Episode 583: Dr. David Perlmutter: Brain Health Expert: The Daily Habits That Protect Your Brain as You Age

Habits and Hustle

In this episode of Habits & Hustle, Tony Robbins sits down with Dr. David Perlmutter, a leading neurologist and author of 'Brain Defenders,' to explore the critical role of daily habits in protecting

Key takeaways

• Alzheimer's progression can be stopped or reversed in up to 70% of patients through lifestyle changes, not drugs.
• Microglial cells—the brain's immune system—are central to determining long-term brain health and are influenced by daily habits.

Main topics

• Brain health and neurodegenerative disease prevention
• Role of microglial cells in cognitive aging

Notable quotes

"The drug is lifestyle. You cannot patent that."

Conclusion

Dr. David Perlmutter emphasizes that brain health is not predetermined by genetics but shaped by daily habits and lifestyle choices. Even

Transcript preview

Speaker 2 (0:01) Hi guys, it's Tony Robbins. You're listening to Habits & Hustle. Crush it! Speaker 1 (0:06) Welcome to Habits & Hustle, where I sit down with the world's biggest thinkers, entrepreneurs, top experts to uncover the habits, strategies, and mindset shifts that actually move the needle in your health, happiness, and success. And today, I'm sitting down with Dr. David Perlmutter, a board-certified neurologist, best-selling author, and leading voice in the brain health and neurodegenerative disease. We discuss why protecting your brain starts decades before symptoms appear, how inflammation and metabolic health impact brain function, and what you can do now to reduce your risk of cognitive decline. We also cover loneliness, sleep, Strength training, oral health, fasting, and insulin. Oh my God, the list goes on. This conversation is packed with practical ways to take more ownership of your brain health instead of waiting until something goes wrong. David breaks down that everyday habits, health markers, and lifestyle choices. that actually influence how your brain ages, plus some of the emerging science that can completely change the way we think about Alzheimer's and other neurodegenerative diseases. So now let's dive in. Before we get into today's episode, I have a quick question. Do you ever hit 3 p.m. and feel like your brain's just done? That afternoon crash used to be really real for me. My focus would completely disappear. Everything felt harder, and I'd wonder how I was supposed to get through the rest of the day. I tried pretty much everything for energy and focus, and I'm very skeptical of just taking supplements that promise too much. But Magic Mind is one of the very few things I genuinely notice when I don't take it. 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Speaker 1 (3:03) You guys, we have a special podcast today. You know, I'm on this really big bandwagon of doing everything for our brain health, cognitive health, all the things. And we have a doctor named Dr. David Perlmutter, who I still can't believe I've never met before. This is absurd considering I've been doing this for many years. You've been doing this for even more years. And we just never, our paths never crossed. Well, Speaker 2 (3:27) the circle is complete now, isn't it? Speaker 1 (3:29) Yes, it totally is. The loop is now finally closed. Dr. What do you want me to call you? David, Dr. David works. David or Dr. Perlmutter. I, you know, you say Dr. Perlmutter, I keep looking for my dad. Okay, so I'll call you David, but yes, but I know, right? You still probably still look for your dad. I know. I don't like when my, when my, when my kids' friends call me miss blah, blah, blah. I feel like a very old person. I don't like it. I like them to call me Jennifer. So David or Dr. Perlmutter has written his 16th book. And this one is called Brain Defenders. You may have read his book, Grain Brain. There's so many. There's so many books. But we're going to talk all about the new book. And like I said, it's called Brain Defenders. I can never seem to see that. Harness the power of your immune cells to protect your brain for life. So thank you for being here. Speaker 2 (4:21) Well, thank you Speaker 1 (4:22) for Speaker 2 (4:22) having me. The subtitle really tells it all. It tells the story of the power of the brain's unique immune cells called microglial cells to really determine your brain's destiny, whether you're going to be along for the ride with your brain or the brain's not going to be there to participate in the rest of your life. So we fear things like Alzheimer's and Parkinson's and all of these issues that... you know, we run the risk of, but it turns out that we absolutely have a big say in determining whether that's in our future or not. And it all has to do with what's going on with the brain's immune