Claudia von Boeselager: If you haven't done so already, make sure to subscribe to the podcast and not miss the latest episode. My guest today is Dr. Austin Perlmutter. We've had his father previously, and now I have the pleasure of having Austin today. He is a board certified internal medicine physician and internationally recognized expert on how environmental influences affect our mental and brain health.

He is a co-author of The New York Times and International Bestseller Brainwash, which he wrote with his father, Dr. David Perlmutter, who has also been on the podcast. He currently serves as the Senior Director of Science and Clinical Innovation at Big Bold Health, where he's running an IRB approved pilot trial, exploring the effects of polyphenols on epigenetic expression.

His overarching focus is on helping people find pharmaceutical strategies for getting stuckness out of their brains and bodies using the best that science and nature have to offer. Austin, welcome on the Longevity and Lifestyle Podcast today. It's a real pleasure to have you on.

Dr. Austin Perlmutter:Claudia, I'm so glad we made this happen, so I'm excited to be here today as well.

Claudia von Boeselager: It's been a few attempts, but we got there in Austin, so thank you so much for coming on. I'd love to start with brain health and its importance to happiness and the quality of life. Can you explain that and also talk around the brain's focus on negative thoughts

Dr. Austin Perlmutter: For sure. So I, I kind of had an interesting upbringing in that my dad is a neurologist and so he's been focused on the brain for a long time.

His dad, my grandfather, was a neurosurgeon, so he was focused on the brain for a long time. And in this context I kind of decided I did not want to focus on the brain. And so, you know, I majored in English and creative writing in college and for a number of reasons, I did find myself eventually being pulled into the medical sphere and going off and doing my MD and then getting a residency in internal medicine, which is kind of general medicine, learning about heart disease, GI issues, cancer management, those types of things.

 And so I spent my training years managing chronic diseases, lots of blood pressure, lots of blood sugar, those types of things, types of medications primarily, and there was this fundamental understanding that came to me over the course of this training, which was I was primarily addressing surrogates, and I'll explain what that means a little bit.

But really the best example of this was that I would sit down with patients, I would look at their problem lists. So whether it was high blood pressure or heart issues or weight issues or whatever else, then I would make recommendations. So those recommendations would be exercise, eat healthier. They'd also take your medications and make sure you show up to your next visit.

And despite all of that, what I found, which unfortunately was not unique to me, is that people don't follow through on those types of recommendations. It's called non-compliance, it's called non-adherence. But the bottom line is that people don't do the things that we kind of know are healthy, that we believe as medical practitioners are the best things for people to do.

And in thinking about what was going wrong here, it led me down a path of trying to better understand what it is that drives human behavior one way or another. Understanding how people make decisions, understanding what motivates behavior. The long story short to all of that is it all comes down to the brain in our state of mental and cognitive function.

The correlation to that is when you look at what it is that kind of leads people to, or allows people to enjoy their quality of life. You know, sometimes it's the lowering of the blood pressure. Sometimes it's the lowering of the blood sugar. But when I say surrogates, what I mean is those things in and of themselves don't matter unless, and the unless is, unless they improve our quality of life, unless they improve our ability to show up, enjoy our lives, spend time with the people we care about.

And that ability to enjoy our lives, to spend time with the people we care about in a meaningful way to feel good is a direct manifestation of our brain health and our brain state. So with these kind of realizations in mind, I did a little bit of a pivot, and coming out of my medical residency, I decided to rededicate myself to understanding what are the drivers of how our brains are being programmed for negative thinking, for unhealthy decisions, for negative mood, and what we can do to reprogram them for basically the opposite.

And I call this kind of this science of stuckness because with all the research that I've looked at over the last years, it's become very clear that a lot of what drives us to stay in unhealthy patterns of thinking action it's these rigid, stuck, biological pathways in the branded in the body, whether that's the immune system, our metabolism, even neuroplasticity, which is the brain's ability to rewire itself.

So with this in mind, with the understanding that our principal driver of happiness, decision making, the ability to enjoy life is the state of our brain function, and that there are things that are happening in our lives that are programming that brain function towards a more negative, maladaptive, stuck state.

There is this question, can we do things to move the needle, to get our brains unstuck? And the answer to that cut to the chase here is, yes, there are many things that we can do. And so that's really been the focus of my work. Some research, a lot of education, and mostly a lot of relearning the medical science in hopes of basically bringing these messages to the general public that, look, we have to make these changes because it is fundamental to everything that matters.

And there are easy and often free and accessible ways that we can reprogram our brains and kind of reclaim our brains for the better.

Claudia von Boeselager: I love that. And I think getting down to the root of it was really fundamental, right? Because, as many doctors will say, they can give recommendations, but their patients don't implement it then.

So finding the product protocol, finding the strategy to help them really get to their why, their purpose and motivate them to actually do it is, I would say phenomenal. What would your protocol, what would your recommendation list look like? If you had a patient that needed to make fundamental change, but you saw that they're limiting beliefs, their neural pathways their wrong neural pathways or get, getting them into negativity versus, being able to rewire for actually getting to achieve their course.

What would that look like?

Dr. Austin Perlmutter: It's a good question, and let's just kind of expand that beyond the doctor patient interaction and talk about how people change in general, there are a number of different models to change the trends. The theoretical models, probably the most popular one, regarding are people ready to change?

Are they in the process of making change? Are they not quite there yet? I do think from my experience in, I guess, examining human psychology and in myself and in people that I know, until a person experiences a certain degree of pain, and that doesn't have to be physical pain, it's more often mental pain, but basically an appreciation that they don't like where they're at.

It's really hard to institute some of these changes. And the reason is that what I see is that motivation to do things differently comes from a need to fix some sort of a problem. And so I do think that one of the primary frameworks I use when I talk about this is the first thing is you have to be curious about what could be different and usually that curiosity comes from a desire to better understand something that is a problem, right? So it might be that you have a friend or family member who's suffering from a brain issue and that is a driver for you. I say this more generally, but in my family's life, my grandfather, the neurosurgeon, developed Alzheimer's disease.

And so that was a major driver for my dad to say, What can I do in my life and how can I educate other people on what can be done to prevent this from happening? In my personal life, some of the things that I experienced as far as mental health, during my medical training were sufficient for me to say, Look, I've gotta find better solutions, because just going along with things the way they are is not working for me.

 I think we all have to have some sort of a reason as it relates to trying to address pain, whether it's psychological or physical pain. Until that happens, I think a lot of these recommendations fall flat. I mean, I've seen people get excited about making changes because they want to bio optimize, right?

They want to make those additional tweaks, but even there, there's some sort of a desire to address a pain point. So for really high functioning people who are at the top of their game in business, when I educate them on decision making, their goal is to improve decision making, maybe so that it improves their ability to make good decisions at work, make more money, and do a better job managing their employees.

And that's still a pain point, right? It's something that they want to address and figure out how to do better. So I think that gets to the initial question of why does a person want to make changes in the first place until that question is addressed, until there's some sort of a meaningful reason why it's hard to make those changes.
So at that place, what I primarily do is just provide general insights and education on the reasons why a person should care about this. And that's where I start with some of these kinds of amazing facts, which is that if you look at the state of the world today, tens of millions of people already have Alzheimer's dementia.

That number is expected to triple by 2050. Hundreds of millions of people have depression, and it's a larger number. When you include things like anxiety and other mental health disorders, that number is especially going up in our younger population. And so if you are a person who has kids, that is a significant concern.
And beyond that, when you look at the state of mental health in the United States and worldwide right now, what you see is really high rates of experiencing chronic stress. So chronic stress we're talking about over half of people in the United States. A lot of that relates to changes that have happened since the pandemic.

Some of it relates to the intrinsic nature of the modern world. And when you understand that chronic stress is one of the principal risk factors for developing depression, for developing cognitive decline, mild cognitive impairment, dementia like Alzheimer's, and just that, if you are experiencing that, maybe you remember that is not a good place to be.

And then you start to understand, okay, well what can be done to address it? So the big idea here is you've gotta find some sort of a pain point, some sort of a reason why to make a change that sticks in my opinion. Until that happens, being curious about the way the world works and the way that the brain works is great, but when it comes to instituting those changes, there has to be some sort of a driver as far as what is it that is, is driving you to get up and make some of those different lifestyle habits stick.

So, in a patient encounter, you can be much more specific. You can ask that person what are your goals for the next few years? You can ask that person, what is it that you care about? You can ask that person, what are the biggest contributors to you not enjoying life right now? And you can really dial in on what those whys are and really customize a plan that is geared towards changing those negative things that are impacting their quality of life, but in the larger sphere of the planet.

And I guess for people who are listening, I would say think about the things that you are not enjoying those pain points. And then with that you can start making these changes that can hopefully address and improve those variables.

Claudia von Boeselager: Thank you for expanding on that. What would you say are some of the biggest challenges people face and is it due to brain health? So, right. That one is the gun ho and I'm gonna do it, and that's fine. And a week goes by, two weeks go by and as we know also everyone has had some personal experience with this, right? That sort of fatigue sets in, in terms of like, again, I need to do this, et cetera.

