This story appeared in the April 2015 issue of Naples Illustrated.
Photography by Vanessa Rogers
The human brain weighs three pounds, contains a thousand miles of blood vessels and more connections than there are stars in the Milky Way. It amounts to 2.5 percent of our body weight, but consumes 22 percent of our energy…when it’s resting.
The health and science of the brain is Dr. David Perlmutter’s profession, but one particular aspect of it is also his obsession: the symbiotic relationship between what we feed the brain and how it functions. After 30 years of study and poring over hundreds of scientific papers and medical studies, the Naples neurologist and author has come to believe that sugar, carbohydrates and certain kinds of wheat contribute mightily to various brain disorders such as dementia, ADHD, migraines, and even depressed libido. Perlmutter believes that dementia, if not resolutely preventable, can be rolled back, at least somewhat. “You can regain cognitive function,” he says. “Not what you had when you were 21, but to a good extent.”
His book Grain Brain (Little, Brown and Company, 2013) features grabby chapter headings such as “The Fatter You Are, The Smaller Your Brain,” earned recommendations from Dr. Mehmet Oz and has been a fixture on The New York Times best-seller list. Grain Brain has been published in 27 countries and has 650,000 copies in print. His latest book, Brain Maker (Little, Brown and Company, 2015), which focuses on how gastrointestinal issues affect the health of your brain, will be published April 28.
When it comes to many neurological disorders, Perlmutter’s generalized answer is a low-carb, high-fat diet, with plenty of vitamin D and exercise. He’s not referring to just a leisurely walk around the block with the dog, but as much cardio as you can take, with “huffing and puffing.” The specific villain in his dietetic cosmology is gluten. He believes high levels of fat—the good kind, not trans fats—are key to peak brain functions. Perlmutter believes that a high-fat diet can cut the chances of dementia by as much as 40 percent.
Along with his insistence on proper nutrition, Perlmutter is adamant that we need to advance beyond the idea of a single pill to cure every disease, if only because that mindset presupposes a tolerance for illness in the first place.
“I believe prevention is actually preferable to looking for a cure,” Perlmutter says. “The old hypothesis was that Alzheimer’s was caused by a chemical lack, so they developed a drug to allow that chemical to accumulate. The drug doesn’t work, but that’s all there is, so doctors prescribe it and feel they’ve done their duty. A one-drug treatment for disease is not going to happen with a multi-factorial disease like Alzheimer’s. The key is to prevent dementia and heart disease before they occur, and that’s what I’m trying to do.”
Unlike so many residents in the state, Perlmutter is a native Floridian; he grew up in Coral Gables, the son of a neurosurgeon. His initial ambition was a career in meteorology—the National Hurricane Center was located right on the University of Miami campus—but, he says, “The physics overmatched me.” Other youthful enthusiasms included fly fishing and playing the guitar, all of which he has maintained in his roster of activities. He initially came to Naples for his medical residency because it enabled him to continue with his fishing and decided to stay.
There was no epiphany, no one patient that led Perlmutter to his theories. “I’ve always been out of step in a positive way—chance favors the prepared mind, but the key word is prepared. I saw recurrent themes developing in my patients. For instance, there are factors that often show up in autism—C-sections, heavy use of antibiotics, and gastrointestinal issues, what I like to call gut bacteria reoccurrence. These influence brain chemistry and the expression of your DNA.”
Deaths from Alzheimer’s increased 68 percent between 2000 and 2010—and by 2014, an estimated 5.2 million Americans were living with the disease, according to the Alzheimer’s Association. Perlmutter acknowledges that part of the increased rate of dementia is due to the fact that people are simply living longer. “To a degree, it’s a function of an aging population, but I don’t believe it’s a natural function of the aging process. Even if you live to be 85, the odds are only 50-50 that you develop Alzheimer’s. But now we’re seeing dementia show up in 40-year-olds! Type 2 diabetes is exploding, and that’s a preview of coming attractions—type 2 diabetes doubles your risk of Alzheimer’s.”
He explains that since Alzheimer’s, Parkinson’s disease and multiple sclerosis are inflammatory diseases, the brain is “basically on fire” and elevated blood sugar only makes it worse.
“Food is information, sending signals to our DNA moment by moment,” Perlmutter says. “Traditionally, humans never ate high-carb diets except during harvest, in late summer or early fall, when fruit came into season, but now we have carbs 365 days a year—sugar is added to nearly all processed food.”
Perlmutter is a slender, fit 60-year-old, with the customary assurance found in high-functioning medical professionals. His diet—Grain Brain contains more than 30 pages of recipes—is not much different than the so-called paleo or caveman diet. “If something has worked for two million years, we should probably keep doing it,” Perlmutter says. The Mediterranean diet also earns his approval, containing as it does lots of olive oil, nuts, beans, fish, fruits and vegetables, and wine with meals. Perlmutter believes if you modify the Mediterranean diet by removing all gluten-containing foods and non-gluten carbs, it’s “the perfect diet.” He is quick to point out that dementia is less frequent in Mediterranean countries, partially, he believes, because the people exercise more.
Perlmutter’s decisiveness extends to his personal life—he met his wife on a blind date and fell in love as soon as she opened the door. He proposed two weeks later. He and Leize have been married for 28 years, and have two children, an artist and a young doctor.
The doctor has received some pushback in response to his theories, among them his assertion that, as he says in his book, “cholesterol is at most a minor player in coronary heart disease and represents an extremely poor predictor of heart-attack risk.”
On the other hand, he is firmly in the medical mainstream in his belief that “smoking, excess alcohol consumption, lack of aerobic exercise, overweight and a diet high in carbohydrates are important modifiable risk factors.”
Whether it’s through praise or criticism, he’s comfortable with his status as an outlier: “I resonate to outliers.” But, he says, “if the facts on the ground change, then I will change my position. I review scientific papers in my field every evening, but I believe that the broad strokes are indelible. Will there be nuanced changes? Sure.”
More than 80 percent of Perlmutter’s practice, at the Perlmutter Health Center in Naples, comes from out-of-town patients. A fairly typical one is Frank Thorn, who lives in Boston and works in securities regulation. Thorn was in his 20s and beset with lethargy as well as inexplicable skin problems. Nobody in Boston could figure out what the problem was, so Thorn’s relatives in Naples canvassed locals for a doctor who could help.
After Thorn came to Naples for a consultation, Perlmutter recommended substantial changes in diet, emphasizing proper nutrition with some use of supplements. “Within weeks, I noticed I had more energy and clearer thought processes,” Thorn says. “He removed all glutens from my diet, and focused on vegetables, grass-fed beef and wild fish.” For exercise, Thorn runs and swims. All this was 10 years ago. In the interim, Thorn says, he has “referred many people to Dr. Perlmutter.”
“This was always my destiny,” Perlmutter says. “My father was very classically trained—by the book. I obviously don’t do the same thing, but I feel a significant level of comfort in doing what I do. I feel comfortable thinking outside the box, but the best option of all is to make the box bigger.”