Balanced Bites Podcast | Diane Sanfilippo & Liz Wolfe

Podcast Episode #204: Mastering your Microbiome with Dr. David Perlmutter, M.D.

Diane Sanfilippo Featured, Gut Health & Healing, Health & Wellness, Podcast Episodes 1 Comment

Topics:Balanced Bites Podcast | Diane Sanfilippo & Liz Wolfe
1. Remedies versus prevention [4:01] 2. Grain Brain and Brain Maker, Dr. Perlmutter’s books [10:09] 3. Dr. Perlmutter’s suggestions for additions to diet [16:09] 4. Antibiotics and SIBO [26:32] 5. Reinoculation of the gut microbiome [32:57] 6. Supplementing with tryptophan and GABA [41:45] 7. Recommended probiotic supplementation [47:45] 8. Research on Parkinson’s disease [57:40] [smart_track_player url=”″ title=”#204:Mastering your Microbiome with Dr. David Perlmutter, M.D. ” artist=”Diane Sanfilippo & Liz Wolfe ” color=”00AEEF” social=”true” social_twitter=”true” social_facebook=”true” social_gplus=”true” ]


5 Core Probiotic Species

Five Core Species-

Lactobacillis plantaram,
Lactobacillis acidophilus,
Lactobacillis brevis,
Bifidobacterium lactis
Bifidobacterium longum.

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Balance Bites: Episode #204: Mastering your Microbiome with Dr. David Perlmutter, M.D.

You’re listening to the Balanced Bites podcast episode 204.

Welcome to the Balanced Bites podcast with Diane Sanfilippo and Liz Wolfe. Diane is a certified nutrition consultant, and the New York Times bestselling author of Practical Paleo, The 21-Day Sugar Detox, and co-author of Mediterranean Paleo Cooking. Liz is a nutritional therapy practitioner, and the best-selling author of Eat the Yolks and The Purely Primal Skincare Guide. Together, Diane and Liz answer your questions, interview leading health and wellness experts, and share their take on modern paleo living with their friendly and balanced approach. Remember our disclaimer: The materials and content within this podcast are intended as general information only, and are not to be considered a substitute for professional medical advice, diagnosis, or treatment.

Diane Sanfilippo: Alright, so today I have a very special guest; Dr. David Perlmutter. He’s a board certified neurologist, and a fellow of the American College of Nutrition. He’s the recipient of the Linus Pauling award, and the author of the number one New York Times’ best seller, Grain Brain, as well as the Grain Brain Cookbook, the Better Brain Book, and Raise a Smarter Child by Kindergarten. He lives and practices in Naples, Florida. His newest book, Brain Maker, and is also a New York Times’ best seller, and explores the relationship between the gut bacteria and the health of the brain. Welcome, doctor!

Dr. David Perlmutter: Well, I’m delighted to be here, thank you Diane!

Diane Sanfilippo: It’s so great to have you. I’ve seen you all over television interviews, and I’ve heard you interviewed on a couple of other podcasts that I listen to, so I’m very pleased to have you for our listeners today.

Dr. David Perlmutter: Well I’m very pleased to be here, and kindred spirit you know. Your books are fantastic; we have them in the office. Practical Paleo really gets a lot of attention. And beyond just telling people how to eat, this is just so focused on what current science is telling us about how simple it is to be healthy by watching things like carbohydrates and bringing fat back to the table. So it’s really revolutionary; we’ve come full circle getting back to the diet that humans have eaten for close to 2 million years.

Diane Sanfilippo: It’s awesome. Thank you so much, that’s very kind of you. I’m really happy to hear it. I know there are so many doctors like yourself who are aware of how this whole thing should be going for folks in terms of nutrition and I’m really happy that my books and resources are able to kind of bridge that gap between what you know and how clinically proven it is, and also creating something that is very easy for people to kind of grab it and go home and use it. I’m really glad to hear that, so thank you.

Dr. David Perlmutter: Well, you know, it’s interesting that you say so many doctors; unfortunately the truth of the matter is, and I’m sure you’re well aware.

Diane Sanfilippo: {laughs}

Dr. David Perlmutter: That the overwhelming number of doctors, with all due respect, could care less about how we nurture our body in terms of nutrition. Doctors are not in health care; they are in illness care. I think the big issue here is to turn that around. We talk about the governmental attempts to deliver health care to everybody through this or that program; call it whatever you want, but the point is we’re not delivering health care, we’re delivering a system that focuses on what to do once you’re sick.

Diane Sanfilippo: Right.

Dr. David Perlmutter: Once you’ve had that first heart attack or stroke, or you’re starting to lose your cognitive abilities or you can’t interact with people socially because there has been some change, for example, in your gut bacteria. No one is really paying; I say no one. Not very many people in the world of medicine are really focused on that. As I say, it is the world of medicine; it’s the world of remedies as opposed to focusing on prevention. And really, that’s a very new mentality in terms of what doctors have done traditionally over the previous years.

1. Remedies versus prevention [4:01]

Diane Sanfilippo: What do you think; I think this is a really interesting conversation before we get into some of the questions and talking about what you're proposing in your book. But what do you think is kind of the reason why that perpetuates. I’ve looked at this from a few different perspectives over the years, and one of the things that seems to crop up is that; this is maybe getting a little deep into psychology at this point, but I feel like there are a lot of folks out there who want to just sit back and kind of observe what is happening in their own life, or they have a little bit of a victim mentality, and going to the doctor and being given kind of an order of, here’s what you need to do to help yourself is so not what people are programmed for. They’re so programmed for, this isn’t your fault, here’s a pill that will fix it.

Dr. David Perlmutter: You’re exactly right. The whole economics of health care provision is focused upon playing catch-up ball. In other words, remedies for problems. And it begins with doctors in training in medical school where there is very little emphasis on anything preventative, and recognize that only about a quarter of medical schools in America require nutrition. {laughs}

Diane Sanfilippo: {laughs}

Dr. David Perlmutter: Nutrition runs the whole show.

