphosate affects mitochondrial function, it affects cytochrome P­450 detoxification, it affects the way that we metabolize what are called aromatic amino acids, which are the precursors to our neurotransmitters serotonin and dopamine. I mentioned serotonin before in terms of its role in depression.

We’re covering a lot of area today, but that said I think these are fundamentally critical issues that I am discussing with you today because your audience is the audience, I think, that can implement changes and vote with their wallet saying, “Yes, I want to    buy food that bears the label non­GMO.” We want to vote with our wallets so more and more food purveyors and manufacturers of products will recognize the value of   sourcing ingredients that are not genetically modified.

Marc: David, I want to make a big picture comment and I’m going to state the obvious. What fascinates me about this conversation is here we are, we’ve ended up talking about these tiny you can’t see them with your naked eye organisms. They are really leading us into a conversation about what is health, what’s good nutrition, how should we birth our children and what’s going on with food companies, what’s going on with the environment.

It feels as if the conversation of nutrition can no longer be limited to, “Hey, what’s good for me to eat?” Of course we want to know that information but, wow, is everything connected here and we have to look at our entire world and how we do business to really understand what’s happening in my body.

David: Chief Seattle said that man did not weave the web of life, he is only a strand in it.

Again, this takes us to this understanding of our vast interconnectedness. Not just with other people on this planet but to the entire biosphere, the entire global biome. The health of your body is dependent upon the health of the multitude of organisms that   live within you. When you take that to the macro level, the health of Gaia, the health of

our planet is certainly dependent upon the health of all of us as people representing the Earth’s microbiome.

You take this to multiple levels. I think that we’re not going to legislate these changes because we’re up against powerful organizations that want to continue to manufacture these products. I think from a consumer perspective when we see going from 2007 to 2014 the number of Americans in a survey who indicated that they have done their   very best or at least tried to avoid GMO has gone from 15% to 40%, voting with your wallet is very, very powerful. That changes what people then supply to us to purchase.

My call to the viewers is choose GMO, choose organic as much as you possibly can. Then in that small way you’re voting for the purveyors of these products to make those products more available to you. Hopefully there will come a day when most of the food available to us is organic.

Yes, you mentioned a moment ago that it’s beyond just the food that we eat. I would submit that in terms of the health of the microbiome, that our food choices are    probably the most powerful influence that we can wield in terms of healing the microbiome, in terms of increasing the diversity of gut bacteria. When you eat foods  that are organic, especially those that have come right out of the ground, your ability to inoculate your gut with a more robust variety of organisms, I think, is enhanced.

Marc: Help me understand how you made the leap from Grain Brain to Brain Maker. First, tell me when Brain Maker comes out.

David: Brain Maker is coming out August 28th of this year, 2015.

Marc: Okay, so this is airing at the end of June, so shortly thereafter Brain Maker comes out. Tell me some of the reasons. I know we’ve been talking about it. Perhaps a why else you’re excited about this book.

David: Well, I guess you can see I’m very excited about it. By the time this airs Brain Maker is already out. Your viewers will know what’s going on with Brain Maker. I think if you  want to see the nuts and bolts about what is going on with this book just go to  YouTube. There’s a trailer, Brain Maker trailer. Just put that on YouTube and you can see a really cool video clip about what the book is all about.

I’m not trying to aggrandize this situation, but I think this is representing a paradigm shift in our total understanding of human health. We’ve been inoculated, inculcated with the notion of germs being the enemy. Every germ, every bacteria is a pathogen and we’ve got to be germ free. “Oh my gosh, my child just touched the ground, I’m going to wash his hands quickly.” That’s the worst thing that we can do. We’ve got to welcome back to the table the notion that germs are our friends, that they are fundamentally important for our health.

When we see globally the research going on in the human microbiome, that in America hundreds of millions of dollars are now dedicated to the human microbiome project, scientists are getting it.

My mission in Brain Maker was to really do what Grain Brain did, and that is to really put it in your face that we’ve got to really understand what our scientists are exploring. In Brain Maker it’s where we are with this powerful role of the gut bacteria in every aspect of human physiology and therefore in terms of every aspect of human health and disease. With Grain Brain we were all over the notion that welcoming back to the table dietary fat is a good thing and restricting our carbohydrates is very, very important.

