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AUTOIMMUNE
DAVID PERLMUTTER, MD
TABLE OF CONTENTS
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FROM THE DESK OF
DR. PERLMUTTER
A Note Before Reading
Normally we think of our immune system as protecting our
body from everyday concerns like the flu, or serious infections
and diseases. But did you know that the health of our immune
system can also impact the health of our brain?
It’s a fact.
In good health,
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How Gut Bacteria
Protect The Brain
Do you know about the blood-brain barrier? can be done to reestablish the barrier, and
The blood-brain barrier (BBB) acts as a protect the brain.
gatekeeper, protecting the brain from
In a stunning research in the journal
various toxic elements, while allowing the
Science Translational Medicine, researchers
entrance of various life-sustaining nutrients
at the Karolinska Institute in Stockholm
like water, amino acids, and gases, that are
studied the blood brain barrier in mice
essential for the function of the brain. It
that were “germ-free.” That means that
is formed by cells that line the capillaries
the mice used in this experiment did not
and are connected by what are called
have bacteria living within their intestines.
“tight junctions,” quite similar to the tight
Using highly sophisticated brain-scanning
junctions in the cells that line the gut.
technology, the researchers demonstrated
Any number of brain disorders is associated that the blood brain barrier in these mice
with breakdown of the BBB, including was significantly compromised, basically
infections, and even cancer. As such, a situation of what we may call a “leaky
scientists have aggressively studied the brain,” and this leakiness of the barrier
BBB to determine specifically what leads to persisted into adulthood.
increased permeability and, perhaps most
Even more compelling
importantly, what can be done to reduce
was their finding that
permeability. In other words, what
when these mice
received a fecal
transfer, meaning that
their intestines were
inoculated with the fecal
material including bacteria
from a healthy mouse, the
permeability of the blood brain barrier
was markedly improved.
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disorders. Professor Sven Pettersson, the
principal investigator involved in the study
was quoted in Science Daily as stating:
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Inflammation Today Means
Brain Shrinkage Tomorrow
As I have emphasized over the past decade, diversity of gut bacteria. So issues that
the fundamental mechanism that underlies threaten gut bacterial diversity, like stress,
neurodegenerative conditions, including artificial sweeteners, and acid-blocking
Alzheimer’s disease, Parkinson’s disease, medications, pave the way for increasing
multiple sclerosis, and other issues (think inflammation. This threatens your long-
diabetes, coronary artery disease, and even term healthy by raising your risk of virtually
cancer), is the process of all those chronic degenerative
inflammation. We’ve conditions you don’t want to
got to do everything get.
we can to bring
It doesn’t make
inflammation
sense to wait until
under control.
you’re having an
Dietary choices
issue with one of
like limiting
these diseases to
sugar and
begin a program
carbohydrates,
designed
avoiding gluten,
to reduce
eliminating vegetable
inflammation.
oils (corn oil, sunflower
This notion
oil), increasing intake
was powerfully
of healthful fats (olive oil,
avocado oil, nuts and seeds), supported in
a recent study
and favoring fiber-rich foods, are all
published in the journal
fundamental building blocks of a lifestyle
Neurology. In this report,
that helps to reduce the risk for excess
researchers from multiple
inflammation.
institutions endeavored to
We know that there is a higher level of determine if inflammation in midlife would
the chemicals that mediate inflammation have any consequences for the brain later
in the blood of individuals with higher in life.
blood sugar, caused by many of the poor
They studied a group of 1,633 participants
choices outlined above. Again, higher
(with an average age of 53) by looking
blood sugar correlates with higher levels of
at their blood levels for various markers
inflammation.
of inflammation. These five inflammatory
Degree of inflammation is, to a significant markers were compiled into what was
amount, determined by the health and called the “inflammatory composite score.”
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After 24 years, the participants underwent in neurodegeneration
a special brain scan to measure the size
and cognitive aging.” The
of various areas of the brain. The study
revealed a marked correlation between important take-home message
midlife elevation of inflammatory markers here is in line with John
and reduction in size of key brain areas, Kennedy’s statement: ‘The
including the hippocampus, the brain’s
memory center. The relationship between
time to fix the roof is when the
these inflammatory markers and shrinkage sun is shining.’
of the brain later in life was modified by age
and race in that younger participants, as That means that we should be doing
well as Caucasian participants, with higher everything we can to reduce inflammation
levels of inflammation markers in midlife today, long before some chronic
were more likely to show reduced brain degenerative condition manifests. In this
volumes during the follow-up. study there was a clear correlation between
elevation of markers of inflammation
The authors concluded: and risk for shrinkage of the brain, and
who wants that? This is what preventive
“Our prospective findings medicine is all about. It’s about doing the
provide evidence for what right things today to pave the way for a
may be an early contributory healthier tomorrow.
role of systemic inflammation
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Gut Inflammation
Affects the Brain
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handed when looking only at the brain in a new concept of brain health and disease,
when trying to explain mechanistically what and these researchers are to be praised for
goes on in things like Alzheimer’s disease bringing us this valuable information.
and Parkinson’s disease.
