A neurologist’s view on brain health

David Perlmutter was one of the early messengers in this field, and he has a new book on the way.

You wonder about anyone described on the internet as an ‘American celebrity doctor’, but he’s a neurologist who’s written several books on the brain. He even has a son who does the same thing.

The book that created his reputation was Grain Brain in 2013. The tag line was: The Surprising Truth About Wheat, Carbs, and Sugar.

He was making the case that what we eat affects our brain function, that the brain isn’t a stand-alone organ, as it had mostly been thought of. In short, our metabolism plays a huge hand in shaping the way our brain works.

The conventional medical world thought this was a bit too alternative for its liking and there was considerable push-back. But here we are over a decade later with no cure in sight for diseases such as Alzheimer’s and a slowly dawning realisation that Perlmutter was right.

The arguments he made don’t just apply to dementia. Conditions such as Parkinsons and multiple sclerosis live under the same neurodegenerative umbrella.

While there are other factors that affect the health of our brains — exposure to toxic chemicals or direct trauma, for example — metabolism is one that’s clearly within our control.

For that matter, metabolism doesn’t just affect the brain. It affects everything. It’s a pity that because of the way medicine is carved up we fall into thinking of each body part in its own box.

How often do we hear about, say, a ‘heart healthy diet’. As though the heart has special needs that are different from any other piece of us.

Perlmutter himself has said that although we talk about the gut-brain connection, what about the relationship between the gut and bone, gut and mood, or gut and heart?

One of the other points he  makes is that we often think of diseases such as dementia as arriving in old age, but that most neurodegenerative conditions have been 20-30 years in the making before they show up.

So instead of crossing our fingers and hoping we don’t have a failing brain at 80 or 90, we’d be better off reminding ourselves that what we do at 50 or 60 creates our future brain function.

The book he has on the way is called Brain Defenders. The early marketing for it — celebrity doctors have major marketing resources — points to a focus on the brain’s immune cells, called the microglia.

They can work for us or against us, and how they behave is determined by our metabolism. Brain Defenders will presumably teach us how to get our microglia happy, healthy and on side.

In the meantime, here’s a list of things he recommends to support good brain function. Not much new here, but it’s a handy reminder.

First is exercise, which he describes as an under-rated brain tonic. It creates beneficial chemicals for the brain, helps generate new brain cells and connections, improves insulin sensitivity, and reduces inflammation.

Aerobic and strength exercise are both valuable, along with mobility, flexibility and balance training.

Again, referring back to the way we think in boxes, we relate to muscles as helping us stay upright or lift things, but they’re also part of our endocrine (hormonal) system that sends chemical messages all over the body.

Number two is avoiding ultra-processed food. A permanent fixture on any how-to-stay-healthy list.

Number three is eating more fat, given the brain is largely comprised of fat. Healthy fat, of course: omega-3 fats, good olive oil, avocado, nuts, and so forth.

Number four is eating a range of colourful plants.

Number five is keeping a healthy gut microbiome. He’s a fan of probiotics and prebiotics, and fermented foods.

Maybe this should have its own number on the list, but he also advocates managing the health of our mouths — the oral microbiome. If bacteria from any source make their way into the circulation and promote inflammation, our organs can be negatively affected.

As expected, number six is getting enough sleep.

And number seven is staying connected and keeping our brain function stimulated.

Let’s see what Brain Defenders has to offer later in the year.