Why You Desperately Need Carbs – Dr. David Perlmutter #553

Why You Desperately Need Carbs – Dr. David Perlmutter #553

August 13, 2019 0 By William Morgan


(electronic music) – Bulletproof Radio, a
state of high performance. – You’re listening to Bulletproof
Radio with Dave Asprey. Today’s cool fact of the day is that the Industrial Revolution
changed more than 10,000 years of human grain consumption. In the 1870s, we invented
the modern steel roller mill, which completely changed
how we milled grain. Compared to the old stone methods, it was really fast and efficient, it gave you really fine control over different parts of the kernel. So instead of just
mashing it all together, you could separate the
parts, allowing the purest and finest of white flour to
come out at a very low cost, and that meant that people with almost, the very lowest levels of income could still afford the fancy flour. And the good thing about white flour is well, it ships better, stores better, allows for a long distribution chain, in fact you could keep it almost forever ’cause it seems like
nothing wants to eat it except for humans, and we now know that it’s ’cause it was
stripped of nutrients and pest problems were less of an issue ’cause well, bugs and
rodents didn’t wanna eat it. The problem was that well, grains, even if they’re not treated that way are not particularly good for humans because before the Industrial Revolution we had the Agricultural Revolution, which is when humans
dropped oh, a foot in height in some places and we
started getting cavities and other degenerative
diseases we didn’t have before. And there’s really good
science to help explain why that happened. And so yeah, pizza and
croissants taste good, doesn’t mean you need to
make them out of grains. There are other ways to do it, and if you wanna continue
eating those things, well, to put it really bluntly, you’ll probably die sooner
from something painful than if you choose not to do that, and you’ll probably not like
the quality of your life as much as you would if
you made better choices. I wish it wasn’t so; however,
that’s what the science that I’m aware of says both
from my own extensive research and self-experimenting and
from having the opportunity to interview some of the
world’s smartest and best and most impactful people out
there on Bulletproof Radio. And I’m really pleased
to have a dear friend, just a fantastic human being,
a guy with a crazy amount of education and experience
across different fields of medicine, a famous author,
and someone who I featured in “Game Changers” on the show again. I’m talking about none other
than Dr. David Perlmutter, author of “Grain Brain”. I think you’re also the author of four other New York Times Bestsellers. And a practicing neurologist and well, just an overall fantastic guy. David, welcome to the show, man. That was the best I could do for you, but it still wasn’t adequate. – Oh my gosh, it’s an honor. And you know, your listeners need to know that right back at ya. We both do podcasts, we both
interview a lot of people, but you and I have had
the, just the great fortune of taking it a step further and spending some really quality time together, family time together,
and it really has been very, very meaningful
for us, that’s for sure. – Well, it’s inspiring for me, and going way off what I
was planning to talk about, but when I first got going on Bulletproof and Bulletproof Radio and all, you see these authors
kinda up in the clouds. You know, they write these books and you read these books
and you’re sorta like, what kind of people are they, right? And then eventually with
the work that I’m doing, I got a chance to meet you and you know? There are a lot of people who
don’t have to write books, and they write books
because they’ve studied this for many years and because
they think it matters, and they just go around
generally doing good work and helping people with an
attitude that’s amazing, and you’re one of the, probably the most giving guys I’ve met. Just every time I’ve seen
you interact with someone, whoever they are, you’re
just like, how can I help? So that’s something that’s hard to see if you read your books or if
you just look at you from afar, but just having gotten to know you, this is a hallmark of people
who succeed really well and it’s one of the things that came out from looking what 500 people do. It’s the people who learn how to be happy tend to be more successful, and everything I know about you says that you figured out how to do that and that that’s powered
some of what you do. True statement? – Um, yeah. I mean, I am eternally grateful
every moment of my life for just the life that I’ve had the opportunity to live so far. I mean, the family that
I have been gifted, the people I’ve gotten to know. I, maybe it’s rose-colored glasses, I see things as being
just extremely positive. I am a realist, I see
what’s going on around us, but you know, I have complete
faith in us as a species and in our ability to do the right things and move things in the right direction despite temporary
setbacks, and I think it is more along the lines of being
an investor and not a trader. I’m looking at where we’re
going in the long run and I think the slope is
exactly where we need it to be. Are there setbacks along the way? You bet there are, but this
is looking at the climate as opposed to looking at
the day to day weather, and we know, and that’s not
necessarily a positive thing, or not necessarily the best metaphor, but it again just speaks to
the long view that I take in a very positive way. And I’ve always said that today
is the best day of my life, the reason being is that
it builds on yesterday. And yesterday, until today,
was the best day of my life, and the good things are cumulative. The bad things do not
enter into that equation, so therefore today has to be
the best day of your life. If one tiny thing was good that happened, then it moves the ball
a little bit further. So that’s the attitude I take. – Well it shows, and part of the reason that I put all the, it
was about 8,000 hours, into “Game Changers” was
to understand the mindset as one of the many things that people who’ve had a big impact do. And when I say you’ve had a big impact, you’ve won the Linus Pauling Award for treating neurological
disorders in a new way. I mean, you’ve spoken at the World Bank, you’re now an author as