cells over which you have control. That's what we'll talk about today. Speaker 1 (5:03) Yes. I mean, this is why, you know, I was really eager to have you on the podcast for personal reasons. My mother was diagnosed with Alzheimer's. I just came back from Montreal to see her. And she's now past the point of mild, I would imagine, in the mid area of Alzheimer's. And, you know, we talk a lot about preventative things. What I would love to hear from you is, like, where is the science or is there any evidence that you can reverse signs of Alzheimer's, dementia, if you're already past a certain point? The answer is yes. Speaker 2 (5:41) How about that? Now, we've never been told that, have we? Here in America, there have been FDA-approved drugs to treat Alzheimer's disease that, according to a recent Cochrane analysis, have abjectly failed. They do not have any meaningful effect on the time course of the decline in the Alzheimer's patient and are associated with a significant risk of side effects in at least a quarter of patients. either hemorrhage in the brain, swelling, or even death. And these are drugs that are FDA approved. It's the best that pharmacy can offer us. And yet when we look at research, for example, there's a study that came out last year by Dr. Rudolph Tanzi at Harvard, along with Dr. Dean Ornish. They took a group of patients who were diagnosed with Alzheimer's already, not at risk because they had diabetes or obesity or something. These patients were already diagnosed. 51 patients, 20-week study. What did they do? They changed their diets, they changed their level of activity, and they reduced their stress. And these individuals, it didn't slow down their progression. In 70 % of them, it stopped their progression or led to improvement in their cognitive function. There's never been any drug that could do that. And the side effects were, in these individuals, that their blood sugars improved, their body weight improved, and they overall felt better. And think about that. And you're looking at me right now with a look on your face like, I haven't heard of that. And you should have heard of that. And you haven't. What is it Speaker 1 (7:13) called? Speaker 2 (7:14) It's lifestyle intervention. Speaker 1 (7:15) But this is the thing. I'm looking at you like that. Published in Speaker 2 (7:18) a peer-reviewed journal. And I wish you had heard of it. And I'm not blaming you for not hearing about it. But I'm... blaming the emphasis in our modern Western world to really offload the agency of our brain's destiny to a hope that a drug is developed. It's, I hate to say it's wrong. I sound so aggressive when I do that. No, be aggressive. But my dad died of Alzheimer's. And had there been a drug, would I have been written the prescription for him? You bet I would have. I mean, his nursing home was, I could see his window from my examining rooms in my office. That's how close my situation was with his progressive downhill decline every single day. And Speaker 1 (8:00) so having said Speaker 2 (8:01) that, would I use the drug? I absolutely would have. Speaker 1 (8:04) What was drug Speaker 2 (8:04) called, though, again? Well, there was no, there is no drug. There was no drug. The drugs I'm Speaker 1 (8:09) talking Speaker 2 (8:09) about right now. Is lifestyle. Well, yeah. The drug is lifestyle. Yeah, Speaker 1 (8:13) the Speaker 2 (8:13) drug is lifestyle right now. And you cannot Speaker 1 (8:15) patent that. It's not a billion dollar blockbuster. You cannot patent that. This is what I know. But with your dad, though, you said that there was no there was no pretend there was no no drug or at that point. Speaker 2 (8:25) Nor Speaker 1 (8:25) is there now. Right. There are these random drugs, but they have bad side effects. My mother was on one for a little bit. They took her off of it. It wasn't doing anything. Speaker 2 (8:34) Well, here's the news. If they would do something, I would have a different conversation with you, Jen, right this minute. But here's what a recent Cochrane analysis revealed. This is the. most highly regarded gold standard way of answering a medical question. Here is the two-part question. Part one, does it work? Part two, is it threatening? Is there side effects? Right. Are there? And here's what the Cochrane analysis of 20,342 individuals in 17 studies, 18 months each study revealed, just published. Number one. The threat of using these drugs is about 25 % of people will have brain hemorrhages, brain swelling, or possibly even die. What about the benefit? The word they used was trivial. So the drugs don't work and they're really risky. And that's very likely what they put your relative on and why they stopped it because likely she was beginning to have side effects. And so... You know, it's not that your