Anna, I am so delighted to be with you today and looking forward to our interview.

Welcome everyone to Couch Talk. This is Dr. Anna Cabeca here with a special interview with one of my favorite people in the world, Dr. David Perlmutter. I'm sure you've heard his name. If not, you've heard his book, from Smarter Kids at Kindergarten, Brain Recovery... Those are some of his old ones. His latest and greatest bestsellers have been Brain Maker and the Grain Brain book as well as the Grain Brain Cookbook that really needs to be on all of our shelves for those of you that are listening. He has a new book coming out. I'm really interested in giving you guys the heads up scoop on what he's been researching, what he's been finding and what he's put together in this really game changing book for all of us. Again, decades above our medical system. For those of you, Dr. David Perlmutter has been a mentor for me, a mentor for our functional medicine physicians and health adventist really all over the world. I just have known him personally since, gosh, 2009 and am definitely a groupie of his as he has mentored me along the way in my career. I'm so appreciative to have you hear, Dr. Perlmutter, today to share your knowledge. Anna, I am so delighted to be with you today and looking forward to our interview. Thank you. Let's talk a little bit about... We want to talk a little bit about the new book that you have coming out and how it differs in the information that you're bringing to what we're constantly inundated with today. Dr. Cabeca, it's been an interesting past few years. Grain Brain, which came out in 2013, really looked at the damaging effects of a high sugar, high carbohydrate diet, especially looked at gluten not just in terms of general health, but did tend to focus on the effects of these lifestyle choices on the brain. That was followed more recently by Brain Maker, which looked at our gut bacteria, the microbes that live within us, and how we knew really nothing about that, but now we do, how the microbes living within us really are involved in so many important determinants of whether we're going to be healthy or not, whether we're going to be diabetic or not, fat or lean or even at risk for brain degeneration. How do we take care of those gut bacteria and what is it that we're doing in our lives that might be damaging them. Grain Brain and Brain Maker really talked about why this stuff is happening. The new book, which is called The Grain Brain Whole Life Plan talks about how do we then take this information and make the necessarily lifestyle changes so that we can reduce inflammation. That's in fact the cornerstone of about everything bad that you don't want to happen. How do we look at the low carb diet? How do we look at reducing sugar? How do we look at getting away from gluten? Also how do we look at nurturing our gut bacteria to achieve a much better state of health day to day and also pave the way for health and fitness in the long term. Here in America if you live to be 85, you have a 50/50 chance of becoming an Alzheimer's patient. We now know that to a significant degree Alzheimer's, for example, is a preventable disease. I really believe that it's time that we have that discussion and really get the word that that here's a disease that has no treatment at all and yet significantly is preventable. To answer your question, that's pretty much the focus of

what my research has been about the past decade. You've dug deep into understanding the microbiome and the different bacterias and probiotic and prebiotics and really getting the word out about that and how to capture a healthy microbiome. That's been fascinating for me to learn and your book, Brain Maker, I just have to ask in a side question. Is there a reason that it's abbreviated BM? I'm just curious. It's funny because prior to publication all of the emails back and forth between me and the writer and the publisher and everything, that was the subject, BM. It got to be very funny, but who knows? Maybe people will think about it and really recognize that it's time to get real serious about what's going on within our intestines. It's always been off limits, taboo. The only people that are going to talk about it are gastroenterologists, but what a moment that you and I are having this discussion and we are looking at the implications of things going on in the gut in terms of your brain health and your heart and your joints and your skin for that matter. What is going on in your gut manages the level of inflammation within your body, having said that when you think about what diseases are inflammatory, that means the gut is throwing a very wide net. The inflammatory issues are coronary artery disease, diabetes, cancer, Alzheimer's, Parkinson's, MS, arthritis, skin issues, psoriasis. These are all diseases characterized by inflammation. Inflammation has its origin in the gut, so we have to pay really very, very diligent and strict