So what are some challenges that typically arise that you see despite the best intentions? And what maybe are some strategies for people looking to really make a long term shift? What can they do?

Dr. Austin Perlmutter: Well, I think there's two things, and one is the reality of we live in an unhealthy world that is doing everything it can to pull us back towards unhealthy behaviors, right?

Everything is geared towards the quick fix. And to that end, you know, when you look at food, most food has added sugar. So if you're trying to cut out added sugar, which I recommend most people do, you are fighting a challenging battle because everywhere you turn, it's going to be set up to make it hard to stick to that decision.
Similarly, if your goal is to cut back on unnecessary stress, and you realize that for most people the way that day is set up is to expose you to the stress. Everyone is watching. In the United States, at least four hours of TV on average a day, TV is filled with stressful content.

People are spending two hours a day on their phones, on social media, again, filled with stressful content. This is the default. So again, 0.1 is to understand. The default reality is unhealthy. And so trying to make these changes is going to be difficult in a world where those changes are set up in a way that is going to be such a challenge.

But two, and maybe the point that's worth addressing in more detail is that I believe most of the time as people go to make these changes, they are not taking into account the way that we know the brain works. And so a great example of this would be when you look at what happens around New Year's, what you see is tons of people making resolutions.

That's the New Year's resolution. I'm going to go to the gym every day. I'm going to eat three healthy whole food based meals a day. These are all really noble and wonderful goals. But I would ask when people are setting these goals, how much are they taking into account neuroscience? And I would argue that the answer is almost none.

Instead, what they're doing is kind of relying on this idea of willpower or this idea of setting a goal and assuming that's the only thing that matters. And what has been very clear from the neuroscience research is that that's just not the way that our brains work. So, a good example of this would be to understand a little bit about habit neuroscience.

And so habits are a psychological, kind of framework that maps onto a neurobiological scaffolding. And they become popular. And everything from motivational quotes to neuroscience conferences because they speak to this exact thing that I was describing, which is why is it so hard for us to stick to and make healthy behaviors a part of our lives?

The way that habits work is that we have a kind of automatic or unconscious part of our brains that is capable of offloading actions that we do repeatedly. And for example, when I'm brushing my teeth, I don't have to think, okay, 30 times across right and left on this bottom right molar. Similarly, when I'm driving in my car, I don't have to think the light turns green.

That means foot off the brake foot goes on the gas, and the gas gets depressed by an inch. And then when a stop light. That means foot off the gas and onto the brake. These are things that kind of get offloaded to these automatic parts of our brain, specifically the basal ganglia, which takes care of our habits.

So why does that matter? Habits constitute upward of 40% of our kind of actions decision making in a given day, and most people do not even know that. So if your goal is to make your decisions healthier, which for most people they are, I want to eat less junk food. I want to exercise more. I want to not make such bad decisions about, I don't know, buying cryptocurrency, whatever it is, you want to make healthier choices, and you're ignoring the fact that 40 plus percent of those choices you make in a day are these unconscious habits.

Best case scenario, you're shooting for 60%. Healthy choices are a given. So to come back to that person who's wanting to make these New Year's resolutions, what would it look like if you incorporated some of these habit neuroscience findings? You would know that you're far better off choosing something that is easy to do and embedding that into your habit loop.

Rather than saying, I'm going to go to the gym and exercise for two hours every single day, the chances you're gonna stick to that are very low. If you said, instead, I'm going to stick to every day for five minutes in the morning, do a stretch or just say, I want to get outside and take a walk every day.

Now walk five minutes, 10 minutes, whatever, something that is going to be easy to do and is replicable by committing to something that is easy to do. What you're going to do is do it more often. And when you do something more often, that's when that habit part of your brain starts paying attention. Takes, on average, about 66 to 67 days for a new behavior.

To get incorporated into those automatic, unconscious parts of the brain that is very different from what we hear about. New habits will stick in a month or in 30 days or whatever else. That's actually not based in science. And additionally, what doesn't make sense is to say go really hard.

Start off these new healthy activities first thing of the year and create these contracts with other people. Just get up and have the willpower watch the YouTube video about being super motivated. That's not neuroscience, just pop psychology. So what I would say is this represents one example of how you wouldn't take what is known about how the brain functions and overlay that on what you desire to do, which is.

Exercise more or just generally feel healthier, you can start making these connections and making things stick that otherwise would've fallen off and left people where most people wind up, which is blaming themselves for not having the willpower to follow through.

Claudia von Boeselager: Which leads down the negative pathway.
And yeah, I mean, I, I also teach my and stress

Dr. Austin Perlmutter: And then what we know is stress actually is toxic to our decision making and is toxic to our brain health. So if you wind up back in stress, you've actually not only fallen short in whatever your goal was, but actually taken a step backwards as far as exposing your brain to chemicals that in the long run are linked to all the things we're trying to avoid.
 
Claudia von Boeselager: So stress is a really tricky one. Right? So we were talking about news and things like that as well. I have some clients that experienced stress reading the news, especially coming through the pandemic and things like that to do that detox of a week and magically the world still continues if you're not updated on all the news and a week we can step out of it as well.    
 
But what are some strategies that you recommend for people who may be in a high powered, very stressful job that may have a challenging situation at home as well, be it with kids or whatever the case may be, to relationship. What are some strategies that you advise based also on the science to help people alleviate those stress responses?

Dr. Austin Perlmutter: Well, one of my pet peeves is when people say, Well just decrease your stress. Like, Oh, I didn't realize it was the thermostat and all I had to do was turn it down. Oh wow. I think very realistically there are unavoidable stresses that we'll all experience in our lives. And I think it's ridiculous for anyone including doctors like myself to say, Well just have less of that.

 I think the way I approach this is there are certain stressors that can be turned down. There are not necessary stressors, and there are, on the other side, things that we can do to mitigate the effect of the unavoidable stressors. So when we're talking about unavoidable stressors, you brought this up, but the news is a top contributor to people's feeling of stress.

When you look at surveys, that's what they say. And I do believe it's important to be informed as to what's happening in the world. I think that the reality is for most people who are trying to be quite informed, they're going far above and beyond what is necessary for them to know what's happening and for them to be able to make changes.

There's this idea that, well, You need to know about the suffering of other people, and you need to be exposed to that in a way that allows you to both have empathy and ideally do something to help alleviate that. I don't think this is a dose response kind of scenario where for the average person watching, that third hour of watching people struggle is what compels them to make changes in their lives.

 Because what we see is in fact that when people are highly stressed, it basically creates tunnel vision in their brains and it keeps them more focused on what's right in front of them rather than the bigger picture. And that's counter to empathy, that's counter to acting, that's counter to being productive in it.

So I think we all just need to be honest about it and say the news groups, whether that's uh, you know, tv, internet, or otherwise, are incentivized to keep our eyes on the screen. So they're always gonna say, you need to watch this. This is the news you need. Their definition of need is very different from what's best for us.

And I think, again, coming back to the idea that in America the average person is watching four hours of TV a day. Granted not all TV is news but they're also listening to many hours of radio a day. And we should be honest with ourselves and say, Are we still becoming informed or are we just getting upset?

Because being upset doesn't translate into action the way most people think it does. Right? So chronic stress, which is the feeling of upset that many people experience chronic anxiety, which is layering over it feeling of discontent and concern for the future is not necessarily conducive to doing something differently.

So the idea here would be to look at sources of stress in your day. And again, it's specific to the person. Some of this may have to do with relationships, right? You get into conversations constantly that are just not making any progress, where you're arguing with your friends and family members over things that will not change.

And being honest saying, Can we put a time limit on this? Or maybe can we ask whether these conversations are constructive? But the other piece of this, which I think maybe is more valuable for other people, is to say’ Look, certain stressors, whether it's work, family, global are not necessarily something that we can address and we will continue to be exposed to’.

And there's some degree that's maybe necessary for us to maintain our lives. So what can we do to mitigate that? And that's where I think some of these other interventions are so powerful. Not everyone's gonna be thrilled with sitting on a couch and meditating for 30 minutes a day. For some people, that's a great stress reducing intervention.

Mindfulness could be paying attention to and being conscious of how you eat your food. It could be paying attention to your thoughts. It could be just closing your eyes and paying attention to your breathing. These are all ways in which research studies have shown that people can be effective in lowering some of these stress pathways in the body and the brain.

The one that I talk about a lot is nature exposure. And the reason for this is coming back to the point I made earlier. I love interventions that are free and readily accessible, and nature exposure for most people is accessible. And I'm not talking about needing to walk out of your house and be in a forest, that's great.

But when you look at the research here, even people in an urban natural setting, so going to a park in a city, these are things that are linked to lowering of stress hormones. So it really is trying to find. I believe the things that work best for you. But if you are somebody who's experiencing a high degree of stress not gonna solve that by just saying don't experience it.

There are perhaps certain aspects of it that maybe need to change, and that's working with your therapist or health practitioner as far as saying, Look, is your job super stressful? I know that the job is necessary, but on the flip side, that stress is also very toxic to your brain. Those are longitudinal discussions that are more complicated.

