Jodi: Welcome to the Parasympathetic Summit. I am your host Jodi Cohen. And today’s guest, Dr. David Perlmutter, is a board-certified neurologist, fivetime New York Times bestselling author, and he serves on the board of director and is a Fellow of the American College of Nutrition. And I’m really excited to be talking about some of the topics he’s covering in his new book Brain Wash, specifically, this idea of disconnection syndrome. Can you please speak to that?
Dr. Perlmutter: Certainly. So it actually is a bit of an encompassing term. We take it from the brain physiology meaning all the way to the societal meaning of the term of being disconnected. And let’s start small. And then we’ll generalize. From the brain perspective, early on in the book, we described two very important areas. One is called the amygdala. And this is a primitive brain center that’s involved in things like impulsivity, and the making of decision just impulsively, self-centeredness, narcissism, anger, fear, tribalism, and is in contrast to another area of the brain called the prefrontal cortex that sits up behind your forehead.
And this is really a human attribute. At least having such a large prefrontal cortex. And that’s an area of the brain that is involved in things like planning for the future, thinking about our decisions in terms of how they’re going to play out, what will their consequences be for us, for our neighbors, for others, empathy, how we feel towards our future selves, how we feel towards others, how we care for the planet.
And importantly, this adult in the room, this prefrontal cortex exercises control over the amygdala. So it calms down impulsivity. It calms down the sense of, “I’m right and you’re wrong.” And that connection is so incredibly valued for exactly that reason. And what we’ve identified is that so many features of our modern lives are disconnecting us from this prefrontal cortex, disconnecting us from thinking about tomorrow, thinking about other people, thinking about our planet, thinking about our future selves. And that is, at least, from the brain perspective what disconnection syndrome’s all about.
Dr. Perlmutter: We’ve come to realize, in our modern world of being told to socially distance, that we need to still be very much connected to other people. We are social beings. Our health absolutely is influenced by the degree of social connectiveness that we experience. What is our social capital? How do we measure that? And that social isolation is indeed very common, especially in urban environments, and is associated with risks for some really bad other issues like cancer, diabetes, Alzheimer’s, weight gain, coronary artery disease, to name just a few.
So our health depends on our ability and our efforts to interact with other human beings in the best way that we can. And that when we become more locked in to the amygdala—and we’ll talk about how we do that—we become more isolated. And that has health consequences. And these days, we’re seeing anger, and self-interest, and lack of empathy being played out on a global scale like never before.
Jodi: Exactly, exactly. And the other thing that you bring up is this idea of safety and when your amygdala’s running the show and making you feel unsafe, that throws off your parasympathetic system and your vagus nerve. Can you speak to that a little bit and the impacts of health?
Dr. Perlmutter: Well, absolutely. So this constant fanning of the flames of fear and anger that is part of our world, but we don’t have to choose to make it part of our world, but by-and-large, based upon what we see on the evening news or for those who are on the news 24/7 watching their social media, watching their newsfeeds on their computers, this continues to enhance our connection just to this fear area of the brain, the amygdala, and powerfully augments our sense of being stressed.
And this stress that we experience, because we know that the world is out to get us and the fear that’s instilled in us, enhances our stress response. So our levels of, for example, cortisol, the stress hormone cortisol, go up. And that has profound consequences on us. It leads to things like not being able to deal with sugar appropriately, it compromises our immune systems, and enhances, fundamentally, something called inflammation.
Inflammation is the cornerstone of all of our dreaded chronic disease. Inflammation further threatens our connection to the prefrontal cortex, and, ultimately, leads to worse decision making, which means that we’ll not get to bed on time, we’ll not eat the right foods, we’ll not get exercise, get out in nature, do our meditation, and all those things that continue to connect us only to the amygdala, away from the prefrontal cortex.
Dr. Perlmutter: What happens? Our decision-making declines even further. It degrades that we make worse food choices, less good choices as it relates to our sleep hygiene. And we create a situation where we develop these chronic degenerative conditions. Now, we wrote this book and published it in midJanuary of 2020 prior to what’s happened since. Simply saying that our lifestyle choices affect our immune systems.
Jodi: Yes, yes.
Dr. Perlmutter: And now we know that our immune systems are front and center. Everything is being talked about immunity, “I want to have a good immune system.” And, in addition, we’re all acutely aware that unrestricted inflammation kills people in the context of COVID-19. So this idea and these recommendations, they become far more meaningful these days in the context of the world in which we live.