attention to what is going on in the gut. We have a diet, for example, that uses artificial sweeteners. We dramatically change the bacteria that live within us. Suddenly, we lose diversity. When that happens, we have a different array of bacteria in the gut because their environment has been changed by artificial sweeteners. We have a different set of bacteria then that think we are starving. What do they do? They cause us to gain weight. Causes us to lose our ability to handle sugar so we become diabetic. The risk of becoming diabetic in people drinking a lot of artificially sweetened beverages is dramatically increased even more so than when they drink regular sugar sweetened beverages. I'm not saying you should drink the regular Coke. What I am saying is that everybody is trying to go sugar-free, no-cal beverages, but when you do that, if they're artificially sweetened, which is the Diet Coke, Diet Mr. Pibb, you are changing your gut bacteria and making much worse your chances of obesity and chances of being diabetic. Think about that. The more diet drinks you drink with no calories, the larger will your belly become and the greater will be your risk for Alzheimer's for that matter. Who knew? It's the worst trick that you can play on women especially, women and men, is that, "Here, drink this diet drink and you're going to get slim." Number 1, it tastes horrible. Once you've been off it for a while, you can't stand the taste of it. Number 2, it's making your fat or insulin resistant increasing your risk of metabolic syndrome. It's so paradoxical, isn't it? Here you are doing your best. You're going to say, "Look, I David_Perlmutter Page 2 of 10

know I should avoid sugar and calories so I'm going to drink Diet Coke or Diet Seven Up." I'm not just picking on one. The reality is you're making your situation worse. Doctors are telling people, "Drink the diet drinks." This was a very big study that came out of Israel. It was both an animal study and a human study that showed dramatic changes in the gut bacteria creating an environment in the gut that let's your body think that it is starving and therefore has to hold onto every possible calorie and slows the transit time in your gut so that your food stays in your gut longer so you can extract more calories. Not a good situation. When I see patients who say, "I don't drink any Cokes or any of that stuff. I just drink Diet Coke all day long," and they're gaining weight, I used to think, "No, they've got to be waking up in the middle of the night and hitting the refrigerator or something is wrong with this story." Now we know there's a powerful mechanism underlying why people drinking Diet Cokes and chewing artificially sweetened gum, which is pretty much all the gum that people chew these days or even taking various fiber products that are sweetened with aspartame, like we see on the shelves in the grocery store... These things are damaging the gut bacteria and creating an environment that amplifies inflammation, the cornerstone of these dreaded diseases, leads to obesity and leads to diabetes. The reason I am so focused on diabetes is because it's preventable. If you become a type 2 diabetic, you have quadrupled your chance of then becoming an Alzheimer's patient, a disease for which there is no treatment. I've got to get this message out. Again, thank you for letting me get the message out because people are being terribly misled. We've called Alzheimer's disease type 3 diabetes, right, Just kind of a continuum? You've shared before how the increase in your hemoglobin A1c directly increases your risk of Alzheimer's disease. What numbers are you looking for us to keep our hemoglobin A1c below? Let me take a step back if I can and explain what this hemoglobin A1c test is. Thank you. If you're diabetic, you know what your A1c is. If you're watching television at night, watching the evening news, you're seeing ads for people taking drugs to lower their A1c. What A1c really represents is a long-term 90-day average of your blood sugar, but what it actually is is sugar binding to a protein, which is called hemoglobin. The reason that's important is when sugar binds to protein, 2 things happen. It increases inflammation and it increases the production of damaging chemicals called free radicals. Now when we look at that hemoglobin A1c, we realize what it's really a marker of. It's a marker of inflammation in your body and it's a marker of what we call free-radical mediated stress, high levels of these free radicals, which are damaging our cells or damaging our DNA. That's what the A1C test means. I believe that people should all have their A1C checked whether they're diabetic or not because it's such a powerful blood test. It's simple and any doctor can do it. I like to see David_Perlmutter Page 3 of 10