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Rebalance the Gut,
Rebalance the Immune System
It is very exciting to see the incredible effectiveness to the fact that they help with
increase in scientific research being reducing gut permeability, possibly through
released that relates gut issues to various changes brought about by the gut bacteria.
health problems elsewhere in the body.
I can assure you that only a few years
The research that explores this relationship
ago, these ideas would not have been
in terms of autoimmune conditions is
anything that mainstream science would
particularly interesting, not just because it
have considered. We have certainly
links gut-related problems to changes in
come a very long way in appreciating the
immune balance, but in terms of how this
important role of the gut, and specifically
new understanding might open the door
the balance of gut bacteria and regulation
for new treatments for these challenging
of gut permeability, in terms of its role in
conditions.
autoimmunity, and keeping inflammation in
In a recent issue of the journal a check.
Neurotherapeutics, researchers embarked
I have no doubt, moving forward, that
on their study with the accepted premise
we will soon see the development of
that intestinal permeability (leakiness of
pharmaceutical interventions for MS, as
the gut) has been widely evaluated in
well as other autoimmune conditions,
terms of its relationship to various forms
that specifically target rehabilitation of
of inflammatory bowel disease, as well as
the gut bacteria to bring about reduction
celiac disease, and that imbalances in the
in gut permeability and balancing of the
gut bacteria are involved in this relationship.
immune system. This will be a manifestation
They also described the well-known of holistic medicine finally entering the
relationship between an autoimmune, mainstream, whereby it becomes commonly
inflammatory condition of the bowel, accepted that events in one part of the
Crohn’s disease, and multiple sclerosis body can clearly affect the health of
(MS). Both of these conditions are now another area.
characterized by increased permeability, or
Truthfully, this understanding of the
leakiness, of the gut.
interrelationships between seemingly
With this understanding as a background, disparate parts of the body has been how
the researchers moved forward and medicine has been practiced for centuries.
postulated that perhaps some of the What a blessing that we are finally
effectiveness of various first-line oral embracing this understanding once again.
medications that have proven useful
in MS may actually owe some of their
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The Microbiome –
Implications for Global Health
What science has revealed over the explain how these important factors
past decade about the role our resident influence health as seen through the lens of
microbes play in keeping us healthy has the microbiome. So, in a sense, this is a two-
truly been remarkable. It’s now clear that step process. Lifestyle choices affect the
the more than 100 trillion microbes living health of our resident microbes, and they in
on and within us are, moment to moment, turn influence our health.
playing a fundamental role in virtually
Hippocrates is credited with stating, “All
every system within the human body.
disease begins in the gut.” And while this
Who would have conceived that research
dictum certainly doesn’t account for cases
would have revealed, for example, that
like trauma, as it relates to so many of our
the bacteria living within the colon are
modern diseases, it’s well on track. Changes
helping shape our mood, regulating our
in the gut bacteria are, for example,
appetite, manufacturing health-sustaining
strongly related to chronic degenerative
vitamins, controlling our immune system
diseases (think Alzheimer’s disease,
and inflammation, and even influencing the
osteoporosis, type 2 diabetes, and coronary
expression of our DNA?
artery disease), which, as a classification,
This expanding science is compelling, have been determined by the World Health
humbling, and, at the same time, Organization to represent the number one
empowering, as we now are beginning to cause of death on the planet, surpassing
make real inroads into understanding how infectious diseases, trauma, and even war.
changes in the microbiome (the collection
This means that the state of health of the
of the microbes, their genetic material, and
human microbiome is directly involved in
the metabolic products they create) affect
the globe’s leading cause of death.
health, disease resistance and longevity.