guest is really, as we talked about earlier, iconoclastic. You had a different word for it. What? Speaker 1 (9:39) Irreverent. Irreverent. Yeah. Speaker 2 (9:41) And I am, I guess. And I'm irreverent because I see, you know, my mission is above all, do no harm. And that's doing harm. And I will speak out about it. I talk about it in the book. Speaker 1 (9:52) Yeah. And Speaker 2 (9:52) that was before this Cochrane analysis. That just came out to be supportive of what I'm contending in this book. And I'm certainly not anti-drug. We talk about. the potential of GLP-1 ozempic-like drugs to treat Alzheimer's. I was going to ask you about that. Am I open for that? Speaker 1 (10:09) You bet. Speaker 2 (10:10) Inflammation and metabolism. That story hasn't been fully written yet. And we're waiting for it. We can double-click on that at some point and really go do it. Well, I want to ask you about Speaker 1 (10:19) that now because they're saying even for people, there's a couple of things. So you do talk about the fact in the book, in this book, and you've said it many times, that Alzheimer's is not genetic. Speaker 2 (10:30) Right? There's like... By and large, it is not genetic. Are there some genetic predispositions that an individual can have to increase her or his risk? Yes, there are. We know that carrying, for example, a variation in a gene called APOE4 is associated with increased risk. Either if you have one of those alleles, five times risk, or two of the alleles, in other words, APOE44, that your risk may be 10 to 12 times increased compared to others who don't carry it. There are other genes. There are about 60 different genes that play a role. But by and large, important message here, here's the soundbite, Alzheimer's should not be considered a genetic disease. It's a disease related to lifestyle choices that is very empowering because we can make better choices and reduce our risk. Genes load the gun. Lifestyle pulls the trigger. Speaker 1 (11:26) Just to keep on this for one second, and we won't need to drone on and on about my mom, okay? But this is why I thought this was a very pertinent thing to talk about. Because you don't know my mom. You never knew my mom. You don't know her. So she's also in the medical field, interestingly enough. She did everything right. Her blood sugar was completely intact. She worked out every day. Physically, even to this day, she's not on any medication except vitamin D. Physically, top notch. But her brain... still decline. Now, this happened because when COVID started, she was extremely isolated and extremely lonely because she had a lot of anxiety around going to see people. To me, what that tells me is loneliness, isolation is probably predominantly more imperative or more of a trigger than, let's say, even exercise or nutrition. What'd you say to that? Speaker 2 (12:26) I think it's incredibly underrated. And when we talk about the dramatic increased risk of Alzheimer's as a consequence of COVID, a lot of the discussion, at least in the medical science field, is what does the virus do? Does the virus increase inflammation? Yes, we know that there's a virus affect mitochondrial function in brain cells and the brain immune cells, the microglia, the subject of this book. Absolutely it does. But you bring up an incredibly fundamental point that for a period of time, it may have been more than a year, your mother had a higher level of stress as many of us did. And isolation. And isolation is a huge event, especially as it continues as it relates to brain health. Why? The downside of isolation is increased stress and therefore increased cortisol. threatening to the brain's memory center, the hippocampus, threatening to the microbiome, the gut bacteria, and therefore increases inflammation that can shift the brain's immune cells away from being supportive to being destructive. The other thing, though, is when we are isolated, we're not experiencing love as much. We're not in contact with individuals that we share love with. And why could that be relevant in what we're having, I consider, a scientific conversation? And I wondered about that for a long time. When we looked at, for example, the blue zone, people have a lot of social connectivity, a lot of involvement in their communities, and have a dramatic risk reduction for Alzheimer's, heart disease, various forms of cancers, and other degenerative issues. But why? Why Alzheimer's? What's the connection between connection and reduced risk? Speaker 1 (14:06) And Speaker 2 (14:06) many things are at play. Cortisol lower, we know that. But here's something I found really fascinating. The book focuses on the shift of the brain's immune cells from being normally wonderfully supportive to help the brain remain resistant to decline, shifting to a situation