Jodi: Yeah, and I love how you, as a neurologist, brought in how the brain and what’s happening in the brain can impact the body, the gut, the blood sugar regulation. And you landed on inflammation as being one of the things that can compromise the communication between the amygdala and the frontal cortex. Can you speak to some of the other things that can throw off that balance?
Dr. Perlmutter: Well, let’s just say with inflammation because there’s one other, I think, really important mechanism that we, and it’s a bit technical, but let me shorten it by saying inflammation threatens our ability to have adequate amounts of serotonin. We’ll leave it at that. For those of our viewers who are in to this, we’re talking about the kynurenic pathway, we’re talking about the metabolism of tryptophan into serotonin.
But, basically, inflammation leads to less serotonin. And that inflammation can be caused by not getting enough sleep, not eating anti-inflammatory foods. We’re eating foods that increase inflammation like ultra-processed foods and foods with refined carbohydrates. Just those two things, not getting enough sleep and eating a crummy diet amps up inflammation that threatens 4 your connection to the prefrontal cortex and threatens the availability of serotonin for your brain.
No wonder, people who don’t get enough sleep have a much higher risk of things like depression. No wonder, there’s this correlation between weight gain and depression. You’re gaining weight because you’re eating high-refined carbohydrate foods. So everything starts to come together and we begin to understand that we have some understanding of a mechanism here with respect to diet, and the gut organisms, and gut leakiness, and inflammation.
And then we have some information over here that depression is an inflammatory disorder because inflammation markers are elevated across the board. And now, these come together where we can relate the gut to inflammation to depression. And we can relate nutrition to the gut to gut permeability and inflammation. And it allows us to say, “You know, it turns out that the food we eat can affect our mood. The food that we eat affects how we see the world around us.”
So take that in the context of the globalization of the Western diet that our Western diet of highly-processed, higher-carbohydrate, high simplecarbohydrate foods is spreading around the globe. And that this diet amps up inflammation, the cornerstone of all these degenerative conditions, and the cornerstone of depression. And that inflammation locks us into a mentality that creates a sense of fear, that creates a sense of us versus them, of thinking only about myself and about no others.
It compromises our ability to express empathy that relates to the globalization of our Western diet to a lot of what we’re seeing happening in the world today with fear, with tribalism, with excluding others from this or that, of us versus them mentality simply from the change that’s happened to our diet, unlike anything humans have ever experienced in the entire hundreds of thousands of years that we’ve been on the planet.
Jodi: Yes. And I’m very grateful between Grain Brain and this book, you give a lot of great recipes to help calm inflammation through diet. You also offer a lot of other really thoughtful suggestions. Can you speak a little bit to how to change the brain’s circuitry, and restore, and rewire a healthy balance of communication?
Dr. Perlmutter: Sure. So, as it relates to disconnection syndrome, there are many, many onramps that we listed in the book, eight areas, then we went into them at length, whether it’s limiting your time in front of your computer screen, getting enough sleep, reestablishing relationship with nature, 5 obviously exercise, obviously diet, and meditation, etcetera. And, I think, for our time together, I’ve focused on a couple of these ideas.
And oddly enough, what may be surprising to many of your viewers who are looking for the secret sauce, it turns out that one of the biggest players for reestablishing connection to the prefrontal cortex back to the part of the brain that balances the person, reduces the tribalism, increases the empathy, helps make better choices so that our immune systems will work better, is getting a good night’s sleep.
Who knew? Who knew that something that we should do for a third of our lifetimes…We talk about exercise and diet. We don’t exercise eight hours a day, or we’re not eating eight hours a day, but we should be sleeping seven to eight hours a day. But it’s not just being in bed asleep for that length of time, we do need to think about the quality of our sleep.
And we live in a time where wearable devices are very common that can give us that information in terms of how long does it take to fall asleep, how much time did you spend in REM sleep and deep sleep, how was your heart rate during sleep, did you awaken that you don’t remember, how many times do you wake up in the middle of the night, and what was your total time asleep last night? And gee whiz, that technology doesn’t require that you go to a sleep laboratory anymore and have a, what’s called a polysomnogram. So very important.