In terms of nurturing the gut bacteria to
It’s certainly clear that so many of our
prevent these ailments, without a doubt
lifestyle choices, including diet, sleep,
the most important consideration is food.
exercise, nutritional supplements, managing
Our food choices have an overriding impact
stress, socializing, etc., influence our state
on the health, diversity, and productivity
of health. And over the years, studies have
of our resident microbes. Unquestionably,
identified the direct mechanisms whereby
the most important task for each of us
these factors influenced health, for better or
is to supply our bacteria with prebiotic
worse.
fiber, the unique type of dietary fiber that
These days however, we are seeing a is not digested by us humans, but allows
proliferation of research that seeks to our microbes to thrive. Foods rich in this
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special fiber include dandelion greens, gain, increased central obesity, higher
garlic, onions, leeks, chicory root, Jerusalem fasting blood sugar, as well as elevation of
artichoke, asparagus, and many other HbA1C, a marker of average blood sugar.
fruits and vegetables. Health food stores Even more intriguing was the researchers’
are helpful for those who may not demonstration that transferring
be eating enough prebiotic-rich human fecal microbial material
foods by supplying effective to normal laboratory animals
prebiotic supplements almost immediately affected
derived from natural their blood sugars, as is
sources like acacia gum seen in diabetics. The
and baobab fruit. authors concluded:
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American researchers studied close to intolerance in mice by
4,000 adult subjects for 9 years and
altering gut microbiota and
showed a direct dose response relationship
between the consumption of diet drinks are associated with dysbiosis
and obesity. This means that the more diet (negative changes in the
drinks were consumed, the more weight gut bacteria) and glucose
was gained. [iii]
intolerance in humans.[iv]
It’s important to understand the vast
implications of these studies. These This is important since diabetes has been
alterations in the microbiome that enhance associated with as much as a 4-fold
metabolic changes affecting things like increase in risk for the development of
glucose balance and body fat are of great Alzheimer’s disease.
concern as just these two factors alone
have been associated with increased risk for Further, to date, efforts by pharmaceutical
a large list of health issues including cancer, companies to develop any meaningful
heart disease, osteoporosis, depression, treatment for Alzheimer’s disease have
and even Alzheimer’s disease (see further come up empty-handed. This is to say that
down). So the health implications related there is currently no meaningfully effective
to damaging the microbiome with artificial treatment for Alzheimer’s, now affecting
sweeteners go well beyond diabetes. some 40 million people around the globe.
As Dr. Michael Schnaider Beeri recently
It’s now clear that dementia, specifically stated in the journal Neurology:
Alzheimer’s dementia. may also share in this
relationship. Boston researchers, publishing Despite great scientific
in the journal Stroke, followed 1,484 elderly
individuals for 10 years. Their evaluations
efforts to find treatments for
included not only frequent testing of their Alzheimer’s disease, only 5
brain function, but also keeping track of medications are marketed,
their diets as part of the Framingham Heart with limited beneficial effects,
Study. The results of this enduring project
revealed an increased risk for Alzheimer’s on a limited number of
disease, nearly 3-fold, in chronic consumers patients, without modification
of artificially-sweetened beverages. of the disease course.[v]
Interestingly, stroke risk was increased
almost as much. Moreover, there was no This fact should really encourage us to
increased risk of stroke or Alzheimer’s take a serious look at factors known to
disease in those who consumed sugar- be associated with increased risk for this
sweetened beverages. In their conclusion, disease. And it seems pretty clear that
the authors explained their findings by artificial sweeteners, likely by virtue of their
stating: damaging effects on the microbiome, show
strong association.
Artificial sweeteners have
While it’s instructive to explore how dietary
been shown to cause glucose
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choices like the use of artificial sweeteners
may connect to risk for serious health issues
through their effects on the microbiome,
the upside of these findings is that they will
undoubtedly spur research that investigates
how the microbiome, once damaged, may
be restored. This represents a very new
playing field for medical researchers that
is replete with huge potential, especially
as it relates to these compelling chronic
degenerative conditions.
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The Real Reason
GMO Matters
When I lecture to the general public, as well The most commonly used herbicide, both in
as to healthcare professionals, I often ask America and globally, is glyphosate. That is
the question, “How do you feel about GMO the chemical name of the active ingredient
foods?” The results are almost universally in the more familiar herbicide, Roundup®.
negative. Generally, the audiences come to In fact, these genetically modified seeds
the conclusion that, for whatever reason, are typically called “Roundup®-resistant”
GMO foods are “bad.” seeds, playing upon this much more familiar
name.
My next question probes a bit further: why?
