Lessons from: Grain Brain

Name: Grain Brain

Author(s): Perlmutter, David

Synopsis

This book starts out more aggressively than the other books I have read on the subject. It seems to me that the author almost wants to wage a war on modern day grains that have become parts of our diet. He says as much: Modern day grains are silently destroying your brain. The central premise of the book is that modern day life is increasingly different from what our body evolved to handle, and we are suffering because of it - more specifically our brain is. The book is about the nutritional and lifestyle changes we can make to keep our brains sharp and healthy.

Dr. Perlmutter is often very direct and prescriptive in the book, and pulls no punches in calling out who or what is to blame for our modern day condition (health wise). Good news is, that even though the style of writing borders on sensationalist, the material itself is fundamentally strong and the advice offered directionally correct. Starting with a self-assesment tool, the book is then divided into three parts: the first is essentially a treatise on how our brains are being harmed by modern day diet, the second is about the things we can do to fix that, and the third is a program that he recommends we follow or use as a foundation.

Core ideas

1. The following diagnostic tests are recommended to ascertain one's risk factors for brain diseases. The author invites us to discuss these in detail with our doctors:
1. Fasting blood glucose; Less than 90 mg/dL should be the target.
2. Haemoglobin A1c (HbA1c); marker of long term blood glucose levels. 4.8 to 5.4 is ideal.
3. Fructosamine; marker of medium term blood glucose.
4. Fasting insulin; early warning for metabolic syndrome. High levels of insulin seem to be correlated with brain disease; it is starting to be called "type 3" diabetes. Ideal case will be a figure of <2 µIU/mL.
5. Homocysteine levels; higher levels of homocysteine can indicate impending ASCVD, diabetes and neurodegenerative disease. <8 µmol/L is ideal, but anything more than 14 µmol/L is a serious cause of concern.
6. Vitamin D; important for optimum brain function. Ideal is 80 ng/mL.
7. C-reactive protein (CRP); marker of inflammation. Ideal level is <1 mg/L.
8. Cyrex array 3 and 4; check for gluten sensitivity
2. Limit carbs and get rid of gluten and sugar:
1. Our ancestors evolved on a diet comprising 70% fat and 5% carbs and hardly any sugar, today the ratio has almost flipped - And this is bad news because our bodies (and brains) cannot handle it.
2. When our diet is continuously carb heavy, we use glucose and glycogen for daily energy while the fat (whatever little we eat) keeps depositing in different places in our body (I wrote about this earlier). When the fat starts getting stored in places not meant to store fat (i.e. viscera, muscles, liver, pancreas etc.) they release inflammatory cytokines.
3. Aside, a high carb diet, through gluten, itself stimulates inflammatory pathways that reach the brain. In fact, the author calls gluten a "modern poison". It is a "sticky" protein composite that interferes with the absorption of nutrients in our gut and contributes to a pasty residue in the gut which prompts the immune system to act and increase inflammation. Later on in the book the author presents cases that link gluten sensitivity to depression, behavioural disorders (ADHD), movement disorders, autism and headaches - he is careful to point out that a variety of other factors play into these conditions - but it is an all-out war against gluten nevertheless.
4. Also, the grains we eat today contain gluten that is less tolerable to us. Wheat is the primary culprit, but the author also lists other grains and starches that contain gluten. 
5. Sugars (BTW carbs are chains of sugar molecules) stimulate glycation (bonding of sugar molecules to proteins or fats). Glycated proteins (often called "advanced glycation end products" or AGEs) (a) do not do their job (make the body work) and (b) increase inflammation. And esp. when we eat pure/refined sugar (products) we essentially put this process in fast-track mode.
6. Inflammation is important for the body to fix itself, but it is supposed to be acute and not chronic. That is, it is a spot treatment by the body to fix something wrong (like when you get a bruise). When inflammation is turned on for a long period of time (i.e. it becomes chronic) a "variety of chemicals are produced that are directly toxic to our cells" that travel through the body and cause harm (including to the brain).
3. In favour of a ketogenic diet:
1. Some fats are genuinely bad like trans-fat, commercially modified fat and oils. But some fats are good, and it is these fats that our bodies evolved to thrive on. Our bodies work best when the primary fuel is fats followed by a sprinkling of carbs here and there.
2. A series of studies and experiments "mistaking correlation for causation" through the 20th century made us think that fats were the enemy when they were not.
3. Monounsaturated fats (olive oil, macadamia nuts, avocados etc.) are good. Polyunsaturated omega-3 fats (like in some fish and plants) are also good; DHA is esp. important. Saturated fats are OK if consumed in moderation. 
4. Cholesterol is not bad, it is essential to life (what the cholesterol is carried in is what matters for heart disease). Statins, which lower cholesterol, might be indirectly harming us.
5. The author invites us to consider a low-carb, high-fat diet similar to what our ancestors used to have combined with the understanding of modern science.
4. Protect and grow your brain
1. It was wrongly understood that we are stuck with the number of neurons we are born with and that it is all downhill once we enter late teens. Neuroplasticity is possible and controllable.
2. The key protein here is "brain derived neurotrophic factor" (a.k.a. BDNF) that protects existing neurons and helps grow new ones.
   