the A1C around 5.2 or so. Under 6.4 normally your doctor is going to give you a pat on the back and say, "Hey, everything is great. You're not diabetic... " With the word yet hanging in the background. You can go to your doctor and you can come out with a hemoglobin A1c of 6 and your doctor is going to say, "Hey, cool. Don't worry about it. You're not diabetic. Everything is fine." The reality is that there is a perfect relationship between A1c and shrinkage of your brain's memory center. The higher your A1c, the smaller is your brain's memory center, called the hippocampus. By the time you get to an A1c of 5.9 or a 6, you're A1c is already correlated to a shrinking brain center that deals with memory. You want it to be as low as possible because when it comes to your hippocampus, your brain's memory center, size really does matter. There's a perfect correlation between shrinkage of your hippocampus and decline in your memory function. We see a small hippocampus in Alzheimer's. We want to keep our A1c low. How do we do it? By restricting our intake of sugar and carbohydrates. You've written on ketosis and Alzheimer's disease. Talk a little bit about that too. We're going to go low carbohydrate, restricting carbohydrates. This you're going to allucinate more in your Grain Brain Whole Life Plan, which I'm so excited about. The ketogenic diet and Alzheimer's risk and how that has an impact. Ketogenic really means that you have altered your diet in such a way that instead of always burning carbohydrates and sugar all day long, your body is starting to tap into using your own body fat as a fuel or the fat that you may be eating. According to author Gary Taubes, who wrote Why We Get Fat: And What to Do About It, it really is the state that humans have been in for as long as we've been on this planet. Nora Gedgaudas in her wonderful book called Primal Body Primal Mind really talks about that as well, that really we've been in ketosis, mild ketosis, burning fat for as long as we've been here because we've never had access to carbs. It turns out that the actual human requirement for carbohydrates in the diet is none, 0 grams per day. We don't need carbs. We should eat certain carbs that gives us dietary fiber, but the point is we don't need carbs. We can burn fat. It turns out that when our bodies are in ketosis or when we're on a ketogenic diet and we're burning fat, number 1, it's a far more efficient fuel, giving us much more energy per gram, but it does so by producing much less damaging free radicals. It turns out that the brain does wonderfully when it burns fat as opposed to burning sugar or carbs. We all learned in high school biology that you have to have sugar because your brain burns glucose. The reality is nothing is further from the truth. The brain loves to burn fat and it does so far more efficiently. Matter of fact now there is an FDA approved medical food... You can go to the pharmacy, have a doctor write a prescription and it gives people a special type of fat to make them more ketonic, more burning fat, which has proven helpful for the brain. That's being marketed now as an Alzheimer's therapy because it's been shown that it does in fact increase brain performance a little bit. What I tell people to do is cut your carbs, cut your sugar and add in a couple of tablespoons of coconut oil every day. There is some merit to the bullet proof coffee idea David_Perlmutter Page 4 of 10

of adding coconut oil and butter, fat, into your coffee. Fat is back, not just for your general health, but really for your brain. Your brain loves to burn fat. If you want to be sharp and protect your brain in the long run, you've got to be more ketonic, as you've talked about. Burn more fat and get rid of the sugar and carbs. I think that was one area as we get into menopausal health and my area of focus as we marry gynecology with neurology was the fact that these low-carb diets made me keto crazy, and I was like, "I can't do it." What you really put into plan and what I worked on in my menopause plans is combining alkalizing foods, lots of greens, lots of vegetables [crosstalk 00:15:56] Did you say keto crazy? Keto crazy. I love that term. Good. You totally go keto crazy. You get neurotransmitter haywire. That's on a low carb diet for women. It's different for men probably, but it's the reason I was like, "What's going on here?" If you check... I do the urine test strips. I created the ph and keto test strips. It's not ideal, but it's a marker. Check your urine for your ph and your keto, and get alkaline first is what I tell women. Your greens, your fermented vegetables that you recommend you put in your menus and lots of greens. Grains or greens? Greens, greens. No grain. No grains because we want to get into ketosis. Greens like beet greens and kale and the cruciciferous vegetables, all those good hormone balancing vegetables too. You want your body alkaline. When we're indoors and when we're stressed, we're so acidic. Add that with ketosis, get that keto crazy combination. When you're alkaline and on a ketogenic plan, oh my gosh, brilliance, energy, hormone