a top expert in the field of the emerging science of
microbiome and the brain, and it’s just kinda this amazing list of accomplishments throughout your career in diverse fields, which are profound. And one of them is your
book, “Grain Brain”, really helped people see
that it’s not just a bunch of cavemen or hippies saying don’t eat grain, and I have no problem
with cavemen or hippies or cavemen hippies for that matter, but if you wanna get people who aren’t doing lots of
research to make a change, well here, I’m a highly
credentialed neurologist, and here’s the hard science
and it’s accessible. So “Grain Brain” really helped
to change the conversation, to make it normal to
go restaurants and say don’t put gluten in that and they actually know what gluten is. But you just rewrote the entire book five years after it came
out, from the ground up. – We did. We really did, and it
was, it was as much effort as went into the first
book, but I will tell you, with this time around,
there was so much enthusiasm in the project I think that was engendered because of the degree and level of science that has come in the past five years that has been so supportive and validating of our original, very much
disruptive contention. So we were talking about gluten and sugar and carbohydrates as being toxins with reference to the brain at a time, this was long ago, this
is ancient history, five years ago, when there
was plenty of pushback. Though the science at
that time was burgeoning, the original book was
written based mostly, no I’d say to a significant degree what brought it about at least was clinical experience
in dealing with patients then finding the supportive science. But as you well know,
in the past five years the science surrounding
lower carbohydrate, dare I say even to the
extent of ketogenesis, as well as the more
recent science on gluten and non-celiac gluten sensitivity,
we’ll talk about that, has really been so
extensive, so validating, and so it’s great to have
now gotten so much support. And you know, this book, “Grain
Brain”, has been translated into 34 languages around the world. I saw one of my books this morning, somebody sent me an
Instagram picture of it on a TV show in Turkey, and it’s just, these are people I will never see, never personally
experience as a clinician, but yet to think that somebody on the other side of the world is gonna get a simple
message, and that is that hey, this aberrant diet that we
feel is appropriate for humans, a diet quite unlike anything
we’ve experienced in 99.6% of our time walking this planet, that we really need to consider that this is a threat directly in terms of the provision of macronutrients
like carbohydrates directly threatening to our health, and also secondarily
threatening to our health in that this is a diet that’s sending really bad signals to our genome, which then expresses genes
that enhance inflammation, that degrade our antioxidant
quenching ability, that compromise our ability to detoxify the very toxins that are now
a part of our environment when we desperately need to amp up our detoxification system. So, I think the one experiment, the one research project I think that really I leverage the most in terms of validating
these recommendations is a study that’s been going
on for two million years. It is called the human being, and it’s demonstrated that you bet a diet lower in carbs,
higher in healthful fat, a diet that gives us lots
of good nutrient fiber, has kept us going for two million years. And suddenly, what did we
learn in the past few days? We learned that for
the first time at least in recent history that life expectancy for men and women in the United States has not only plateaued, but
has now begun to decline. We haven’t changed genetically. We certainly have changed
the epigenetic signaling that we are now engaged with. So now more than ever,
I think we’ve got this robust data that says,
suddenly take a deep breath. What has changed and what
can we do to make it right? – It’s interesting that you
talk about carbohydrates because in “Game Changers”, where I summarize all this knowledge, one of the 46 laws of high performance is feed the little bastards in your gut. And you’re one of several
experts I cite in that, like this is what the people
who are performing really well actually do, and I wrote the law that says the bacteria in your
gut control a lot more than you might imagine. They have the power to make
you fat, tired, and slow, to give you extra energy,
to tap into new power, or even to make you depressed. They’re in the driver’s seat,
and if you treat them poorly, your performance will suffer. When you treat them well, they serve you. Learn how to make them do your bidding. But they eat, at least
primarily, carbohydrates in the form of fiber. – Correct. – Because fiber is a carb,
and I’m a little concerned. I’ve seen, I’ve even
experimented with something very close to the carnivore diet where people are eating only eat, or you get what I would
like to call the keto bros, where well if it’s not a
carb, I’ll just eat it. So I’m having pork rinds,
bacon, and you know, that’s it for the rest of my life. And is there some carbohydrate confusion? – Oh, without a doubt. – Walk me through that. – Yeah, I’d be delighted to. And it’s, I think that,
I’d like your listeners to really tune in, ’cause I think I don’t know where we’re going
later in our time together, but this is very important. And indeed it is carbohydrate confusion because we desperately,
desperately need carbs. So many people adopt a ketogenic program and totally abandon
their carbohydrate intake and what happens? They feel crappy, they become constipated, they get brain fog, they don’t sleep well, they’re agitated, and it’s all because they fail to understand that we have to be quite specific when we
talk about carbohydrates, that we are desperately in
need of fiber in the diet, which is by definition
a complex carbohydrate that we don’t metabolize but is yet metabolized by our gut bacteria. When we throw that baby
out with the bathwater, we set the stage for not
nurturing what you mentioned, these hundred billion
organisms that live within us that really depend on your food choices, a hundred trillion, depend
on your food choices to nurture them to allow