But on the, uh, side of mitigation, it's saying, Well, what can you do to prioritize your mental health and help to reduce some of those stress pathways in your brain?

And that's nature exposure, mindfulness, even just getting better sleep, if you can, that could be helpful and lowering some of these stress pathways.

So these are some of the things that can be done. And last thing I'll just say here is we actually do want a little bit of stress in our lives. This is, you stress, this is positive stress. It keeps our brain sharp. It may actually have a benefit to preventing things like Alzheimer's disease because you're actually building up resilience under your brain.

So I just wanted to caution that we're not talking about getting rid of the stress in your life. That's not the goal. The goal is to make it more manageable and to help to offset some of that more toxic chronic stress that is most linked to negative health outcomes.

Claudia von Boeselager: I wanna pick up on something you mentioned before for the science space rewiring right?

 It takes about 60 to 66 to 67 days, I believe you said, as well. And those are literally that you have to do that pattern every single day for that period of time. Or is it sort of dipping in and out within that space?

Dr. Austin Perlmutter: That's a good question. The core concept of habits, and I've had the opportunity to speak with one of the world's leading researchers on this subject.

It's basically to do something repetitively. And so in the same place, in the same way, so that your brain's habit system takes notice of your brain's habit system, it's looking for the stuff that doesn't require a ton of your cognitive processing. So if every day you're doing something that's really intellectually challenging, that's always different, there's no way that's going to move to your habit loops.

You know? So if you were Living in a new city and you had to find your stores and stuff, that's not going to your habit loops the first couple times cuz it's all brand new. You're gonna be a little bit stressed. You're gonna be trying to think about, Oh well is this the right turn? And where is that store?

That's not habit loop type stuff. If you do that same drive to that store, or let's say your office every day and it's always the same traffic lights and there's never anything new on it for months, that's where your habit loops start picking it up. So basically you're speaking to your habit, part of your brain when you do something in the same way, In the same place day after day.

 And it's usually the things that don't require a whole lot of your high level cognitive demand. So how does this come into play? Well, you want to find something that you're willing to stick to for that amount of time, and in order to do that, you need to find something that is easy and is enjoyable.

So that's really important. If you hate it, the chances that you're gonna stick to it for 67 days or whatever are really, really low. If it's really challenging, the chances that you're gonna stick to it for 67 days are really, really low. If you decide, I want to be somebody who is in great shape, and the way I'm gonna do that is I'm gonna run a 5K at 5:00 AM every day, what are the chances that after two weeks, you're gonna still be excited about getting up outta bed at 5:00 AM and running that 5k that you're gonna stick to it?

It's really low, but what you can do is say, I wanna start with creating a habit that is easy, that I can commit to every day that is enjoyable. The enjoyable piece is interesting. There's a researcher named, BJ Fogg, who actually talks about this a lot. He talks about celebrating after you do these things, because you create a little bit of dopamine, you make it more enjoyable.

So to put that into practice, what we're talking about here is you want to be somebody who's in better shape, that's your end goal. The way you're gonna do that is to more consistently exercise. That's your sub goal. And then the way that you're gonna get yourself there is not to run on a 5K every day.

It's to say, create a simple, easy, enjoyable, and readily reproducible each day habit. And that is going to be that at 7:00 AM you are going to have a cup of coffee, which is maybe already a habit, something enjoyable. And you're gonna put on your shoes, right? You're going to put on your gym shoes and you're gonna walk outside the door.

And that's it. That's the habit. So it's easy, it's reproducible, it's gonna be tethered to some enjoyment because you're gonna give yourself a cup of coffee. All you have to do is that to embed that. Now, maybe once you're outside the house, you're probably gonna go for a little walk around the neighborhood, but that's not necessarily the main goal.

The main goal is to solidify in your head this habit loop so that in a couple of months you won't even be thinking about this as you're sipping the coffee, you're putting on the shoes and you're walking outside. So it's finding ways to build it in that way. And the flip side of this would be for unhealthy habits.

So let's say there's something that you do that you really don't enjoy, that you really don't enjoy as it relates to your health. A good example would be on the way home from work. Every day you drive by and purchase fast food from a restaurant. And then you wind up eating that in the car or on the way to work.

You wind up purchasing an unhealthy coffee drink every day, and you wind up drinking that because you want the caffeine and the sugar. Or when you get home from work, you find yourself on the couch watching Netflix, eating a bag of chips. Chips in the American sense, or a bag of crisps, right? And so you say, these are things that I do repeatedly that are obviously habits, and how do you know they're habits?

Because when you're doing it, you're probably not all that conscious of it, right? You're plopping down on the couch, you're opening the bag, You're not necessarily thinking, I got home from work. I am stressed. I'm going to go pick up this bag of chips, then I'm going to go sit on the couch and then I'm gonna watch my tv.

This becomes automatic. So you have to deconstruct it. And the way that you deconstruct it is you say, How do I make it less easy? How do I make it less enjoyable? And if you start applying this and you say, Well, if basically on the drive to work, I am buying this unhealthy drink and I don't like the way I feel after that, you may need to change your drive to work.

Because what you may not know is that the trigger for you to purchase that drink isn't necessarily that you are feeling so bad and wanted the sugar. It's that you drive by that coffee shop and the coffee shop, every time you drive by it, your brain says, I know this one. When I go buy this, I turn right.

I park in the spot. I go order. So if you could get upstream of that then you can really cut the snake off at the head or whatever you wanna say. So how do you make it less easy? How do you make it less enjoyable? So making it less easy in the context of the eating of the crisps or the chips at home.

Maybe that just means you gotta stop buying those bags when you're at the store. And you say, Okay, well that's obvious, but not necessarily because what you may not appreciate is that. The habit of going and sitting on the couch and eating that junk food is something that really needs to be cut off a week ahead of time when you're at the store and making those decisions.

 So the basic concept here would be if you look at the things that you wanna do more of, make them easy, make them reproducible, make them enjoyable if you look at the things that you wanna do less of, make them difficult, make them less fun, right? And so when you start applying this and you start looking backwards as to what are the series of steps that leads me to either a healthy or an unhealthy behavior, you're able to make changes.

Before you are actually experiencing the kind of felt state of the action, you're able to be a whole lot more objective about it and these are things that have been shown to be effective in behavior change. But this is a far cry from what I was saying before, which is the heart of the motivational space, which is just wanting it harder.

 Just get up earlier, just force yourself to do it. That doesn't actually work. We can all watch these workout videos of whoever Dwayne Johnson getting up at 4:00 AM and lifting all the weights. But if you wanna get to the neuroscience of it, The things that we do are more a reflection of things like habit loops than they are levels of motivation on a given day.

That's just not a good overall plan for rewiring your brain.

Claudia von Boeselager: I love that summary. Thank you so much, Austin, of having, you know, setting yourself up to win by almost baby steps. Right? So just getting on the shoes, having the rewards, celebrating, Right. Rewiring those new pathways that this is pleasure, this is a good thing, and celebrating that, that even the shoes got on and walking out the door, and also setting yourself up to win in terms.

Avoiding going down that aisle, maybe in the supermarket so you don't go buy the bag of chips or driving a different route to work so that you don't go buy that fast food restaurant and buy yourself a, whatever it is, McDonald's breakfast or that coffee with all the sugar and unhealthy food as well.

So, I think if people actually think about it, probably it's a matter of sitting down for 20 minutes, maybe even half an hour, and writing the list of things you wanna do more of and how to set yourself up to win, and then things you wanna avoid and how to make it a pleasure to avoid them.

What is the reward maybe if you do actually manage to, to avoid it as well? And just those, those little steps along the way. I think the typical example with the New Year's resolutions you were mentioning before, is that the gym membership, I mean, the gyms love it, right? How many people are there in January killing themselves on a treadmill?

And in February it's quite quiet again at the gym. So it's the baby steps and it's like a staircase, right? You build that muscle, if you will over time. So, I love that analogy. Thank you for sharing that, Austin.

Dr. Austin Perlmutter: That's right. Let me just say one other thing on that front. So I actually think the strategy of sitting down and writing out the activities that you go through in a day as it relates to specifically the unhealthy stuff.

So if there's something you wanna change, look at the things that you wanna change, whether it's, I don't like. I want to be healthier, I want to eat healthier, I want to have better relationships, I want to move more. And then you look at what you actually do in a day? Right? So for many people they might be surprised, Well, I actually spend two and a half hours each night watching TV and I don't wanna do that anymore.

 Or I actually find myself most days eating donuts at work because people bring them in and they bring them in. It's a nice thing. They wanna celebrate the workday. But that's something specific, because I think more generally what we say is, Well, I wanna be healthier. I want to get into that swimsuit.

I want to feel better. And the way I'm gonna do that is I'm gonna do a detox. Right. Or I'm gonna take a supplement. And we don't always say, Well, what are the things that are the biggest barriers as it relates to what is specific to my day? So I think it's a great exercise to go. And do a couple days, not just the weekdays, but the weekends, and say, Well, here's how I actually spend my time, and here are some of the things I eat, and here are the things that I believe are not great for my health.

