RHR: How the Modern World Is Affecting Our Brains, with Dr. David Perlmutter

In this episode, we discuss:

• How inflammation affects our decision-making
• The problem with disconnection and why we need to get reconnected
• Applying the test of T.I.M.E. to technology use
• The beneficial effects nature has on our brains
• How lack of sleep impacts decision-making
• The ways that mindfulness improves our health
• Why social connection and empathy are so important

Show notes:

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Hey, everybody. Chris Kresser here. Welcome to another episode of Revolution Health Radio. This week, I’m really excited to welcome back Dr. David Perlmutter as my guest. Dr. Perlmutter is a Board Certified neurologist and four-time New York Times best-selling author. He serves on the board of directors and is a fellow of the American College of Nutrition.

Dr. Perlmutter received his MD from the University of Miami School of Medicine, where he was awarded the Leonard G. Rowntree Research Award. He serves as a member of the editorial board for the Journal of Alzheimer’s Disease, and has published extensively in peer-reviewed scientific journals including Archives of Neurology, Neurosurgery, and the Journal of Applied Nutrition. In addition, he’s a frequent lecturer at symposia sponsored by institutions such as the World Bank and IMF [International Monetary Fund], Columbia University, Scripps [Research] Institute, New York University, and Harvard [University], and serves as an associate professor at the University of Miami Miller School of Medicine.

His books have been published in 34 languages and include the number one New York Times best-seller Grain Brain: The Surprising Truth About Wheat, Carbs, and Sugar—Your Brain’s Silent Killers with over 1 million copies in print. He’s the editor of the upcoming collection The Microbiome and the Brain, [which] will be authored by top experts in the field and will be published in 2019 by CRC Press. Dr. Perlmutter’s new book Brain Wash, which we’re going to be talking about today, was co-written with Austin Perlmutter, MD, his son, and is out this year.

So I’m really excited to dive into this book with Dr. Perlmutter. It’s a little bit of a departure from his previous work in some ways, but also just an iteration and a continuation of some of the themes he’s been exploring for many years. And I really love the direction he’s taken in this book, and I think you will, too. So let’s dive in.

Chris Kresser:  Dr. David Perlmutter, it’s a pleasure to have you back on the show. Thanks for coming.

David Perlmutter:  Well, I am super delighted to be here. Again, this is great.

How Inflammation Affects Our Decision-Making

Chris Kresser:  I’m really looking forward to talking to you about this book. It seems to me an iteration on some of the books you’ve done before, but also a little bit different, a little bit different direction. So what inspired you to write this?

David Perlmutter:  That’s a great question. And let me just first respond to the iteration comment. And that is, you know, what we’ve talked about over the years, you, as well, and so many of us have really focused on the powerful role of inflammation as a kind of cornerstone mechanism for so many of our chronic degenerative conditions, that, in fact, rank as the number one cause of death on our planet.

So we’ve looked at inflammation in the context of coronary heart disease, Alzheimer’s disease, diabetes, cancer, you name it. But what we discovered, and in writing this book, and I guess that’s the segue to the new book, is the role of inflammation in our decision-making. And interestingly, the genesis of this book that I co-wrote with [my] son, Austin Perlmutter, also an MD, he’s an internal medicine specialist, actually, the genesis was right in the room from which I’m speaking to you right now. And we were lying back, kicking our feet up and asking, Austin would ask me, “What’s the most frustrating thing about practicing medicine?” And I said that, “It’s not that we don’t learn as much as we can. We try so hard to learn as much information, we read all the research and books and go to the lectures, then we transmit all that information to our patients.

“The problem is the big breakdown occurs when patients then take the information and don’t do anything with it.” So what research reveals is that about 50 to 80 percent of the information we give to patients doesn’t get acted upon. And whether they’re wanting to be vegan, Paleo, carnivorous, or who knows what, ketogenic, it doesn’t really matter if they don’t put it into play. So we started to unravel what it is about patients and generalize that to the population of humans at large, what is it that underlies our ability to make decisions that we know are good for us or not make those decisions. And we realized that there are really two fundamental brain areas that are involved here.

One is called the prefrontal cortex behind your forehead. And that’s a much more sophisticated decision-maker; it looks at the long-term consequences of what you decide to do today. It looks at right and wrong, in contrast to another area of the brain called the amygdala, which is far more impulsive. I want the jelly doughnut right now, future be damned. And we realize that there are so many aspects of our modern world, getting back to our inflammation introduction here, that are determining whether we’re going to function in a more thoughtful, sophisticated way or that we’re going to lock into impulsivity.

And as fate would have it, inflammation is playing a pivotal role in determining who is the decision-maker. Are we having the adult in the room and making good decisions as they relate to our futures? Or is the impulsivity center lit up, not only by the inflammatory nature of our lives, but the inflammatory nature of our lack of sleep, our lack of exercise, our lack of communication with nature, and certainly, perhaps tops on the list, is the inflammatory nature of our modern Western diet? So, yes, we could say that, hey, our diets are involved in brain degeneration.

