Jodi: Hi, I’m Jodi Cohen, your host. And I’m really honored to be joined by one of my personal favorite leaders in this space. Doctor David Perlmutter is a board certified neurologist and a five time New York Times bestselling author. He serves on the board of directors and is a fellow of the American College of Nutrition and the co-author with his son of this fabulous book on resilience called Brainwash. Welcome Doctor Perlmutter.
Dr. Perlmutter: Delighted to be with you today, Jodi.
Jodi: Thank you. So I wanted to ask you, what does resilience mean to you?
Dr. Perlmutter: Resilience means the ability to respond appropriately to a stress. That’s I guess the physics diagnosis. And I think it certainly applies to biological systems that lets talked about where we are and that is humans. How do we respond to various potential insults to our health, physical and mental health? How do we respond to challenges? And I think that, I’ve used the term resilience in a quote that I developed called, “Diversity breeds resilience.”
And I’ve used it in the context of the gut bacteria that the more diverse our gut bacteria, the more resilient we can be. The more able we are to respond to challenges that are seen through the lens of the gut bacteria. But we could be talking about the Amazon rainforest, the more diversity we have there, the better it is able to respond to environmental challenges. And certainly we could even be more macroscopic and talk about humanity and welcome and embrace the notion of diversity of our fellow human beings and see how that allows us to be resilient in the face of, for example, environmental challenges as well.
Jodi: Yeah. I love that. And I really love your book because I think resilience is your energy, both your physical, mental, and emotional energy. And you do such a wonder full job helping people understand how they can build up their reserves so that when they’re thrown off balance, they’re better able to recover.
Dr. Perlmutter: Well, I think a central theme of Brainwash is that we have two important areas that govern our behavior and certainly govern our decision making, our choice making, and they are a primitive area. The other areas are involved, but to simplify called the amygdala that is, doesn’t really take into consideration the bigger picture. Doesn’t leverage a lot of information and makes very quick decisions that are generally self-serving.
And not that that’s necessarily always bad because it’s not, there are times when we have to respond instantaneously for a specific outcome to occur. You’re backing up your car, look in the rear of your mirror, there’s a kid on a tricycle. You don’t want to be thinking well, probably a good idea that I slow down. Maybe take my foot off the gas, maybe put it over on the brake. You’ve created a problem.
But by and large, our day to day behavior and decision making should be more resilient in that it is able to bring more information to bear. And allow us to handle some confrontations with potential issues and stresses by bringing as much information. By being as resilient as possible to bear on a specific decision and look at the outcome, not just in terms of today, how it’s going to benefit me or what I want to eat that jelly donut, but more long term. If the eating of the jelly donut is necessarily in my long term interest, how will affect me, but how my decision might affect other people and might affect the planet around me. That’s a prefrontal cortex type of resiliency that we talk about in Brainwash.
Jodi: Yeah. I really love that. And you call it disconnection syndrome. Do you want to define how you refer to disconnection syndrome?
Dr. Perlmutter: Sure. So the importance of this anatomy between the impulsive, self-centered quick thinking part of the brain and the more reflective less reflexive part of the brain, the prefrontal cortex that thinks about things like empathy and compassion. What is the future consequence of today’s decision, is that this prefrontal cortex that lives up here behind the forehead exercises what we call top down control over the impulsivity center. In other words, it is the adult in the room.
And it allows for the impulsivity center to remain functional, but not function in moment to moment. It takes control over behavior and decision making and allows more thoughtful experiences and decisions and really thought processes. It is the adult in the room. Now, a lot of things threaten that. And moment to moment, some things take us offline and we respond and behave from the amygdala. I describe in the book how I had an experience in Costco one time with somebody who was accosting my wife. And I was not thinking through. And anyway, we’ll leave that one for a moment.
But so we depend upon this connection then from the prefrontal cortex down to reign in the amygdala, and this is the top down control. And when we become disconnected, this disconnection syndrome, we are functioning directly from the amygdala at all times. We’re not able to use this beautiful prefrontal cortex gift that we have as humans. And we revert to a behavior whereby, “I am always right. I will not listen to your opinion because it’s not my opinion. Therefore, I won’t participate in that.”
And my decision-making will be looking at what’s best for me today. Not looking at tomorrow’s consequences of what we do today. Whether it relates to me or it relates to something environmental. We’re going to dig and we’re going to for oil no matter what the risk whatever it may be. And that’s what disconnection syndrome really is all about is getting away from the ability, the gift that we have to really make better decisions and behave in a way that’s good for ourselves, but also good for others and good for the future.