Because when you do that, you can work backwards and deconstruct what is contributing to those things. Yeah. And the one other thing I wanted to mention here is we all have a really hard time drawing the connections between the drivers of our behavior as it relates to our brain function and the outcomes of those behaviors.

So for example, if you find yourself eating the donut at work each morning and you realize that's actually a big impediment to me meeting my health goals for most people, I don't think there would be an understanding. Okay, what can be done differently? Besides just saying, I'm gonna go and I'm gonna say, It's enough.

I know, you know, Tracy always brings in those donuts and that's really nice of her. But from now on I will say no to those donuts. It's not asking why it is so hard to say no to those donuts. So a great example of why that might be the case is research shows that when we get lower levels of sleep, so less than about seven hours of sleep at night, we are far more likely to make unhealthy decisions around food.

We're far more likely to eat more food and to choose unhealthy foods. This is what happens when people are sleep deprived and we may not make the connection that one of the reasons it's so hard to say no to those doughnuts is because we are cutting into our sleep because the night before we're watching Netflix for three hours and staying up till 1130 and then waking up at five 30.

So now the goal is to say, I don't want to be eating those donuts. What can I do? Maybe one of the things is to give yourself more sleep the night before and another example would be when we are stressed, we tend to make worse, more impulsive decisions. Maybe an intervention prior to you getting to work is to engage in 10 minutes of mindfulness a day, trying an app or something.

Because lowering some of those stress pathways may actually improve the quality of your decision making. Make it easier or maybe it is, if this is really a big struggle, the question of saying, I don't want to be eating the donuts. Maybe I do need to eat something before I get to work.

 So maybe it's saying protein shake first thing in the morning, so you're not so hungry is the solution to it. But the point here being I think the deconstructing those principle elements of the day that are taking you away from, or keeping you from living that healthy life that you want, and then asking what are the contributors to those outcomes.

and then ask, what can I do to influence them before I get to that moment of choice? Once you get to the moment of choice, you've actually lost most of your opportunities to make a healthy decision. They've been taken off the table. But when you start to write them out, then you can work backwards and you can say, Well, giving myself that seven to eight hours of good sleep tonight is not just gonna make me feel better.

That's actually part of my plan for avoiding the donut the next day.

Claudia von Boeselager: That is a really good point to get to the root cause, right? And to set yourself up to win as much as possible by creating those environmental factors as well. I wanna touch on before, before we continue on the concept of decision fatigue.

I was doing some research around this as well. It's really fascinating. I think there was research, I dunno if you've read this in Israel around judges for prisoners with parole. Yeah. I think you know this as well. And the best more likely to get a yes that they prisoners could have parole was directly in the morning or after lunch
And the other time that sort of decision content was drained away. What is your view on decision fatigue and I know that there are concepts around automating your wardrobe. I mean, just look at Steve Jobs, right? Keep it simple. Same outfit every day. Don't need to think about it too much. How much science around that have you looked at and what is your view on the concept of decision fatigue?

Dr. Austin Perlmutter: Yeah, I've seen more research in psychology than in neuroscience around this. But I would say, at least anecdotally, I do think it's a real thing. I think that when there are tons of decisions to be made, it's very hard to give each one the level of concern that you would if you only had a few decisions to make.

 I also think in our society where we are overwhelmed by choice, that it can be very hard to make choices when there are so many potential choices to make. So I have a couple of kinds of rules of thumb around this. One of them is in general, if you're a thoughtful person and you're stuck between multiple decisions and you're stuck for multiple decisions for a couple of days or whatever, chances are good that they're both fine decisions.

This is something I think about in my life. So if it's something where I really can't decide, it's probably that both options are fine and giving myself the kind of flexibility to say, With that said, I'll just choose one and I'm not gonna beat myself up for not worrying as much about or what I could have done differently.

I think that's important. I also think, much easier said than done, but our world is set up in a way that we're supposed to care about everything, have an opinion on everything. Make important decisions about everything. And in that, I think finding the decisions that are most meaningful for you to make consistently so that you can show up with a healthy brain as often as possible is really important.

 To that end, I'm a huge proponent of doing everything we can to nail down the key lifestyle factors that are linked to brain health, because regardless of how many decisions you have to make in a day, the quality of those decisions is a reflection of your brain state. And it may be the case that if your brain is in a better state, that you can make more good decisions.

But regardless, good decisions are a reflection of your brain state. So how do you do that? It comes down to these key lifestyle variables, and I think sleep is the single most important intervention for people to pay attention to. And the reason for that is because it's the quickest turnaround as far as improving the quality of your decisions.

So if you get one night of bad sleep, you feel crummy the next day, your focus, your attention will not be as good. That's not. Something that has to be debated. I feel like we've all experienced that you skip a night of sleep and then you have to take a test or go for a long drive and stay focused. That's not good, right?

But the correlate of that is our decision making is compromised the next day. So if you wanna make good decisions, whether it's a ton of decisions or less decisions, get better sleep the night before. And then there's the other things, right? So it's the diets, the exercise. There's some really fascinating research showing that exercise improves quality of cognition immediately afterwards.

So if you're making challenging decisions, getting exercise beforehand might be a good intervention. I do think though, to come back to the principal point, yeah, there are certain decisions that are more important than others. And if you can prioritize those and automate the ones that are not as important, that makes a ton of sense.
I am not going to be telling people that. Pick one outfit and stick to that. I haven't seen the study that shows that is a good plan. I also think for some people fashion and wearing different clothes is really important. And so it's presumptuous to say Oh, this is what you need to do, just buy a bunch of the same t-shirt and pants.

But for me, and based on at least some of that psychological literature I've seen, I do think automating the less important decisions can be really helpful in allowing us to focus on the more important decisions. And to that point, I think there is a real correlation of decision fatigue and I do think trying to focus on your major decisions earlier in the day when your brain is sharper versus really late in the day. Makes sense. I think also from what I was saying earlier about sleep fatigue, and medical training. We often were doing overnight shifts. Sometimes would come directly off of day shifts. And I think that's a crazy practice as it relates to expecting people to make good, weighed decisions for what is arguably the most important thing, which is people living or dying.

 I think there's a number of ways to dig into this. And if you're saying, I have to make x many decisions a day, where would I want to focus my quality decisions? I think earlier in the day before all the other things kick in Makes sense. I think after meals, depending on what you're eating, it makes sense.

As opposed to when you're hungry. I think ideally when you're not super stressed, as opposed to when you are more stressed makes sense.

Claudia von Boeselager: Let's look at some of you mentioned with exercise before making decisions is great, but I'd love to look at some lifestyle things as well, particularly around brain enriching foods, right?

So that really supports it as well. So one from a nutritional perspective, what are some of your top recommendations? And also with exercise as well, like certain types of exercise and also time of day. What would be some of your recommendations that you think work very well?

Dr. Austin Perlmutter: Sure. Having prescribed exercise many times and seeing that was not so helpful. Over here we'll say something like, Oh, well, 30 minutes a day for five days a week of aerobic exercise. Mixed with maybe some resistance exercises. Best based on population level studies where there's correlation analyses that don't necessarily apply to the individual.

 And if you are Somebody who doesn't exercise at all, who is like 40 plus percent of Americans, I just, I don't do that. Right. I move when I have to, but I don't move voluntarily. For me to say you need 150 minutes a week and try to get some jogging in is absurd. So the point I would make is any movement is good movement as it relates to brain function.

I think that holds up as far as the research. And some of that relates to things like people who do yoga have benefits to their brain function. stretch it, right? Like it,

We're not talking about running a marathon. So if you're not somebody who moves their body regularly, any movement is fantastic and I would applaud you for it.
If you're in a slightly different camp where you're saying, I wanna optimize my brain function, that's where you start to get closer to some of those recommendations around getting 30 minutes of high intensity or aerobic exercise. That might be worth your while. I would say too though, we've had a bias as far as saying it has to be this aerobic training.

Things like running, jogging, those things that, or, cycling that really get your heart rate up. What we're seeing now too is resistance training. So weight training, for example, also correlates with some of these benefits to brain function, and some of that is through a marker called brain derived neurotropic factor.

Protein made in our brains that supports healthy brain function. And that seems like it goes up as well, even with resistance training. I think there is a spectrum between the people saying, I'm willing to do anything to optimize my brain function. Where you get into some of these questions of, okay, how much basically what do you need your aerobic conditioning to look like?

What do you need your anaerobic conditioning to look like? These are often people who are trying to supplement with things like creatine and other potential brain enhancers. For most people, my opinion would be any sort of movement that is sustainable is the best movement for your brain.

Walking, yoga, stretching, all of this is fantastic. I find it personally. Even doing 15 minutes of high intensity weight training is sufficient to power up my brain processes and I feel the difference in my thinking. And I've actually gotten a lot more into weight training for a number of reasons.

I think it's very brain healthy as well. But, I would just come back to the principal point of finding something that is fun that you can. Repeatedly, whether that's salsa dancing or swimming or walking around the block with friends or walking your dog or doing chair yoga. My partner sometimes teaches people on chair yoga, especially people who, maybe have some physical pain.

I just don't love a society in which we start telling everyone this is what has to happen. So this is a very, kind of broad answer, but the best exercise for the brain is the exercise that your brain's going to enjoy, right? So that's the one that you can do repeatedly.