I wrote about that years ago in Grain Brain. But to think that our diets, this modern Western/pro-inflammatory diet, is influencing our decision-making to determine, for example, what we should be doing or should not be doing, was really, I think, a very profound revelation for us.

Chris Kresser:  This is so fascinating to me. And one of the reasons I was so excited to talk to you about this book is because I think we’ve both come to a similar conclusion about the problem, which is essentially behavior. If you look at the modern world, it’s not really a lack of information that’s holding people back.

The statistic I often use is, according to the CDC [Centers for Disease Control and Prevention], only about 6 percent of people consistently engaged in the top five healthy habits of:

• Maintaining a healthy weight
• Getting enough exercise
• Not smoking
• Not drinking excessively
• Getting enough sleep

And it’s not because they don’t know that those things are, they should be doing those things. Most people know that by now. It’s that they’re not able to follow through on making those successful behavior changes. And I’m approaching it with health coach training and from a behavioral perspective and a behavioral solution.

And I love that you’re approaching it from the perspective of inflammation and how biochemical mechanisms that are driven by the choices that we make are affecting our ability to successfully change our behavior. So it seems to me that we need to approach this problem from all different angles to come up with a solution that will stick.

David Perlmutter:  Well, that’s true, and you brought up a very good point, and that is that we don’t suffer from the lack of good information. Whether you’re reading The Paleo Cure or Grain Brain, those books, meaning your book, or my book, or any number of great books out there, they’re useless. Our books, your books are useless unless people act on the information that you’re giving them.

Chris Kresser:  Yeah.

David Perlmutter:  So we don’t suffer from a lack of terrific information today, we suffer from a lack of implementation. And so we created the new book Brain Wash to be the bridge between information and action. Now that you have the information, what do you do with it? We know pretty much what’s good food and bad food. We know we should be getting a good night’s sleep and we know we should be exercising. But so many of us struggle and blame ourselves. That self-blame thing is so huge. And we as healthcare providers, with all due respect, have a tendency to blame patients for actually not following through. What’s wrong with these people? Where is their willpower?

And what we learned in writing this new book is that active interventions in this world have taken our ability away to make good decisions. That there are forces at work, be it the pop-up advertising, the clickbait on the internet, the changing [and] the modification of the modern diet, etc., that these forces are at work to hack into our brains and keep us from accessing this prefrontal cortex, the adult in the room, the good decision-maker, through, again, the powerful influence of diet on brain wiring.

And indeed, we know that impulsivity is fostered by so much of what happens when we are online. And we dedicate a lot of the book to making very clear to our readers that there are active efforts underway to mine your attention, to take your attention when you’re online doing something.

Chris Kresser:  Yes.

David Perlmutter:  Whether it’s pop-up ads [or] the next queued YouTube video that happens to be interesting because of what you’ve been watching, because ads are going to pop up there, as opposed to the judicious use, for example, of digital media to do something that you want to accomplish. Like, we wrote this book based upon the internet and unlimited access to information. But I think we’re all aware of the fact that these days, it’s really gotten away from us that 42 percent of the awake time for Americans is spent in front of one screen or another. That’s more than six hours a day.

Add that up in a lifetime, [and] that’s 22 years of screen time that is harmful, potentially harmful in and of itself, but also is time that isn’t spent doing the things that Chris Kresser talks about. Things that are good for us. And we’ve got to pay attention to that. And I think step one is really becoming aware that this is happening. And later in the book, we talk about what are the steps two? What do we do to unwind this and what do we do to reconnect to that part of the brain that can lead us, finally, [to] make better choices?

Did you know that lack of sleep, too little exercise, and a nutrient-poor, inflammatory diet can impact your ability to make decisions? Check out this episode of RHR to find out why. #optimalhealth #wellness #chriskresser

The Problem with Disconnection and Why We Need to Get Reconnected

Chris Kresser:  I’m so happy to hear you talking about this and that you include this in your book. We have a whole module in our health coach training program about technology addiction. I think it’s probably the least acknowledged and most significant threat to, really, kind of our humanity at this point. And it’s so insidious, because with other addictions, like, certainly drug addiction, alcohol addiction, maybe perhaps less so with food addictions, but those tend to be a little bit more obvious. And in the case of drug and alcohol addiction, less culturally acceptable. But technology addiction has just become kind of the default to where it’s not even recognized in most cases.

David Perlmutter:  Well, it’s certainly not recognized as a diagnostic code. But when you look at the characteristics of addiction, being disruptive to one’s ability to make a living, disruptive to one’s social life, disruptive to one’s family life, then by [those] criteria of definition, then about 6 percent of the world right now is internet-addicted. That is a quarter billion people. That’s five times the population of England. These individuals have twice the risk of suicide. And if they’re under 18 years of age, their risk of suicide is quadrupled.