where our brain immune cells basically turn their backs on us. They become what I call in the book, the evil twin. A powerful way of keeping them supportive and loving and nurturing is to stimulate these cells. called the M2 supportive immune cells. And one of the powerful stimulants to keep them in their supportive mode is a chemical called oxytocin, a hormone called oxytocin, the love hormone that increases when we have relationships with people. Your mom's isolation for whatever length of time that was reduced her oxytocin and at the same time increased her cortisol and the brain. has significant experience with that. It bodes for a brain to be less able to resist decline. Now, you told me your mother's blood sugar was intact, that she exercised quite frequently, did all of the things. What Brain Defenders does is, through the lens of the brain's immune cells, looks at those things and so many others that influence whether those brain cells are going to be supportive. Or they will turn their backs on us and pave the way for the brain to decline. Speaker 1 (15:35) Because you keep on, you mention a lot in the book, what was it called again? The immune cell, micro... Microglia. Microglia. I've never heard that before. And you are going to hear about it left, right, and center moving forward. See, that's because you also, in another book, you talked about uric acid was the other one. Uric acid. Uric acid. I mean, so these are things that are not very usual, right? You hear about strength training. You hear about... loneliness. You hear about, you know, even now, I know you wrote the book, Grain Brain, but like, you know, no process, ultra processed food. But these are, those are the two things that really kind of stood out to me. Can you talk a little bit about what an immune, what immune cells are? You are Canadian. Can I talk about, Speaker 2 (16:20) you got me on the about, Speaker 1 (16:22) there you go. Yeah, sure. Speaker 2 (16:23) I can do that. Yes. His wife's Canadian. So, and I have my, okay. And you're Canadian. Yeah. So, It's a new paradigm in Speaker 1 (16:32) neuroscience, and it's exciting because... How'd you even get to it? After all these years of writing about it, all of Speaker 2 (16:38) a Speaker 1 (16:38) sudden... I Speaker 2 (16:38) didn't Speaker 1 (16:38) write about Speaker 2 (16:38) it for all these years. No, no. I'm saying you've been writing Speaker 1 (16:40) about all of this neurology stuff for years and years, and now all of a sudden we hear about it? And Speaker 2 (16:45) what is so exciting, Jennifer, is that everything I've written about, whether it's the relationship of the gut to the brain and the microbiome, grain-brain talking about gluten and talking about... High refined carbohydrate diets, uric acid and drop acid, how that threatens our metabolism. Everything converges on the brain's immune cells. Finally, everything I've studied and written about and lectured about for 40 years has converged on the brain's immune cells. That's the upstream event in everything I've been interested in. But Speaker 1 (17:17) what took Speaker 2 (17:17) so long? What took Speaker 1 (17:17) 40 years? Speaker 2 (17:18) I think we didn't recognize... that the immune cells in the brain, the microglia cells, through such a wide net and were upstream of all of these mechanisms. And it's just come to light, really, mostly in the past five years. I've been talking about the microglia for decades, but we didn't really understand how they could change. From being supportive to being destructive. Speaker 1 (17:39) Right. So let's talk about that. So explain what the microglia is and how it can go from being supportive to being destructive. And Speaker 2 (17:48) that's the take-home message of our time together today because we can control it. Yes. Understand first that this is the upstream mechanism that underpins Alzheimer's and Parkinson's and MS and issues related to long COVID, PTSD, even major depression. All of these issues are fundamentally related to the change in the microglia cells from nurturing our synapses, nurturing our neurons and blood-brain barrier, to suddenly shifting and becoming the evil twin, destroying the synapses, actually gobbling up the connection of one brain cell to the next, setting up an environment in the brain that leads to the neurons falling apart and leading the blood-brain barrier, which we depend upon to keep them. The brain, you know, excluded from certain things leads to that breakdown, just like the gut barrier. We have a very important barrier in the brain that needs to be maintained. So many things can threaten to cause these cells to turn their backs on us. Elevated blood sugar, changes in our proteins because they bind to blood sugar, like hemoglobin A1c. Increased inflammation