balance, lose the hot flashes, lose the fat. It's harder for women than it is for men how we were designed, but it's fascinating because especially in this menopausal shift, it's harder for us to get into ketosis. It's harder for us to get and stay alkaline. Checking and making sure that we are makes a huge difference. That changes the lives of so many people. That's why I'm so passionate about your Grain Brain Whole Life Plan and that coming out and putting that into perspective for people in a way that says, "Let's get this together. Let's make sense of it." You don't want us walking around keto crazy. You've got to keep us getting those greens on, [inaudible 00:17:36] bone broth and the alkanizing minerals and those factors that will help balance our hormones, which is part of that marriage between gynecology and neurology is where the microbiome, our GI health... Our GI health helps with hormonal balance too. When that's out of balance, that's been on an acidic, high-glucose diet, high-carb diet, that's just type 3 diabetes. We're on the road to that unless we make this shift. David_Perlmutter Page 5 of 10

It's true. You mentioned hormones. Understand that enzymes for processing hormones and enzymes for detoxification of environmental chemicals that may mimic hormones in our bodies are taking place, are created even at the level of the gut, in the gut, in the liver. It is a very powerful argument in terms of nurturing the gut bacteria, the microbiome because the modification of these environmental chemicals that may look like hormones takes place under the direction of gut bacteria. Gut bacteria are important in the manufacture of the neurochemicals that are so important, the happy chemical serotonin, for example, gut bacteria play an important role in how our bodies create serotonin. In fact, 90% of that neurotransmitter, brain transmitter isn't made in the brain. It's made in the gut. We have to reposition our lens and look at the gut in terms of how it's affecting gynecology, gastroenterology, neurology and all of the ologies and recognize that it's really time for us to be so specific in how we look at the body and disease processes and take a step back and say, "What are the leverage points that are affecting every part of the body?" The gut is on the top of that list. To further that... I know when we talk about how important GI health is for brain development, that starts early. That starts in pregnancy. As a OG/GYN, I want to talk with you about this a little bit and C-section associated with increased risk of neurologic issues in our children and what you thought about vaginal inoculation of a C-section baby and what your feelings are about that. I won't take credit for thinking of that. It was actually brought forward by Dr. Maria Dominguez-Bello at NYU. Let met take a step back. We know that when a baby passes through the birth canal, he or she is anointed with the bacteria that live in mother's birth canal. That just doesn't happen to be there. This is a system of transferring bacteria to the newborn that is seen in mammals who are born that way, in birds who when the baby is born pecks at the shell. We see it in fish, in insects, in turtles, reptiles, mollusks and even sponges. This is a system of transferring information to the newborn that dates back 350 million years. Suddenly we've developed a new way of delivering children, where they don't get that information at the time they're born. Their faces are not covered with the stuff that contains bacteria. Those bacteria that that child picks up passing through the birth canal are loaded with information. They're instructing that child as to what the world is like, "What is the current environment? Do we have food scarcity? What time of year is it? What has my mother's diet been like?" It gives that child the bacteria that he or she will need to break down mother's milk, to extract nutrients from the milk that it's then going to nurse and receive. It's building a robust immune system and helping to temper inflammation. When a child is born by C-section, that doesn't happen and that child then gains bacteria from the operating room, from what's on the surgeon's hands, what's floating around. That has a dramatic impact on that child for the rest of his or her life. You've doubled the chance of obesity of that child when he or she is an adult. You've increased his or her chances dramatically of type 1 or autoimmune diabetes, increased risk by about 70%. About an 80% increased risk of that child developing celiac diabetes. David_Perlmutter Page 6 of 10

