Perlmutter's Grain Brain - Only Half the Story. He Forgot about TMAO, Cancer, Atherosclerosis, Diabetes & the Heart

 

 

 

 

Many of you have asked me to "copy" a recent a Facebook post I wrote this weekend about Dr. David Perlmutter's hot new book, "Grain Brain: The Surprising Truth about Wheat, Carbs, & Sugar - Your Brain's Silent Killers".

So here it is!

If you received this post via email/smartphone click here to get to the web site for all the links, videos & to leave a comment!

 

 

What's Up with the Grain Brain??

 

What's up with the latest "Low-Carb High-Fat" diet recommendations from neurologist Dr. David Perlmutter??   Another doc recommending a high-fat, low-carb, gluten-free, meat, egg, sat-fat, & high cholesterol diet to "Save Your Brain".   Really, Dr. Perlmutter?  I don't think so.

The questions about Perlmutter's book all started with this provocative Psychology Today post: "Is Your Healthy Diet Killing You?"

I just answered one reader--& I'm posting my LONG RANTY-ish reply. Perlmutter will be on Dr. Oz on Monday, October 21st--so I'm sure everyone will be asking the same question.

Bottom Line: If you are already eating a high-nutrient dense plant-based diet low in saturated fats, sugar & refined carbs--Perlmutter's message is not for you!  But, I'll give him some points!  He's right about some things.  Sugar.  Refined carbs.  Insulin spikes.  Bad news for everyone's brain. 

 

READ ON:

Look out! Everyone will likely be jumping onto this bandwagon (especially after Dr. Perlmutter appears on Dr. Oz) because it's a great excuse to load up on fats & meat.  Bet his book is going to be a BIG BEST-SELLER.  They always are.  Everyone wants to hear that meat, fat, eggs, & dairy are good for them.   They're not.

I happen to be eating a plant-based no-added oil diet PRIMARILY TO PROTECT MY BRAIN from the same fate as my parents: strokes & dementia. No thank you, Dr. P. on your meat, oil, eggs, coconut oil, cholesterol, & sat-fat recommendations!

But, look, Dr. Perlmutter's audience is the more than 99.44% of Americans who are ALREADY eating loads of meat, saturated fat, eggs & cholesterol---along with loads of sugar, refined carbs, & restaurant meals--& if they do choose a "whole grain" it's likely to be "whole wheat" (like a big fat bagel) which is the LEAST nutrient-dense of the grains--& Perlmutter is right - even "whole wheat" is high-glycemic.  It's not like eating sugar--but, other grains are better. 

Added to which, grains are best when they're eaten in their WHOLE INTACT form---not ground up into flour which gives a quick rise to the blood sugar.   Eating whole wheat flour is not the same as eating WHEATBERRIES, for goodness sake!

CHOLESTEROL CONNECTION: As for his claim that we need cholesterol---well, our bodies make all the cholesterol we need without eating a speck of animal protein--as long as we aren't blocking that natural process by taking a statin - which inhibits HMG-coA Reductase, the enzyme in our body that makes cholesterol in our liver.

Perlmutter is right--we do NEED some cholesterol for our brains & for hormone production---which is one good reason to let our bodies make what we need, without having to disable our natural cholesterol production by taken a statin.

There's a balance of how much cholesterol we need. TOO MUCH IS BAD for our cardiovascular system--TOO LITTLE IS BAD FOR OUR BRAINS.

Problem is: no one knows exactly what that "just right" amount is, according to Alzheimer expert Dr. Murali Doraiswamy.

Our brains also need GLUCOSE--from carbohydrates to function!! Ever notice how crabby people are when they're on a low-carb Atkin's style diet?

WHY PLANT-BASED ROCKS!  For those of us on a nutrient-dense plant-based diet--we are already getting all the anti-inflammatory high-fiber benefits we need from a diet extraordinarily high in vegetables & fruit. We don't need what Dr. Perlmutter is "serving up" with his anti-grain, high fat, high animal protein diet.