At the time of this recording today you’ll note that it was just last week that an advisory dietary committee, a government committee told us that we’ve got to do exactly that. We’ve got to start welcoming back to the table foods higher in fat, that carbohydrates are the killers, that there is no relationship between dietary cholesterol and risk for coronary artery disease or any other disease, for that matter.

Earlier this year, in April of this year, of last year, 2014, how welcomed it was that the Annals of Internal Medicine published a report indicating in their study of over 500,000 individuals that consumption of higher levels of the dreaded saturated fat conferred no added risk for coronary artery disease. Yet all these years we’ve been told you’ve got  to eat low fat and don’t eat this because it contains saturated fat.

We’ve got to understand that it’s time to stop scientizing our foods and recognize that the best foods that we should eat are the foods that we’ve always eaten. I’m not concerned about the past few decades when scientists told us low fat, use artificial sweeteners and by all means don’t worry about eating carbs. That is a complete

aberration that hopefully we can put to rest and recognize it was a period of our naiveté that we told people that.

Paleo type foods are important, really what we’ve got to pretty much fill our plates with. This is an area that people say, “Gee, you’re talking about eating meat and all these things. It’s in such contrary distinction to things discussed in the China study and the people who are vegetarian are talking about.” Not really.

Most of the plate needs to be filled with fiber­rich, nutrient­dense, generally above­ground vegetables that are colorful. You can welcome back to your plate meat, eggs, fish, etcetera. We’ve got to be careful how these are sourced. Meat should be grass fed, not grain fed.

There’s been a statement that it takes 14 or 16 pounds of grain to make a pound of beef. Well, that whole notion is, in my opinion, not very appropriate. Cows shouldn’t eat grain, never have eaten grain nor has their predecessor, the arac, which is where cows came from, they ate grass. When you return those animals to their Paleo diet, which was grass, then you create a healthful food, a food that’s much higher in the omega threes, inflammation reducing omega threes, that reduces the omega sixes, that caters to the human microbiome.

Again, we’ve talked about this. This is getting people back to the garden like Joni Mitchell wrote when she wrote the song Woodstock. We’ve got to get ourselves back   to the garden. We’ve got to get ourselves back to the original lifestyle environment that created us, that made us who we are. That can be the garden of Eden, whatever  garden you want to think about.

The point is we’ve got to understand that every bit of our discussion today has centered upon the science of what is called epigenetics. The idea that the human genome is nothing fixed, it’s nothing static. It is highly responsive and expressive in terms of its signaling from the environment.

The most powerful signaling to our genome to change its expression, to upregulate certain genes to protect us at certain times, has to do with both the food that we consume and the role therefore played upon our food on the microbiome and how the bacteria in our guts change in terms of their gene expression. Even more heady is the

notion that the bacterial expression in the gut affects our own DNA. Changes in the complexion of the gut bacteria affect the expression of our own DNA.

Those 23,000 genes that we carry, they’re altered in their expression by the ratios of healthy to disbiotic bacteria that are contained within our gut. That is affected by our food choices as well. Wow, there are a lot of entrance points into this discussion, aren’t there?

Marc: It’s a brave new world and it makes me think. Here we are, we started out talking   about brain health. It takes a very I want to say flexible mind to embrace many of the concepts that you’re introducing. Indeed, having a flexible mind will help us have a better brain and a better mind and all that sort of thing. I’m just really taken at what our opportunity is here, really.

David: Yes, that’s the empowering part. It’s wonderful to embrace this information and look at the various vectors that are coming in to alter our health based upon changes in the microbiome. I see the glass as much more full than even halfway because you said it very well. This offers us up great opportunities to intervene based upon our new understanding of this science and these new, very powerful leverage points that are  just beginning to be defined and giving us incredible opportunity to not only reverse disease but to keep people healthy in the long run.

Marc: If you could wave your magic wand and have a bunch of wishes fulfilled for the next couple of decades in terms of where this is all going to go, what would you like to see happen?

David: I think that I’d like to see mainstream, well­funded pharmaceutical endeavors to get involved with this. I think that’s going to happen. I’d like to see, as mentioned, a bigger understanding on the part of the general population in terms of the role of the gut bacteria in health and how influences like food choices play and perversions of our  food choices like GMO and glyphosate are affecting the microbiome.