Jodi: Yeah. I love it. “The opposite of disconnection will be reconnection.” And that’s one of your quotes in the book. It’s our interconnectedness, our inner relationships, not just among people, but also among all living things that sustains us and provides resilience against diversity. Could you elaborate on that?
Dr. Perlmutter: Yeah. And again, it’s this resilience against diversity. The more that we are connected to each other, the more we can come up with novel solutions when we are challenged. That is a powerful aspect of being resilient is bringing in as many resources as you possibly can in an attempt to deal with some form of confrontation, some form of threat. Each of us does not have all the answers. And we’re getting more and more away from that these days, recognizing that other people’s opinions have value. I may not agree with those opinions, but at least have the notion of cognitive empathy whereby I can try it on. I can feel what it’s like. And that’s how we come up with novel solutions.
If you’re always going to be stuck with David Perlmutter’s ideas on every problem, our solution set will be quite limited. Because I’m quite limited in my experiences, in my life, in my intelligence, and my decision making skills, but if we bring you on board and the next 10 people and who knows how many else, man, oh man. If we embrace each other’s ideas and have a dialogue in terms of what might make sense moving forward, we can come up with novel, new ideas. That’s progress.
And that’s been the state of affairs with humanity for as long as we walk the planet. And now suddenly there’s a threat. “I don’t believe that the world is flat.” Having said that, if you believe the world is flat, I’m going to take the time to listen to your argument. I still will likely not believe it, but you do. I’m not saying you in particular, a person
Jodi: I think it’s round.
Dr. Perlmutter: I want to listen to it. I want to listen to why you said you’re getting vaccinated or why you said you’re not getting vaccinated. Or why you choose to wear a mask, or why you don’t. I’d like to know the reasoning behind it. And then allow me to use my frame of reference, my paradigm to allow me to judge for myself, in my opinion as to the validity and the importance of your decision. But let’s at least have common ground and talk.
Jodi: Right. And to your point, and what you talk about in this book, when you’re amygdala’s hijacking the situation, you can’t even access your cognitive process to hear other people and things like that.
Dr. Perlmutter: And to be sure, we are manipulated to lock us into amygdala based responses. Our attention is sold to the highest bidder. We all know this based upon the targeting popups on our computers, what we see on television. And it really tries to lock us into thinking of doing something right now and not looking at the long term. Not trying to make decisions for ourselves by thinking about stuff, by being again, reflective as opposed to reflexive. And that’s fully taken advantage of I think by modern marketing, to make us do things that are not necessarily in our best interests, but are in their best interests.
Jodi: Well, that’s another good point. Even we were talking about how we’re not 12. Like in my lifetime, the introduction of social media and all these things, life has gotten a lot faster and interactions have gotten a lot briefer and more distance. We’re not connecting with people in person, knocking on their door and biking around the neighborhood. We’re snapping them, which takes two seconds.
Dr. Perlmutter: I’m still biking around the neighborhood, but this whole COVID thing, they say, “We have to maintain appropriate social distancing.”
And I think it’s a terrible term. We don’t want to be socially distance. We can be physically distanced from people, but we don’t want to be socially disconnected. We need that. We desperately need it, it’s part of our hard wiring. And our desire to live in groups has been a powerful survival mechanism with sharing of labor, specialization of labor. And it’s what’s good for the herd. But unfortunately these days, some of the messaging is, “No, what really matters is what’s best for me, the rest of the world be damned.”
Jodi: Yeah. That is an excellent point. And if you can get into some of the tools like you mentioned in here pausing technology, getting out in nature, connecting with others. What are things that are good for both? Obviously they’re not concentric circles. There’s an overlap of what’s good for us individually that is also good for us as a planet. What are some of the things you would recommend?
Dr. Perlmutter: Well, let me develop something first all, then I’ll get to that. And that is the notion that so many of our day to day activities create what is called a feed forward cycle, whereby our decision making gets worse and worse. And what I mean by that is this disconnection syndrome locking us into poor decision making is worsened by for example, inflammation, having higher levels of inflammation. Not really overwhelmingly high levels, but just chronically elevated levels of inflammation in the body tends to hamper the connection between the prefrontal cortex and the amygdala locking us out of this top down control that I talked about earlier, such that we behave more from the amygdala impulsive set of behavioral choices.
And therefore when we’re making bad choices, for example, we’ll make bad food choices. And what does that mean? We’ll eat more highly processed foods, sweeter foods, more sugar. What does that do? Increases inflammation. And that makes decision making even worse. That’s the feed forward part of this I’m telling you about. That the worst our decision making is, the worst will be our decision making. And that’s a scary proposition.