THE CANCER & ATHEROSCLEROSIS CONNECTION OF A HIGH ANIMAL PROTEIN DIET: Is Perlmutter also forgetting about the "cancer connection" (especially prostate cancer) that goes along with a high-animal protein diet?   Here's a good summary explaining the recent research (scroll down to "Red Meat Associated with Many Different Cancers") .  The most recent study on the subject can be found in:

Di Maso, M. et al "Red meat and cancer risk in a network of case–control studies focusing on cooking practices," Annals of Oncology, : Published online on Oct. 11, 2013. http://www.ncbi.nlm.nih.gov/pubmed/24121119

TMAO: And if you need more convincing--look at the recent research from Dr. Stanley Hazen of the Cleveland Clinic N Engl J Med & Nature Medicine 2013   Read/listen to Dr. Hazen's Science Friday interview explaining the meat/TMAO/cholesterol/atherosclerosis connection.  Turns out, a diet high in meat (carnitine) & eggs (choline) causes the gut bacteria of meat/egg eaters to produce a gas known as TMAO which promotes atherosclerosis in the presence of cholesterol.

His test to measure TMAO as a predictor of the risk of death, heart attack & stroke just made the list of the Cleveland Clinic's "Top 10 Medical Innovations for 2014".

Watch the 1:34 minute video all about it, here

Read my Face Book post about the TMAO award here.

 

"The biomarker, called TMAO (for trimethylamine-N-oxide) is produced by the liver after bacteria in the intestines digest red meat and other animal products. In three clinical studies, TMAO has been a good predictor of heart disease risk—those with the highest levels of TMAO had risks of negative outcomes that were two to 2 ½ times higher than those with the lowest blood levels of the biomarker."

Hazen: "The gut bacteria of meat-eater's turns carnitine into a gas called TMA (& it smells like rotting fish), then our livers turn TMA into the artery-damaging metabolite called TMAO."

[I call TMAO "Too Much Atherosclerosis--Oy!]

TMAO is what CHANGES our metabolism of cholesterol. Hazen explains, "SO THIS PROCESS IS NOT INDEPENDENT OF CHOLESTEROL. It actually works through cholesterol. It changes how our body senses cholesterol and metabolizes cholesterol at the artery wall, in the liver and in the intestines. TMAO makes our cholesterol pro-atherogenic & accelerates atherosclerosis. Which helps to explain why some people with normal cholesterol levels still have atherosclerosis & heart disease.

In contrast, the longstanding vegetarian or vegans [in the study], and to be enrolled in [the] study, the subjects had to claim that they had had no animal or no meat product within the last year. So they were longstanding vegetarian or vegan. WHEN THEY INGESTED CARNITINE, THEY MADE VIRTURALLY NO TMAO."

 

Further, take a look at the illustration in the N Engl J Med of what arteries look like on a high-protein, low-carb diet. http://www.happyhealthylonglife.com/happy_healthy_long_life/2011/04/ornish.html

 

Smith, Steven R. MD.  "Clinical Implications of Basic Research.  A Look at the Low-Carbohydrate Diet."  N Engl J Med  361(23):2286-88, December 23, 2009

 

ORNISH ON "WHEAT BELLY": When Dr. Dean Ornish recently visited my hospital he was asked about books like "Wheat Belly" which is the same premise as "Grain Brain".

His answer: "It's misguided. Refined carbohydrates are bad. Whole grains are great--on so many levels! There's a big difference between the two. It's always easy to demonize ONE FOOD--but, the "whole picture" is far more complicated than that."

Ornish has 30 years of success in preventing & reversing heart disease & early prostate cancer (& now in increasing telomeres), all with a low-fat, plant-based diet, exercise, & stress management. My money's with him.

 

All that matters is what's happening inside of the the arteries. 

The traditional intermediate risk-factors of cholesterol, weight-loss, blood pressure, HDL & LDL don't always tell the whole story--which is why promoters of the high-protein high-fat low-carbohydrate diets, like Atkins & Gary Taubes, think their (HPLC) diet works--while all along, unbeknownst to them, it promotes plaque & atherosclerosis. 

If you're eating a diet that's high in animal protein, high in fat, and low in healthy carbs--your weight & lipid numbers might even be looking good--but your arteries are not!