That's the one that maybe you can do with friends. That's the one that maybe you use an app or maybe you don't, maybe you go to the gym, but, baseline recommendation. If you can get that 150 minutes a week, 30 minutes, five times a week, get your O2, use up your VO2 up, but I don't think that is a recommendation that does well for the majority of people who are hearing this conversation.

So that's why I say find something you enjoy that moves your body and then build from there.

Claudia von Boeselager: Before we touch on food and nutrition for a moment, BDNF right? I think this is really fascinating. Would you say exercise is one of the best?

Dr. Austin Perlmutter: I would say it's the best, yeah. Yeah. I would say as you look at interventions that support elevating BDNF and that, I mean, so there's a number of ways to ask whether something is good for the brain.

If you look at cognitive decline in exercise, which you'll see is people who exercise have much lower risk for developing Alzheimer's and other dimensions. So that's really important. When you look at depression. What you'll see is that people who exercise have lower risk of developing depression.

So that's really important. And I would say cognitive issues and mental health issues are the two best markers of what really matters for the brain. Sure. You can look at it in real time. What does exercise do to vascular supply to the brain? That seems like it's helpful. What does exercise do to improve other molecules like brain derived neurotropic factors?

And that's another way to look at it too. But in the big picture, when you look at what are the outcomes we really care about, it's the quality of our thoughts. It's the ability to have good or well reasoned thoughts that matters. So that's cognition and mental health. Both of those correlate with exercise.

That exercise appears to translate into a lower risk for developing problems with mental health and with cognitive health. But to come back to your point, When you tell somebody exercise and maybe 20 years from now you won't develop Alzheimer's disease, you know that motivation may not be as high, but if you say there's this really cool molecule called brain derived neurotropic factor, or bdnf and BDNF levels are lower in depression and BDNF levels promote what's called neuroplasticity, which is the rewiring of your brain.

And we know from human data, which I think is important because so much of this is done on animals. That when people exercise, and again we're talking, jogging, weightlifting, that increases levels of this molecule, this peptide that seems like it's really good for brain function. I think that's important.

 So of the things that we know increase BDNF. Exercise, from what I have seen, has the single strongest correlation as far as this is something you can do today to increase that molecule. And there are a number of other things that may increase it too. So certain dietary strategies, we're learning that certain drugs, so specifically mental health drugs may increase BDNF, but you know, that gets us down a whole other channel.

So I look at what is readily available to people. Exercise is the answer.

Claudia von Boeselager: To keep it simple. Nutrition, Austin, I know this is a big topic, let's do it. What are some of your favorites? Or let's say top 10 strategies for a great, average, healthy individual, relatively healthy individual looking to optimize their health.

I know you see a spectrum, but let's look at the optimization place, which would be a lot of my audience.

Dr. Austin Perlmutter: So yes, as you said, nutrition. It's nuanced, it's controversial. There's gonna be people you probably had on that said you need to eat all the meats. And other people say you need to eat all the plants.

Other people say you can't ever touch gluten. Other people say, it's all about your gut. Forget everything else. The way that I look at this is trying to make sense of nutrition research, which is in some ways a disaster, but it's looking at these major trends and saying, if you look at the big picture as far as what the research is telling us, not this one supplement for this many milligrams, this many days is linked to these benefits and three people and this country that I'm gonna tell everyone, now you have to take this supplement.

So instead what I look at is what are the recommendations that both scheme to hold up scientifically from a pathway biochemical perspective that have been associated with better health across populations and specifically that relate to better brain health. And the reason I say that is, If you don't have brain health, the other stuff doesn't really matter.

And that might be slightly controversial, but coming back to my original point, if you wanna enjoy your life, if you wanna be able to think clearly, if you wanna be able to connect with other people, that is a brain health issue. Additionally, if you wanna make healthy decisions about anything else, you need the brain onboard.

So with that in mind, here's how I approach a brain healthy diet or just a generally healthy diet. I think just like I said with exercise, a healthy diet is one that you can sustain. So some people say, Oh, it's the kale smoothie with all these powders and I'm doing a 10 day detox.

That's not a healthy diet. A detox is by definition not a healthy diet. You're trying to detox from something. I'm talking about what I would recommend for years, decades as it relates to health benefits. So I'll go through the macronutrients, the carbs, fats, and proteins, and some of my general thoughts and we'll start with.

What is arguably the easiest area, which is proteins. So there are a number of people who will say, Here's how much protein you need. Here's how much protein you don't need. Here's the right source, here's the wrong source. From what I can tell, the healthiest sources of protein as it relates to brain function, fish, nuts, seeds, poultry, beans, and maybe eggs, and then less red meat.

And again, there are people who will say, You're totally wrong, Austin. And people who will say, you're right on this, but wrong on this. I'm saying when you look at the big pictures, what are the things that relate to better brain health? And one of the themes you'll see as I go through this is that it very strongly correlates with what's called the Mediterranean diet.

And that's important is if you look at the research on which diets most strongly correlate with brain health, cognition, mood issues, the Mediterranean diet is number. I don't think that's really contested. So what is the Mediterranean diet? It's very high in Whole Foods. It's very low in processed foods.

So you'll see that theme. If you wanna go and look at the best diets for brain health, you'll see the Mediterranean diet. So again, proteins. I won't get into how many grams of protein a person needs a day. I think there's a little bit of controversy there, but it probably differs depending on the person's age.

 I would say in general, if you're getting your protein from these sources, that seems pretty solid to me. So let's go to now some of the more controversial stuff and start with fats. There are still many people who are on an Anti-fat kick as it relates to the body, as it relates to the brain.

 I don't think that's as well substantiated as it used to be. I think even as it relates to saturated fat, what you'll see is these large populations where you're not seeing correlations between saturated fat consumption and these negative health outcomes. There's still a ton of research in animals on a high fat diet and correlation with a number of negative health outcomes.

What's important to understand about this is when you give a rat a high fat diet, that's not the same thing as giving a human a high fat diet usually what they're giving this animal is a bunch of vegetable fats or lard, and that's not in any way what I'm trying to advocate for here, because when you look at what humans eat and the fat consumption that humans eat, it can be hugely different.

And going back to the animals for a second, what you'll see is the negative health effects that come from a high fat diet are very different depending on what that high fat is. So if it's coming from a fish, they don't really exist. The negative health effect, so just talking about eating less or more fat, I don't think is the conversation we should be having. As it relates to healthy sources of fat as it relates to this brain piece of the conversation. Olive oil, nuts, seeds, fatty fish and eggs, that's where I start. Part of this conversation and kind of buried in there is the omega-3 fatty acids, which have probably the strongest correlation with brain health and overall health of any sort of fat group.

And so those are going to be at higher levels in the nuts, the seeds, the fatty fish. Some types of eggs. And I will note I put eggs in both proteins and fats obviously they have fat and protein. Some people will debate whether eggs are super toxic. If you look at the recent studies as it relates to brain health, as it relates to overall health, what you find is pretty much neutral.

Some of it's showing a benefit, but what you pretty much find is people who eat more eggs don't have any downsides for their brain health, don't have any downsides for their heart health, don't have any downsides for general mortality. Why that matters is, I think beyond saying that we need certain nutrients that are really good for our brains, we also need to be saying, Look, people need to be full, and they also need to have options that are not toxic to the brain.

And when I look at the most toxic meal of the day for the brain and for the body, that's breakfast. Because for most people, breakfast is basically dessert where they're eating a whole lot of readily digested carbohydrates that converted to sugar or just basically sugar. What we know now is that our metabolic health is directly related to our brain healththat having issues with our blood sugar relates to issues with our brain function. So I think eggs are a great alternative to what most people are eating for their breakfast. I know that doesn't necessarily work for people who are vegan but I do think that for many people is a good option.

So that brings us then to the last and most contentious of the groups, and that would be the carbohydrates. Here again, you have people saying, Oh, you need less carbs. It's a popular conversation. You only have three macro groups to pick from. That's carbs and proteins. I feel like every couple of years somebody picks one and says, Don't eat this one, and picks another one and says, Eat more of this one.

It's like there's only three options, but there's a lot of combinations or permutations. And every year somebody comes up with a diet. Don't eat protein, don't eat carbs, don't eat fats, or do eat fats, but only these ones. So I think carbs are super contentious. I eat carbs and there's a number of reasons for that.

One, maybe important one is that carbs are our sources of dietary fiber. If you're at all concerned about your gut health, that seems essential. And people would push back on that. That's one of the reasons, other reasons would be that when you look at societies that eat a good amount of other calories from carbohydrates, they do great too.

So here again, just like with other categories, I think we're talking about quality. So with carbohydrates, generally speaking, I think it's important to look at first.

Produce intake of added sugars. This is a universal thing. Whether you're a conventional doctor, an integrative doctor, a functional doctor, everyone agrees that added sugar is bad for us.

The only people who are out there pushing this isn't the big deal, are basically the sugar industry people themselves. So the top tier highest yield thing that a person can do as it relates to carbs is I believe, read the labels and try to reduce added sugar, especially in your beverages. Sugar sweetened beverages of all the carbohydrate sources have the strongest correlation with negative health outcomes.