Then we decide we’re going to binge watch TV and stay up really late on Netflix. Don’t get a good night’s sleep. The next morning, our amygdala is as much as 60% increased inactivity from one night of sleep deprivation. What does that mean? It means now today having been up last night, my amygdalais solidly in the driver’s seat. I’m seeing the world as threatening. I am struck with being fearful all the time. My food choices will be wrong. I won’t exercise. I won’t go to bed on time tonight. I’ll be in front of my computer again or whatever I’m going to do. And yet the next day I’m even worse. So we have to interrupt that whole feed forward cycle. And that brings then me back to I think the subject of your question, how do we do that?
Jodi: Yes.
Dr. Perlmutter: And we offer these as off ramps, getting off the super highway of poor decision making. And you can take any number of off ramps and you’ll be off the super highway. Let me give you a case point and how this whole thing got started. Austin, my son, a co-author of the book, and he’s an internal medicine doctor. We’re actually sitting in this room and we’re talking about what are the challenges that we have as medical doctors and, Austin, I believe said, “So often our patients just don’t do what we tell them to do.”
And he really hit on something I think that was profound. Because we realized that to get change to occur for better health of a particular patient, three things have to happen. Number one, I, as the treating physician or healthcare provider have to learn some stuff. I got to go to medical school, maybe the conference, maybe the journals, whatever it is. I got to learn what’s the best advice to give?
Step two, I then have to transmit that information to the patient so that he or she knows what to do. And we spend a lot of time on step one and two. But step three is then the patient has to do it. They have to act on it. And that’s where the system falls apart. And that’s the area that never has received any attention at all. We just say, “They’re non-compliant, they don’t do what they’re told, next patient.”
“Poor Mrs. Jones continues to gain weight, her blood sugar’s going up because she is non-compliant. She’s not complying to these wonderful recommendations that we are making. And therefore there’s something wrong with her.” We tell her that basically, “You haven’t followed the advice I’ve given you.” And she feels awful. She feels guilty. When she gets home, she looks in the mirror and she’s castigating herself again, blaming herself for not following through.
And the problem with that is it isn’t her fault. She has not gotten those mechanisms squared away to make better decisions. Her decision making apparatus has been hijacked. She’s fully unable to carry out the recommendations. If she’s a diabetic or overweight, there’s no chance or very little chance, let’s say that first visit with her and as she’s walking out, I pull out a standard low sugar diet and hand it to her like I did with the last patient that she’s going to follow that.
Because that’s the 10th doctor she’s seeing who’s given her pretty much the same diet. It isn’t going to work. She doesn’t have the decision making skills to put that into play. Though I know, and probably she knows that it’s best for her. She can’t do it. And you know what I’m saying is true, because we all go through that. We all make decisions to do one thing or not do something, whether, “I’m not going to floss my teeth tonight damn it. I just don’t want to do it.” But you should, but you don’t. And we all do that to a certain degree. Some people a lot more than others and they develop lifestyle related issues as account of it.
So what we want to do then is work first, not on the decisions that are made, but on the decision making apparatus. We want to rewire the brain. We want to bring the adult back into the room and we want to regain this top down control that has basically evaporated .Not necessarily because of the choices this patient has made, but because how they have been basically manipulated.
And that might be that, “Okay patient X, I know you’re here because you want to lose weight. But this week we’re not even going to talk about diet. I’m not going to give you a diet. I suspect you you’ve been to the, whatever the Weight Watchers or Jenny Craigs, whatever it may be. And obviously it’s not working for you. It has never worked. We’re going to work on your decision making.”
And it might mean that with that patient, what you do for the first couple of weeks is you concentrate on sleep, let’s say. Because turns out they think they’re sleeping well, but they may not be. They may say, “I sleep eight hours a night.” But do they really? And is it restorative? Because if it isn’t or is not long enough, they’re fanning the flames of inflammation and they’re locking themselves out of the ability through disconnection syndrome to make decisions that relate for example, to their diets.
So let’s work on your sleep. “Well I get a good night’s sleep every night. I know it. I go to sleep at whenever 10. I wake up at eight. So plenty of sleep.” “Well do you remain asleep all night?” “Well, I think so, I’m not sure.” “And what is the quality of your sleep? How much time do you spend in REM and how much time do you spend in deep sleep? And what was your sleep latency? How long did it take you to get to sleep? And what does your heart rate do during sleep? How much heart rate variability?” All the things.