So, as you say, it’s under-recognized, but it’s a major problem in China. They actually have boot camps to help, let these people reconnect with human beings, with the world around them. These are digital detox efforts so that people can reestablish connection with real people. And we describe in Brain Wash something called disconnection syndrome. And that is, in a physiologic sense, a pathophysiologic sense, disconnection of the amygdala, the impulsivity brain, from the overriding governance of the prefrontal cortex. It also means disconnecting from the people around you; it means disconnecting from the messages of your genome, disconnecting from the messages of your microbiome.

So it’s a very kind of wide net that we throw by this term. The whole mission is about reconnection. And I have to tell you, I wanted reconnection in the name of the book, but I was overruled. And they settled on Brain Wash. I, like, it’s a play on words, I get it.

Chris Kresser:  Yeah, yeah.

David Perlmutter:  But it’s all about reconnection. We want to reconnect in a subcellular way to the messages of our DNA that this environmental mismatch between our heredity and our environment is really the central player in virtually all our illnesses these days. That’s part of the underlying Paleo doctrine. If we can get back to a place of giving our DNA the signals that it is used to, then we’ll be healthier. There’s no question that that’s reality. That we’re living a life in conflict with what our DNA wants to see. But this connection thing is much further. Connecting to ourselves now, and even connecting to our future selves.

When we talk about empathy, empathy for another person, treating that person compassionately, we can have empathy for our future selves. I can be empathetic toward the David Perlmutter 10 years from now by treating, by making decisions today that are going to treat that individual better 10 years hence. Similarly, we talk about something very specific, called cognitive empathy. And what does that mean? It means the ability that we have or not to see things from another person’s perspective, whether we agree with it or not. It means a Democrat could embrace the views of a Republican and try it on and vice versa, that vegans consider what carnivores are talking about and carnivores think about vegans, and whether it’s Paleo or keto, whatever, that we have dialogue and we communicate. We have so lost that.

Chris Kresser:  Yeah, imagine that world.

David Perlmutter:   Yeah, and that isolationism of ideology is absolutely fostered by our social media sites, [which] only lock us into one frame of reference to the exclusion of everything else that’s in the agora that we could have learned from and tried on and maybe not agreed with. That’s okay. But interestingly, this whole notion of empathy, and specifically, cognitive empathy, these are also functions of the prefrontal cortex, which is why it is so darn valuable for us to look at the tools that we have validated today that can allow us to reconnect. And I think that is, that’s step one. I mean, in any health program, for example, if you’re wanting people to follow through, first we’ve got to work on their decision-making ability. And that paves the way down the line for them then to incorporate the recommendations that they receive.

Applying the Test of T.I.M.E. to Technology Use

Chris Kresser:  Absolutely. I want to back up and highlight something you said, because it’s something I’ve been thinking a lot about, and I think it’s key. It certainly was a key realization for me, and I know it is for a lot of people, which is, you mentioned it in the context of technology. Like, there are neuroscientists and brain hackers that are employed by these large technology companies explicitly to manipulate, to basically teach the companies how to manipulate our attention. Because we are not the customers of these companies, we are their products. They are selling our attention to advertisers.

And so, the more they can maximize our attention, get us to spend more time on the platform, the more money they make. And you mentioned that they hire these scientists to do that. I think, for me, it’s really important for people to understand that that’s happening in so many different areas of the modern world. And you point this out in your book, that the foods, the highly processed and refined foods, are tapping into those lizard brain limbic system desires that we have and overriding our frontal cortex. The exposure to light, artificial lights, is having that same effect. The sedentary lifestyle that we’re living.

The disconnected nature of our isolated nuclear family living arrangement has those effects. So you mentioned that to make good choices, we have to have a brain that is optimized for reflection and balanced thinking and long-term outcomes. Really those prefrontal cortex-based processes. Yet we’re living in a world that is really doing its best to exploit the impulsive, emotionally reactive part of our brain.

David Perlmutter:   It’s so true, and why is that done? Because it’s valuable.

Chris Kresser:  Right.

David Perlmutter:  What you do and where you go online has value to others. And it is totally monetizable, and every single person who’s now on a site doing something brings value and, face it, what you pay attention to online impacts your choices, and is valuable. So when we see now the research showing that functional MRI [magnetic resonance imaging] is being used, looking at what areas of the brain light up, to refine advertising. It used to be in the day that they would use, like, what was called a focus group.

Chris Kresser:  Right.

David Perlmutter:  Or they would create an ad and 20 people [would] be in rooms. “Yeah, I like it.” “Well, I don’t really like that.” Whatever. They’d vote. And now, they’re looking at how advertisements target our brain activity, our reward centers, and cultivating specific ads to light up your brain’s reward center. I mean, that’s part of the battle of Brain Wash is first to call it out.

Chris Kresser:  Yes.

David Perlmutter:  Like you said, we’ve called it out. It is what it is. We’re sure as heck not making this stuff up. But we’re offering up tools so that you can be, you can increase your online self-defense, as it were. A term that I think I learned just from Abel James yesterday on the Fat-Burning Man.

Chris Kresser:  Yes, I love it.