It’s at that point that very few hands are The connection I am making, and that I
raised. People generally have the sense that want you to make, is that when you see
there’s something threatening and sinister agricultural products that do not carry the
about GMO foods, but, for the most part, “non-GMO” designation, the reason they are
they don’t know why. likely problematic is because of the residual
herbicide glyphosate.
So let’s take a step back. I’d like to
explore why it is that we should indeed do Dr. Stephanie Seneff, a highly regarded
everything possible to avoid GMO foods. M.I.T. researcher, has published
extensively regarding the dangers of
First, let’s take a look at the scope of the glyphosate. She has made it clear
issue. At least 90% of the canola, cotton, that this dangerous herbicide
corn, soy, and sugar beets sold in United threatens the human
States come from seeds that have been microbiome. More
genetically engineered. The main reason recently she has called
that these crops are genetically engineered our attention to
is to make them resistant to herbicides. how readily
That means farmers can spray these crops
to kill weeds, and because of genetic
engineering, the crops themselves are
not affected by the poison. Nonetheless,
residues of the poison remain in the food,
which is then consumed across our country.
My point is that most of the agricultural
products consumed by Americans come
from genetically engineered seeds and have
residues of herbicides.
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glyphosate leads to the formation of cancer Dr. Seneff, a past guest on The Empowering
cells. Beyond her work, it’s very important Neurologist, has found that glyphosate
to remember that the World Health hass a number of dangerous effects on
Organization recently labeled glyphosate as biological systems that may strongly relate
being “probably carcinogenic” in humans. to its ability to form cancerous tumors.
These include direct damage to DNA,
interruption of amino acid balance, removal
of trace minerals, as well as impairment of
detoxification. As she recently stated:
Epidemiological evidence
supports strong temporal
correlations between
glyphosate usage on crops
and a multitude of cancers
that are reaching epidemic
proportions, including breast
cancer, pancreatic cancer,
kidney cancer, thyroid cancer,
liver cancer, bladder cancer
and myeloid leukaemia.
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THE EMPOWERING NEUROLOGIST
David Perlmutter, MD
& Dr. Amy Myers
DP The thyroid is, as you call it, the “master gland.” It controls the
metabolism, as you say, and every cell has thyroid hormone receptors
on it. It seems to me that we’re hearing an awful lot about thyroid
problems these days. How prevalent is thyroid disorder in American
society?
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to look at is a free T3. Our free
hormones are the ones that matter.
When you’re looking at a total,
they’re bound to other proteins and
we can’t use them. But when it’s a
free hormone, it’s able to go into
receptors and into other cells. It’s
that free T3 that keeps us warm,
gives us energy, keeps us from
having brain fog, and regulates
everything else in our body.
Click here
to watch
full interview
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THE EMPOWERING NEUROLOGIST
David Perlmutter, MD
& Dr. Susan Blum
DP When the immune system becomes overactive, we can develop
what’s called bottle immunity, where the immune system actually
reacts against our own body tissue, like the thyroid gland for example.
It’s called Hashimoto’s thyroiditis. Can you tell us what Hashimoto’s is
all about?
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SB Starting from the top, the
simplest preventative measures are
lifestyle. Food, right? What does the
gut need? The gut needs a lot of
vegetables and fiber, a lot of plant-
based material, to feed it and keep
it happy and healthy. In the 1950s,
when we started processing food
and taking a lot of the nutrients out
of it, we stopped feeding our good
bacteria, and instead, we started
eating a lot of processed foods,
which are all filled with sugar and
simple carbohydrates. It’s very
interesting, they’ve done studies
that show if you completely change
what you eat, your bacteria can
change within three days. Food has
a big effect on the flora. That’s the
simplest place to start.
Click here
to watch
full interview
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About The Grain Brain
Whole Life Plan
It’s time to turn advice into action. The Grain Brain Whole Life Plan is your practical,
comprehensive empowerment guide for achieving optimal health, preserving brain
vitality, losing weight and reducing your risk for chronic diseases. Dr. Perlmutter
leverages the leading edge of published science on nutrition and wellness, taking
the lessons of Grain Brain and Brain Maker to create a powerfully actionable plan for
optimizing health and achieving peak mental performance. The Grain Brain Whole
Life Plan – live happily ever after.
Facebook.com/DavidPerlmutterMD Instagram.com/DavidPerlmutter
Twitter.com/DavidPerlmutter https://DrPerlmutter.com
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