So look at your drinks. There's added sugar in there, which they're in general is going to be, because on average, this is where sugar hides, cut that. But then look at added sugars in your foods. I think this is the lowest hanging fruit of all. Also look for in general carbohydrate sources that are minimally processed.

So you cut out the sugars. The next thing to do would be to look at foods that directly turn into sugar when they're digested. So that's your white bread, your white rice, basically all your baked goods, your muffins, your croissants, your danishes. These are things that directly convert into sugar in your body.

Again, the point I'd like to make here is that when you look at sugar consumption and your health, what we see is that sugar consumption and high levels is bad for health, but it's the result of it, which is dysregulation in your metabolic health that correlates with things like brain dysfunction.

So not only do you need to be careful of added sugars, but you also need to be careful of foods that directly convert into added sugars and stress your metabolic health. So looking to cut out those heavily processed carbohydrate sources. Most breakfast foods, cereals, toast, that's all a great example of that.

 The other thing I would say on this front is that if you're going to be eating these carbohydrate sources, there's some research indicating that if you eat it with protein and fat sources, it blunts the amount of sugar levels that go up in your bloodstream. So eating a muffin at 8:00 AM on your way to work is different from maybe eating that same muffin in the context of a breakfast that includes some eggs and maybe some other protein sources and some fats that can help blunt that glucose excursion.

 So here again, a consideration. The carb sources that I tend to eat with some regularity would be kind of the. Weirder ones. Not necessarily wheat. Right. Buck wheat is an interesting example of that. Buckwheat is much higher in nutrients than most conventional wheats.

 Quinoa. One that is gained popularity if you're gonna eat rice, maybe not white rice, maybe it's wild rice or forbidden rice. These are, usually higher in fiber and higher in other nutrients. So it's experimenting with some of the kind of atypical sources of carbohydrates. And the last thing I'll say on this front is I think of all three of these, the fats of proteins and the carbs.

The carbs are the ones that I think probably do benefit from personalization the most. One person may eat a piece of toast and have really no major issues with their blood sugar. Another person may eat that and see a huge spike. And so I think of all the areas that it may make sense to work with a health practitioner.

To get more insight, and this is where something like a continuous glucose monitor becomes interesting. It is what carbs do to your blood sugar and due to your health. So those are the, those are my definition, the macronutrients and how I approach them. A couple other things if you don't mind, just as far as general dietary considerations.

So I think eating a diversity of colorful plant-based foods is important. I think that incorporating polyphenols and plant nutrients into your diet is important. And these are nutrients, again, found in plants that have been linked to a variety of health outcomes, including better brain health.

Where do you get these? So tea, coffee, not everybody can tolerate coffee, so I'm not saying that's a blanket recommendation, but tea, coffee are big sources. And then herbs, seasonings. So whether that's clothes or rosemary or curcumin, these are or turmeric, which contains curcumin. These are ways that we can incorporate some of these plant nutrients into our diets, and that might be good for our brain health.

And then fiber and fermented foods. These are great for gut health. We're increasingly learning. This may be relevant to brain health. So sources of fiber are basically gonna be any plant based food that you eat, but certain fibers that may be especially beneficial to the brain are what's called prebiotic fibers.

And so some examples of those would be Jerusalem artichoke, hickma, dandelion greens, onions, Leaks bananas. So these are fibers that may be especially helpful to our gut and by kind of extension, helpful to our brain. And then fermented food. So kimchi sauerkraut, nato for people who tolerate it, Miso and Tempe, which are soy based sources, you can also get fermented condiments.

These are also things that are linked to better gut health, which by extension brain health. And the last thing I'll mention, I know this is kind of a long rambling here. I think alcohol is one that's worthy of consideration. We've for a while now been saying, Oh well, a glass of wine a day. It's good for your heart, good for your health.
I think that's wrong. I think we will pretty soon be of the mind that alcohol consumption is not great for the brain in any dose. So I think that I'm not gonna be a teetotaler and say Don't drink wine. But what I am saying is, Try to minimize alcohol consumption if you're trying to improve your general quality of life, brain health, et cetera, to a glass or less a day.

I think that's my new recommendation. So a lot of things, but I guess that's the general way that I'd approach basic nutritional strategies that have been linked to better brain health.

Claudia von Boeselager: Thank you, Austin. So a couple questions out of that. Just pick up with alcohol. Cause we just mentioned that first. I know some people are saying, Oh my goodness, like in my twenties and college days I was drinking far too much. Have I damaged my brain for life? What would you say to something like that?

Dr. Austin Perlmutter: I mean, I don't know if this is like an inappropriate thing to say, but I probably drank more in college than I, you know, looking back, I think was a great idea.

Claudia von Boeselager: A lot of people send me in included.

Dr. Austin Perlmutter: It's an interesting thing in our society where there is so much peer pressure around alcohol. And I think it's partially because in college and in high school even people are trying to figure out who they are. They're trying to feel comfortable. And alcohol is a social lubricant.

It does have that function and there is some value perhaps to that. But, there are many things that many of us have done that we could say are not good for our brain. Whether it's eating unhealthy food, whether it's unnecessarily dealing with a bunch of chronic stress, whether it's exposure to a ton of air pollution, that's another one that we should probably discuss. Or just not prioritizing sleep for decades. Alcohol use is one that is just such an interesting thing in society because it has all these associations. You're at your best friend's party and he wants everyone to take a shot to celebrate. That's just an interesting thing, like when you understand what it is you're actually doing. My bias in all of this is always the falling back on this fundamental truth about the brain, which is that it is plastic.

 Which means that it is always changing, which means you have billions of neurons and you're growing new neurons, you have trillions of synapses, the connections between neurons, and they are always changing moment to moment. How do we know this? If you've hopefully learned anything in this conversation today, it's because something has changed in your brain.

If you're a different person today than you are yesterday, but you are with new memories, new ideas, that's because your brain has changed. So your brain is changing right now. You can always direct that change or you can let that change be directed by what's happening around you. So it may have been the case, probably was the case for me that the alcohol consumption when I was younger, did some not great things to my brain function.

Can we do things to help offset that? I think the absolutely the answer is yes. That means perhaps preventing additional damage in the future. It also means engaging in what we've already described as far as some of these strategies that have been linked to better brain health. So it mean paying a little more attention to the quality of sleep you're getting, it may mean paying a little more attention to the foods that we can eat that can help to improve our overall brain state.

I think it's important to acknowledge that there are things that we may have all done that we're not great for our brains, but it's maybe more important to acknowledge that there are things that we can and should be doing moving forward that can help bring things back to a state of closer to equilibrium.

So yes, it might have been a problem, however, yes, there's still a lot that can be.

Claudia von Boeselager: Excellent. I wanna switch over to the topic of microdosing and smart drugs, Neutropics Austin. I'd love to hear your, it's a hard pivot, if that's okay with you. Before we're gonna go back and the topics, and I'd love to talk about brainwashing as well, your book that you wrote with your father, but in terms of microdosing and smart drugs and neutropics, what is your view on this?
I know there's a lot of science and research, and I've had guests on the podcast that specialize actually in this area, some in Canada, some in the US, but I'd love to hear from a neuroscience also perspective. What are you seeing?

Dr. Austin Perlmutter: Well, not from a neuroscience perspective, but what I'm seeing is that there's a lot of conversation about this.

And so, I know people who are very in this world. I also know that. Many people are either hearing about the benefits of something like microdosing or experimenting with it themselves. Let's take a step back and just talk about this whole kind of area of brain enhancing supplements, nutrients, drugs, whatever.

 This isn't new. People have been dabbling in this for a long time. But what we see is just a lot more, a bigger spectrum of these molecules. And the best example, the most commonly used example of a psychoactive brain boosting drug is what was up until very recently in this, in this month, which is coffee.

It's caffeine. So in the United States at least, most people are using caffeine with regularity. Caffeine has obvious brain effects, and how does it influence their brain? While. It's unclear that it benefits us outside of people who are a little bit sleep deprived. When people are sleep deprived.

It does seem to have certain benefits to cognition. There's other research saying that it may have some benefits to cognition, but I think, in general, when you look at the spectrum of all of the different things that people are consuming as brain boosters, and I would include supplements, I would include drugs.

It gets a little bit hairy when you start talking about drugs like med AOL for example, because that usually, first of all, very few people have access to it unless they're getting it in an illicit fashion. And second of all, the indications for its use are usually nothing like what people may be using it for.

But on the whole, I would advocate against reliance on ne tropics or supplement drug related brain enhancing drugs for that purpose, unless you are being prescribed it for a specific reason. Because I think that the lifestyle stuff is far more important. Because I think that based on the science that I have seen, the effect sizes are usually not that impressive.

And so even if there is some sort of a benefit, it's unclear to me whether that's substantiated enough for us to really be talking about this as something that should be generally used. I'll say personally, the only ne tropic that I use is coffee as of now. I've tried some other things.