And so we not only emphasize how dreadfully important it is to get enough restorative sleep, but then what you can do to improve your sleep if it’s not where you want it to be and recognize that the research we described in the book shows that even one night of non-restorative sleep is associated with 60% increased activity in the amygdala.
Why do you suppose it is if you’re up all night, for whatever reason, that very next day you make very bad food choices? Those choices are impulsive. They’re not based upon what you darn well know is good for you. It’s going to be the glazed doughnut and a coffee. Face it, doesn’t that sound really good? Well, it may not sound good to you right now, but if you were up all night, it’s going to look a lot better.
Jodi: Right.
Dr. Perlmutter: So what do we do? Well, we recommend not having caffeine after 2 p.m. Simple enough, right?
Jodi: Right.
Dr. Perlmutter: We recommend turning off our digital devices by dinnertime so that we’re not exposed to the blue light that these devices are emitting that can compromise our sleep because it reduces melatonin. Looking at things like making your room quieter, more quiet, reducing sound, a couple of degrees cooler, believe it or not, or darker. Thinking about if there’s somebody in your bed, might they have leg movements at night, we call them these periodic leg movements that may be awakening you. Or that person may know darn well that he or she doesn’t sleep. And they have sleep apnea. And they’re using CPAP or whatever it may be.
You need to sleep so does it mean maybe you put a pillow between you. Maybe it means, now, twin beds instead of one king. Maybe it means another room. In the end, you’ve got to get a good night sleep. So I’m not trying to dismiss people and break people up, I’m talking the value of sleep in reestablishing your brain’s connection to the prefrontal cortex, and allowing you to dramatically reduce your risks for some really bad health outcomes.
Jodi: Yeah, so there’s a lot to be said for those biological rhythms. The circadian rhythms, and how that ties to the digestion rhythm, and even the normal balance of communication in the brain.
Dr. Perlmutter: Well, that’s right. We have lived in a powerful relationship with the cycles of our environment. We call this Kronos Biology in terms of when we slept, when we were awake, the timing of our food consumption, our activities. And for, virtually, the entire time we’ve lived on this planet, we would go to sleep when it was dark and we would wake up when it was light. Now, that doesn’t happen. And all parts of our physiology are based upon that diurnal cycle.
And now we see that we’re becoming out of sync with that part of our biology by eating later at night and going to sleep later at night. And it really sets the stage for the manifestation of a lot of issues, not the least of which is difficulties with glucose metabolism, an increased insulin resistance, very strongly correlated with many parts of that desynchronize lifestyle.
Dr. Perlmutter: So books have been written about that. Dr. Satchin Panda wrote a wonderful book about this whole notion of Kronos Biology, and timing of our meals, and timing of our sleep, etcetera.
Jodi: Well, and I love that you talked about forest bathing and time in nature because I think when you align with nature, that helps reset your natural biological clock.
Dr. Perlmutter: Well, that’s for sure. Again, for virtually all of our time on this planet, we were intimately relating to nature. And our bodies are signaled by what we experience in nature by various scents that we experience in the forest and, certainly, by the day-night cycle that we are intimately involved with when we’re in nature, the calming of nature. And the fact that that’s our history. That’s our legacy, as well.
And so lots are written of this relationship to the extent that an intervention using nature as something that is now being described. A lot of that work coming out of Japan. They call it shinrin-yoku where they are known as forest bathing, as you characterized. And it’s not as if everybody has access to a national forest. And you don’t need that. Ideally, if you can get to a place where there are some trees, even in an urban environment, the research shows that that [crosstalk 18:04].
Jodi: Central Park. Yes, exactly.
Dr. Perlmutter: And if you can’t even get out of your house for whatever reason, just a potted plant in your kitchen, or dining, or living room, or whatever it may be. And if you don’t have the green thumb, and don’t want to have plants in your house, even a photograph of nature has been shown to calm the amygdala and to lead to less impulsive response. So that’s very valuable. And it’s not in a prescription form. And it has great play in terms of allowing us to reconnect.
Jodi: Yeah. And I feel like part of that is the summit is the parasympathetic state in the way…Well, I’ll let you speak to how the amygdala aligns with that. But I feel like the amygdala puts us in that sympathetic fight-or-flight state. And the prefrontal cortex helps calm us down. Can you talk to that a little bit?