I would say I can foresee a time, maybe a decade, maybe two decades from now, where there will be specific interventions geared at restoring the microbiome in terms of being actually disease specific. In other words, treating specific disease by offering up specific species of organisms to be implanted in the gut to specifically target a disease.

Beyond that, I think we’re going to come to a time when preemptively people will undergo 16S RNA sequencing, or characterizing their gut microbiome. In fact, there  are companies right now that offer that up. There is a company called uBiome that’s  out there that can actually allow you to look at the bacterial array that you have, which   I think is great. The question that I have is what do you do with that? We don’t know what to do with that yet.

What I’m hoping is in the near to mid­term that we then can look at that information    and then say, “Okay, here is what we found and here is what will be more ideal for that individual. Here is how we can correct it.”

Here’s what we can do today. Again, we can implement the knowledge base that we traumatize our microbiome with chlorinated water, with exposure to toxins, with over usage, non­judicious usage of antibiotics both directly and also in our food chain. That we’ve got to emphasize whenever possible vaginal delivery as opposed to Caesarean section. That, again, we shouldn’t be treating our children with antibiotics every time they have an ear infection or a cold. Recognizing that each of these events alters the microbiome.

This is a big call for breastfeeding. That’s an important player in the developing microbiome. Finally, understanding that we can augment and enhance the diversity of organisms in the gut by our food choices, by choosing foods that are rich in probiotics, fermented foods as well as prebiotics that I’ve already listed.

There’s good news here. There’s great news. This is the new dawn. This is as big a news as the discovery, the creation of the so­called germ theory, the antibiotics that followed that which saved countless lives.

I’m not knocking antibiotics, I think they’ve been a powerful tool. When I was a kid my dad had bacterial endocarditis. Had it not been for intravenous antibiotics it’s quite clear what would have happened to him. There are countless stories. Antibiotics have a place, a very valuable place.

It’s certainly quite clear that they’ve been and continue to be aggressively misused. We’re paying the price for that.

Marc: Here we are in a brave new world, amazing opportunities. It feels like this body of research is just exploding. It’s exploding now. Why don’t you give us a sense of how we can stay on top of this, stay in touch with you and your world and other resources that you can recommend from what you’re doing. Fill us in.

David: Sure. I have a website, DrPerlmutter.com. I blog almost every day. Generally the nature of my blogs is I pull a peer­reviewed study, I attach it to the blog and then I explain it so everybody can understand why it’s important.

For example, a recent blog demonstrating the role of inflammation in depression. Who knew? Who knew that there are higher markers of gut permeability found in   depression than individuals who aren’t depressed? I link to an article peer­reviewed, I explain it. Follow me closely there.

I do a video post every week. Hopefully by the time this interview airs I will have a weekly podcast that will be live probably on a platform that allows people to interact with me in real time.

I have another PBS program that will be airing in September of 2015. I’m doing my   best to get this information out. It is exploding, no question. This information is  exploding around the globe because people finally are recognizing the potent leverage points that are offered by embracing this information. We’re at the very primordial   stage of our understanding of this.

You ask me 10 years, 20 years, I can only wait to see what we’ll be doing at that time.   I think this is a brave new world in a very, very positive way and it’s probably what we’ve been waiting for. It’s absolutely the paradigm shift.

Marc: Dr. Perlmutter, thank you for continuing to be a cheerleader, an innovator, somebody out there at the front lines really digging this stuff out from the research and translating  it and making it understandable for the general population. Again, what you’re saying,   it is profound and I’m thrilled about it because as you’ve said, you gave a couple of powerful examples of how this can really work in a real, live way, in a clinical way.

We’ve got some powerful tools to use. Thank you so much.

David: Marc, thank you for the opportunity. I want to commend you for what you do. Getting information out like this is helping a lot of people. You’re helping push the ball down the field and I sure want you to know how much I appreciate that.

Marc: Thanks so much, my friend. That’s what we do. Thank you, David. Thanks, everybody, for tuning in. I’m Marc David on behalf of the Future of Healing Online Conference.

Lots more to come, my friends. Take care.