Diane Sanfilippo: Yeah.

Dr. David Perlmutter: We’re so focused on what we feed our pets, and how we nurture our yards, understanding that nutrition is so fundamentally important, but for us it’s all about illness and it starts in medical school where kids. I say kids because my son just graduated.

Diane Sanfilippo: {laughing} Right.

Dr. David Perlmutter: Are focused on mechanisms of disease and then pharmacology. What happens, what goes wrong, and then what can we do very quickly through the coin of medical commerce, which is the prescription pad, attempt to fix the downstream effects of things that have gone wrong. In other words, really focusing on the smoke while ignoring the fire. That is absolutely perpetuated once you become a physician and medical journals are just peppered with advertisements for drugs to fix this or that problem; here’s how you fix high blood pressure, here’s how you lower cholesterol; you simply write a prescription for this or that pill.

So then, we have now direct to consumer advertising, which is a relatively recent phenomenon but is hugely effective in driving consumers to then ask their doctor for a purple pill or a green pill or whatever color pill they saw on the nightly news last night that will help their acid reflux, or their joint pain.

Diane Sanfilippo: {Sigh} Oh, yep.

Dr. David Perlmutter: Or their diabetes, when these are issues that have fundamental relationships to diet in the first place. So there’s no real way that preventing an illness can be monetized, because there’s no problem to fix. So our whole system is based upon establishing these problems and then creating remedies, because that’s what makes the wheels go round in terms of huge profitability for pharmaceutical companies primarily and much less so for the treating doctors. And the doctors don’t realize this. They are absolutely the pawns in the middle of this whole play that ends up supporting just the use of these pharmaceuticals.

So, there are a small cadre of health care providers who do focus on the role of nutrition and other lifestyle issues to keep people healthy in the first place. And these are not necessarily MDs.

Diane Sanfilippo: Yeah.

Dr. David Perlmutter: I mean, you in writing the books that you’ve written, have done a huge service to the population at large by saying, hey. Here’s how you can eat in a way that will more cater to your physiology, keep you healthy in the first place, and redirect some of these very important health parameters, like body weight and blood sugar for example that will pave the way for remaining healthy. But again, it’s a very difficult challenge. We have to stay the course, because the reason that people are suddenly reading books like you are writing and I’m writing and so many others in the field is because they are getting results.

When you read your online feed about what people are saying; you know, I read Practical Paleo and suddenly this happened, and that happened, all positive, it’s because people are finally getting results that can’t be solved by simply sliding into this mentality of, live your life come what may, and then take a magic pill.

Diane Sanfilippo: I think that’s all completely spot on. It’s just, yeah, it’s amazing to see how much we can affect. It’s one of the reasons I actually love podcasts. For years, I’ve been able to tune into podcasts. Jimmy Moore has had his for years and years and years. He’s probably the first person who interviewed me, before I ever had my own show, and I’ve heard so many doctors who are, like yourself, way more in tune with this new sort of natural medicine or preventative frontier holds, and being able to access this content in a way that’s not only free, but accessible to anyone in the public.

I think this is awesome, and I’m really glad that you take the time to do interviews like this one. You know, we are not ABC news; this is a podcast that has a great reach, but our audience, it’s slightly preaching to the choir, of course. Our folks are already listening, and they are interested, obviously, in preventative health. But we do have a ton of questions from people who, they find this information where they’ve already gone through working with doctors, and obviously like you're saying, it doesn’t work. They hit a point where they’re like, ok these medications aren’t working anymore, or I don’t want to do that anymore because I’m finding this works better, and then they have deeper questions from there.

2. Grain Brain and Brain Maker, Dr. Perlmutter’s books [10:09]

Diane Sanfilippo: So I want to get into some questions for people in a minute here, but I think it would be great if you give folks a little bit of background about not only the newest book, but I would say your previous, if you want to talk about your previous library of books, I know you have quite a number, but maybe even just touching back a little bit on Grain Brain, and then Brain Maker, since those are the two newer ones that a lot of our listeners and readers are very, very familiar with. Just curious, you know, what inspired that.

Dr. David Perlmutter: Grain Brain was a book that really, as really all my books do, stem from my clinical practice. What I was observing and dealing with patients in a neurology clinical practice day to day. Clearly, over the past couple of decades, I’ve been seeing patients with far more issues than just neurological. And when you realize the importance of diet and the effect of diet on human health, you would understand why I began seeing a lot of patients with gastrointestinal issues, joint pain, skin issues, diabetes, cancer, etc., because these things are all very much related to the effects of diet in terms of changing our immune function, our levels of inflammation, etc.

Grain Brain focused on the idea that higher carbohydrates are bad for the body and bad for the brain because they induce inflammation, and also focused on this very important role of a protein called gliadin found in gluten, wheat, barley, and rye, also in terms of inducing inflammation and the relationship of that chemical to some of our most dreaded conditions.

Then, we began to explore the human microbiome. This collection of more than 100 trillion organisms living within each and every one of us, which is now considered to be an organ within the human body that we never understood, never even recognized. A 3-pound organ weighing about the same as the human brain, that is a collection of bacteria, viruses, fungi, etc., that live within us that are regulating every important part of our physiology, being run by things like bacteria. Who knew?

I mean, we thought that detoxification was the role of the liver. Well, it is to some degree, but detoxification is absolutely a fundamental role of gut bacteria. We thought that brain chemistry, neurotransmitters like, for example, serotonin and dopamine were something that was indigenous to the brain, made in the brain and affected our mood. Now we know that 90%, for example, of serotonin, the happy chemical, is made in the gut.

