Is Your Lifestyle Causing Your Brain to Shrink?

by Vin Miller, November 24th, 2013

Grain Brain by David PerlmutterIn 2007, when I began eliminating gluten from my diet, the idea that this food ingredient could cause psychological dysfunction without causing gastrointestinal symptoms was practically unheard of. In fact, even the general concept of gluten sensitivity in the absence of celiac disease was not nearly as widely accepted as it is now. And even now, there are many medical professionals who disregard non-celiac gluten sensitivity despite a growing amount of research demonstrating its prevalence. Dr. David Perlmutter, a neurologist who has been studying the brain since the 1970s, has courageously made it his mission to advance the awareness of gluten sensitivity one step further. In his book, Grain Brain, he makes the bold claim that gluten is a serious concern for cognitive health, and not only for people who test positive for gluten sensitivity, but for everyone. However, the book is not just about gluten. Dr. Perlmutter provides an evidence-based explanation of why many of the lifestyle habits that have led to our current epidemic of degenerative and chronic disease are also contributing to a broad range of cognitive dysfunction.

Up until 2007, I began each day by waking up in a disgruntled mood and with the thought that there was no reason to get out of bed. To say this was a depressing way to start each day would be a major understatement. Although I always managed to get out of bed, the remainder of the day was always a struggle due to fatigue and irritability, which often led to frustration, and periodically led to depression. To make a long story short, I was eventually diagnosed with chronic fatigue syndrome, and I now attribute most of it to gluten. When I eat it, many of these symptoms return. However, one thing that was atypical about my case is that I rarely ever experienced gastrointestinal symptoms. In Grain Brain, Dr. Perlmutter explains why gluten can have adverse neurological effects even in the absence of gastrointestinal symptoms. In fact, one of the cases described in his book is very similar to mine.

My own health is not the only reason why I am personally invested in Dr. Perlmutter’s mission to spread awareness. He begins the book with the following dedication: “To my father, who at age ninety-six begins each day by getting dressed to see his patients – despite having retired more than a quarter century ago.” This kills me every time I read it, partly because I can relate. Each time I visit my parents, my father asks where I live and what I do for a living. Fortunately, he still recognizes me, but who knows how long that will last. Taking inspiration from empowering individuals like Eckhart Tolle and Byron Katie, I am able to accept this for what it is, but it does not change the saddening and sobering fact that much of the disease and suffering that is so prevalent today could easily be avoided if it were not for decades of misguided nutrition recommendations and a health care system that is completely inadequate for treating chronic health conditions. With Grain Brain, Dr. Perlmutter has made a great contribution towards resolving these unfortunate circumstances. I sincerely hope it will make a dent in the current health care crisis and greatly reduce the number of people who will have to deal with the pain of watching a family member go on a permanent mental vacation.

The Body’s Most Precious Organ

In regard to my own health and wellness, there is nothing more important to me than my cognitive ability, and I suspect most people feel the same way about their own health. Based on his book, it is apparent that Dr. Perlmutter agrees as well, and he even included a quote suggesting that the purpose of the body is to carry the brain. After all, how much value is there in life when you cannot think clearly or maintain a stable mood? Dr. Perlmutter makes it abundantly clear that this question is especially relevant to anyone still living the typical modern lifestyle characterized by processed foods, high stress, a lack of exercise, and a lack of sleep.

Relating mostly to weight loss and metabolic health, cardiologist William Davis wrote a great book called Wheat Belly, which presents a compelling case as to why everyone should consider avoiding wheat, regardless of gluten sensitivity. In regard to cognitive function, Dr. Perlmutter takes this compelling case one step further by suggesting that everyone should not only avoid wheat, but all gluten containing grains. Based on the evidence associating gluten with a wide range of cognitive disorders ranging from headaches, migraines, depression, and attention deficit disorder to dementia, Alzheimer’s disease, seizures, schizophrenia, bipolar disorder, and autism, he argues that avoiding gluten is such a simple solution to such major concerns that it should be avoided even if gluten sensitivity is not detected by testing.

Dr. Perlmutter’s recommendations seem a lot less bold when you consider the foundation of science they are based on and that gluten is only a part of a much bigger picture. As he thoroughly describes in his book, oxidative stress and inflammation are major risk factors for cognitive dysfunction, not to mention most other chronic health concerns. Poor blood sugar regulation is a major cause of these risk factors, and as described by Dr. Perlmutter, as well as Dr. Davis in Wheat Belly, grain-based foods tend to cause considerable blood sugar fluctuation, even when they consist of whole grains. For example, both doctors point out that whole-wheat bread has a higher glycemic index that table sugar.