The high-fat high-protein low-carbohydrate diets cannot produce the circulating endothelial progenitor cells (EPCs) that are needed to repair damaged blood vessel walls & improve endothelial function. 

And the HPLC diet doubles the nonesterified fatty acids (NEFAs) which promote inflammation & atherosclerosis.  If you think high-protein-low-carb is good--think again!

And it's all about what's going on inside of the arteries--not just the lipid numbers!  A low-fat high-unrefined-carbohydrate diet increases those endothelial progenitator cells--and keeps the artery walls healthy, flexible, and atherosclerosis-resistant.   Read more in the PNAS "Vascular effects of  a low-carbohydrate high-protein diet"

Full disclosure: the graphic is from an animal model study.

--My paraphrasing of both Dr. Dean Ornish's comments on the graphic & Smith's N Engl J Med article--

 

OMEGA-3's: And yes, Dr. David Perlmutter recommends omega-3's.  I couldn't agree more.  But, we can get plenty from chia, flax, & algal omega-3 supplements - and when we lower our intake of corn-fed meat & fish, and cut out vegetable oils, we don't need those mega-doses of omega-3's.

 

RENOWNED ALZHEIMER EXPERT, DR. MURALIY DORAISWAMY:  Last week, I listened to one of the top Alzheimer specialists in the country, Dr. Murali Doraiswamy, on People's Pharmacy.  He explained the connection of dementia & diabetes & the negative effects of a high fat, sugar, refined carb diet on the brain. He does NOT recommend coconut oil (its benefit is for people who's brains are so damaged, primarily from diabetes, that they can no long absorb glucose to function--("diabetes of the brain")--& he also happens to be a vegetarian.  Just saying.

Dr. Murali Doraiswamy's interview: http://www.peoplespharmacy.com/2013/09/28/919-avoiding-alzheimers-disease/

GOOD GRAINS: Personally, I do agree with Dr. Joel Fuhrman---I don't avoid them, but neither do I go overboard with my intake of grains---not because they're unhealthy--but because other foods have more nutrients.  Namely, vegetables, fruit & legumes.  When it comes to potatoes (which I love) I choose sweet or purple potatoes over big fat starchy white potatoes.

Steel-cut oats ROCK--& similar to other complex carbs like barley & quinoa, they have both soluble & insoluble fiber, as do all the legumes (BEANS ROCK, TOO)--which feed the healthiest of gut bacteria--and they prevent insulin spiking, which is what harms the brain. 

THE MEAT & DIABETES CONNECTION:  Read more here & here.  From the Harvard Magazine:

 

"Why is red meat harmful?  Saturated fat, which can lead to cardiovascular disease, is really just the beginning of the story,” explains Harvard investigator, Frank Hu. Even though it is “difficult to pinpoint one compound or ingredient” as mechanistically linked to diabetes risk, three components of red meat—sodium, nitrites, and iron—are probably involved. Sodium is well known to increase blood pressure, but it also causes insulin resistance; nitrites and nitrates have also been shown to increase insulin resistance and to impair the function of the pancreatic beta cells. Iron, although an essential mineral, can cause beta-cell damage in individuals with hereditary hemochromatosis (a disorder in which the gastrointestinal tract absorbs too much iron), and heme iron—the readily absorbable type found in meat—at high levels can lead to oxidative stress (and cell damage) and systemic, chronic inflammation in some people."



Dr. Neal Barnard's "Power Foods for the Brain":   I also refer you to Dr. Neal Barnard's recent book presenting the case for a plant-based diet to protect the brain: "Power Foods for the Brain". His case is the polar opposite to Dr. Perlmutter's.  Watch a video of Barnard here

THE HIGH COST of MEAT IN $$$ (especially grass-fed) & to the ENVIRONMENT + THE SCARCITY OF TOXIN FREE WILD SALMON: Lastly, the grass-fed beef, cage-free eggs & poultry, & toxin-free wild salmon that Perlmutter glibly recommends doesn't come cheaply, doesn't exist in the quantities that can feed the majority of the population, & has an environmental price tag.