We recognize that the gut bacteria make important vitamins, like vitamin K, B12, folic acid, that are critically important for brain function. We realize that the gut bacteria are playing such a key role in regulating our immune function and inflammation, and these have important aspects when looked at in the context of things like diabetes and cancer.

So, suddenly, in the past 5 years, there’s been an explosion of research dealing with this microbiome. 90% of all the peer reviewed literature has only been published in the last 5 years. That was yesterday; I mean, think about what you were doing 5 years ago. Similar to what you're doing now. But for me, in the field of neurology, where our motto has pretty much been diagnose and adios, because we couldn’t really help people, suddenly the playing field has been changed, and we have been given an incredible new array of tools to help people with brain related issues by focusing, of all things, on the gut bacteria. Who knew?

So for me as a neurologist, it’s a very, very exciting time to look at the research going on around the world, to be involved in that research, to be treating patients now by modifying their gut bacteria, and seeing results in such conditions as autism and depression by simply modifying or changing the gut bacteria. It’s a very empowering time, because most of what we do are things that are diet related, are things that people can do on their own, and that’s really the focus of my new book, Brain Maker.

I will say that the commentary that we’re seeing online, on Amazon, etc., has been so supportive in terms of people finally gaining the ability to realize such important changes in how they feel by changing their diets through the lens of how their diets affect these 100 trillion gut bacteria.

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3. Dr. Perlmutter’s suggestions for additions to diet [16:09]

Diane Sanfilippo: It’s pretty crazy, and I think people are, you know, getting also more aware of the importance of proper bacterial balance, as you kind of alluded to there, I’ve even seen commercials, which most of the time the television will be on in the background for some noise, I have this weird thing where I like to work and there’s noise in the background, and these commercials for yogurt and talking about probiotics, and even just additional probiotic supplements. Seeing an ad for that on television, not that I think that’s necessarily a great thing, but it’s bringing it to people’s attention, and it’s actually saying that it’s already part of people’s attention at this point, because the media, they’re going to focus on promoting something that they think they can get people to buy. And if people are more aware of this whole scenario, then it’s kind of a great time for us to give them more information and provide these resources for them.

So, when you talk about nutrition, I know that your big platform is definitely a low carb, we know grain free approach. What are some of the nuances you like to talk about in terms of things that people add and things that people avoid that might be sort of beyond what we would think of as a traditional paleo type of diet? So, our listeners are pretty familiar with obviously grain free, dairy free for the most part, though we do have some folks that will do grass-fed raw dairy, things like that if they feel good eating that, and obviously they’re avoiding sugars. But what are some other nuances, maybe some other things you like to see people avoid, or other things that you like to see people add in, because we’re really big on encouraging people to add in certain foods as well.

Dr. David Perlmutter: Well I think the newer ideas that play upon, again, the importance of the gut bacteria, the importance of the microbiome, and this incredibly expanding level of research that we’re seeing globally that relates the microbiome to all manner of brain function, heart function, sugar regulation, whether we’re fat or lean, mood regulation, etc., we’re seeing so much literature on that so it is now time to add in those nuances as you well describe. So again the fundamentals are low sugar, low carbohydrate. Why? Because through the lens of the gut bacteria, when you are eating a diet higher in sugar and higher in simple carbohydrates, then you tend to nurture gut bacteria that pave the way for ill health. That increase the transcription of our DNA in areas that, for example, lead to more inflammation.

So, what I like to now add to the recommendations of your books, and even my book Grain Brain, and what we describe in the new book, Brain Maker, are foods for example that are fermented. When foods ferment, the sugar is broken down by gut bacteria, and that’s where carbohydrates are, complex carbohydrates, and through this process of fermentation good things happen. So we want to first have higher levels of good bacteria in the gut, and when we eat foods that are fermented; kimchi, kombucha for example, cultured yogurt, sauerkraut, fermented vegetables, fermented eggs, meat, fish, etc., we’re already loading up on those good types of bacteria. The bifidobacteria and to a lesser extent the lactobacilli that help keep the gut healthy.

And make no mistake about, all disease begins in the gut, and with that said, we’ve got to do everything we can to keep the gut healthy. So number one is to welcome to the table those fermented foods. Kimchi is a fermented cabbage dish that is a traditional food in Korea, but now is really sweeping the country. You find kimchi in even regular grocery stores now, and it’s something you can easily make at home; highly fermented, lots of bacteria.

Now, step two is we want to give our gut bacteria the healthy gut bacteria, what they need in terms of the food that they eat. Let me take a step back and just characterize these gut bacteria by a term that’s very common, I’m calling them commensal organisms. So, we call them probiotics, we call them commensal. In the literature, you often see this word, commensal, and what it means basically, co- means with, mensal means eat. It means they eat together, and they eat what we eat. So from this day moving forward I’d like all the listeners of this podcast to realize that when you look at your food, and you're assessing your food in terms of its protein, fat, carbohydrate content in terms of what you think is good for your body, I’d like you to also think about the fact that you are nurturing, or not, your gut bacteria based upon your food choices.

You know, they’ve said that women who are pregnant are eating for 2. Well, I would submit that we are all, moment to moment, eating for over 100 trillion.

Diane Sanfilippo: {laughs}

Dr. David Perlmutter: Because every bit of food you eat is nurturing or not your gut bacteria. So when you begin to embrace your food from that perspective, and recognize that if you are nurturing your gut bacteria that paves the way for health, but when you're eating simple sugars and not eating a more paleo type of diet, you’re creating a scenario that’s damaging to your gut bacteria, and that sets the stage for illness. So that’s a new perspective on eating.

That said, eating foods that are rich in what is called prebiotic fiber, a special type of fiber that will then nurture the gut bacteria, allow them to replicate themselves, and allow them to metabolize food, do the things that they do, create life supporting, short chain fatty acids, various vitamins extract nutrients from food, help to lower the ability of bad bacteria to replicate, keep the gut lining intact so we don’t develop leaky bowel, balance the immune system, reduce inflammation, regulate blood sugar. These are the tasks of the good bacteria.

