Grain Brain. The Surprising Truth About Wheat, Carbs and Sugar, Your Brain’s Silent Killers
by David Perlmutter, MD, with Kristin Loberg
Little, Brown & Company, 2013
David Perlmutter, MD, a board-certified neurologist and faculty member at the Institute of Functional Medicine, has written several books devoted to informing and empowering the reader to develop a more effective and healthy brain through education and lifestyle change, including: The Better Brain Book: The Best Tool for Improving Memory and Sharpness and Preventing Aging of the Brain (2005); Power Up Your Brain ( 2012); and Brainrecovery.Com: Powerful Therapy for Challenging Brain Disorders (2000). He also wrote a book for parents: Raise a Smarter Child by Kindergarten: Raise IQ by up to 30 points and turn on your child’s smart genes (2008).
But in this book, Grain Brain, coauthored with Kristin Loberg, a ghostwriter, Perlmutter focuses mainly on nutrition and food, but includes other lifestyle factors such as exercise and sleep to demonstrate how they affect the brain.
Perlmutter says that the “killer carbs promote inflammation; highest in the SAD (standard American diet) are refined wheat products, which represent about 20 percent of all ingested carbohydrates in the form of breads, pastas and sugars. Specifically, high fructose corn syrup (HFCS) is the number one source of calories in the SAD.”
Americans are encouraged to eat many fruits, which are a ready source of high glycemic carbs as well. Perlmutter recommends consumption of fruit in small amounts, as a dessert or snack. Fruits found their place in the ancestral diet in summer and early fall when people needed to bulk up on fat for the winter months ahead. People did not eat fruits year round until sugar became more common and fruits could be preserved with high amounts of sugars. Preservation through drying also concentrates the sugar content.
It is overindulgence in these carbs that forms those fat pads on our buttocks and thighs. Reminiscent of Atkins, the ideal diet, he says, is low carb and high fat, which reflects the common diet of our ancestors. He recommends that we eat good fats found in butter from grass-fed animals, coconut oil, and olive oil and avoid trans fats and fats found in industrial foods, such as soy, corn, and canola oils.
Perlmutter devotes much of the book to the subject of gluten and the damage that gluten does to the body and especially the brain. It’s contained in wheat, spelt, kamut, barley, triticale, and possibly oats if they are contaminated with wheat during processing. Modern foods contain up to forty times more gluten than traditional grains, and modern gluten can be addictive. When gluten gets into the blood stream, it binds to the brain’s morphine receptors, which creates a mildly euphoric condition and a reward effect.
Gluten is made up of two major proteins, gliadins and glutenins. But twelve minor components make up gliadin and a person can be sensitive to one or more of all these components. In gluten sensitivity (GS), which is an exaggerated immune response to gluten, inflammatory messengers form which migrate to other parts of the body, including the brain. This sensitivity seems to arise mainly from ingestion of gliadins in hybrid wheat and deaminated wheat. Deamination is a process used in modern bread making that makes wheat more water soluble. GS condition can lead to celiac disease, a serious life-long autoimmune condition with damage to the small intestine. GS, on the other hand, can occur without any gut involvement. But in many cases leaky gut results and other food sensitivities can occur. Leaky gut is a condition where the gut lining becomes weakened because of gluten and other factors, and larger food particles can pass through causing immune issues.
Gluten can also pass through the brain blood barrier. Research links GS to schizophrenia, epilepsy, depression, bipolar disorder, autism, ADHD (attention deficit hyperactivity disorder), migraines and other problems. Perlmutter describes several of his patients with ADHD who improved significantly through a gluten-free diet, and with the addition of probiotics, resveratrol, vitamin D and DHA (docosahexaenoic acid). However he misses the boat when not including vitamins A and K2 as part of the package when recommending vitamin D because all three are needed together. Fermented cod liver oil is a natural source of all three vitamins―A, D and K2.
Research shows that babies born through cesarean section have a higher risk of developing ADHD because they miss out on the probiotic inoculation that babies normally receive when passing through the birth canal. Breastfeeding is also important in that it may dampen later immune response to gluten and the development of food sensitivities.
In the past, laboratory testing existed only to diagnose celiac disease, and indicators for gluten antibodies were not positive until a certain degree of damage was done. Thus celiac disease is referred to as a “silent disease.” Today testing has been developed to identify GS in its early stages through Cyrex Laboratories. Because research shows that mothers who were gluten-sensitive are 50 percent more likely to give birth to a child who later develops schizophrenia, it is important to identify and control gluten sensitivity early on with a gluten-free diet, especially before pregnancy and childbirth.
Perlmutter makes some really interesting points about specific foods and beverages that “cross-react” with gluten. But he fails to define the term and give it a bit of explanation. Cross reactivity means that the immune system, already unhappy about encountering gluten, treats these other substances as if they were also a member of the gluten family. Even though instant coffee, chocolate and grains may be gluten-free, the immune system reacts to them as if they were a piece of pizza or bowl of pasta. PEG, polyethylene glycol, found in many personal care products, baby teething gel, and food items, is also gluten cross-reactive. PEG is also contained in the gallon of bowel prep (Golytely, Colyte, Nulytely, etc.) that patients awaiting a colonscopy are asked to drink prior to the procedure. Because of this factor, inflammation due to the bowel prep may shows up on the test results.