you to not just be healthy but be healthier, to be able to combat risk of illness moving forward, in other words, preventive programs. So if you want to make it more simple, then perhaps if you talk about the notion of net carbohydrates, which is fiber minus these simple carbohydrates and minus sugar alcohols for example. So we want to understand
that we do need fiber. We’ve eaten fiber and in fact, looking back at our ancestors, they ate a heck of a lot of fiber, as much of 100 to 120
grams of fiber a day, and had many bowel movements a day and nurtured their gut bacteria. So it’s a huge mistake, and if that helps to unwind or unpack this notion of carbohydrate confusion,
I’m really happy because again, we want people
to eat a lot of good fat, a lot of good fiber, not a lot of protein. In fact, this recommendation
that we’re making is absolutely not an Atkins redux. We don’t want you sucking down pork rinds and meat all day long. I mean, the China study, Dr. Campbell drew a correlation between
red meat consumption and risk for colorectal cancer. And as a matter of fact,
does Dr. Perlmutter agree with that? You bet I do. Why? Because first of all,
there are some downsides to taking in too much
protein with reference to certain biochemical pathways, activation of mTOR for example,
ultimately leading to– – You’re talking about too much cystine, too much methionine, the amino acids that come from eating too much protein? – Exactly right. – They cause aging basically, right. – Correct, and turn on
cell signaling pathways that are disruptive. But beyond that, the data that is utilized for these studies
involves dietary analysis with a question on the dietary, a question they’re asking simply, how often do you eat red meat?
How much red meat do you eat? So that they’re ultimately
able to categorize people into eating high
amounts of red meat versus low. Now red meat, by and
large, is one of the most dangerous foods on the planet. And by that I mean the
factory farmed red meat that typifies the type of red meat that people generally consume. If you’re consuming a food
that comes from an animal that’s been antibiotic exposed, that’s been fed glyphosate-rich grains, and has been stressed
throughout its existence, you’re gonna, there’s no
alchemy that occurs here. You’re gonna create a food product that is absolutely
threatening to your health. On the other hand, if you
choose to be omnivorous, and choose to eat some
red meat on occasion, then it must be grass-fed
beef or other type of meat, you know, really emulating
how these animals did live prior to this industrialization
of our food supply. So by and large though, I would indicate that the more plant-based is your diet, the better off you will be. If you choose to have
a garnish of red meat, then it should fulfill the
criteria I just proposed. Wild fish as well, some
free range chicken. Eggs I think are a really
handy food and a really– – But those don’t sound
plant-based though. – No they’re not, I’m just saying. – It scares me when people say
the more plant-based you are ’cause that drives you to become a vegan, and I can tell you I know
very few longterm vegans who are even average health. I mean, it’s exceptionally rare. So was that a plug for veganism? – No, not at all. I said by and large, the
diet should be plant-based. And again– – Mostly plants, but it
doesn’t mean all plant-based, and it’s that nuance where
I think people get stuck. – Absolutely. – And by the way, I’m in
alignment with you here. I think red meat can be great for you. You eat a couple ounces of it, you never eat industrial meat, it never has antibiotics in it, and if you do that and you
take care of your gut bacteria, you don’t have the gut
bacteria that make TMAO, which is a compound that causes all of the risk factors, at
least most of them I would say, from these studies of red meat. And I’ve had my gut bacteria tested. Guess what? I don’t have
anything that makes TMAO ’cause I don’t eat
antibiotic-tainted meat. So there’s nuances. There’s also what kind of cut? Are you doing collagen from red meat, which has a different effect ’cause it doesn’t have
all these amino acids. So it’s such a complex thing,
but I just wanted to make sure that unless you were meaning to do it that people didn’t say oh if
mostly plant-based is good, therefore only plant-based is better. That has been my experience. – I am so glad that you’re holding my feet to the fire on this,
because we don’t want people to get the wrong idea,
and I would agree with you that by and large without
certain important caveats, that people, vegans can get into trouble with low levels of certain things, vitamin D, vitamin B12, even not getting adequate levels of dietary fat. – Yeah. – Who knew? I mean, who knew
this was going to be an area of actual importance? And that said, overdoing the
meat side of this equation at multiple levels, not
just the antibiotics but as you well mentioned,
the conversion of TMA into TMAO when a diet is rich
in choline and carnitine. We see even higher levels of
trimethylamine oxide, TMAO, even in the spinal fluid. So this becomes not just
a cardiovascular event, increasing inflammatory changes within the coronary arteries,
but it becomes an event with reference to the brain as well. So there are multiple levels upon which we can discuss these dietary nuances directly in terms of the
macronutrients and micronutrients, but the second order, which really I think should probably be the first order, would be how these things are viewed through the lens of the gut organisms. And there are so many things to consider. I mean, I mentioned
detoxification earlier. Our frontline of detox
is the detox that happens as one of the tasks that our gut bacteria lovingly do for us day in and day out, which we certainly need these
days in our very toxic world. We know that these gut bacteria are producing various metabolic products, the short chain fatty acids that have effects throughout the body and even vitamins, some of the B vitamins. We’re learning form my
perspective as a brain specialist, that the gut bacteria
actually are playing a role in the production of this
really important chemical called brain-derived neurotrophic factor. We’ll probably touch on that later, but important for making
connections in your brain. we call that neuroplasticity, for growing new brain cells,