I'm sticking with my high-nutrient anti-inflammatory diet that minimizes sugar, refined carbs as much as possible--& keeping whole grains (except for oats, barley, quinoa, & sprouted flour-less breads) to a smaller portion of what I eat. Emphasis is on greens, all vegetables, legumes, lower sugar fruits like berries, citrus, grapes, apples, pears & stone fruits. And I include EXERCISE (aerobic & muscle-building strength-training) as one more defense against DIABETES--a significant contributor to dementia.

 

"Eat Your Way to Dementia,"  New Scientist, September 1-7, 2012

 

Final parting thoughts. Take a look at the illustration & text of "The Save Your Brain Diet" that minimizes FAT, SUGAR, & High-Glycemic Refined Carbs.  It tell a different story from Dr. Perlmutter's!

The "Save Your Brain Diet"--cut the fat, the sugar, the high-glycemic refined carbs, & start exercising. You might want to read "Eat Your Way to Dementia" in the New Scientist Sept 1-7.

Bottom Line: Multiple ongoing studies not only link a high fat, high sugar, high glycemic diet to the insulin dysfunction in the brain that causes cognitive impairment & Alzheimer's, but researchers are starting to understand how this diet increases the damaging beta amyloid plaques that can lead to dementia. Exercise, along with diet, can play a preventive role--by decreasing blood sugar & keeping insulin levels at an even keel.

Read more about one of the top scientists mentioned in the New Scientist, Suzanne Craft, PhD, "Could This Be the Alzheimer's/Dementia Prevention Diet? It's the Ultimate Food Fight Face-Off - The VA Puget Sound Study Shows How a Low Fat Low-Glycemic Diet Improves Markers for Alzheimer's Disease in Just Four Weeks"

THOUGHTS??

 

 

Comments

[Kim Hawkins]

Hey, my father in law was in that Puget Sound VA study!

[Annemarie]

I appreciate you responding to Grain Brain because I just finished reading it on the weekend and was curious what the plant based world thought of it. I took away a different message than you did. Dr Purlmutter takes his patients off dairy he does not promote it. While he does suggest the consumption of eggs and certain meats he also explains on his web site how to lead a Grain Brain vegan life style and does not make any negative comments on it at all. In fact when it comes to DHA supplementation he advocates algae based over fish. For the record I've been vegan over 30 years and don't plan on changing that. However I did find all the science and studies interesting and worth further consideration. While I was feeling confused as I read the book (who do I believe??) by the end I felt empowered because of what I learned about the brain and what I can do to generate the production of new brain cells such as intermittent fasting, the addition of more plant based DHA, adding more turmeric to my diet and more exercise. I am not opposed to adding more nuts and seeds back into my diet. As for gluten I don't eat much anyway and can easily switch my baking to oat flour instead of spelt and wheat. So instead of seeing negative in Grain Brain I saw possibilities for making my brain better while remaining vegan.

[Tami @Nutmeg Notebook]

This is a lot of information to absorb but its fascinating. My father has type 2 diabetes and dementia, my father in law had three different types of cancer during his lifetime, I have borderline high LDL so my husband and I have plenty of incentive to continue with a plant based food plan.

It just makes so much sense to eat plant based and there doesn't seem to be any negative side affects to eating this way.

[Sandy]

I LOVE LOVE LOVE what you wrote!
So sad that people are soooooooo desperate for answers that they will believe any garbage they hear. :-(

[Don]

I have always had cholesterol ranging from 200 to 225 until one time years ago I only ate cheese, range free eggs (at least 12 a week), red meat and chicken, salads, and fresh fruit, avoiding all carbs and refined sugar. Shockingly my cholesterol plummeted to 120 - too low. I took statins once briefly and had muscle problems and had to stop. How does one explain this result. My doctor couldn't! Personally I believe the primary cause of heart disease is inflammation not cholesterol. In the Framingham study, the basis of statin use, Linus Pauling years ago looked at the data and said sugar, not saturated fat, was the culprit in heart disease. He said fat in moderation is good for you. Most likely the data was selectively used due to pressure by lobbying by from the pharmaceutical and sugar industries!