anywhere in the body makes its way to the brain. It sends a signal to these cells to shift and become destructive. Think about that. Where can that inflammation come from? A leaky gut. So your diet, whether it's supportive of your microbiome or not, through this mechanism of a leaky gut, can increase inflammation, tells these microglial cells. We're going to destroy your brain just because the gut changed, because you took antacids or overused antibiotics or other types of drugs, non-steroid anti-inflammatory drugs like ibuprofen. Speaker 1 (19:34) Okay, so let's start with the idea of this. So is there a test or a way that people can even know how healthy their microglia, I can never pronounce it, micro... Speaker 2 (19:45) glia Speaker 1 (19:45) cells are. Is there some type of blood test for us to know where we are in terms of health? Speaker 2 (19:53) Absolutely. One thing you can do is look at your calendar and ask yourself how old you are. 29. Speaker 1 (20:00) There Speaker 2 (20:00) you go. Because microglia shift more aggressively the older we get. Speaker 1 (20:05) Okay. Speaker 2 (20:06) So that's a very powerful metric. The next thing you could do is- What Speaker 1 (20:09) age do we start shifting it? It Speaker 2 (20:10) happens earlier than you think. It happens around 50. Speaker 1 (20:14) Okay. Speaker 2 (20:15) Aggressively, but it happens in our 40s as well. Okay. It brings me to a very interesting point, and that is the paradigm under which we live right now related to brain degeneration is one that would say, wait until you become cognitively impaired. Think about your mother's experience and your experience with your mother. Nobody paid any attention to her brain until suddenly she started complaining about things and went to the doctor to say, hey. No, that was Speaker 1 (20:42) just because she got very confused. But yes, until someone else recognized it. That's very, very typical. But Speaker 2 (20:48) why do we wait until then? May I ask how old your mother is? Well, now Speaker 1 (20:52) she's 83. But Speaker 2 (20:53) when did those issues begin? Speaker 1 (20:55) It started, honestly, like only a year and a half ago, two years ago. Speaker 2 (20:58) 81 or 80. Yeah. Speaker 1 (21:00) Is that normal? Is that a normal age for this? Speaker 2 (21:02) My point is those issues began in the 40s and 50s. That's when the seeds are sown. So your audience needs to hear this, that the metabolic issues that will threaten your brain and presage the cognitive issues begin decades ahead of time. See, Speaker 1 (21:20) I did hear you talk about that, that that's been out there. But then what are the signs? Because you know when people, we all kind of... joke around like, oh, you know, like I'm in menopause, I'm in perimenopause. Oh, I have got like, you know, like I've got the people think that when they're forgetful or confused or just kind of just mindless, it's like their situation or circumstance. It's not necessarily that. So how do you, how do you distinguish between if it's like decline of your cognitive? functions or just circumstance? Yeah. Speaker 2 (21:55) Let's get back to, I think, the original question. Where do we get the sense that we're already setting the stage for brain decline? Your blood sugar starts to elevate. Your fasting insulin level goes up. Speaker 1 (22:06) You're Speaker 2 (22:06) working too much that you can't get exercise. You have fragmented sleep. You're looking at your Apple Watch or your Oura Ring and you're seeing that you're not getting enough deep sleep. You are isolated. You're not spending time in nature. Your waist to hip ratio is increasing by a very sophisticated piece of machinery called a measuring tape. I mean, these are powerful indicators that your microglial cells are shifting. You Speaker 1 (22:31) know, I'm noticing you're not wearing an Apple watch, an Oura ring, a whoop, none of it. You're right. And is that by design? Speaker 2 (22:39) No, because I do. Oh, you do? And Speaker 1 (22:42) I do Speaker 2 (22:42) wear a continuous glucose monitor. You do. But you're wearing a Speaker 1 (22:44) suit, so I can't see that part. Oh, I'm not wearing it right now. Okay. Speaker 2 (22:47) But I do these things not all the time. You know, there's been some commentary that, well, can we get a little neurotic about it? And I find it's a little bit stressful for me. But I do want to know. So I wear my, I use an Oura ring. I do it, you know, for several weeks at a time every month or two. Same thing with CGMs. I have, you know, boxes of them at home. I work with Levels Health, so I get as many as Speaker 1 (23:11) I Speaker 2 (23:11) want. But here's the point. I mean, this continuous glucose monitor is powerfully informative for you, Jennifer, as an individual. What is your blood