which I still am not over. I mean I still, it takes my breath away, from the old school where I came that we didn’t believe that could happen. So there are many things,
not the least of which, and perhaps certainly
towards the top of the list would be the very important role that our gut bacteria are playing in affecting the setpoint of
inflammation in the human body. They do so in that they are in charge of maintaining the gut lining, where we wanna have a gut lining that is patent or intact or has integrity. When dietary issues, food
issues, toxic issues, et cetera threaten the integrity of our gut lining, we enhance through some mechanisms that we may or may not
have time to talk about, we enhance inflammation in the body. Why is that a big deal? It’s a big deal because
we correlate higher levels of things that we measure
that relate to inflammation with just about every chronic bad thing that you don’t wanna have. Whether it’s coronary artery disease or it’s Alzheimer’s or Parkinson’s, yes, the truth of the matter is there are higher markers
of inflammatory mediators in the bodies of autistic individuals. Certainly diabetes is
inflammatory and even cancer. So our main mission here is
to keep inflammation at bay, and that is what happens when we are good to our gut bacteria. And I think it’s really
interesting to consider a study that was published in the
highly respected journal Neurology, back in 2017. That is the journal that’s
put out by the board that says you’re a
board-certified neurologist. It’s really the go-to neurology journal. And it was an interesting
study that looked at 1,600 individuals and
evaluated these people many years ago in their
30s and in their 40s and did some blood work on them measuring markers of inflammation. And these were inflammatory
markers back then, which we don’t really use these days, but fibrinogen count,
von Willebrand’s factor, if anybody’s interested,
total white blood cell count, we use different ones
today, C-reactive protein, TNF-alpha, but anyway. – By the way, those are
in “The Bulletproof Diet”, those are in “Head Strong”,
those are the core lab tests for inflammation ’cause it doesn’t matter where you’re getting the inflammation. If you got it, you gotta fix it, and then you start solving it. – You bet. – So anyway, thanks for repeating those. I’d love to have those in every show. – But here is what this
amazing study revealed. So they look at this group of 1,600 people in their 30s and their
40s and they follow them for 24 years, this ongoing study. You know, the researchers dedicated and probably passed the
torch a couple times. 24 years later there is
a perfect correlation between the level 24 years ago of these inflammatory markers
and decline in brain volume and even episodic memory today. In other words, they look at a
group of people 24 years ago, those who had the highest level of these inflammatory markers
in their 30s and their 40s today have the worst
memory and shrunken brains. The point is A, it really
correlates the importance of inflammation as a mechanism, but B, it also reinforces the notion that we’ve gotta pay attention to these recommendations and ideas long before we are threatened, or seemingly threatened, by them. You know, as a neurologist,
I deal with people who begin to have memory issues
and they’re 60, they’re 70, and in their 80s, and by then, this is a process that’s been going on for three or four decades. So the message here,
the take home message, and in fact, I did talk
about this at the World Bank, is that we’ve gotta target
younger and younger audiences in terms of the longterm message
to keep your brain healthy. Alzheimer’s is a dialogue that happens between doctors and individuals
once it’s started raining. And John Kennedy, why I use the metaphor, is he told us in his inaugural address that the time to fix the roof
is when the sun is shining. So now that makes sense. So I’m not gonna say
it’s in your 30s and 40s you need to start paying
attention to this, I’m gonna say it’s in your adolescence, when we’re now seeing massive
increases in type two diabetes and obesity and overweight. I’m gonna say it’s in childhood. I’m even going to go even a step further saying that it is during pregnancy, that choices a mother makes
will have outcome markers in terms of that adult. How do I come to say that? I will say that based upon our
understanding, for example, that women taking certain medications like proton pump
inhibitors and antibiotics have a significantly increased risk of having a child who will then go on to develop issues related
to immune function like type one diabetes and even obesity. Therefore, what mother
does during pregnancy has a role to play in the
risk of her son or daughter ultimately developing Alzheimer’s disease. And– – It’s real! – We’re now learning– – I just love it that you said that. My very first book was what do you do before and during pregnancy to have the healthiest, smartest child possible? Because that’s exactly it. What even your grandmother
ate has a huge impact. So this is multi-generational. But I wanted to ask you a question there, if you’re listening to this
and you’re saying well, I’m 20 and I’m inflamed right now and 24 years later I’m
gonna have a high risk of all this stuff, it
appears we can either fully or almost fully mitigate the problems of having inflammation when you’re young as long as you undo the inflammation. ‘Cause that’s been my own experience, my hippocampal volume is in
the 86th, 87th percentile for people my age, so
my brain didn’t shrink even though I was 300
pounds and screwed up and ate all the wrong
stuff and had inflammation everywhere you can
probably have inflammation. And I keep it under
control really dramatically and my brain works better
now than it did in my 20s. But do you think I’m still
going to pay the cost of we’ll say those years of hard living for the first quarter century of my life? – Well, I think that there is a debt and I think that you’ve
probably paid the debt back and then some, so I think you’ve
put money back in the bank based upon the things that
I know you’re doing now. So I think you’ve undone the damage and you’re ahead of the game. You’ve demonstrated that
through your voxel imagery of your hippocampus as you just mentioned, but those people who do not
do the work have great risk. And I’ll give you another– – There you go.