You have doubled that child's risk for ADHD and at least doubled that child's risk for autism. These are serious issues that we need to talk about. That's published literature in peer-reviewed journals. The citations are in Brain Maker. We really have to have discussions with parents before giving birth, saying, "Look, there's a lot more going on with this decision than simply how big will my scar be and when will I be able to go home from the hospital." It's a major event in the birth of that child. There is a wonderful time and place for a C-section. It saves lives. It's wonderful. We all are grateful, but now 1 third of all births in America are born in this way. It's hard to imagine that 1 third of all births are so complicated for either mother or baby that we have to deliver them by C-section. The discussion needs to be, "Yeah, your scar is going to be as long as it's going to be. You're going to get out of hospital a couple of days later, but more importantly, if you don't deliver your child vaginally, there are significant increased risks that you should know about right now before you make the decision." Certainly there are emergencies and to save a child, you do a C-section. Everybody agrees with that, but when you again choose it as an elective and the child is born by C- section because, "It's convenient," or, "My last baby was born by C-section. I have to do this baby by C-section." That we know isn't true. There has been some discussion, "What can we do to make up for the fact that that child didn't get that inoculation by passing through the birth canal?" That's where this technique, developed by a heart nurse at NYU, Dr. Maria Dominguez-Bello, was put forward. She suggests putting a sponge in the birth canal prior to the C-section, taking it out, doing the C-section, keeping it moist and warm. Then when the baby is born, you rub that stuff all over the baby's face. It's just beginning to be studied. We don't know what it's actually going to do. The worrisome part of that story is that virtually 100% of women in America, who undergo a C-section get a nice big blast of antibiotics intravenously when they're the waiting room to go into the operating room and we don't know what a dramatic change that's going to have on their vaginal microbiome so these are questions that need to be answered, but I think the take-home message here is that there's a lot of concern about being born with C-section that needs to be on the table now and people need to talk about it. I agree. I couldn't agree more. I've seen the rates, in just my practice as a obstetrician, for C-section increase from 20% in community hospitals to 50% in our small community. It is devastating. I think it's important not only the microbiome, but the process of pressure and the mechanics of vaginal birth delivery have beneficial effects on our No question about it, on mother and baby I might add. Mother and baby. To further on is a quick plug to encourage breastfeeding because we're passing the microbiome and imparting a healthy immune system onto the babies through breastfeeding too. I think we really do need to revisit the whole C-section scare and really change the obstetric practices and the medical legal aspects of the obstetric practices, which have pushed these higher rates of C-section as well as inductions. David_Perlmutter Page 7 of 10

That's right. It starts.. I don't know that there are many obstetricians who are going to be comfortable in having the second child born vaginally if the first one was born by C-section and yet you and I both know that... That's in your literature. It can be done and it probably should be tried unless there's some other overwhelming issue like the mother is diabetic and the baby is large or something like that. I think we have to rephrase our discussion of C- section versus vaginal delivery not just with how long you're in the hospital and the size of your scar, but now take this new information into consideration to help parents make the right decision. With that too, the antibiotics that are put in the baby's eyes in case there's chlamydial conjunctivitis... The chance of that because we've tested the mom for chlamydia... I'm like, "Why is that a routine practice?" It's just a check box. Old habits die hard, and I think you brought up a good point and that is the liability issues. When our children were born, they came around with the drops and we said, "No." They said, "You have to put drops." I said, "What are those drops for?" "We don't what your child to have gonorrhea in its eyes." I said, "My wife doesn't have gonorrhea, so we're going to forego the drops." We had to sign papers. We had to call the President of the United States. It's a crazy thing. I like rocking the boat though. You can be sure. I know. Question the practices absolutely. All those vaccines at one time. That's not studied either so let's not create an experimental population. So much to be said there. Our microbiome is affected at birth and even before birth. Just probiotics in pregnancy and probiotics post-partum and reducing our reliance on antibiotics and all those things where our food choices- You mentioned something very important and that is the idea of taking a probiotic during pregnancy, in other words pre-natal probiotic. There's some really wonderful literature that's coming