We give our good bacteria high levels of prebiotic fiber through the food choices that we make. Foods that are rich in this special type of prebiotic fiber are things like jicama, or Mexican yam, dandelion greens, Jerusalem artichoke, chicory root, asparagus, onions, leeks, garlic, etc. I list these in Brain Maker, and recognize that it’s been estimated that our paleo ancestors would consume about 135 grams of prebiotic fiber each day, whereas the average American now is consuming about 45 grams a day.

The messages, first two are; number one, get back to eating fermented food, and number two you’ve got to find good sources of prebiotic fiber. Now, it’s important to recognize that people are taking fiber supplements, and all fiber is not prebiotic fiber. Prebiotic fiber is a unique type of fiber that then nurtures the gut bacteria. Not digested or absorbed in the small intestine, but is available in the colon for the good gut bacteria to use as a food source, a fuel source.

So that’s a real important concept, and interestingly, I just reviewed some literature last night on the use of a prebiotic fiber as a way of reversing diabetes in an experimental animal model. Now think about that. We’ve now seen, in humans, reducing issues related to asthma in simply treating children with fiber. And it makes sense; asthma is an inflammatory issue. Inflammation is dictated by levels of good versus bad bacteria. When you improve that ratio, you reduce inflammation.

This process of inflammation goes well beyond asthma. It is the cornerstone player of Alzheimer’s disease. So, certainly of particular interest to me. Here’s a disease affecting 5.4 million Americans, for which we have no meaningful treatment and certainly no cure, Diane and you and I have this conversation, and yet we understand that this fundamental mechanism of inflammation is playing a pivotal role, and that diet regulates inflammation based upon it’s affect on gut bacteria. So these are the new horizons that we in clinical medicine are starting to embrace, so it’s a very, very exciting time.

Diane Sanfilippo: It’s interesting, too, because I think a lot of the success that people have when they remove grains, remove extra sugars, and basically go paleo is, you know, they’re experiencing this shift in their gut microbiome that’s huge, and it’s something that can be initiated by removing certain foods, but as you mentioned there are other steps. I talk about this in Practical Paleo, I’ve talked about it on the podcast many times, that when we talk about healing the gut, or having this whole approach, it’s not a one step process. It’s not just eliminate these foods and you’re done.

Although for many people, if their symptoms and health challenges were not very severe, they didn’t have a diagnosed condition, for many people getting rid of those foods and simply going about their life by eating paleo friendly foods and not thinking too much more about it, some people do just fine with that. But for a lot of people, as I’m sure a lot of our listeners are, it does require those further steps of adding in more fermented foods. Maybe they were eating some already, and didn’t even realize it. So, maybe they’re doing fine with that.

4. Antibiotics and SIBO [26:32]

And then as you said, prebiotic rich foods. Which, that’s something that we talk about a lot. I think one of the things we have challenges with, a lot of our listeners struggle with digestive issues. I just have a quick question for you on this, what you would say about it. A lot of folks that we have listening to this show have issues with small intestinal bacterial overgrowth, where they can’t tolerate a lot of the foods that you’re talking about that are high in those fermentable carbohydrates, or FODMAPs. So while FODMAP foods can be great for somebody who is trying to rebalance their gut health, if somebody is dealing with something like an infection, would it be a recommendation that they go ahead and get that infection handled, and then come and figure out how to now rebalance after that. Would you say that’s a good approach for them? What would you say about that type of issue?

Dr. David Perlmutter: Well, let me first address the first part of your question, and that is the idea of removing. Removing the sugars, removing the grains. And I’d like the sound bite that your listeners take away from our time together today to be the sound bite of, remove and replace. So, yes we want to get rid of those pro-inflammatory foods; the simple sugars, the grains, etc., but let’s also consider, as we just mentioned, replacing as you well stated.

Diane Sanfilippo: Yeah.

Dr. David Perlmutter: With fermented foods and the prebiotics. Now, with reference to your second commend about small intestinal bacterial overgrowth, it’s a very common problem we see these days, probably induced by antibiotic exposure, and certainly there’s a strong dietary component. And I think that your question in dealing with, surrounding whether this should be treated with antibiotics, I will say there are times when we absolutely resort to antibiotics and treating patients with SIBO, small intestinal bacterial overgrowth, a very common problem. It’s not my first choice, but I do do it.

There are several antibiotics that seem actually very effective, but understand that we have to consider antibiotics in terms of risk versus benefit. One of the biggest issues in terms of damaging gut bacteria that is prevalent in western cultures is our aggressive usage of wide spectrum antibiotics. So many scientists these days are certainly warning us in our most well respected journals about the dangers of overusage of antibiotics. That is even mainstream medicine more focused on the creation of super organisms, or resistant bacteria, but we now understand, Dr. Martin Blazer in his wonderful book, Missing Microbes, talks about the effect of antibiotics in terms of damaging the gut bacteria, a really important narrative we need to keep that information alive.

But my first approach to dealing with small intestinal bacterial overgrowth is really based upon peer reviewed literature, and deals with giving aggressive probiotics first. This has been published in various European journals; one the European journal of gastroenterology and hepatology, meaning liver diseases, published in December of 2014, I think really well characterized of how effective a fairly broad spectrum probiotic can be in terms of alleviating SIBO. They used a variety of probiotic species; many of them are very common, Bifidobacterium bifidum, Bifidobacterium lactis, Bifidobacterium longum, etc., and even Lactobacillus acidophilus, and had really good results. So that’s my first choice.