– So I hope you feel better. – Well and also, I know
people are listening, but you can start, you can change it. I was in, I was the
worst example, I think, of what you could get. ‘Cause I, the pre-diabetes, the high risk of stroke and heart attack,
the high inflammation markers across a whole bunch of different things, pretty much everything
bad on this list of aging other than maybe cancer. I didn’t have Alzheimer’s but
I had cognitive dysfunction. But just a really, really
not an autoimmune stuff. So if I can get to where I am, you probably weren’t as
far down the hole as I was, so it should take you
less work than it did me, but if you do the work,
you can get yourself to where you’re actually
younger than you were before, which is kinda cool. – Well, I mean you just came back from an anti-aging conference, and that’s exactly what we’re
talking about right now. And we’re talking about
reversing this stuff, reversing these declines, which
with reference to the brain, we never were schooled in,
we never thought the brain had a second chance, and that was the fundamental premise of “Grain Brain”, that you do get a second chance through this gift of
neurogenesis and neuroplasticity, and we spend so much time in the book talking about what you can
do to enhance that process. But you know, you mentioned years ago that you had a lot of extra body fat, and I think it’s very instructive to talk about a study that was published way back in 2008, ancient history, again in the journal Neurology, where they looked at a
group of individuals, and this was a much larger,
it was 6,580- something, 83 individuals, and similarly, they looked at these people
at the beginning of the study and then said check you later. We’re gonna see you in many years. They actually checked back with
these people 34 years later. And 34, 36 years later. The only study they did at
the beginning of the research was they measured their
sagittal abdominal diameter. Basically, how big is your belly, right? They took a group of individuals,
close to 7,000 people, how big is your belly, check you later, they checked back with
these people 36 years later and they found a perfect correlation between the size of your
belly three plus decades ago and risk for dementia. In comparing those who had the largest sagittal abdominal
diameter, biggest belly, versus those who had
the smallest diameter, the risk for dementia
was increased threefold. A threefold increased risk of dementia simply related to making the choice to having a bigger belly. It is not a cosmetic issue anymore that you got a big belly, and yet we tend, in media, to be normalizing this notion that being fat is okay. You know what? If you don’t care what you look like, that’s not what we’re talking about. I’m gonna ask you, do you care if you’re at risk for
dementia in 30 years? And maybe people don’t care about that because they’re placing their hope on the idea that there’s
a wonderful treatment for Alzheimer’s, and I would tell you that there is no such treatment, there is zero treatment for Alzheimer’s. There is no drug, Dave
Asprey, as you and I have this conversation right now, that has any meaningful
effect on that disease. And I wanna take this
a little bit further. Last month, the Journal of the
American Medical Association published a meta-analysis,
meaning a review of other studies, by a
researcher by the name of Richard Kennedy, and
his research looked at probably the best 10 studies that looked at the two major classes of
so-called Alzheimer’s drugs, the cholinesterase inhibitors, drugs like Aricept and
another drug called memantine marketed as the drug Namenda. And what he found was not
only do these drugs not work, but as published in the Journal of the American Medical Association, those people taking
these Alzheimer’s drugs actually declined much more quickly in terms of their cognitive function. I wanna tell you right now, I can barely, I can barely talk about that with you because think about
the literally millions, there are 5.4 million
Alzheimer’s patients in America, the millions of these individuals
who are taking these drugs and whose families put
their faith in these drugs because their doctor
wrote the prescription, and these drugs are
actually making them worse, it’d be like giving somebody
a blood pressure pill that raises their blood pressure or a treatment of diabetes
where your blood sugar goes up! – Or a diet soda that makes you obese? – Well that’s– – It seems like a
business model that works! – Yeah, but why– – It’s evil! – Why was this not on the front
page of the New York Times or why didn’t NBC News,
CBS, ABC cover this? CNN? This was published and put out by the American Medical Association that the very drugs that are
being given to these people, when I say given they’re
being sold to these people. Financially it’s an
issue and the heartbreak from my perspective, having
lost my father to Alzheimer’s, so I know what it’s like. But the notion that these
people put their faith in their doctors and in
the pharmaceutical industry and the very drug that they’re taking is causing mom, dad, husband, or wife to actually decline more quickly. We have to, you know,
that’s important news. So go to drperlmutter.com,
read the blog I wrote about it, and the full PDF is available there in the science section, the
learn section on my website. – You said something
profound in your new book, in the new “Grain Brain” that’s actually got the same title, but
it’s a very different book than your first version. And you said 90% of literature
peer-reviewed journals ever published about the human microbiome have been in the last five years. And that’s since you
published your last book. – Yeah. – So in addition to
talking about Alzheimer’s and inflammation, what, I
mean, this is incredible. And I mean, my really
big diet book was 2014, so that’s four years ago, so that’s 80% of this five year period. And so all of this new