Dr. Perlmutter: You’re exactly right. So when we’re living off…And let me just retract for one second or go back. There’s an upside to the amygdala. That’s for sure. The amygdala allows instantaneous response, which is a good thing at times. Meaning that you put your foot on the brakes because a kid was in your rear-view mirror on a tricycle. And you didn’t think about that.
It wasn’t, “You know, this might well be a good thing for me to go ahead, and take my foot off the accelerator, and shift it over to the brake because there’s a kid.” By the time you’ve done that, you’ve got problems. So there is a great place for this instantaneous response. That’s the role of the amygdala. And that can be lifesaving. We need sometimes fight-or-flight. That’s a good thing, but not day in and day out.
And this day in and day out activation of our fear syndrome, fight-or-flight, does two things. Number one, it strengthens our connection to the amygdala at the cost of reducing our connection to the prefrontal cortex. And it does upset the balance then between the parasympathetic system, which is involved in our day-to-day activities of digesting our food, and really the maintenance work of our bodies, and more of the sympathetic sudden fightor-flight kind of activity.
We need both. But when we weigh the sympathetic activity far more aggressively, then it does tend to have negative consequences. And that feeds into elevating cortisol. That damages the gut lining by changing the array of organisms in the gut. When we damage the gut lining, that leaky gut, as it’s been called, augments the process of inflammation in our bodies.
And that is something that we cannot let happen because chronic elevation of these inflammatory mediators is damaging to our DNA, it’s damaging to various parts of the body, and certainly to the immune system. It’s also associated with Alzheimer’s, coronary heart disease, diabetes, cancer, all of the chronic degenerative conditions that are increased in risk because we’re constantly under stress, and we’re activating our sympathetic immune systems.
And then those functions sub-served by the parasympathetic nervous system may not get the attention they need. For example, digestion, when we suddenly shunt blood away from the gut by activating the sympathetic nervous system, well, we need blood and we need gut motility to be happening to extract nutrients from our foods to have healthy digestion. So when we constantly are bombarding our bodies with stress and shutting that system off, no wonder people have such issues with respect to their guts these days. And interestingly enough how profoundly correlative that is with depression. What an interesting other side light on the so-called gut-brain connection.
Jodi: Yeah, I know, it’s fascinating. And I love how you connect the amygdala with the sympathetic response and how you were talking about where you put your attention is where it grows. So if you’re constantly in stress, that almost wires your brain neuroplasticity to become more stressed in the future.
Dr. Perlmutter: Yes, mam, it not almost wires your brain, it does rewire your brain. So through this process of neuroplasticity, the more you’re tapping in to the amygdala, the stronger that connection becomes. That happens. And the opposite of that is the fact that when you’re not using certain pathways, they tend to decline in their efficacy. 9 In other words, when you’re not connecting to the prefrontal cortex, this connection between the prefrontal cortex and the amygdala that normally would have calmed the amygdala down becomes less effective. And we can’t have that. We need to reestablish that connection. And then nurture it.
Jodi: Yes, it’s like the amygdala’s highjacked. It just keeps running on its own.
Dr. Perlmutter: Yes, let the amygdala do your job. “Your job is to alert us if we’re in clearly a threatening situation. But otherwise, we need you to calm down now. We need you not to be fearful day in and day out. And sorry, amygdala, I’m sorry I’ve been bombarding you with news from 24/7 exposure to TV and my screen.” What does that do?
That strengthens the amygdala’s role. It says, “Look, things are really, really bad. And it amps up sympathetic activity, increases cortisol at the cost of the parasympathetic nervous system, our heart rate goes up, blood pressure goes up. All the things that we’re trying to avoid are happening by virtue of the choices that we make. We choose to fan the flames of amygdala activity by watching news nonstop, by engaging in fear-based social media interaction. Put that stuff aside and go out and walk in the forest, for crying out loud.
Jodi: Exactly. That’s the one thing I really want people to land with in this. There’s so much outside of our control, but we get to choose our own choices, and we get to make choices that can help us calm our amygdala, and activate our frontal cortex, and drop into parasympathetic state. And you have so many good suggestions. I love diet focus, sleep. Are there any other tools that you have found really helpful to help people?