out now showing that the gut bacteria of the mother dramatically affect the health of the newborn and then the child to be especially as it relates to allergy and what's called atopic disease and allergic conjunctivitis, things like that. We're seeing now the notion of pre-natal probiotics. In the health food stores, you will see pre-natal probiotics being recommended. You'll see those products. Very intriguing. I want to just mention one thing. It's kind of a plug, but on my new book, which is the Grain Brain Whole Life Plan, if people go to my website, which is DrPerlmutter.com... I don't want to get it mixed up with Facebook. DrPerlmutter.com... I'm giving everybody who preorders that book. We're sending them a free DVD of my public television program, which is Brain Change. They're going to get that DVD and learn about carbs and sugar and gluten and the brain. It's really a public television program that I did based upon the book gut Brain Grain. We're sending that out for free to everybody who David_Perlmutter Page 8 of 10

preorders their book. They just have to email their receipt or something along those lines. For preorder from your website at DrPerlmutter.com and watch the DVD while you're waiting. The book is being released in November. Correct? Sure to be another bestseller. While they're waiting, I'm going to plug your Brain Maker book too because just love your Brain Maker book. Y'all need to get this book too, just cutting edge information. We really go deep into the microbiome there. As we end, I want to ask you one more question about the microbiome. Let's talk about kissing and the microbiome. I've emailed to you about this before like, "What does the study say?" You think of Biblically a concept of soul ties. It's true. There is a dramatic exchange of organisms that happens. Actually intimate kissing was how the study was defined. I guess we can think about that for a moment, "What is intimate versus a peck on the cheek?" I'll leave that up to anyone's imagination, but I think it's pretty much when fluids are exchanged. It really brings to question others of our practices that we engage in with other people and how there may be exchange and there are exchanges of microorganisms during all kinds of things where fluids are exchanged. That study has in fact been looked at. That study was published. There's a dramatic exchange and it shows that people who intimately kiss with time, that their microbiomes of their mouth, both of them become very, very similar. There is an exchange of organisms that do take up residence in the mouth of the other person that you are kissing and do change that person's oral microbiome. It might be a very advantageous thing. I would think it would unlikely be harmful. We've got to just reframe our whole sense of bugs and bacteria. I say bacteria to people, they think, "Germs, bad, wash the hands." Right. Bacteria are all bad. Almost all the bugs on and in your body are helping you right now. They're making vitamins. They're detoxing you. They're helping shore up your gut lining. They're making neurotransmitters. All these wonderful things and the truth is that within us, we all have bad bugs right now, but they're being held in check when we take away the good bugs, then the bad bugs can do bad things. For example, take an antibiotic and kill off a lot of your good bacteria and suddenly this bug called Clostridium difficile that most of all carry right now... I probably have it. You probably have it. When you take away the good bugs, all of a sudden C. diff can multiply and can put you in the hospital. It will kill 30,000 Americans this year so that's something to think about. It only happened because people changed their gut bacteria by abusing an antibiotic. I guess in closing, I want to vote for the bugs and say that we really have to be grateful that they are there and we have to nurture them. We have 100 trillion organisms in our gut. We say when a woman is pregnant, she has to be careful because now she's eating for 2. I would challenge that and say, "Look, pregnant or not, everybody on the planet is eating for 100 trillion because the gut bacteria and other microbiomes eat what you give them. What you give them is what you eat. That will help reframe the notion of your food choices now. It's not just what you think is good for you in terms of fat and David_Perlmutter Page 9 of 10

carbohydrates, protein, fiber, etc. It's what is good for your gut bacteria because that is the key to health. That is and the diversity matters. Not just what we eat, but how we eat and how we live. So, so excited for your Grain Brain Whole Life Plan to come out. I encourage our listeners to go to DrPerlmutter.com and get that DVD. Get the book. You know it's going to be awesome. Really thank you so much, David, for being here today and being with me. There's so many more things I have to ask. I look forward to it. Thank you. Bye bye. David_Perlmutter Page 10 of 10