gut bacteria comes out, I read a lot of literature,
probably not as much as you ’cause you just wrote a book about it, but what really stood out
as what’s different now than when you first
wrote the first edition of “Grain Brain”? – Well, it’s a very good question. I think that so many people have been so hard at it in terms of the research. We have some wonderful
leaders in the field, Dr. Rob Knight at UCSD for example, just putting out so much research that ties in the actions
of these gut bacteria with some really fundamental
processes that underlie whether we live or die,
whether we get cancer or not, whether we develop inflammation or autoimmune conditions or not. So I think in so many areas of medicine where we’ve been stymied
with lack of opportunities to really be impactful, we’re now learning that we have a brand new playing field that can be leveraged
to give us wonderful new empowering opportunities, and it is just beyond exciting to watch
the literature every day. There’s a wonderful online journal called Cell Host and Microbe,
actually that is available in print copy if you choose,
that on a weekly basis is just giving you these
wonderful new studies that are just incredible aha moments for those of us in the field. And for me, I like to portray it as that these new studies are
connecting dots for me. I mean, we’ve got a lot of
dots that have been connected, but there’s a couple of still, couple of funny pieces
to the jigsaw puzzle that we haven’t really found yet, but when you find that
piece and you drop it in and it fits, oh my gosh it
really adds to continuity. You can start to see the whole picture. Let me give you an example. There’s a researcher at the
University of Louisville, his name is Yun Teng, and Yun Teng again in this journal
Cell Host and Microbe recently published an article. It came out actually
when I was in Switzerland lecturing on this exact
topic a couple of months ago, and he noted or discovered
that plant cells that contain their own
genetic material, RNA, when we eat plants that
encapsulations of their RNA called microsomes or exosomes
once they leave the cell through digestion, that these exosomes of this genetic material
travel in the gut, bind to the cell membranes
of our gut bacteria, insert themselves into the gut bacteria, and make their way to the genetic material of our gut bacteria, and then influence the genetic expression of
the gut bacteria’s genome, causing at least three things to happen. Number one, changes in
the reproductive activity of that particular species
of bacteria, number one. Number two, changing
the metabolic products that that gut bacteria might make. And number three, actually
changing the location of these gut bacteria,
which is important when, as mentioned earlier, we need
some of our good gut bacteria to cluster around, especially
clostridial species, to make their way towards the gut lining where they can be at
work helping us maintain the integrity of that gut lining. But how incredible that we now understand that plants, yeah, we get prebiotic fiber and that’s good for our gut bacteria, but no, we are influencing
the genetic expression of the gut bacteria, and
make no mistake about it, that connects to another
dot that’s really important, and that is the dot that
we’ve already understood, whereby the genetic
expression of our gut bacteria influences our DNA, our genome. So this now connects
the plants that we eat to the expression of our DNA. Wow, those are two very important dots that are now connected, and I think that, as I say, what a very important piece of the jigsaw puzzle has
now been put in place. Beyond that, stay with me, and think about the notion, then, if the RNA, the genetics of the plants that we eat, is so important, influential
through the mechanism I just described, what
then should our level of concern be as it relates to the notion of genetically modifying
the plants that we eat? So, people have said well
there’s no real evidence that genetically modified food is creating a health issue for us, and plus, it’s going to allow us to feed the planet whereas otherwise, the
planet would starve. We can challenge that one on
multiple fronts, that notion, but that said, now that we understand that the genetic material of the plant does in fact influence
the genetic expression of our gut bacteria that plays a role in our DNA expression, then
you bet it’s time to take pause as it relates to modifying the
genome of plants that we eat, and look at it through a new lens in terms of the doctrine
of primum non nocere, above all, do no harm. – Very beautifully put. And there’s something else
that you came out with in your new version of “Grain Brain”, a study that I talked
about a lot on social media and I believe blogged about last year, and they looked at just
about all of the fatty plaque in people who have heart disease, and they found that it
doesn’t come from egg yolks, it doesn’t come from butter,
doesn’t from beef fat, it doesn’t even come from bacon, it comes from microbes in your gut. And I actually mentioned
this in a friendly discussion with a proponent of the vegan diet. He was saying you know,
meat causes heart disease, and the evidence is in. Gut bacteria are what’s
causing heart disease, ’cause if you eat meat and you
have the wrong gut bacteria, they make that TMAO stuff
we talked about earlier. And even if you don’t
have that TMAO stuff, even if you eat vegetables, if you have plaque in your arteries, it
was made by your gut bacteria. Do you believe that’s the case? I believe the study, it looked well done, there’s no way to argue with
the isotopes they’re looking at in this stuff, but
what’s your take on that? How real is it? It’s not the end-all cause,
but I think that again, it really speaks to this notion that the health vitality of our, and diversity, perhaps the