David Perlmutter:  He made that up. I thought it was terrific. I said, “I’m going to steal that one from you.” But it’s true. And so, in the book we talk about, for example, online to ask yourself is your online experience passing the test of time? T.I.M.E.

• T, how much time are you dedicating for whatever it is you want to go online to do? To learn about some scientific thing or to reconnect with your high school friends, whatever it is, how much time?
• I, is it intentional? What is the goal? What do you hope to get out of it?
• M, do you remain mindful when you’re online and aware of the efforts being made to hack into your attention?
• And finally, E. T.I.M.E. Is it net positive? Is it enriching? Enriching.

In other words, when it’s all said and done, do you feel like that was a good experience in front of a screen, or [do] I just, you know, kind of wish I [hadn’t spent] the last four hours binge-watching something on Netflix? So it’s a great tool. Christian Lange in 1921 won the Nobel Prize. He said that technology is a useful servant, but a dangerous master.

Chris Kresser:  A poor master, yeah.

David Perlmutter:  So, again, we’re not calling for people to turn off. You and I are communicating right now with incredible digital technology. That’s great. But we sure as heck want to make it clear that efforts to manipulate your brain and your brain wiring moving forward, I might add, are very real, [it] is what it is, but what can you do to increase your defenses?

Chris Kresser:  I like how you emphasize that, not just with technology, but also with the modern food system; industrialized processed food companies also hire people to maximize the addictive nature of those foods and try to get us to eat more of them.

David Perlmutter:   You bet. That 68 percent of the foods, of the 1.2 million foods sold in America, have added sweetener.

Chris Kresser:  Yeah.

David Perlmutter:  Now why do that? Well, because people are going to eat more of it. It’s not that they’re adding something that’s really good for us.

Chris Kresser:  No.

David Perlmutter:  It’s not in our interest that there’s added sugar in our food.

Chris Kresser:  But this is not a failure of individual will. And I always make an effort to point this out, and you do in your book, as well, because I think that helps people to get out of the guilt, blame, and shame game, which is paralyzing and tends to lead to inaction rather than action. Whereas when people understand that these things are being done to them, they’re actually subjects in these experiments that are being performed. And I’m not saying that we don’t have personal responsibility; of course we do. But I think it can be empowering for people to understand that they are subject to these forces and they’re acting on them that don’t actually have their best interests at heart.

David Perlmutter:   Chris, your point is absolutely profound. And that is what we’re trying to do here is to stop the self-blame. That, guess what? You’ve failed on your New Year’s resolutions. You read somebody’s book, you thought it was great, but you’re not doing those things that you know are good for you. And as a matter of fact, you’re making wrong decisions.

Chris Kresser:  Yeah.

David Perlmutter:  And it’s, people look at themselves in the mirror and they blame themselves. And we’re calling out that, “Guess what? Your brain mechanism for making these good choices has been taken away. And here is how you can regain that.” And I will say that it certainly begins with us in the healthcare world, that we tend to blame those people for whom we render care. We blame them for not following through on the great information. We think it’s great that we’ve studied so hard and tried to purvey, and yet [it] isn’t acted upon on the part of the client/patient, and we’ve got to stop that. We’ve got to realize that Mrs. Jones doesn’t have the machinery upstairs right now to make good decisions.

So we are now incorporating the premises of Brain Wash into the Functional Medicine coaching program, just got this arranged a couple of weeks ago. And where we’re going with that is really training the healthcare providers at the beginning, not to focus on in week one handing out a piece of paper with this specific diabetic diet for weight loss, you name it. But when we first are with a patient, what we focus on are changes that can bring about a better ability to make decisions. That’s the real goal. Because if you don’t work on the decision-maker, then everything else you provide to a patient is, again, completely useless.

So we’ve got to make better decision-makers out of the patients to start off with. And then you recognize that this is all of us, because whether you’re a patient or not, we as people who live in our modern society have been experiencing this powerful disconnection in our minds. And it turns out that there are some powerful things we can do right now that can allow us to regain control, bring the adult back into the room, and ultimately make better choices and become more empathetic and compassionate along the way.

The Beneficial Effects Nature Has on Our Brains

Chris Kresser:  Couldn’t agree more. So that’s a good segue into some of the solutions that you talk about in the book. And one of my favorites, personally, is nature and connection with nature as an antidote to stress and technology addictions. Can you talk a little bit about what the science is telling us about how nature affects the brain?

David Perlmutter:   Sure. Well, let me just start off by saying that nobody goes out in nature and doesn’t feel better than staying home watching videos. And we all know that [if] we go out for a walk in the trees and the fresh air, we feel better. And it turns out there is some really good science as to why that happens. We know that nature exposure, most of this work [is] actually being done in Japan, [and] some of it [is] being done here. Nature exposure, even for as little as 10 minutes, significantly lowers the stress hormone, cortisol.