[Erica]

Thank you for setting folks straight! I get so sick of books like this giving people misguided advice based on an oversimplification of the data.

[meg]

For a research librarian and a medical one at that I am disappointed that your research skills are limited by your personal dietary bias.
Go back and dig out the whole research articles cited by Perlmutter and others relating to what he advises we eat and then read papers relating to meat and fat consumption taking close regard to how the experiment was conducted, variables, conflict of interest Harvard has been well known for its plant based bias, though recent comments from Willet and Mozzarin suggest a softening on their hard line attitude towards dietary fat in light of recent saturated fat - cholesterol connection.
A good research librarian would have also picked up the screaming bias in Fuhrman's work -- the alarming language and verbal trashing of any dietary suggestion contrary to his own is evidence enough to suggest he is perhaps being a tad too protective of his own empire to consider, scientifically, all the dietary options on the table.
McDougall's attitude is just a head scratcher in the face of growing scientific evidence against starch and fructose.
You are in a position many would consider enviable in that you have ready access to the whole gammut of medical literature but can only see those that suit your own dietary paradigm.
As librarians we are expected to find and make available information to those who ask. We should never be interpreting that information through are own bias filters.
Dietary advice and advisors have many vested interests from stakeholders in government and business.Funding for research is limited and scarce in this day and age.I am sure I don't have to remind you to check who owns the purse strings before you take the results of a particular finding to heart.

[John]

You seem to be crediting Dr. Perlmutter with recommending eating high amounts of protein. Did you read his book? He does not suggest eating high amounts of protein. In fact he suggests limiting calories overall. Further he suggests using ketone strips to ensure that you are not too highly ketotic - a mark of consuming too high of a percentage of protein in your diet.

His premise is that eating too much sugar of any kind (even wholesome grain) is going to damage LDL, and this will lead to inflammation in the body and cause a narrowing of the arteries. You counter his premise by referencing Dr. Ornish as saying this is basically wrongheaded. Do you have scientific literature in your library to support your position, or should we just trust you?

Bottom line - and I do not mean to disparage you - but as a person trained as a librarian you simply do not have the educational credentials nor the research background to critique Dr. Perlmutter's work.

[Healthy Librarian]

@John: Did you follow the links to top-flight journal articles to support the comments I made? Look, scientists disagree over so much--there are always different interpretations & schools of thought. Also--I wasn't saying that everything Perlmutter was saying was incorrect. Insulin ups & downs caused by a poor diet are bad news for the brain. BUT, NOT ALL CARBS ARE CREATED EQUAL!! Sugar is bad news. Refined grains & processed foods & bakery desserts. Crap! Soda, fruit juice--avoid. And yes, I too limit whole wheat flour products & breads. But whole intact grains (excludes flour even if made from a whole grain) & legumes that are low-glycemic & are a tremendous source of soluble & insoluble fiber & make up the fermentable substrate to feed & promote a healthy gut microbiome---these are the carbs that are beneficial, IMHO. Also, extremely beneficial for GI health.

At the time I wrote this I was unable to get a copy of the book & I was responding to the Psychology Today post about the book.

Living on grass-fed animal protein or wild salmon isn't economically feasible or sustainable for the world population.

[Philippe Orlando]

I think many doctors are discovering they are tired of practicing medicine. I happen to know a few. So what's next for them? Write a book. Do you make money by writing what people don't want to hear? No. You make money by writing what people want to hear and you bring them some bogus scientific proof, you're a doctor after all, and voila.
As far as I'm concerned, Perlmutter knows what he's doing. He's trying to make money.

[James Richardson]

I just heard this guy Perlmutter on "The People's Pharmacy" on radio. A smooth talker. Convincing at first. Radio hosts fawn over him, like Smiley and others fawn over Oz on TV. They get a free pass.

Gosh, so -- Drs. Ornish and Esselstyn and Mirkin, all proven beyond doubt by now, plus this website itself -- have all been wrong about very low-fat diet and atherosclerosis reversal?? And cardiac events and strokes?? After all this time?? Wow, what a revelation. I guess I've been a gullible sap to believe them.