most operative word here, of our gut bacteria is massively important in determining our health destiny. And beyond that, we understand that it isn’t the quantity of certain fats or fat carriers, the lipoproteins
that is really the issue. Madison Avenue, somebody
came up with the notion of calling LDL bad cholesterol. And again, they get a great prize for that because everybody’s latched onto that. I wanna get my bad
cholesterol, since it’s bad, it should be as low as possible. And well, there must
be a good cholesterol. Oh yes there is, it’s HDL. A, they’re not cholesterol,
they’re proteins, B, they’re both really, really good. Yes, LDL is what transports
an important fat to your brain called cholesterol that
we desperately need. It does a great job. When you compromise LDL
you’re in big trouble. We know that LDL in terms
of its, how it’s modified, how it makes its way through
the brain vasculature for example, the blood
vessels within the brain, crossing what we call
the blood-brain barrier, when LDL has been damaged,
we see great relationships to mechanisms that underlie
significant brain degeneration. So let’s just first by
characterizing LDL as good and HDL as good, and that the issue, and let’s relate this
back to our gut bacteria for a moment, that becomes important is not the amount of LDL,
it’s good to have LDL to transport our fats, but
it’s the state in which we find our LDL, has it been damaged? Or has it not been damaged? And what do I mean by that? LDL is damaged in a couple of ways. It can be oxidized, in
other words the action of free radicals, and that
certainly is influenced dramatically by the foods we eat and how the foods influence the expression of our gut bacteria, whether
we’re on a ketogenic diet for example, whether we are
eating types of vegetables that enhance pathways to
increase our antioxidants like the Nrf2 pathway, i.e.,
why we want to eat broccoli and drink coffee and use turmeric
in our cooking, et cetera. But beyond that, another issue that is so influential in terms of our LDL is has it been glycated? What does it mean? It means has it been not just oxidized but now has it bound itself to sugar? Glycation is a process by
which proteins bind to sugar and once they do so, they are modified to become less functional. The main issue that we need from our LDL, which is not bad cholesterol, we love, we love our LDL, it’s keeping us alive. The main issue is, what we’re
looking for is functionality. We will compromise the
functionality of our LDL and therefore be in great
trouble, like heart disease, like cerebrovascular
disease, strokes, et cetera. We compromise functionality of our LDL, which is not bad cholesterol,
when it is either oxidized by the excess activity of
production of free radicals in the presence of
inadequate antioxidants, or it is glycated. Now, let’s just look
at, not everybody can go and have their glycated
LDL blood test done. But a terrific surrogate marker that anyone can tomorrow go
to their doctors and have done that correlates almost perfectly
with the level of glycated and even downstream oxidation of LDL is a very simple test, a
glycated hemoglobin test. Is that unusual? That’s the A1C that they talk about on the diabetes drug
commercials that you see on the evening news. Everybody knows about their A1C because there are 60% of Americans
now that probably have their A1Cs checked because
they’re pre-diabetic or I mean, adults, or frankly diabetic. So everyone’s familiar with A1C. What does it mean? It means glycation, in this case, sugar binding to a
protein called hemoglobin. That’s the oxygen-carrying
carbon dioxide-carrying molecule within our red blood cells. So that is a terrific surrogate marker for this LDL glycation and LDL oxidation or oxidatively damaged by
the actions of free radicals. – So the glycated
hemoglobin also tells you whether your LDL is oxidized, not just whether your LDL is glycated? ‘Cause those are types of damage pathways. – Absolutely, so there’s a– – Both. – Well when things are, great point. When things are glycated, they oxidize. Two things are triggered by
the glycation of proteins: oxidation, higher levels of free radicals, and who knew? Inflammation. So these things all come together. Again, it’s all about these dots, and when you’re pulling the research, writing a book, or updating a book and these things come together, you just say to yourself
why, that’s fantastic, or hashtag WTF, why that’s fantastic. (laughter) Because it really is, and
you make these connections. I gotta write about
this, people have to know that lowering inflammation in your body and lowering your blood
sugar to reduce glycation of proteins is so very important. One graph that I included in “Grain Brain” and now with the new release
of the revised edition, I included, ’cause it’s so
compelling, is the relationship of A1C to brain shrinkage. Higher A1C, higher rate
of brain shrinkage. It’s linear, you’ve got to know that. And having an A1C of six,
when your doctor says oh, you’re not diabetic,
everything’s cool. Go home, keep doing what you’re doing. That does not jive with the
science that’s telling us that a hemoglobin of A1C, if A1 six is good for you, that’s BS. You need your A1C down to
5.2, and that’s pretty much take that one to the bank. – How low would you go if you could set it as low as you wanted? Like, I don’t wanna be
average, I wanna live 180. – I don’t know the answer to that, but I will tell you that
one thing I’ve learned over the years is that
there is this notion of what we call the U-shaped curve, or perhaps the sweet spot, where too low, or Goldilocks area, right? Where the porridge was too cold, the porridge was too hot,
and this one’s just right. So we know that higher A1Cs for example are correlated to cognitive decline, but we’ve been talking for
years about keeping your, not just your blood sugar low, but actually your insulin level low. And I will note that a recent