That has a role to play in terms of neurotransmitters, in terms of what’s going on in the gut, in terms of gut permeability, hence, inflammation. But nature exposure also directly lowers this inflammation process, which, as I mentioned earlier, severs us from the prefrontal cortex. So nature exposure very quickly allows us the ability to reconnect to the prefrontal cortex, regaining some better decision-making ability and allowing us to be more empathetic, even as it were, toward nature. Back toward the environment. And when we first talk about this, I think people kind of nod their heads thinking, “Well, I don’t live near a national park. And it’s not going to be possible for me.”

But what the research shows in really good scientifically controlled studies of impulsivity, for example, in the laboratory, is that just showing people a picture of nature for as little as 10 seconds dramatically reduces, for example, the amount of activity in the fear center in the amygdala when these individuals are shown threatening photographs. So just 10 seconds of looking at a picture of a natural environment. Even more powerful is actually having some physical contact with nature, as in the form of a potted plant in your living room or kitchen. Or, as it were, it was in some of the studies, in the hospital room or in the waiting room. So it’s really quite simple, but yet dramatic.

You don’t have to live near Yosemite and take a two-hour hike four times a week. If you have access to a park, that’s great. It can be as little as 20 minutes. The studies show that, they’ve demonstrated how even with just measuring the level of stress hormone cortisol in the saliva, even in an urban environment, but a natural setting in an urban environment, like a small city park, that salivary cortisol measurements, measurement of stress, if you will, goes down quite precipitously. So, again, it’s to make this more user-friendly. You know, we talk about sleep and meditation, and dietary changes, and exercise, not to really throw the book at people as you got to be all in.

But each of these as a potential on-ramp for an individual to allow him or her, thereafter moving forward, to have a little crack in the door in terms of better decision-making. That it might just be the potted plant or getting out in nature for one person, whereby another person is really not getting enough restorative sleep. Target that.

Chris Kresser:  Yes.

How Lack of Sleep Impacts Decision-Making

David Perlmutter:  Look at the blue light exposure in the evening, look at the temperature of the room, look at caffeine consumption late in the afternoon, whatever it may be. But here’s a person who needs to make better choices with respect to his or her diet. [The] first time you’re with this person, you say, “You know what? We’re not even going to talk about it today. I’m going to talk about something seemingly unrelated: sleep.” And it’ll raise eyebrows. But it turns out that even one night of non-restorative sleep is associated with as much as a 60 percent increased activity of the amygdala. Meaning that very next morning, your decisions are far more impulsive, you’re much more likely to snap at people, and you’re going to be able to participate in far less empathy than a person who’s had a good night’s sleep. And we all know that to be true.

Chris Kresser:  Yes.

David Perlmutter:  If you’re up all night for whatever reason, or you don’t get a good night’s sleep, we’re all a little irritable the next day. But the problem is that now you’ve set yourself up to make bad decisions across the panorama of your lifestyle choices, including food. So that very next day, what do you do? You eat bad foods. And what does that do? It increases inflammation; [it] increases, ultimately, body fat. And the more weight you gain, the less quality sleep you’re going to get.

So it’s quite literally, and excuse the pun, a feedforward process. It’s been demonstrated that people who chronically don’t sleep well will consume, on average, approximately 380 calories more each day, without a similar increase in energy expenditure. Meaning that’s a pound of fat about every week. You stretch that out over a couple of months, and what’s happening? People are gaining more weight. Fat is pro-inflammatory, leading to more impulsivity, leading to poorer sleep, and it creates these feedforward cycles that are so characteristic of our modern world. You walk through an airport, you see people who are clearly suffering.

Massive weight gain in our society and now, I have to admit, I walk through looking at these people thinking, “Why can’t you just make the changes that people like yourself, you and I write about? Why can’t you just do that?” And then, again, when you realize that because they’re gaining body fat, they’re going to eat more. Gary Taubes once [had] a great quote. He said, “We don’t gain weight because we’re eating more. We’re eating more because we’re gaining weight.” And it’s a different perspective, but I think it’s extremely valuable to recognize how body fat is controlling our hunger, our ghrelin, and amping up inflammation and disconnecting us from making good decisions.

Chris Kresser:  Yes. Yeah, I couldn’t agree more. And it’s, I think sleep, fortunately, has gotten more on people’s radar, but not just for the impact that it can have on mood and cognitive function. But the very direct connection, as you pointed out, between sleep and cardiometabolic function, which is now beyond a shadow of a doubt. And I’ve also seen studies suggesting that poor sleep affects judgment around food. Even one night of poor sleep can affect the choices that we make about what we eat the next day. Which comes back to your point about it’s not just information, it’s our capacity to make the right decisions. And that will be significantly impaired by lack of sleep.

David Perlmutter:  And that’s right. And it’s been demonstrated there is profound increased desire for calorie-dense, non-nutritious foods after even one night of poor sleep. I mean, most people have probably experienced that. But you know, the problem is that when our sleep quality and quantity decline over time, these decisions become ingrained in us and we make further bad decisions that, as I mentioned, [are] powerfully affecting our sleep. So, again, what we did in Brain Wash is created the off-ramps. How do you disengage from these cycles? And certainly, sleep hygiene is so important.