Down the line, do we need antibiotics? We see how patients respond. But I think this opens the door to a discussion about antibiotics, and I think, you know, it’s now recognized that antibiotics do impart significant changes on the gut bacteria, and with new literature indicating that these changes, some can be permanent changes to the microbiome, we really want to take a step back every time we have a cold or a cough and we go to the walk in clinic and expect to walk out of there with a prescription for an extremely powerful broad spectrum antibiotics and, you know, I often tell my patients, if you take an antibiotics for a cold, it’s only going to last 7 days. But if you don’t take the antibiotics, it’s going to last a full week. And I always hope that they get the joke.

Diane Sanfilippo: {laughs}

Dr. David Perlmutter: But often times, that’s what people want.

Diane Sanfilippo: Yeah.

Dr. David Perlmutter: I get the phone calls all the time; hey doc, I have a wedding coming up, or whatever, I have to travel, and I feel like I’m coming down with something. Can you call something in? And that’s just poor medicine.

Diane Sanfilippo: Yeah.

Dr. David Perlmutter: Colds are caused by viruses; treating them with an antibacterial makes no sense. I tell them, look, it’s like you have acute appendicitis and we’re going to take out your gallbladder. It doesn’t make any sense. And yeah, people want the quick fix. This is the wrong thing. Certainly, there is a time and a place for antibiotics, just like there’s a time and a place for C-sections, but the reason I segue to C-sections because kinds that are born by C-section are deprived of their initial inoculation for their microbiome. When you're born through the birth canal, there’s a whole array of bacteria that live in your mother’s birth canal that you then pick up that will inoculate you through your nose and mouth into your gut, and give you the right microbiome, some of which will last you the rest of your life.

When a child is deprived of that; when the child is born directly out of the uterus through a surgical procedure called a C-section, then he or she doesn’t get that initial microbial baptism, and that set the stage for significant increased risk for things like type 1 diabetes, celiac disease, allergies, asthma, ADHD, autism, and even becoming obese as an adult. That’s what peer reviewed research is telling us. I’m certainly not saying there shouldn’t be C-sections, because they are a life saving procedure for mothers and children alike; but Diane, right now in America, one-third of all births are born by C-section.

5. Reinoculation of the gut microbiome [32:57]

Diane Sanfilippo: Mm-hmm. And not without consequence. I think, you know, hopefully there’s also some, because there’s so much more information for folks like our listeners, who are very aware that it’s not without consequence, and our listeners are not typically of the mindset that it’s no big deal. They understand the gravity of it. I’m curious; this is totally off topic, but I’m actually curious if some of the more progressive birthing centers and places like that that are aware of how important that is, I wonder if they do any sort of nasal, or any way to quickly and immediately try to inoculate that infant. That’s totally off topic, so we don’t have to go down that rabbit hole, but it just got me thinking.

Dr. David Perlmutter: The best questions for me are the off topic ones.

Diane Sanfilippo: {laughs}

Dr. David Perlmutter: Because you know, I think people are kind of expecting to hear what you and I are talking about, so off topic works really well for me. So there’s a researcher at NYU, her name is Maria Gloria Dominguez-Bello. {laughs} I made sure I committed her name to memory. She has developed a technique, it’s in Brain Maker, we talk about it, to do exactly what you just mentioned.

That is, when a C-section is mandated, they put a sponge in the birth canal, and they extract it prior to the antibiotics that are so routine now in C-sections, given to the mother, and they keep it in a moist, warm environment, and then when the baby is born they do exactly that. They cover the baby’s face, nose, and the rest of the body with these bacteria from the birth canal as that child would have otherwise normally received. And that research is ongoing, and I think it's very, very exciting. That was an excellent question.

You know, when I talk about, for example, this relationship of autism to being born by C-section, it’s not mommy bashing. Plenty of women listening and fathers too who are listening to this whose children were born by C-section may be offended by this. My hope is to empower by giving the knowledge that, hey, this is what our scientific journals are telling us. I’m not pointing fingers. Again, C-sections are important, they’re life saving. But, it focuses on the role of the gut bacteria, for example in my world, in terms of how the brain works.

There is a video on our website, which is, of a child with autism who underwent a process called fecal transplantation. I actually talk about this kid in Brain Maker, with his mother’s permission, of course. This is a child who couldn’t speak, had no real social interaction skills, as is typical of autism, and underwent a process where healthy bacteria from stool, in other words healthy stool material from a healthy donor was transplanted into his colon, and then he was videotaped several weeks later. His mother sent me the video when I was actually lecturing in Germany, and this is a child speaking, talking to mom about what he’s going to have for lunch, where he’s going to go today after school, his friends, wonderful eye contact, and he remains in that situation. He’s in regular school. Again, I didn’t do the fecal transplant, mother had it done. How incredible is it that the University of Arizona has recruited a large number of children with autism, and they’re going to do fecal transplantation on these kids.

Diane Sanfilippo: That’s awesome.

Dr. David Perlmutter: Because we understand that there’s a fingerprint of the gut bacteria that characterizes autism. What an incredible validation of the notion of gut-brain connection.

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Diane Sanfilippo: That’s huge. That’s huge, and I think we’ve been hearing more about fecal transplants, and also just different types of scenarios and conditions that it can help with because it’s basically endless. It’s almost like anything that could be going on, when we look at what’s happening in terms of our health, really rooting from the gut and our gut health. We know that about 80% of the dry weight of our stool is bacteria, so for those that thought that was kind of useless, why are eliminating all this bacteria, well here’s a great reason why {laughs} Now so we can help donate that, perhaps, to others. That will be really interesting to watch that evolve in medicine over time and see how healthy donors are identified. I just find that really fascinating.

Dr. David Perlmutter: I do too, and beyond fascinating I find it empowering.

Diane Sanfilippo: Yeah.

Dr. David Perlmutter: And it is. I have another video on on patient with multiple sclerosis who basically couldn’t walk unless he had assistance. And he underwent 6 fecal microbial transplants at a clinic in England, and now walks wonderfully, his video is on our site, without canes. He was in my office telling me his story about very aggressive antibiotic usage prior to being diagnosed with MS. So, you know, this isn’t the first person who has undergone fecal transplant for the treatment of MS. There has been a large cohort of individuals published in the literature from Australia, who have undergone this procedure.