Dr. Perlmutter: Meditation. Who knew? So meditation is a very rapid fire way of immediately calming the sympathetic nervous system, letting the amygdala show out, and allowing parasympathetic activity, allowing the prefrontal cortex immediately to come on line, and do its thing. We can demonstrate this on various sophisticated brain imaging studies. And we actually showed them in the book how meditation immediately lights up the prefrontal cortex, calms the amygdala. And the more you do it, the more indelible that becomes.
And indeed, it lasts through this process of neuroplasticity where we’ve strengthened this connection. And it can be demonstrated that long after the time of meditation, you remain connected to the prefrontal cortex, the world is less threatening, the immune system is better, blood sugar control is good, blood pressure is better, and it’s free. So what is the push back?
Jodi: No, exactly. This is so timely and so helpful. Thank you so much for all of this amazing advice and these great tools to help people shift. Is there anything else that you’d like to talk about with the amygdala and the prefrontal cortex?
Dr. Perlmutter: Well, let me just take a step back in closing. And, I think, the whole mission of our book and even our time together today, Jodi, is the notion of self-empowerment.
Jodi: I love that.
Dr. Perlmutter: That we tend to live in this world that would have us believe we should live our lives however we choose, moment to moment. And that when, suddenly, we develop a condition, there is a magic way of fixing it. And the reality is that’s pretty far from the truth. And that we are the arbiters of our health destiny, as it relates to these chronic conditions.
And to a significant degree in these times of this COVID-19 experience, that we have a lot to choose in terms of how we are going to experience this infection. It’s been estimated that between 60% to 80% of the global population is going to become infected. Meaning that likely we’re going to be in that group. And so that happens…
Jodi: Well, exposed, we’ll be exposed–
Dr. Perlmutter: Yeah, that’s right.
Jodi: But how our body reacts, we have choices.
Dr. Perlmutter: And we can be the arbiters of that response based upon the lifestyle choices that we make right now. We know that people who have obesity or are significantly overweight having diabetes, coronary disease, coronary heart disease, other chronic, or general problems, which are a manifestation of the lifestyle choices we made previously, those issues speak to a worse outcome. That’s clear.
And it’s not like, “Well, that’s what I have. End of story. Too bad for me.” No, we can choose right now to improve, for example, our blood sugars by being on a diet that’s more restricted in refined sugar. We can control our blood sugar by eating less sugar. Who knew?
Jodi: Yes!
Dr. Perlmutter: Engage in exercise. Get a good night sleep. All those things to work on those mechanisms that would otherwise have led to these diseases. 11 Or if we already have one of those diseases, we can reduce their severity. We now see the data that shows that you can cure type 2 diabetes with a Ketogenic diet, for example. There is no medicine on planet Earth that cures type 2 diabetes.
We have tons of medicines that will lower the blood sugar. When you watch television, they say, “Oh, gosh, I lowered my A1C. Aren’t I special?” But you can cure type 2 diabetes and get off medications, for example, by going on what’s called a Ketogenic diet.
So what I would like to leave your viewers with is really the notion of empowerment.
Jodi: I love that.
Dr. Perlmutter: That it’s not good enough to outsource your health destiny to others. That we have the tools. Today, we know the information as to what we can be doing to reframe our future in terms of our health and even in terms of what would happen should we become infected with this virus.
Jodi: Mindset is so important, and stepping out of victim, and stepping into personal responsibility. And, I think, that’s what Brain Wash is all about. It’s really empowering people with very accessible tools to make a difference in their health immediately. And it can be as simple as looking at a photo of a plant. That’s amazing.
Dr. Perlmutter: Who knew? Those are all offered up as on ramps to reconnection, whether it’s, again, reconnecting with nature, however that works for you, paying attention to your sleep. Maybe getting a wearable device and seeing where you are to start off with, then making changes, and see how that impacts your sleep.
Yeah, as a matter of fact, aerobic exercise is something we’ve all known is good for us. And it is. As you mentioned, reconnecting to nature, changing our diets, and reconnecting with other people, very important. We need that. Loneliness is a powerful risk factor for illness.
And finally, I think, working on tools to increase our empathy. Keeping a gratitude journal. Saying to others thank you for what you did. Apologizing to others. All of these things reconnect our hearts in a figurative way to others and to ourselves. And that will strengthen our connection to those good parts of the brain.
Jodi: That is so helpful, and so amazing, and so timely. Thank you for everything you do.
Dr. Perlmutter: Oh, my, gosh, thank you.
Jodi: This was amazing. Thank you so much.