 I've tried taking some ketones and seeing if that improved my brain function. I don't, I haven't personally experienced enough benefit to where I would do that consistently. So that's the general kind of supplement and drug space. But where a lot of the conversation is going now is specifically around psychedelics and, things like functional mushrooms.

In that conversation, what you have is a couple of studies that have come out pretty recently. So one that was just published earlier this year. So this one was published in Nature Scientific Reports, which is a pretty prestigious journal, looking at the correlation between microdosing and brain health, basically.

So mood and mental health cognition and finding that people who microdose compared to those who do not do better on some of these markers of mental health and cognition. It's really interesting. it's interesting for a number of reasons and one of those that I'm very kind. Interested in learning more about is what do psychedelics do to the brain?

What seems like maybe the case is that it may increase certain aspects of neuroplasticity. it may act on certain neuro immune or inflammatory pathways. It may help our brains to rewire in a more positive way. But this is still super early. And I think where I land on this is some people will look at this as conclusive evidence that this is a good plan.

And I think that given that at least in the United States, this is still an illicit activity, you have to understand that there's still gonna be a ton of variability in the quality of what person would get. And we're still just early. It's, these are association based analyses that look at people who do something versus people who don't.

They're not necessarily interventional trials. I'm optimistic about it. Not necessarily psychedelics for the context of microdosing to give people a little bit of an edge on their cognition, but psychedelics as an additional opportunity to manage what I believe is the single greatest issue we face right now, which is our mental health challenges.

 And to that end, yes, they're smaller studies, but we are seeing an increase in studies published in very prestigious journals, showing that psychedelic use in the right populations, especially people with treatment resistant depression, people with ptsd, and increasing a little bit around addiction and some other mental health issues, can be a benefit.

So my point that I make would be, If you're looking to optimize your brain health and you haven't already paid attention to the quality of your sleep, the quality of your diet, the quality of your exercise, the quality of your stress consumption, that is by the Pareto principle or whatever else you wanna look at, that is definitely your 80 20.

That's definitely your 90 plus percent benefit. And I would absolutely go there first. For some people. And moving into the future of our better understanding of how these molecules work. There will likely be a desire to experiment with some of these other things. And I think that as we know more safety protocols and as these things become legal and regulated, definitely they're very interesting.

But, if you're out there listening and you're looking to improve your brain function, you haven't already paid attention to your sleep. I think that is far better yield for you than trying to worry about micro.

Claudia von Boeselager: Very good point. Yeah, I like Pareto's concept there, just to focus on the fundamentals, the basics first as well.

 But again, there are PTSD, anxiety, things like that. The studies are showing that it can be very helpful as well. Thank you for sharing that. I wanna touch on the book that you brought out last year, two years ago now, 2020 I think it was, brainwash. Can you share with my audience what the book is about, your purpose for and motivation for writing it?

Sure.

Dr. Austin Perlmutter: Yeah. So it came out in spring of 2020 and I don't know if everyone can remember back, but there were also some other things going on. So maybe it was the second most important thing that happened in 2020, obviously. I'm kidding. So I wrote this book with my dad and the fundamental question that we tried to address is why is it that despite having all the information, we continue to make unhealthy choices, gets back to what we were speaking about earlier in this interview and.

We did a lot of research, several years of research on this subject. And the main finding is that in the modern day, our brains are being programmed for unhealthy decisions. And until we understand how that's happening, our chances of making healthy choices are very low. What we do is we will blame each other.
We'll blame ourselves for the quality of our decisions, rather than ask what it is about our brains that is making that so likely. And so the goal, hopefully, is for people to get curious about what it is in the modern world that is programming our brains for unhealthy decision making, and then what we can do to reverse that process.

What we can do to reclaim control over our brain's decision making components. And so we talk about some of the basic neuroanatomy that's involved with decision making. One kind of central part of this is that we have obviously a lot of different parts of our brain. They do a lot of different things as it relates to decision making.
The kind of core concept is that you have a part of your brain called the prefrontal cortex, which is located behind your forehead. That is thought to be central to our ability to make well thought out reflective decisions. So in order to weigh the pros and cons of a choice, as opposed to just impulsively or reactively doing something, we need that prefrontal cortex to be online.

And there are a number of things about our modern society that are taking that prefrontal cortex offline. And some of those are the things we already discussed, right? So chronic stress is a great example of that. Chronic stress appears to sever the connections between the prefrontal cortex and another part of the brain called the amygdala which in essence allows the amygdala to run unchecked, and it doesn't give you that top down reflective thinking. So that's a problem. That's what stress is linked to. We also see that in conditions like Alzheimer's disease, the prefrontal vortex is one of the first areas to go offline. And that's concerning because again, from a cognitive decision making perspective, that's not great, but it's not just Alzheimer's.

So in aging, what we see is that prefrontal functions tend to decline, and that may contribute to why there are some data showing that as we age, we may have a harder time making progress. Well thought out decisions. It's also one of the reasons that scammers may tend to target the elderly and take advantage of this because it's harder to make these challenging decisions when somebody tells you about your car warranty expiring.

That sounds right. And we may not have the presence of mind to pause and say, Well, you know, what are the chances? This is a real thing. Let me get back to you. It may make it more likely D for us to make impulsive choices. So that's the basic premise kind of the book. We talk about how that maps onto, diet and other lifestyle factors.

One really interesting finding we came up with when we were looking at the research was that several studies have now showed that inflammation in our bodies correlates with more impulsive decision making. And that's a really interesting thing. What we've seen is that when you look at what happens to us when we become sick, so when you have a viral infection or a bacterial infection when you're under the weather, that your thought patterns are different, that people tend to be more socially withdrawn, they tend to feel more fatigued.

They tend not to be as interested in doing math problems as they are just laying in bed. What that says is that the inflammation associated with being sick is influencing our brain function. But what hadn't been really shown up until pretty recently is that the inflammation that we may experience in our bodies, as a reflection of an unhealthy diet or chronic inflammation or bad sleep, that this correlates with in real time, making more impulsive choices.

So this is a deep cut into what I've already described as far as if you want to improve your quality of life, you have to improve your brain function, you wanna improve your brain function, you need to know what is influencing it. The immune system and specifically inflammation seems like it is influencing it in a negative way.

And it's just, it's more fodder for more support for all the things we've already described as it relates to understanding how diet, exercise, sleep, something like air pollution. Even the quality of what we put on our skin. Everything that we're taking into our bodies is influencing our brain health when you layer in this inflammatory pathway.

But one of the, I guess maybe the last thing I'll just say as it relates to, If we consider now that the standard American diet or the Western pattern diet, which is high in added sugar, high in processed foods is becoming rapidly the standard diet around the world, that we're basically exporting this around the world and that this is the diet that most strongly correlates with higher levels of inflammation.

 And that higher level of inflammation correlates with worse brain function, with worse decision making, with even lower levels of empathy for other people. And you can see how there is this hidden epidemic of, in essence, exporting. Worse brain function around the world. As we look at the major concerns that we have for a society, can we live in harmony with each other?

Are we going to use nuclear weapons to destroy another country? Are we going to be able to come together and pay attention to climate change? Or are we going to only be focused on increasing our GDP for each country and not worry about that. These are reflections of our brain function, and they may directly relate to the food that we eat by way of this inflammatory pathway.

So it really speaks to this global significance of what we're talking about here, which is brain function as specifically a decision. Decision-making is the biggest determinant of whether we survive as a species, and that aspect of our brain function is being influenced by all of these lifestyle factors, and maybe mostly the quality of the diet that we eat.

So the food that we eat is not just a reflection or does not just lead to whether we're overweight. Food that we eat doesn't just lead to did I enjoy that meal or did I feel a little bit sick afterwards? The food that we eat is a major determinant of our brain state and by virtue of that is a major determinant of whether we can survive as a species on this planet for the next hundred years.

Claudia von Boeselager: It's very profound. Thank you for sharing that point. Austin, I think for people to understand the wider context of eating healthy, right?

 So many people just associate sort of a healthy diet with aesthetically looking good, but when you actually think that it's impacting the decisions that you are making every day and the quality of your life, I hope that, for some people listening will really be the penny dropping to make those shifts and make those changes as well.

And as you were saying before, set yourself up to win, make small choices, small decisions, and see the benefits and then build up from there. So set yourself up to win. We talked about also decision fatigue. If you're trying to do 20,000 new things, , you're not gonna have much success.

Austin, I wanna touch on also the work you're doing with Big Bold Health. Can you talk a bit about your mission there?

Dr. Austin Perlmutter: Yeah, so I've had the opportunity in the last few years to get to work with this company and the company was founded by, Dr. Jeff Bland, who many people know from functional medicine.

The goal of Big Bold Health is to try to create better immune health for people around the world. And one of the ways that we're doing that is by researching how foods influence the immune system. And specifically there's a focus on a plant called Himalaya and Artery Bucky, which is in the spectrum of plants, is unique because it is able to thrive in the context of extreme temperatures, of extreme UV radiation.

What lets it live in the Himalayas is that it's able to tolerate those extremes and the way that it does. So...

Claudia von Boeselager: I can, for people listening, cuz you flew over that, Can you repeat the name just so people can
hear it?