While gluten causes inflammation due to interaction with the immune system, many sources of carbohydrates can cause inflammation through fluctuations in blood sugar, regardless of whether or not they contain gluten. As such, gluten and carbohydrate intake can contribute to cognitive dysfunction independently of each other, which is why Dr. Perlmutter recommends a diet that is not only gluten free, but also low in carbohydrate. Furthermore, based on the evidence showing ketones to not only be an efficient source of fuel for the brain, but to also be protective against neurodegeneration, he recommends that the low carbohydrate diet be ketogenic, which he equates to less than 60 grams of carbohydrate per day. For more information on the ketogenic diet, including related research, health benefits, and implementation, The Art and Science of Low Carbohydrate Living by Dr. Stephen Phinney and Dr. Jeff Volek is an excellent resource. There is a considerable amount of research available to support the benefits of a ketogenic diet, and much of it was conducted by the two authors of this book.

Dietary Misconceptions about Fat and Cholesterol

It is hard to mention a low carbohydrate diet without drawing concerns about saturated fat, cholesterol, and heart disease. Dr. Perlmutter thoroughly explains why fat and cholesterol do not carry the risks that are so commonly mentioned in mainstream dietary guidelines. He also explains why inappropriate carbohydrate consumption is the real concern. A more exhaustive review of the politics and science involved in these misconceptions is provided in Good Calories, Bad Calories by Gary Taubes, which Dr. Perlmutter references in his book.

Beyond the relevance of fat and cholesterol to a low carbohydrate diet, Dr. Perlmutter describes how these nutrients are critically important for brain health. He also describes the evidence indicating that statins, the most popular class of cholesterol lowering drugs, do not protect against dementia and Alzheimer’s disease as sometimes claimed. In fact, the lower levels of cholesterol commonly produced by these drugs are associated with increased mortality and depression and decreased cognitive function. Dr. Perlmutter also points out evidence indicating that these drugs increase risk for type 2 diabetes which, in turn, increases risk for Alzheimer’s disease. Statins are a significant focus of the book, and anyone taking them should definitely read it.

Beyond Diet

It is a major misconception that adults cannot generate new brain cells. Furthermore, it is well known among scientists that exercise in particular has a profound effect on stimulating neurogenesis. In his book Spark, Dr. John Ratey thoroughly describes how this happens, how it contributes to learning, and how it can be used to prevent and treat cognitive dysfunction. Similarly, Dr. Perlmutter reviews some of the key evidence showing that exercise stimulates neurogenesis and how increased activity is associated with reduced risk of Alzheimer’s disease, memory loss, and other forms of cognitive decline. He also reviews some of the evidence showing reduced sleep to increase the risk of cognitive decline.

Diet, exercise, and sleep are undoubtedly among the lifestyle factors that have the greatest influence on health and wellness. While gluten and carbohydrates are the primary focus of Grain Brain, it is clear that Dr. Perlmutter’s approach to treating and preventing cognitive dysfunction is based on a holistic perspective in which brain health is derived mostly from overall health. Furthermore, based on the content of the book, much of this perspective is clearly rooted in evolutionary principles. I find it quite refreshing to see such a well-rounded perspective from a conventionally trained medical specialist.


The are two primary factors that dictate whether or not I will consider a book to be worth the time I spent reading it. First, it must broaden my perspective, and when appropriate, it must also be evidence based. There is nothing I find more frustrating about a book than bold claims that are not cited with supporting research. Being the geek that I am, I read through the entire bibliography of Grain Brain and read at least the abstract of nearly every study cited. Based on this, I can say with confidence that Grain Brain is evidence based and well referenced in addition to being a great resource that flows in a logical and easy to read manner.

One of the first and most fundamental lessons I learned about optimizing health and wellness is the flaw in accepting chronic dysfunction as an inevitable part of aging. Years later, I still consider this to be an extremely important concept. In Grain Brain, Dr. Perlmutter does an excellent job of explaining why cognitive decline is not inevitable with aging. More importantly, he empowers us with the knowledge of how to prevent it. As such, I think this book is a must read for anyone who has a brain and wants it to function well.

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