And they look at you like, “Well, how in the world should I know that?” So maybe we have them wear a wearable. Maybe we say, “Go and buy an Oura Ring or an Apple Watch or something that can start to give you some feedback. So you’ll know the answers to these questions.” Why? Because they are really important. They’re at the cornerstone of why you may be making bad decisions.
So we’ve leveraged one on-ramp which in this case is sleep to help this patient then be in a better place to make better decisions as it relates to maybe getting some exercise. Maybe getting out in nature. Maybe picking up a meditation practice. Maybe writing a gratitude journal. Maybe even changing the way that you eat. And allowing that adult to come back into the room.
So there’s so much information people can gain from wearable devices that can inform them as to what their lifestyle choices are doing moment to moment. Knowing what your blood sugar is through a continuous glucose monitor. That’s powerful information. Not just as it relates to food, but as it relates to exercise and sleep and stress and what TV show you’re watching. All these things can be reflected in your blood sugar, which you can read on your smart phone any minute of the day.
Jodi: I love first of all, that you’re setting people up for success and that also you’re making it accessible and manageable. That is my whole goal with this summit. Will McCarty is talking about how when you have resilience, basically if your trauma score is high but your resilience is high, it’s easier to manage it. It doesn’t get you thrown off. And what you’re doing is helping people take that first crawl before they walk, walk before they run. I love that. Can you share some of the other off ramps, some other starting points so that people that are listening they’re are like, “My God, that’s me, that’s so me, thank you.”
Dr. Perlmutter: You’re welcome. And I think that it’d be really good to not only characterize what a person can do, but really what they probably are not going to be able to do early on. So again, there’s a lot of people who want to change their diets. That’s what everybody’s talking about these days. But in dealing with patients or if they’re clients who want to make a dietary change, not the first place to start. It’s really quite clear that first we have to get them, it’s call it a mindset if you will. We have to get them prepared then to make those better decisions., whatever that decision may be.
I’m not arguing in favor or against whether it’s a vegetarian diet, a paleo diet, a keto diet you name it. Because frankly it often doesn’t really matter. It’s the notion of adhering to a diet that brings about salubrious changes. So having said that, sleep is huge, especially these days when around 40% of Americans are indicated that in given week, they don’t feel like they’ve got enough restorative sleep. It’s a big number.
And I think to understand that people are spending as another onramp is to maybe divest a little bit of the time that you’re dedicating yourself to your digital media each day. 42% of waking hours by Americans spend in front of one screen or another, whether it’s their iPad, their phone, their computer, or even the television. So that’s an awful lot of time. In an average lifetime, that translates to 22 years of time spent in front of a device.
And we wrote this book with the gift of the internet giving us some incredible information that we were able to digest and then repurpose to bring about a source of information for people so they can make changes in their lives. So there is a powerful upside to this incredible wealth of knowledge, this democratization of knowledge globally. Well, not actually globally, some places don’t have access. But by and large, the ability that we have to learn stuff is breathtaking.
But to be sure this hack into our consciousness is being exploited aggressively by so many to make us make decisions that are not in our interest. To make us lower our sense of self-worth and to enhance our impulsivity away from good decision making. To think that putting a good check on our time spent in front of digital media is very, very important. Not just because it’s 42% of our waking hours, but that number is very important because time spent there means that there are other things then that you didn’t do.
You didn’t spend time shopping or preparing meals. You didn’t spend time interacting in real time with other people. And you didn’t spend time exercising. And didn’t spend time in nature. Didn’t meditate, all the other things that are really important for reconnecting.
So we created what is called the test of time, and it is an acronym T-I-M-E, TIME. “You’re going to sit down and get in front of the internet to do what?” “I want to answer all my emails.” “Okay, good. How much time is that going to take? How much time are you going to allot for that to happen? Pick a time.” “An hour.” “Okay. It’s not two hours. It’s an hour.” And you stick to it. You set a clock. Your computer has an app for that, so does your phone.
What is the I? I is intention. What do you want to accomplish? Why are you doing what you’re doing? You want to visit your Facebook site from all your high school friends, fine. That’s where you’re going. And that’s what you’ll do with a certain amount of time. That is your intention. M, while you’re doing whatever it is you’re doing, are you mindful? Are you remaining on task? Are you seeing all of the attempts to pull you off task and to harvest your attention?
And finally E, when it’s all said and done, was it enriching? Was it powerful, do you feel net positive now that you did what you did online? Was good for you is was what you accomplished? You accomplished your goal. We all know that while we’re online, unless you turn things off, you’re constantly barraged by attempts to harvest your attention and make decisions that may not be in your interest.