All the recommendations that we’ve made with respect again to screen time in the evening, to possibly using a little melatonin, to using a white noise generator in the background if you’re not able to sleep in a quiet area, to our timing of sleep, our timing of eating, our timing of exercise, not going to sleep with a full belly because you just finished dinner. And so many things that play a role in our ability, as Dr. Matthew Walker described in his book Why We Sleep, that are really very important. I’m glad that you and I went there first, because we should spend about eight hours of our 24-hour cycle sleeping. We don’t spend eight hours eating or exercising, right? Maybe you could, I guess.

Chris Kresser:  Hopefully not.

David Perlmutter:  But food and exercise is what everybody talks about. And I think it’s great to talk about those things. But the big thing that we do for most of our lives, in terms of a lifestyle choice, is sleep or not. And it’s great that people are writing these books like Michael Breus writing The Power of When, and, as I mentioned, Matthew Walker, because it’s, especially in our society where one third of Americans [do] not get enough restorative sleep. And in Japan, it’s close to 70 percent of adults.

Chris Kresser:  Yeah. I had Matthew on my podcast. Because when I talk about this with patients, I have a feeling that a lot of patients suspect that they’re in that extreme minority of people who can thrive on just six to seven hours of sleep. And Matthew is very clear about pointing out, when he says seven and a half to eight hours of sleep, that’s not time in bed; that’s sleep. So, depending on what your sleep efficiency ratio is, you might need to spend eight and a half or nine hours in bed to get eight hours of sleep.

But a lot of people I talked to think that they’re in that minority of people who really can be fine with six hours. And he said something that really struck me and I haven’t forgotten, is that you have more of a chance of being struck by lightning than you do of being in that tiny, tiny minority of people that can thrive with fewer than seven and a half or eight hours of sleep.

David Perlmutter:  Yeah, I mean, there [is] a very, very small group of people. I mean, there’s one, there’s a mutation gene that’s called ADRB-1 that may allow a very small number of people to sleep as little as four and a half hours a night and then not feel tired. I don’t know how specifically they’ve been studied in terms of their amygdala activity the next day and their choices, whether they’re impulsive or not.

Chris Kresser:  Or what are the long-term health consequences of that?

David Perlmutter:  That’s true.

Chris Kresser:  Yeah.

David Perlmutter:  So, it’s very interesting. I think for all of the rest of us, we need to get a good night’s sleep. And guess what? Everybody kind of knows that or should know that.

Chris Kresser:  Yeah.

David Perlmutter:  I mean, with all the things being written these days, these wonderful books and podcasts talking about sleep, it’s really time that we ratchet that up probably to the top of the list. You can fast for weeks and weeks if not months; you can decide never to exercise again. But you know, sleep, miss out on sleep for a few days and you won’t survive.

Chris Kresser:  Game over. Yeah.

David Perlmutter:  Yep, that’s right. And it powerfully, powerfully disconnects us from the prefrontal cortex. It’s a powerful player as it relates to disconnection syndrome. But more importantly, it’s such an important callout for us in terms of building a program, to regain connection to the good decision-maker and that part of the brain that allows us to share opinions with other people. That’s, again, this cognitive empathy that we sure need to think about these days. Because our world is so divided. And it’s okay for us to have this diversity of opinion. But when we share our ideas with others, then we can move forward with a consensus and go to a better place. We can make progress. But when we’re all locking ourselves into our unique ideologies, how can we make progress that way?

The Ways That Mindfulness Improves Our Health

Chris Kresser:  Yeah. Let’s talk a little bit about something I think that’s connected to sleep and everything, of course, that we’ve discussed so far in the show, which is mindfulness. Because it’s always been my argument that if we can’t be aware of what we’re doing, then we have little hope of making any kind of successful change. Awareness is really a precondition to making change. And mindfulness is one of the best ways of cultivating awareness. So you write a little bit about mindfulness as being one of the strategies for reconnection in your book. Tell us what you learned in your research on how mindfulness impacts these mechanisms in the brain.

David Perlmutter:  Sure. Well, mindful practices are absolutely the superhighway to the prefrontal cortex. Whether it is a mindful breath program or a mantra-based program, which is in a sense, mindfulness, or it’s deep religious prayer, whatever it may be, it is, again, just a really powerful way to light up the prefrontal cortex. Let the amygdala calm down. And the health benefits associated with mindful practices are legion. And I think many of them, in fact, are derivatives of the role that these practices have on reconnection to the better decision-maker in your brain and also with respect to lowering cortisol and lowering inflammation, which happened to be powerful players in the etiology of so many of our chronic diseases.

So when we see less coronary artery disease, less diabetes, even some suggesting of [a] reduced risk of cancer related to mindful practices, I think it could be through these mechanisms. And what we’ve learned is that eight weeks of meditation is able to change the brain almost as dramatically as is seen in lifelong meditators, and that it may only take 12 minutes a day. So we’re really very specific about calling out to our readers that we don’t have to retire to an ashram to gain the benefits of a mindfulness practice. And it’s all about being in the moment. Not thinking about what happened yesterday, or what one plans to do tomorrow or this evening. It’s about just being in the moment. And incredibly and ironically, if you can practice being in the moment, being in the now, it paves the way for you to plan for the future even better.