3. We can increase BDNF production in the body through:
1. Exercise, esp. aerobic exercise
2. Calorie restriction (CR) incl. intermittent fasting (though how effective it is for the body overall needs careful consideration)
3. Consuming exogenous ketones or following a ketogenic diet to allow the brain to use ketones as primary fuel.
4. Learning new skills and intellectually challenging yourself is important to keeping a nimble brain.
5. Free radicals are oxygen atoms with an electron missing. Free radicals are created as part and parcel of normal living even if we are not generating an excess of them through poor habits like high sugar consumption, smoking etc. Free radicals lead to oxidative stress in our bodies and should be removed.
6. The body has ways to do generate antioxidants that neutralize free radicals. Nrf2 is a protein that tells the body to increase antioxidant production in cells. We can "turn on" Nrf2 by engaging in calorie restriction (CR) consuming:
1. Fish oil (source of EPA and DHA)
2. Curcumin (turmeric)
3. green tea extract
4. Silymarin (milk thistle)
5. Bacopa extract
6. Sulforaphane (broccoli)
7. Ashwagandha
8. Coffee
7. BTW consuming exogenous antioxidants like vitamin C may be an exercise in futility since the body generates so many free radicals each day (10^18 by the author's estimate) that these supplements may be like a drop in the ocean.
5. Exercise is the most effective way to prevent cognitive decline: Especially aerobic exercise, the kind that gets you steady in zone 2 heart rate for about an hour or so, a couple of times a week. If you are not able to find the motivation to exercise, then a simple intervention is to design the right environment. And the good news is that it does not take much to make an impact, so just get moving.
6. Sleep can't be ignored: All of us should strive for 7-8 hours of solid sleep each night. But it is not just the quantity, the quality also matters. Unfortunately, sleep gets harder as we get older, fortunately a few simple acts can help a lot.
1. Sleep also powerfully impacts our hormones (which powerfully impact us) - Leptin is a such hormone. It tells us whether we are hungry or not (along with its mirror hormone "ghrelin"), it decides whether our body will store fat or burn it and also controls inflammation in the body. It also influences other hormones (including thyroid), so it's a pretty important hormone overall (like its friend, insulin).
2. Leptin (like insulin) is put out of whack by refined carbs. And like insulin, when leptin levels are chronically elevated (like with when we have a habit of overeating), the body becomes leptin resistant. This is a double whammy: you have a habit of overeating and the one thing that signals to you that you have eaten enough starts getting ignored by body.
7. Do the following to fix "grain brain":
1. Start essential supplements:
1. DHA
2. Resveratrol
3. Turmeric (Curcumin)
4. Probiotics
5. Alpha linoleic acid (ALA)
6. Vitamin D
7. Coconut oil
8. Vitamin B6, B12 and folic acid (to control homocysteine levels)
2. Remove from kitchen:
1. All sources of gluten
2. All forms of processed carbs
3. Packaged foods labelled "fat-free", "low-fat"
4. Margarine, vegetable oil, soybean oil, corn oil, cottonseed oil, canola oil, safflower oil, sunflower oil, rice bran oil, grape seed oil, wheat germ oil.
5. Non-fermented soy (e.g., tofu, soy milk) and processed foods made with soy (things that have "soy protein isolate" in ingredient list.
3. Add to kitchen:
1. Healthy fats like extra virgin olive oil, sesame oil, coconut oil, organic/pasture-fed butter, ghee.
2. Healthy seeds like flaxseed, pumpkin seeds, sunflower seeds, sesame seeds, chia seeds.
3. Herbs, seasonings and condiments mustard and salsa.
4. Low sugar fruit like avocado, bell peppers, cucumber, tomato, lemon.
5. Protein (whole eggs, wild fish, grass-fed meat, poultry etc.)
6. Vegetables like leafy greens, lettuce, collards, spinach, broccoli, cabbage, cauliflower, green beans, radishes, turnips.
7. In moderation (like 1-2x per week): Carrots, cottage cheese, cow's milk, yoghurt, legumes, (whole) sweet fruit (non-juiced), non-gluten grains.
4. (Optional) Fasting: 24-hour, water only.
5. Limit your daily carb intake to 60 gm (40 gm for first month): The carbs can only come from the stuff you added to your kitchen above. This will make your body more adept at using fat (ketones) for fuel. You can track this through the use of a food journal.
6. Aerobic exercise: 20 minutes per day minimum. Stretching (or yoga) is good (and important) but does not count as exercise, that time must be separate from exercise time.
7. Focus on sleep: Read what I wrote above.
8. Remove bathroom toiletries and beauty products that contain gluten.