Jodi: Yes. It’s very easy to get very distracted very quickly. I love that. That’s really wonderful. So that helps people manage their time and they can manage their priorities, and then they can start to do the real work. It’s almost like the Pre-course.
Dr. Perlmutter: Now, given yourself the time to make that happen. Like meditation, people say, “Yeah, I’ll meditate if I find the time.” Well, what we say in the book is, “No, make the time.” So there’s a huge difference between making the time and finding the time. Finding the time is if I happen to have some time here, then I’ll maybe let it happen. As opposed to, when we wake up in the morning, we’ll drink our coffee, whatever it is. And then we’re going to sit down to meditate and then get on with the rest of the day. And I would submit that making the time is going to be confronting the notion of finding the time, especially if 42% of your wakeful hours are spent in front of the computer.
Jodi: So you’re basically giving people a roadmap to enhance their ability to comply. You’re not starting with the end goal, you’re starting with where they are now and helping them work their way there.
Dr. Perlmutter: That’s right. And look at the other aspects of what this does when the brain is rewired back to the prefrontal cortex. The prefrontal cortex is the area of the brain that allows us to engage things like empathy. Not only emotional empathy whereby we can experience the pain or joy of others, but also cognitive empathy. The notion that we can participate in the frames of reference, the viewpoints of other people. And it is the area of the brain that allows us to be compassionate, allows us to be forward thinking and allows us to draw in a lot of information in terms of how we interpret the world around us and how we then make decisions.
So that’s the added benefit of regaining this control to the prefrontal cortex. It’s, in my opinion, bringing us back on the road to enlightenment. When we can be fully engaged in a place in the brain that allows us to be fully empathic and compassionate and responsive to the needs of others, that’s a pretty close definition to being enlightened that I can think of.
Jodi: Yeah. It allows you to show up as your best self.
Dr. Perlmutter: That’s right. And that should be the goal, depending, of course, on how people define the term best.
Jodi: The version of yourself that you don’t regret later.
Dr. Perlmutter: That’s right. And I think we have to visualize ourselves in the context of all that’s around us. Not just the other people around us but the entire planet. That we are, according to Chief Seattle, “Man did not weave the web of life. He’s merely as strand of it.” So everything we do influences the entire web, and it’s only quite recently that we’ve viewed ourselves as being apart from all of that, distance from that. And we’re not,
Jodi: Well, I think you’ve done a lot to influence the web with this amazing talk. Is there anything we haven’t touched on that you’d like to share?
Dr. Perlmutter: Oh, there’s always stuff that’ll come up later. No, I would simply say thank you for having me. I’ve enjoyed our time together. And I appreciate all the work that you’re doing. Thank you.
Jodi: I appreciate everything you shared. This is exactly what I was hoping to empower people with is strategies, low-hanging fruit to increase their capacity for resilience. So this was wonderful. Thank you. Do you want to share where people can find you and what’s coming next?
Dr. Perlmutter: Yes. So I’m at drperlmutter.com, D-R-perlmutter.com. And what’s coming next is a new book called Drop Acid. And I’m very excited about this book coming out soon. And it is about lowering your uric acid. It’s not about psychedelics. It’s about how important something called uric acid is in terms of weight loss, blood pressure control, blood sugar control, diabetes risk, cardiovascular risk.
We never knew this and it’s new information and we can reign in our uric acid levels by simple lifestyle changes. So I’m real excited about that.
Jodi: Which is huge for anyone who suffers from gout also. That’s wonderful.
Dr. Perlmutter: Yeah, but gout is what, one to 2% of people. And this is something that may affect 80 to 90% of people, trouble losing weight, trouble, getting your blood sugar under control. And people struggle with this, doing so-called the right thing. And yet uric acid may well be that missing link. And we’ve been measuring uric acid in patients for 35 years.
But again, as you mentioned, only in the context of gout. And now we know that uric acid is a key mechanism, a key warning signal for the body that winter is coming and you better start making and storing fat. Well, we don’t need to do that nowadays. So it’s an interesting story. And there’s a lot of user friendly things that people can be doing to lower their uric acid, even measuring it at home like we do for blood sugar.
Jodi: That’s amazing. When does it come out?
Dr. Perlmutter: February of 2022.
Jodi: Okay. So they’ll be able to pre-order.
Dr. Perlmutter: There you go.
Jodi: Wonderful. Thank you so much.
Dr. Perlmutter: My pleasure. Thanks for having me.