Dr. Austin Perlmutter: Yeah, It's, it's Himalayan Tartary Buckwheat, or, it's basically, it's not, Really very similar to common buck wheat.

 But it is a type of buckwheat plant. And so if Google, it's hard to read buckwheat. You'll learn about this. But the idea here is that if you look at plants, they're not able to, if they're stressed, pack their bags and flea they have to deal with it. And the way that they deal with it is they produce these molecules called polyphenols.
And these are again, these little plant molecules, people have probably heard of some of these, Corin resveratrol, E G C G. What they do is they help the plant basically fend off stressors, whether that's a microbe or UV radiation, or toxins in the environment. And we've known for a while that people who eat more plants that are rich in these molecules tend to have better health outcomes.

They live longer, they have better mental health, they have better cognitive health. But what's been less clear is how that works, right? So how do these molecules translate into human health benefits? and the majority of the research there has focused on these molecules is antioxidants. So people probably heard of antioxidants who say, Oh, you need your vitamins, you need your antioxidants.
The actual clinical validity of the idea that antioxidants improve human health is very low. It's all these molecular studies where you have, you measure oxidation, you give antioxidants and it lowers it. And we would say that's a good thing because by virtue of a number of different steps, oxidation is linked to inflammation, is linked to, damage to ourselves and so on and so forth.

And so our goal here is to try to go beyond that and to try to understand how these molecules influence human health in other ways, and specifically the immune system. Because we know that immune imbalances for which inflammation is the best example are linked to so many chronic diseases today.

Actually, I was recently reminded by Tom O'Brien, who I spoke with, that when you look at the top 15 causes of death in the United States and you map those onto inflammation, you'll see that 14 of the 15 correlate with inflammation. Wow. So how do these molecules, how do plants improve our health beyond just the antioxidants?
And so what we're doing, we're actually wrapping up now, is an exploratory study looking at how these molecules found in this similar rebuck, we can influence our epigenetic pathways. And I know we're getting real technical here, but the idea would be you have 20 ish thousand genes, which is not a lot like there.

Insects, There are small animals that have way more genes than we have. So we have 20,000 genes. How is it that we have all the diversity of effects from those genes? It's something called epigenetics. So it's not just the genes, it's how they're used by the body. It's how they're read by the body.

 And we know that factors in our environment are capable of changing the way that those genes, the way that DNA is being used. And so now we're learning that some of these plant molecules, these polyphenols may actually work by way of changing our gene or DNA expression. So we're looking at that right now with kind of the idea being, we like to see whether first there are changes to our gene expression that come from consuming these molecules.

And secondly, whether some of those changes map onto changes with the immune system. And so it's exploratory work. We're not exactly sure what we'll find, but. The it here being, we know that humans tend to benefit from eating these foods. We know that at a biochemical level, that consuming these molecules, the the corset, asperin, Lins, rutins, those are the ones in Tartary Buckwheat that these seem to influence positively, these pathways related to our cell health, our immune health, et cetera.

But we still are really interested to know, is there something a little bit more, different from Antioxidation, different from what we're usually hearing that we can help to tether this to something a bit more grounded in some of this new science. It's really fun work. It's complicated stuff for the average person.

I think anything that I say around epigenetics and polyphenols gets to be a bit heady pretty quickly. But the basic concept here would be we know that people who. Plants, diversity of plants tend to do better. Why is that? Well, fiber antioxidant, sure. But can we start to look at certain plants as more than just one of a diversity of plants that a person consumes?

And rather look at what are the things that make this plant unique? And whether those aspects of a plant may be more directly tethered to, therapy for a specific condition. So in this case, we're looking at the immune system. I think that changes the game a little bit as it relates to how we approach diet for health, because we're no longer just saying, Well eat more plants, eat some, some whole grains, eat some healthy fats.

What we're instead saying is here's why. Right? We know these influence, these pathways. So it's very exciting stuff. We're, we're coming to the end of the study. We're gonna have some of the, results out soon. So I'm very excited to hopefully get those published and out into the, into the world.

Claudia von Boeselager: Very exciting. So I look forward to reading up on that Austin, when it comes out. Thank you for sharing. Fantastic. Just finishing up, I wanna ask, what excites you most Austin about the future of health, wellbeing, and longevity over the coming years and beyond?

Dr. Austin Perlmutter: It's a good question. There's several things that are kind of disappointing as it relates to where the world is going right now. I wish I could say we're seeing the turning that the curve changing, that chronic preventable diseases are starting to go the other direction. I don't think that's true. I think all the indicators are for the negative, but as it relates to, what I think has to change, I think it has to be a mindset, a perspective change.

And I think that comes hopefully from people experiencing changes. In their brain function that allow them to have that perspective shift. So what are the things that can be done to make that happen? I mean, psychedelics are one of them, and I'm not here advocating that everyone needs psychedelics, but I think that is an example of how not necessarily the using of psychedelics themselves, but the interest in finding novel solutions to expanding the mind and improving mental health.

That gives me some hope. It tells me that people are interested in these ideas. in the larger picture, there does seem to be an interest, an increasing interest in brain health. And I see podcasts like, Andrew Huberman taking off, and that's just really exciting because it means people are paying attention to how the state of our brain is influencing the state of our wellbeing and of our health.

 In the last couple of years, I've seen a whole lot more traction for some of the ideas that I'm putting out and people putting them into practice, even as it relates to the basics. So like people are paying attention to sleep. That seems so trivial, that seems so mundane. And yet the idea that more people are going to pay attention to and hopefully get better sleep is fundamental to our ability to show up to have good brain function.

So I do think in the macro sense, what excites me most is just an increased curiosity about how our brains work and what we can do to optimize their function at a slightly more micro scale. I think some of the, the emergent interest in mental health and ways that we can leverage things like psychedelics, transcranial magnetic stimulation, basically new solutions to serve as an adjunct to.

 What we already have. And unfortunately, conventional antidepressant and specifically antidepressant therapy is just not that great. That gives me hope. And just more people talking about it in general, I guess. So there's a lot of really cool work to be done in the field of epigenetics in the field of the immune system.

That's very technical stuff that I'm excited about. So we're learning about how the immune system relates to aging concept called immunosenescence and how an aged immune system may, contribute to the aging process and whether there are certain nutritional and lifestyle interventions that can reverse that Super cool stuff there.

I think that's stuff that isn't quite ready for prime time and for the general public, but I imagine in 10 or 20 years, that'll be stuff that everyone is talking about as it relates to how can you decrease not your chronological age, which is how many birthdays you've had, but your biological age, which is how your body experiences those birthdays.

But yeah, I think, if you're a little bit of a science geek like me, that's really exciting stuff. if you're looking at the bigger picture of where the world is and some of these positive signals, I think it is the excitement around brain function, the excitement about disease prevention and the excitement about the seemingly silly, but super important things of which I think sleep and to some extent nature exposure are good examples.

Excellent. Very exciting. And a lot of my listeners will be biohackers as well. So quite interested in this. I also do my biological age testing. I've gotten down to 14 years younger, so , I'm 20 and stay there. Let's see how we f to go with that. Thank you. Austin. Where can people learn more about what you're up to and, and follow you, be it social media or websites?

I'd say the two areas. Are most consistent for me in interacting with other people would be, social media. So Instagram is where there's the majority, but that would be at Dr. Austin Perlmutter. But if you're looking forward more of the comprehensive high level content, the best place to find me would be my newsletter.

Uh, put in a good amount of time to that. I just started earlier this year, but there's already, I think we're up to around 5,000 subscribers. So if you go to my website, you can find that and that's probably the best, unless you're gonna come find me at one of these conferences I talk at.

Claudia von Boeselager: Excellent. Do you have a final ask recommendation, or any parting thoughts or message for my audience?

Dr. Austin Perlmutter: Yeah. So I'd like to go back to one of the points that we made before about changing your health. You know, I think if your goal, most of us, our goal will start with changing health for ourselves, and I think that's the right place to start.

 But empowering your own health is I think, the best step to be able to help other people. And specifically empowering your own brain health. Some of this stuff can seem selfish, which is like, I'm not gonna go out and do the friend stuff because tonight I need to pay attention to my brain and get good sleep.

Or I'm not going to, eat the junk food that everyone else is eating or have that third shot of alcohol because I'm paying attention to my brain health. It feels weird. It can feel selfish. And as somebody who has been there many times, I can tell you, you can get the sense as to, why am I being so difficult?

And, I think the message I would put out is if you're really prioritizing your brain health, you're going to be seen as weird. You're going to be seen as strange. And I think that's where you want to be. Because in a world where the average person is very unhealthy, both from a brain and body perspective, you have to deviate from that mean to have a chance at something better.

So for those people who are out there who are saying, Well, yeah, but isn't it going to make me a bit weird? Feel a little bit, you know, awkward socially, and they, I would say, I'm there with you. And I feel like that is the right place to be. If your goal is to improve your brain health,

Claudia von Boeselager: well said.

Here's the awkward places to be , putting yourself out of your comfort zone. Thank you so much, Austin, for coming on today. It's been such a pleasure.

Dr. Austin Perlmutter: Thank you for having me, Claudia. Thank you.