The author has included a 4-week plan that puts to use the information contained in Pt.7. Apart from that is included a meal plan and recipes.

Notable quotes

• Modern grains are silently destroying your brain.
• I believe that the shift in our diet that has occurred over the past century — from high-fat, low-carb to today’s low-fat, high-carb diet, fundamentally consisting of grains and other damaging carbohydrates — is the origin of many of our modern scourges linked to the brain, including chronic headaches, insomnia, anxiety, depression, epilepsy, movement disorders, schizophrenia, attention deficit hyperactivity disorder (ADHD), and those senior moments that quite likely herald serious cognitive decline and full - blown, irreversible, untreatable, and incurable brain disease.
• There is little doubt that one of the largest and most wide - reaching events in the ultimate decline of brain health in modern society has been the introduction of wheat grain into the human diet. While it’s true that our Neolithic ancestors consumed minuscule amounts of this grain , what we now call wheat bears little resemblance to the wild einkorn variety that our forebears consumed on rare occasions.
• We are increasingly challenging our physiology with ingredients for which we are not genetically prepared.
• Brain dysfunction is really no different from heart dysfunction. It develops over time through our behaviors and habits.
• While it’s true that we are living longer than previous generations, most of our gains are due to improvements in infant mortality and child health.
• And now we have the evidence in the scientific literature to prove that when cholesterol levels are low, the brain simply doesn’t work well; individuals with low cholesterol are at much greater risk for dementia and other neurological problems.
• The inescapable fact is that we have evolved into a species that requires fat for life and health.
• It’s my belief that gluten is a modern poison, and that the research is compelling doctors like me to notice and re-examine the bigger picture when it comes to brain disorders and disease.
• Modern gluten-containing grains are more problematic than ever.
• “So this is your brain on wheat: Digestion yields morphine-like compounds that bind to the brain’s opiate receptors. It induces a form of reward, a mild euphoria. When the effect is blocked or no exorphin-yielding foods are consumed, some people experience a distinctly unpleasant withdrawal.”
• Gluten is our generation’s tobacco.
• But it’s a fact that few foods produce as much of a surge in blood glucose as those made with wheat.
• ... consuming excess carbohydrates — even those that don’t contain gluten — can be just as harmful as eating a gluten-laden diet.
• Interestingly, the human dietary requirement for carbohydrate is virtually zero; we can survive on a minimal amount of carbohydrate, which can be furnished by the liver as needed.
• ... alleged correlation between higher cholesterol and higher cardiac risk is an absolute fallacy.
• Fat — not carbohydrate — is the preferred fuel of human metabolism and has been for all of human evolution.
• Both the heart and the brain run more efficiently on ketones than on blood sugar, by as much as 25 percent.
• ... cautioned against eating omega-6 oils in the absence of omega-3.
• Overall, omega-6 fats fall under the “bad fat” category; they are somewhat pro-inflammatory, and there is evidence that higher consumption of these fats is related to brain disorders.
• ... our hunter - gatherer ancestors consumed omega-6 and omega-3 fats in a ratio of roughly 1:1.5.
• One of the most pervasive myths I’m constantly debunking is the notion that the brain prefers glucose for fuel. This also couldn’t be further from the truth. The brain uses fat exceptionally well; it is considered a brain “superfuel”.