To make better decisions so that the future outcome will be better. That’s one of the important things about reconnection to the prefrontal cortex, is that it lets you be with the experiencing and understanding what might be the long-term consequences, either positive or negative, be of the decisions that you’re making today. As opposed to just making these decisions, come what may, in terms of our lifestyle choices, in terms of how we invest our money, how we treat people, and not worry about the future consequences.

And frankly, Chris, this is the time in our discussion today to indicate that this reconnection to the prefrontal cortex is associated with more pro-environmental behavior. Research demonstrates that. We talk about it in the book. Meaning that the better connected we are to this part of the brain, the more likely we will be engaged in acting in a pro-environmental way. I mean, you talk about making, having some consideration for the future; let’s have some consideration for the future of the planet on which we live, in terms of the actions that we engage today.

Chris Kresser:  Absolutely, yeah. And it’s mindfulness. To me, it’s one of these meta capacities that enhances everything else. So we talked a lot about technology addiction and how to address that. Well, if you’re mindful, you’re able to catch yourself engaging in one of those patterns more quickly, and then make a conscious decision with the prefrontal cortex to not do that. You’re able to make better choices about food because you’re paying closer attention. You’re able to make better choices about sleep, about exercise.

As you’re saying, you become a better citizen of the world. Because likely, for a lot of reasons, but you’re paying more attention, you’re more engaged, you’re more connected to yourself, [and] you’re more connected to the world around you. So it’s one of these things that, I think everything that we’re talking about, good diet, exercise, it has kind of, like, a virtuous cycle effect where you start doing one thing, as you mentioned before, that can be different for different people, and then it makes it easier to do the other three or four things. And you start to do those things, and you start to build this upward spiral rather than the downward spiral that most of us have been stuck in.

David Perlmutter:  That’s right. And just to go back to the application of what we’re talking about to the, kind of the worldview. You’ve talked about the changes in human nutrition that we characterize as the modern Western diet, which I think we will all agree is a very pro-inflammatory diet. And that’s becoming the global diet. The global diet is becoming this very highly processed, highly containing sugar diet inducing inflammation. It’s the global [diet] that [is] responsible for these dramatic increases, upticks in coronary heart disease, diabetes, cancer, Alzheimer’s, all the inflammatory disorders.

When you consider the role of inflammation in changing brain wiring, keeping us out of the prefrontal cortex and locking us into impulsivity, into us versus them, and keeping us away from empathy, then think about the implications of the globalization of this Western pro-inflammatory diet. It’s changing the mindset, the worldview of people around the world, making them more tribal, more locked into this us versus them mentality, less able to make good decisions for the long term, and, frankly, less able to engage in this cognitive empathy whereby they can listen to other people. We’re watching it happen.

I mean, you just, it’s happening all around us. I’m not going to suggest that food is the only reason that it’s happening. But I think that it’s playing a role and to identify inflammation that we’ve all been talking about for at least the past 15 years, to identify inflammation now in the role of changing how we see the world puts a very important new spin on all the things that we do.

Why Social Connection and Empathy Are so Important

Chris Kresser:  You mentioned empathy. You’ve mentioned it a few times actually throughout the podcast. And one of my favorite studies actually mentioned in the chapter on social connection in my first book, The Paleo Cure, is a study that found that lack of social support is a greater predictor of early death than smoking 15 cigarettes a day. I’m not sure if you’ve seen this one. But tell us a little about why connection and empathy and bonds with people are so important to our brain.

David Perlmutter:  Well, man is a social animal. When I say man, we are a social animal, and we thrive when we are able to relate and interact with other people. And the problem with that is that this becomes a very powerful hack. This thing called social media, for example, is a powerful hack into our desire to be social. It worked for us very well when we lived in groups where we could have specialization of labor based upon people’s skill sets. And this is what, social media, why it’s so pervasive now, because it hacks into that.

Much as sugar and our desire for sweet was a powerful adaptive great thing that humans had. That when we ate sweet, we would make body fat and we would then survive through periods of caloric scarcity. So that was a hack, as well. So I think it’s, what you’re bringing up about loneliness, I think lonely, and the reason I went there is loneliness is fostered by social media despite its name. We know that it is a powerful influencer in terms of risk for disease. Forty-three percent of seniors feel lonely on a regular basis in this country. Forty-five percent, rather, of these seniors, have a 45 percent increased risk of what is called all-cause mortality. These are the lonely individuals. And, like you say, that statistic correlates, according to the research, with smoking about 15 cigarettes a day.

So, cigarettes are a tangible metric, right? You can count out the cigarettes. You know what it means. It’s something you can see. But loneliness is something that is kind of hidden in the background, and is not fostered by our online experience, I mean, social interaction. Loneliness is made worse by the time that we spend isolated in front of our screens and interacting with so-called social media. So it’s a pervasive issue. It’s worsening with time. And that said, as I mentioned earlier, I wanted to call this book something that had the term “reconnection” in it, because reconnection is really important, especially for older adults.