sugar doing in relation to the foods that you choose to eat in your relationship to your level of exercise, quality of sleep, relationships, time in nature, et cetera? You wouldn't know that if you don't measure. So you've got to measure. And you can buy a CGM at Costco without a prescription. How wonderful is that? You know, it wasn't that long ago that there was an editorial in Journal of the American Medical Association saying, oh, there's a trend that people who are non-diabetic are wanting to get CGMs to learn about their blood sugar. And the comment was in the editorial, we shouldn't allow that because people are going to become neurotic about their blood sugar. With that logic, we shouldn't allow people to buy bathroom scales because they'll wonder what their body weight is. No, we should. have the option of knowing these metrics. Right. And taking the ownership Speaker 1 (24:11) in our own hands, right? And having informed, like having informed information. Speaker 2 (24:15) That's my mission in life. Yeah. Is giving people stewardship over their brain's destiny. Right now in America, we offload that stewardship to pharmaceutical companies with the hope that we can live our lives however we want and there'll be a... magic drug to fix the problem. That situation is non-existent right now. I mentioned before, would I be supportive? You bet I would be. Speaker 1 (24:39) That's Speaker 2 (24:40) my job. And I will put that drug in my toolbox, but we don't have it yet. Speaker 1 (24:45) So, okay. So let's just stay on this for the, because you're like, but that's a very, very good point. Like you're, if someone is concerned about a lot of these, you know, diseases that can happen in the 70s, 80s. It starts 40, 30 years before that. And when you're confused between if it's just like circumstance, like whatever, perimenopause, children, stress, work, whatever it is that you're, and or if it's something larger, some of the metrics are to check your blood. blood sugar levels. What was that? The one that says check your hip... Waist-to-hip ratio, your fasting Speaker 2 (25:21) insulin level, your A1C. And I think beginning at age 50, a little bit more sophisticated testing, one called P-tau-217, very predictive of Alzheimer's. And I didn't know that when I submitted the manuscript for this book just several months ago, because that study came out three weeks ago in the Journal of the American Medical Association. saying that this p-tal-217 that we used previously as a diagnostic for somebody who's having cognitive decline to determine is it Alzheimer's is now demonstrated to be predictive in terms of who's going to get it. So that would be a great test to have. I just had mine done. Speaker 1 (26:01) Where did people get that test? Any lab Speaker 2 (26:03) could do it, and you don't need a prescription. Walk into a Quest and say, I want a p-tal-217. They'll sit you down in the chair and they'll draw it. Speaker 1 (26:10) Really? Speaker 2 (26:11) You bet. Speaker 1 (26:11) I think this is also, you know, Dr. Dale Bredesen? Is that? Speaker 2 (26:14) Bredesen. Bredesen. Very, very well. Speaker 1 (26:16) Right. Okay. He was on here a while ago. I think he mentioned that test actually, or a form. Is there another version or a form of that? No, He taught 217. That's the one? Speaker 2 (26:25) There are others that he talks about, GFAP, neurofilament light. Those are ones that he's very fond of, but he's correct. And the other thing that Dr. Bredesen talks about. is he believes that once we reach a certain age, like 60 or 65, that we should have annual evaluations of our cognitive function. He calls it a cognoscopy. Yeah, I love that. How would we do that? You can do them online now. In fact, he has web-based tools that allow you. We talk about him in the book. In fact, I feature him in the book, some of his case reports. And, you know, I so honor his work. And he is, you know, he takes a lot of criticism and wrongly, I believe, because he is a trailblazer. One of his recent books I wrote the foreword to, and I talked about him in terms of a Nobel Prize, because not only the work that he's doing, but the idea that he challenged the idea of. Modern science looking at one variable to test something, like a drug or a single intervention. As you know, his approach to dealing with Alzheimer's brings in multiple inroads. Diet, nutrition, exercise, identification of toxins, for example, and even heavy metals. All the things he talks about. And that is absolutely breaking the mold. And I'm grateful that he's done that. Because now we see new studies coming out where people are doing multiple things at one time and seeing great results and reversing Alzheimer's disease. Yes, it is happening right now without drugs. Speaker 1 (28:02) I mean, how old