• ... statins — the blockbuster drugs prescribed to millions of Americans to lower cholesterol — may cause or exacerbate brain disorders and disease.
• And if I had to name the kingpin here in terms of avoiding all manner of disease, I’d say “diabetes”. That is to say, don’t become diabetic.
• Fat is an organ. And it could very well be one of the body’s most industrious organs, serving a lot of functions beyond keeping us warm and insulated.
• A low-carb, high-fat diet will outperform a low-fat, high-carb diet any day, and by virtually every measure in the body, from its internal chemistry to its external waistline.
• In fact, we can define this mild ketosis as the normal state of human metabolism when we’re not eating the carbohydrates that didn’t exist in our diets for 99.9 percent of human history. As such, ketosis is arguably not just a natural condition but even a particularly healthful one.
• But many kids today aren’t getting enough DHA, and this is partly why we are seeing so many cases of attention deficit hyperactivity disorder (ADHD).
• Glutathione is regarded as one of the most important detoxification agents in the human brain.
• If you’ve got low cholesterol, you’ve got a much higher risk of developing depression.
• The bigger your belly, the more at risk you are for headaches.
• ... there is no greater tool at our fingertips than physical movement.
• Not a single drug or supplement on the planet can balance leptin levels. But better sleep, as well as better dietary choices, will do the trick.
• Remember that contrary to popular wisdom, dietary cholesterol actually reduces the body’s production of cholesterol, and more than 80 percent of the cholesterol in your blood that is measured on your cholesterol test is actually produced in your own liver.
• The popular misconception that eggs are bad for your blood cholesterol and therefore bad for your heart persists among many people and still continues to influence the advice of some health professionals. The myth prevails despite strong evidence to show that the effects of cholesterol-rich foods on blood cholesterol are small and clinically insignificant.
• I recommend that people fast at least four times a year; fasting during the seasonal changes (e.g., the last week of September, December, March, and June) is an excellent practice to keep.
• This is life, and accepting a certain give-and-take is okay. But see if you can stick to a 90/10 rule. For 90 percent of the time, eat within these guidelines and let the last 10 percent take care of itself, as it inevitably does in life. Then hit re-boot whenever you feel like you’ve fallen too far off the wagon. You can do this by fasting for a day and committing again to the same four weeks of restricting carbs.
• Get to know your grocers; they can tell you what just came in and where your foods are coming from. Aim for choosing produce that’s in season, and be willing to try new foods you’ve never had before.
• Drink half of your body weight in ounces of purified water daily.

In closing

"Grain Brain" is mainly a diet book with the other bits on exercise and sleep thrown in for good measure (not that any of the stuff is incorrect). I like the fact that the book reads easy, and even beginners to the health and longevity space can pick it up and start making progress. The author's direct style is also refreshing and leaves no doubt in the reader's mind about what to/not to do. The lifestyle and nutrition plan contained at the end is also good for a beginner.

Personally, most of the information and advice was already known to me, however, the role of gluten and how a component of almost everything we like to eat can be so insidious was new. Good to read once and absorb.