Actually, he allowed me to include his video and his story on my upcoming program on public television. So people are going to learn about this, and it’s going to be challenging for people to be thinking about such as crazy procedure as transplanting fecal material from one person to the next. But make no mistake about it; this is a procedure now being done at more than 150 hospitals right here in America to treat a specific disease situational diarrheal illness called clostridium difficile. S

Diane Sanfilippo: Mm, yeah.

Dr. David Perlmutter: So people are really getting their arms around the incredible amount of information that is contained in the stool. One gram of stool contains, in terms of genetic information, about 100,000 terabytes.

Diane Sanfilippo: {laughs} Whoa!

Dr. David Perlmutter: That’s an order of magnitude greater than your home computer. Two orders of magnitude greater than your home computer, at least. So it’s breathtaking to recognize that from a genetic perspective, your gut bacteria are representing 99% of the DNA in your body. 99% of your genetic materials, not your wonderful 23,000 genes that you inherited from mom and dad; it’s bacterial DNA. And again, 10 times as many bacteria are found in your body than there are cells of you; of Diane.

Diane Sanfilippo: It’s crazy.

Dr. David Perlmutter: You are 10 times more bacteria. So wow, it’s a very humbling notion. We’ve always considered gut bacteria; rather, bacteria, to be agents of death.

Diane Sanfilippo: Yeah. Kill it, kill it, kill it!

Dr. David Perlmutter: Everything about bacteria was bad. The germ theory here; the bubonic plague wiped out a third of Europe in the 14th century, so no. As a matter of fact, most of the bacteria that live within us are supporting our health. Very few are actually pathogenic or causing problems. And every aspect of our health depends on that. So it takes your recommendations, making nutritional recommendations, to a new level. Because it’s not just, as I mentioned before, analyzing the nutritional contents of our food for our health, but now looking at it through the lens of if that will nurture or not the health of our healthy gut bacteria.

6. Supplementing with tryptophan and GABA [41:45]

Diane Sanfilippo: I’m sure at some point in time, the idea of putting someone else’s blood into someone else’ body was also, you know, people probably thought that was a little crazy when they first started doing it. I think it’s just the next frontier.

So we have a ton of questions; I will be able to get to a handful of them. We’ve had an awesome discussion so far, I think our listeners are going to love this. I think it was just we got into some really great topics {laughs}. That was really fun, so thank you. We have some questions here, and I’ll kind of roll into them, and let’s hear your take on a bunch of these different topics.

Some food and supplement related questions; we have one from Mandy that says, “I’m interested in hearing his opinion on supplements like tryptophan or 5-HTP and GABA for mood support. I feel like tryptophan and GABA have been great to help me; are there any downsides or risks to taking these supplements long term?

Dr. David Perlmutter: Well I think the first disclaimer would be, obviously, you want to check with your health care provider. Moving forward in our podcast today, let me preface all of these recommendations with that. Because everybody is different. I’m making a global statement here, but that individual might have specific issues for which the comments may not necessarily be on target.

By and large, I don’t find any problem with supplementing, using tryptophan 500-1000 mg a day. We know that tryptophan is the precursor by which the body manufactures the neurotransmitter serotonin, and as such, amping tryptophan does help to some small degree to increase serotonin levels. But understand that by and large, there is plenty of tryptophan available to make serotonin the chemical pathway for the manufacture of serotonin only uses about 5% of the tryptophan that is found in the gut.

Diane Sanfilippo: Wow.

Dr. David Perlmutter: And of course, this then relates to the health of the gut bacteria. And here’s why. When there’s inflammation in the gut, then it shuttles tryptophan away from the pathway making serotonin, and then tryptophan is used to make other chemicals. One of them specifically is called kynurenic acid, which you can actually measure in the blood, in the urine. So when you see high levels of this kynurenic acid, it’s an indication that there’s inflammation, and it’s drawing tryptophan away from being able to be used for serotonin production.

Similarly, the gut bacteria are fundamental in the production of GABA; gamma-Aminobutyric acid, which is also, like serotonin, a neurotransmitter, but it is a neurotransmitter that we call inhibitory; it tends to call the nerves that it is received by, instead of firing to be let’s say inhibited; relaxed. So in that regard, GABA levels are important as they relate to things in which the nervous system is a bit overactive; like, for example, ADHD. There is, in fact, a correlation between GABA and ADHD, which probably relates back to the gut bacteria.

So my mission then is to say rather than focusing on putting back GABA and putting back serotonin and even putting back tryptophan, that’s a couple of steps down the line. Let’s go to the very origin where the problem is, and look at the gut bacteria because that’s where these issues begin. Again, I’d like to focus on the fire, not the downstream effects, like lower levels of these transmitters. Let’s get to the root of the problem as it relates fundamentally to the gut bacteria.

Diane Sanfilippo: I think that’s super interesting, and we know that a lot of folks do supplement with things like amino acids, but what you just said about 5% of it being used and converted in that way; we know that we’re getting tryptophans in the foods that we’re eating, especially when we’re eating animal proteins, and we’re getting that stuff in our diet, but the real root is that that use is not happening, so finding out why that’s not happening, that’s far more interesting. {laughs}

Dr. David Perlmutter: That’s for sure. Again, that’s what really matters to me most in terms of really fixing issues, as opposed to just treating the downstream symptoms.

Diane Sanfilippo: Right. Which, you know, in looking at these natural remedies, something like tryptophan as opposed to a pharmaceutical where taking it probably won’t have those negative effects that maybe a pharmaceutical might have, and it might help somebody in the short term feel better. But as you're saying, it’s probably not the reason. Lack of tryptophan is probably not the reason for whatever symptom you may be experiencing.