It’s been estimated that the, we say that loneliness and isolation has its play out in terms of these chronic degenerative conditions. And it’s been estimated that $6.7 billion of our annual federal budget is attributable to treating the problems that are associated with social isolation among older adults. So you make a very, very good point. And this is a big deal. And it’s all about reconnection. One of the powerful metrics of the Blue Zones is that people have both a sense of purpose in their lives and are socially integrated. Socially integrated across generations and socially integrated in their communities.

These days, that’s just not happening. And it, to some degree, I think, gets back to this lack of cognitive empathy whereby we’re just unwilling anymore to listen to people talk, because they might have a viewpoint that’s different from ours. I might be a Democrat, they might be Republican, or vice versa. And again, they may be all in on being vegan and I’m, let’s say all in on another dietary choice, and we’re just not going to have a connection. I recently interviewed on my pod, a very good lesson for me to learn, I interviewed somebody who was a proponent of veganism. And just saying, “Look, I’m not vegan. I certainly will eat some grass-fed beef and some free-range chicken and eggs for sure.” And this individual was respectful of that but offered up her viewpoint, and the pushback that I got was breathtaking.

Chris Kresser:  Yeah.

David Perlmutter:  And the main reason I did this interview was I thought that there, that she had some interesting things to say that we could debate and talk about. The main reason I did it was to challenge the audience with another viewpoint just to see if they could take a deep breath and listen. It was very sobering.

I interviewed a guy a couple of years ago, you may know him. His name is Dr. John Douillard, and he wrote a book called Eat Wheat. Now why would Grain Brain guy, me, interview Eat Wheat guy, John Douillard? Well, I did it for a couple of reasons. First of all, I’ve known John for 25 years and I really love him. He taught me Ayurvedic medicine so many years ago, A. B, I think he’s very thoughtful, and does his research. And C, I thought it would be fair to vet an alternative opinion to mine. I thought it would do me some good.

So we do our interview, and you know, you’re looking at the comments. And the comments had nothing to do with [the] content of our podcasts. Nothing to do with gluten and gliadin, gut permeability, whatever it was; the comments were that, “Wow, you guys had such divergent opinions, but yet you were respectful of each other.” And mission accomplished. That’s what I wanted to do. I mean, I wanted to get his word out there because he had an opinion, and I had my opinion. And I certainly did not agree with him in a lot of what he was saying, but it was respectful.

And it’s like reaching across the aisle. People need to listen to each other, and it’s just not happening anymore. And that’s a function of the prefrontal cortex. The modern Western diet is threatening our ability to communicate, to share ideas, and to keep people from feeling lonely.

Chris Kresser:  Well, David, I really enjoyed this conversation, and I love this book. I think it’s such an important contribution to the conversation around health for all the reasons we’ve discussed, and especially in the introduction. That we both have done this work long enough to know that it’s not just about hammering more information into people’s heads. That’s the definition of insanity, right?

David Perlmutter:  Right.

Chris Kresser:  It hasn’t worked. It’s not going to work ever. And so we need to find a different approach. And I particularly love the approach that you’re taking. I’m looking at it from a slightly different angle with the health coaching, but certainly we both zeroed in on the problem. And I think it takes a whole bunch of different ways of getting at it to make the change that we need to make. So thank you for writing this book. And can you tell everyone where they can find out more about it and pick up a copy?

David Perlmutter:  Sure. Well, the site for the book is, as you might guess, BrainwashBook.com. It’s available at all the bookstores, the airport, wherever you want to find books. I’m really excited that the book was just published, and is now being published in 16 countries, 16 languages around the world, which is a great thing. Including, I will say, including Russia, Korea, Turkey, France, and Germany. Places, the more people that we can get on board with the idea that we can make better decisions that will help each and every one of us, but help us at large, as well, I think the better.

So I’m so excited about that. And Chris, thank you for everything you do. And you know what it’s like, I know what it’s like, that people say what you’re doing is outside the box. And I’ve always said that well and good, but our mission is not to get in the box, but rather make the box bigger so that it’s more inclusive of some of our ideas. And so thank you for staying in the batter’s box and also giving me the opportunity to spend time with you today.

Chris Kresser:  Absolutely, David. And I enjoyed it, and I’m 100 percent with you on the need for, the dire need really, at this point, to be able to have, to respectfully disagree and have those conversations in [the] public forum. I think the health of our society and the world at large depends on that. So I couldn’t agree more that we need to do everything we can to get back to being able to do that as a people.

David Perlmutter:  So true.

Chris Kresser:  So thank you again. BrainwashBook.com. I highly recommend this book. Go out and pick up a copy. And I look forward to seeing you at Paleo f(x) in a few weeks.

David Perlmutter:  Yeah, looking forward to it, my friend.

Chris Kresser:  All right, take care.

David Perlmutter:  Okay, bye for now.