Perlmutter says that “50 percent of the people who are gluten intolerant are also sensitive to dairy.” But he does not spend any time on the subject of pasteurized dairy versus raw dairy products. Raw dairy can often be tolerated by some people who are intolerant to industrial dairy and provides a good source of probiotics and other immune factors. His recommended diet allows a small amount of cream and milk. The Cyrex Labs, array 4, can establish exactly the components of milk that cause a reaction including whey, butyrophilen, casomorphin, and alpha and beta casein. In addition, the test provides laboratory testing for other gluten-associated cross reactive foods and food sensitivities such as milk chocolate, soy, egg, corn, potato, rice, tapioca, sesame, yeast, oats and other gluten-free grains (cyrexlabs. com).
Perlmutter emphasizes that all carbs should be restricted, specifically highly refined carbs as well as high glycemic foods such as corn, potatoes, rice and others, in order to keep blood sugar under control at all times to prevent brain inflammation. Recent studies show that elevated blood glucose readings even at the high end of the normal range are a risk factor for brain shrinkage, which is implicated in the development of Alzheimer’s disease (AD) and dementia. AD has been called “diabetes type 3,” a condition not caused by diabetes but by a similar mechanism. Coconut oil has been successfully used with AD patients to reverse certain levels of cognitive decline, which scientists think are caused by insulin resistance and the inability of the brain to use glucose for fuel. Dr. Mary Newport presents her positive experiences using coconut oil with her husband in her book, Alzheimer’s Disease: What If There Was a Cure? Coconut oil, which contains medium-chain fatty acids has also been used to treat patients with epilepsy, multiple sclerosis, Parkinson’s disease and other neurodegenerative diseases.
High blood sugar as a result of a high-carb diet causes AGEs, advanced glycation end products, which create free radicals and damage DNA. In this process, sugars bind with protein and cause the fibers to become distorted. A typical example of the effects of AGEs is premature aging of the skin with wrinkling and sagging, caused by sun exposure, smoking and other factors. HFCS intake increases the rate of glycation by a factor of ten.
AGEs are associated with cognitive decline, diabetes, kidney disease, stroke, heart disease and the aging process itself. Oxidative stress furthers cognitive decline. Doctors can test the levels of AGEs in the blood by the hemoglobin A1C test, which is used to test blood sugar. When blood sugar levels are elevated, increased glycation takes place. Studies show that those with high levels of A1C experience brain loss (atrophy) at rates almost double compared to those with lower levels. High levels of A1C are also associated with development of depression.
High levels of triglycerides cause leptin resistance. Leptin is the hormone made in the adipose tissues which signals our brain that we are full and to stop eating. With too many carbs in the diet, especially those from fructose, we become leptin-resistant and the signals don’t reach the brain; the person ends up constantly thinking about food. High carbohydrate intakes also affect insulin levels and can cause insulin resistance, an inability of the cells to take up insulin, which leads to diabetes and many other health problems. On the flip side, grehlin is a hormone that signals the brain when we are hungry. But if hormone signals become dysregulated, the stomach continues to think it is hungry and the brain continues to give the “eat” command.
Perlmutter also highlights the reasons why the brain thrives on cholesterol and fat, and their role in good mental health. He gives an in-depth review of specific diseases, conditions and actions which are linked to low-cholesterol levels and lowfat diets.
Perlmutter’s thirty-day plan to bring back an effective brain starts with a one-day fast, followed by week one, which focuses on food and eliminating the refined carbs from the diet. Carbs are limited to 30-40 grams per day; then after four weeks, carb intake increases to 60 grams per day. Coffee and wine are permitted in limited amounts.
Week two of the plan recommends establishing a fitness routine with a regular exercise program. Exercise increases blood circulation in the brain and several sessions a week prevent brain shrinkage. Even walking for twenty minutes daily is helpful in this regard. Perlmutter advises eventually attaining a daily exercise session of thirty minutes or more combining aerobics, strength training and stretching, including yoga and Pilates.
In week three, the patient concentrates on getting restful sleep. For men sleep is key in keeping grehlin levels happy and healthy, although this doesn’t prove true for women. But sleep is not only important for regulating hunger signals. Research shows that those who have disrupted sleep patterns are twice as likely to develop dementia in later years. He also recommends a small high-protein snack at bedtime for those who have trouble sleeping, along with other general common sense guidelines such as setting a regular bedtime, and keeping electronics out of the bedroom. Week four of his program focuses on reinforcing new lifestyle patterns and brain-healthy habits.
The book contains a nice recipe section which reminds me of a healthier Atkins program. But like Atkins, he neglects to address the importance and role of healthy carbohydrates in the diet, especially those prepared in ways which enhance their nutrient absorption by soaking and fermenting. He also ignores the fact that bread has been the basis of civilization throughout the ages and old forms of wheat such as spelt and kamut do not contain the high levels of gluten that modern hybrids do. Sourdough breads, made properly with longer periods of fermentation, are shown to be acceptable to those with gluten sensitivities in several studies. Restricting healthy carbs and fruits may be impossible and impractical for many people, but avoiding highly refined sugars and carbohydrates contributes to a healthier brain. Raw milk products provide excellent protein, vitamins, minerals and fats, along with immune factors that are bioactive and easily absorbed. Unfortunately Perlmutter, who often recommends DHA to his patients, considers DHA produced from algae a source equal in value to cod liver oil. This Martek product causes serious digestive upsets and diarrhea in babies and some adults. Cod liver oil represents a natural source of DHA and other nutrients.
Grain Brain is a good read packed with a great deal of knowledge related to reviews of the latest research in current nutrient brain-related issues, as well as good detail on gluten sensitivity, celiac disease, testing, cholesterol and fats, and hormones related to inflammation and obesity. The book continues to enjoy phenomenal success on a number of New York Times best seller lists. I give this book a qualified thumbs up.
This article appeared in Wise Traditions in Food, Farming and the Healing Arts, the quarterly journal of the Weston A. Price Foundation, Winter 2013.