Dr. David Perlmutter: Oh, exactly. And again, there are correlations between variations in these neurotransmitters and actual clinical problems; for example, there is technology that allows researchers to actually measure GABA in the brain, actually image it using what’s called J-difference edited MRI, or rather magnetic resonance spectroscopy. So you can do a special type of scan of the brain and measure GABA in certain areas of the brain, and it shows clearly that in ADHD there are certain areas of the brain that has lower levels of GABA in comparison to non-ADHD children.

So I’m not downplaying the role of the neurotransmitters; I think there’s plenty of evidence to suggest that there’s correlation. But again, recognizing that these things are made in the gut, and they’re made in the gut when the gut is healthy; that’s job one.

7. Recommended probiotic supplementation [47:45]

Diane Sanfilippo: So, we have some questions here; there were a few different forms of this question, so I’m going to generalize it. Of course, you’re talking about getting probiotic content into our bodies through food ideally. So as I mentioned or alluded to before, for the folks that are having issues, they really just can’t even start eating the fermented foods because their gut reacts so poorly to it, I’m sure that there are some supplements that you’ve recommended. People are curious; are there certain strains that you’re always looking for people to get. Are there brands that you recommend; are there ways to do this, of course with the caveat that people do need to work with a practitioner than just going out and loading themselves up is not always going to be the best approach.

But is there something for the person that’s out there feeling like they’re staring at the probiotics in the store, and they’re like, I don’t know if any of these will help me, they’re all pretty expensive. Should I be getting something from a refrigerator or not. What’s the basic run down for folks on that approach?

Dr. David Perlmutter: I would say that there is very good merit to the notion of taking an oral probiotic, that’s for sure. What I would encourage your listeners to do is go to and I list on our website my 5 core probiotic species. You’re right; you go to the health food store, and it’s dizzying to try to figure out what you should take. There’s all kinds of preparations, all kinds of species. And again, it’s really, you understand that there’s 10,000 species of bacteria in the gut, and when you’re at the health food store and there’s a product that has one or two species, why is that important?

It’s important because certain species have been vigorously studied and play a huge role in gut health. Now, I doubt people are going to be able to write this down, but I’ll just list what I think is important.

Diane Sanfilippo: We have a transcript, so they can go check it out in the transcript. My transcriber will have a fun time with this.

Dr. David Perlmutter: Excellent. There are 3 species of Lactobacilli called Lactobacillus plantaram, acidophilus, and brevis, meaning short; and only 2 species of bifidobacteria; Bifidobacterium lactis and Bifidobacterium longum. And the reason I focused on those 5 is because they are by far and away the most heavily studied, so much scientific literature on those species, and they are very, very common in various products at the health food store from various manufacturers.

I think beyond that, what you want to look for in a product is to make sure that it is a product that is designed to really give you a large number of organisms in terms of what are called CFUs; colony forming units. You want to get billions of CFUs in your product, and be careful not just that the product package says that it had 50 billion CFUs at the time of manufacture; that’s not really what you want. You want that 50 billion units, if that’s the number that you choose, to be available to you when you consume the product. So you want to have a product that has demonstrated that it has shelf life of, let’s say, 2 years, and even if you buy the product then and you consume it, you’re still getting that level of activity.

The other thing that I like to see mixed in with these products, and we’re now seeing it on the shelves in health food stores, is the presence of prebiotics actually mixed in with the probiotics, and we’re starting to see that. Prebiotics like acacia gum and resistant starch found in some supplements found in the health food store that are probiotics.

There are countless studies that clearly demonstrate changes in measureable parameters in the blood markers of inflammation when animals and even humans are given probiotics at the levels that you can buy at the health food store, and there are even changes in the gut bacteria that are observable and measureable when people take an oral probiotic. So I’m all over it. Even in treating patients, using probiotics has been really very, very helpful. Because frankly, there isn’t a huge array of species found in the fermented foods, not everybody likes the fermented foods, fermented foods are not something necessarily easy to travel with or easy to find when you are on the road. So you can always pop a bottle of probiotics in your bag, making travel even easier.

Diane Sanfilippo: So then in terms of refrigerated or not, is there any kind of general, it’s not that critical that they’re refrigerated? Because obviously what you’re saying is, you would hope that the shelf life that they can survive.

Dr. David Perlmutter: Truthfully, the main thing, though you do find wonderful probiotics that are refrigerated, the main thing that damages the viability, compromises the viability of probiotics is moisture, not heat. I mean, certainly, if you leave a bottle of probiotics, although there’s no moisture, in your car at 110 degrees, that’s going to be damaging. But by and large, even on the shelf in health food stores, if there are approaches incorporated to reduce the humidity within the bottle, desiccation for example, that’s the biggest issue that ultimately leads to less CFUs, less billion organisms that are available to you. So that’s the big issue.

Diane Sanfilippo: Great. Very interesting, and very practical, usable information for our listeners. Just a reminder, you guys can get the details on the probiotics that the doctor mentioned in the transcript, so Amanda will hunt down the names for all of you.

Dr. David Perlmutter: Thank you, Amanda!

Diane Sanfilippo: And we’ll list it out. Maybe what we’ll do is even bump that into the top little summary of the show notes, because I know that’s really important for people. It’s been something that Scott, my fiancé, and I have been talking about for a long time where we’ve eaten very well, and we’ve done all this stuff, but neither of us is great with supplementing regularly with anything, and we’ve recently started getting on top of a multivitamin that we’re like, ok, we’re going to test it for a few months, see how we feel, and we’ve been talking about going back to probiotics. Both of us have done it on and off for periods of time, and this is great because just like our listeners, sometimes I need that extra motivation, and these conversations are always motivational, so thank you for that.