Unfortunately, reality intrude. They and this website (my first link) sure saved my life with a reversal, four years later. And Bill Clinton's life too. I heard Doc Perlmutter say that low-fat diets were a disaster based upon work in the 1990's? What?! Gosh..I think that says-it-all post above me by Phillippe Orlando sums up this guy: "As far as I'm concerned, Perlmutter knows what he's doing. He's trying to make money."

The best semi-quacks are always very smooth convincing talkers, and usually have falsehoods sandwiched between several truths. Goes down best that way. Like Mercola and current heros, Mehmet Oz and Andy Weil, (Oz and Weil are the smoothest yet, like Jim Bakker was in his genre). *Spend an evening by Googling* Mehmet Oz and Andrew Weil (not at the same time)+ the word "quack." Be prepared for an eye-opener. As the juvenile blurb about Perlmutter's book says, it "blows the lid off." FYI, I just learned from always-smiling Oz in the checkout line yesterday that I can "Detox (sic) My Thyroid," and lose a pound a day. What good news! The man is a genius, ahead of his time! Perhaps an earlier method of his in that same publication before Thanksgiving, to "Turbocharge (sic" my something or other and lose even more weight per day, is too old-fashioned. I can barely wait for the breakthrough secrets he and Prevention magazine will reveal in 2014.

[Lynn Asher]

Hi,
I came upon this GRAIN BRAIN book recently. I have taken the course in plant based nutrition and have eaten Dr. Campbell's diet for a year and a half. I have deteriorated but have been steadfast in my support of this way of eating. I eat whole grains, beans veggies, fruit and small amount of nuts, seeds and avocados. No sugar, oil or processed food. Results have been depression, constant food cravings due to constant stomach issues with all the fiber. Beans kill me as do all the broccoli family foods. I lost all my tight muscles and although have gained no weight I'm all flab now. I still exercise every day, take Vit d , don't need b12 as levels good and have regular blood checks. All is well. My hair has fallen out, my moods terrible and I have come to the conclusion that this way of eating is really a cult eating disorder . All I know is my former animal based diet of no grains, as I never liked them, no beans and just veggies made me feel great. I love learning new things and when this plant based explosion diet appeared on the scene with all the plant based superstar doctors, I was sold. If only I felt great like they all contend. This Grain Brain concept is another floating concept which will bring many over to the diet . Maybe I'll try it . Being depressed and having brain fog and never feeing good on this wonderful plant based diet has taken precious happy years from my life EVEN if it lowered my cholesterol….At what cost however?

I am sure there are many others out there like me as well as many who do great. I'm happy you are the latter but all of these restrictive diets are really glorified eating disorders in disguise as I have now come to believe. I'm just frustrated at the power and influence these books and their respective studies have over us. Bottom line is feeling good is paramount to a successful diet. Leave the rhetoric behind . These plant based diets will be history as more problems arise from those following them. I unfortunately don't have the answer as to the ideal diet for mental and physical health out there. For me, it's DEFINITELY not the forks over knives one.

I would enjoy hearing from you if at all possible.
Thanks, Lynn.

[Denis MacDougall]

Sadly there is so much confusion out there given the plethora of conflicting "scientific' studies about what we should eat for optimal health. I suggest you read Michael Pollan's book "In Defense of Food" which recommends 3 basic rules for healthy enjoyment of food.
1. Eat real food as opposed to the processed variety by the corporate food industry.
2. Mostly fruits and vegetables.
3. Not a lot.
Kinda makes sense doesn't it?

[JH]

I think that that was a pretty good response, however, I am still confused about saturated fats and cholesterol-they may lower our risk of dementia, and people with higher LDL levels had just as many heart attacks/risk of heart attacks?
Please respond to this, I'm quite confused.

[Dana Burns]

Thanks for your thoughtful response. You provide a better balanced, more broadly supported set of information. As a Stage 4a cancer survivor, I am particularly concerned about maintaining a nutrient rich, plant based diet for the obvious reasons.

[MacSmiley]

Permutter's advice to eat cholesterol for brain health is short-sighted. AFAIK, the brain manufactures its own cholesterol, and serum cholesterol from the liver can not cross the blood-brain barrier. Whoops!