Dr. David Perlmutter: Yeah. Well, let me say that, you had mentioned about brands. I would indicate that there are some really good brands out there, because I am working with a specific company. I don’t think it would be fair for me to mention either that brand or any other brand.

Diane Sanfilippo: Ok. Thank you. I think folks can do their research based on what you’ve mentioned. What I’ve learned, as well, is that if you take one for a period of time and you don’t feel any benefit for whatever it was you were hoping to se benefit for, try a different one, because there may be a different type of balance that works better for you, or maybe one is less effective, and it’s not always going to be the best, even if it worked really well for somebody else. So I think that’s something.

Dr. David Perlmutter: Well, Diane let me take that a little bit further. One of the things I talk about in Brain Maker is a specific laboratory test that measures inflammation and measures the leakiness of the gut. In other words, in sort of an indirect way of assessing the health of the gut bacteria. So while you might not feel more energetic or that your mood has suddenly improved or that you’ve lost 15 pounds, there are blood tests that you can take that can let you know if changes are starting to happen that will then pave the way for those other wonderful things to happen.

Diane Sanfilippo: Mmm.

Dr. David Perlmutter: So the change doesn’t happen immediately. We do know that even with dietary changes, the gut bacteria change in as little as 3 days. But again, there are lab tests that you can get. I list them in Brain Maker, and these are tests that you can ask your doctor to perform. How the doctor can do that, it’s simple blood work, and they can just contact the laboratory. Very straight forward measuring.

For example, something called LPS, lipopolysaccharide. That’s a marker straightforward marker of leakiness of the gut. And we see, for example, elevated levels of LPS in major depression, autism, Alzheimer’s disease, and even ALS or Lou Gehrig disease, so it’s widespread and it shows us, as the graphs in Brain Maker demonstrate, how pervasive is this relationship between leakiness of the gut and various disease situations.

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8. Research on Parkinson’s disease [57:40]

Diane Sanfilippo: I love it. It’s awesome. Wow, we’re creeping up on close to an hour here, so I think we only have time for a couple more questions, because I think, or maybe even one because I don’t want to take up too much of your time today, and boy we have a ton that we just weren’t able to get to. But I think this conversation has just been super fascinating.

We have some questions about Parkinson’s disease, and just in general the question was, what does the research show about Parkinson’s’ with regard to what you’re teaching about. Diet or lifestyle changes that might be anything beyond what you’re talking about typically, and what have you seen in some of your patients?

Dr. David Perlmutter: I’ve actually spent quite a lot of time in dealing with Parkinson’s disease. As many of your listeners may know, we pioneered the use of something called glutathione, an injectable treatment for Parkinson’s; published data on that. Interestingly, there was an article recently that said, that challenged me in terms of our use of glutathione, because the statement was, oh the research shows it doesn’t work. Well, if you read the research that we did, it showed that it really actually did work.

What is exciting I think, to remain to our conversation today, is that there is LPS elevation in Parkinson’s. Meaning, and this has been measured back in January 2013 in the journal Brain, Behavior, and Immunology showing that there is elevated LPS in the brains of Parkinson’s; LPS comes from leakiness of the gut. So what I’m saying is, there’s a strong gut issue related to Parkinson’s disease, and there’s no cure for Parkinson’s, and there’s no cure for Alzheimer’s disease, yet what I’m talking about on public television on my new program is that my feeling is the reason we’re not curing these diseases is that we’re looking in the wrong place; time to get out of the brain and look at the gut.

When we see literature, peer reviewed literature, showing a high level of a marker of gut leakiness, therefore inflammation, correlating to Parkinson’s in comparison to controls, we have to take a step back and say, whoa! This is new and wonderful information, maybe we need to look at the gut. And hey, when you’re talking gut, you’re talking nutrition, and we’re right back to Hippocrates now. We’ve just taken a step back.

Diane Sanfilippo: {laughs}

Dr. David Perlmutter: Or my hope is, a step forward, in completing this circle, getting back to the critical role of how we nurture our bodies with nutrition, again now through the lens of how we nurture our gut bacteria, and that is the key to health.

Diane Sanfilippo: Well, this has been an amazing conversation. I really appreciate you taking the time to enlighten our listeners. Man, I wish I was better about chugging through questions faster, because we had so many. I want to thank everybody for submitting your questions, and hopefully the way I see it, a lot of what Dr. Perlmutter is talking about today; truthfully when you look at the root of every question that you guys are asking about different conditions, I think Dr. Perlmutter’s stance on a lot of this stuff really is covered in the content of his books, and the way that he’s looking at an approach to healing the gut and rebalancing that microbiome and reinoculating it in order to allow the body to rebalance and to heal based on what you're seeing in the literature and in research that you’re doing, as well as in your patient population. So, I think that everybody who is asking those questions, you’ll be able to kind of dig in and get some more answers for them based on that information.

Is there anything you want to tell people, as well, about if they do have more questions where can they go to get more information? Obviously we know your book and your website here.

Dr. David Perlmutter: Yes! If I’m being invited to make a final comment here, I just want to thank you for everything you’re doing. You know, the word doctor means teacher, and through your books and through this form as well, you’re giving people wonderful information; you’re teaching them and showing them the way. So I, like your listeners, offer up a great deal of gratitude for the work that you're doing. It’s wonderful. And if people want more information about the work that I’m doing, I would say visit my website, which is, Facebook is David Perlmutter, M.D. And you know, I have a lot of public television things that are out there, a lot of videos on YouTube; there’s a channel. It’s all about getting information out, so I’m inviting people to join me and learn that information.

Diane Sanfilippo: Well, thank you to Dr. Perlmutter. That’s it for this week. Don’t forget, you can find me at You can find Liz at You can find Dr. Perlmutter at Don’t forget to join our email list to make sure you’re staying updated on everything that’s going on, and get lots of free goodies while you're there. While you’re on the internet, please leave us a review in iTunes. We’ll see you next week.

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