study that came out of Sweden looked at, was published
just in May of this is 2018, I know this’ll be evergreen, but published earlier this year, 2018. The study also published in
one of my favorite journals called Neurology looked at 1,200 women between the ages of mid-30s
somewhere up to age 60, followed them for 34 years
and what did they find? Again, they measured one thing
at the beginning of the study and that was their fasting insulin levels. They found that those
individuals with the lowest level of insulin actually had an
increased risk of dementia of about 2.3-fold. Those in the middle
range of insulin levels as they defined it by
definition of their study, their risk was put at one,
and those in the higher ranges of insulin, as you might expect, also had a higher risk
for dementia of 1.7, not as high as the very,
very low levels of insulin. And so the notion of trying
to keep your insulin level really, really low, I think
we have to temper that. The notion of over-exercising
I think should be looked at in terms of the U-shaped
curve, the sweet spot. The amount of sleep that
we get, for example, the amount of nutrients that we take in, the amount of fat we consume, vitamins we can overdo or under-do. So I think that the notion
of the more the merrier, and I for one have been
guilty of that personally, if I was told that it’d
be good to do something I always did twice that or more than that, and I know you are the same way. I’ve been to where you’re
broadcasting or recording, this studio, leave it at that. So you are like me, we both have been aggressive about things. And I think understanding
that there is an ideal place. So the question then becomes
how do we zone in on that? How do we fine-tune that
analog dial on the FM radio to get the very best signal? You turn the dial to the
left, you get static. Turn it to the right, get static. You really wanna fine-tune,
that’s what bio-hacking is all about, that’s what
understanding biometrics and crunching the data is all about. – What’s really
frustrating is when you see well, here’s how you
score your testosterone compared to the average 46-year-old. Like, that’s one of the
laws in “Game Changers”, is average is the enemy. I don’t wanna be the average 46-year-old, ’cause most of us are
like, developing dad bod the way I had in my 20s, and
our muscle mass is going, our testosterone’s going down, and like, don’t compare me to average. You tell me ideal, but
medicine has failed us in telling us what’s ideal. – You’re right. – So I’m like well, if this works let me try doubling that and tripling that and then try going back and
tuning that dial myself. But I feel like even some of these studies that you talk about in “Grain Brain” over the last five years, we’re starting to understand enough that maybe we can get these numbers dialed in so I
don’t have to do the guesswork, so the bio-hackers listening,
and certainly there’s a lot of people listening
who are not bio-hackers and don’t go out and do all this stuff, they just wanna feel
good and perform well. And I think we’re sort of failing them by not saying here’s the number, and you did it right here, Dr. Perlmutter. Like okay, you want to
have a number of 5.2. You don’t want it to be six and you probably don’t want it to be four. But that’s based on very recent knowledge versus most of the other lab metrics, when you get it back, what
the lab tells you is garbage for the reference range, because
you don’t wanna be normal. Normal people die! – Yeah, well that’s in the normal range. And what is normal these days? Normal is by definition average. That’s how they develop these lab values, you take a large number of people and then they use one standard deviation on either side of the peak and they say that’s in the normal range. And I think that’s a huge disservice to people who want to be optimized. So yeah, we can talk
about a vitamin D level being in the normal range, 30 to 100, and that means that I’m okay at 31. Well that, you are not okay. You’re not okay, quite
literally in my book, you’re not okay in my book, because I want as many people that I can touch over time to be their best, to
be not only their best today in terms of their functionality but to be their best tomorrow
in terms of being resistant to the degenerative processes
that are so pervasive now in global society. So you have your
opportunity to be your best when you begin to understand
that you have to be that N of one, that challenges the notion of normal range of the medical model, where only as much as 3% of people ever, data from 3% of people are extrapolated to the remaining 97%, or actually the 100% because they’re then included in that, in terms of the
recommendations that are made by mainstream medicine. That is, as my dad used
to say, bass ackwards. And it raises this discussion
of personalized medicine, where we wanna know about
Dave Asprey specifically. Not your wife, not your neighbor,
we wanna know about you. What’s your pedigree, what
does your microbiome look like, what do your current biometrics look like? And from that, we’ll develop a
program that is best for you. Now having said that, and I gave this talk at Jeff Bland’s Personal
Lifestyle Medicine Institute conference, I guess it was two months ago, that that’s the future,
that’s the best we can do, and we should extrapolate
from that information back to the notion of making the broad stroke recommendations. There’s great value in the
broad stroke recommendations in terms of those, the broader
reach of the population that’s not going to necessarily be able to participate in a very in-depth personalized medicine approach. And those broad stroke recommendations are that you’ve got to cut down
on your simple carbohydrates, you’ve got to understand
what is the notion of net carbohydrates, and by all means as we talked about at the
beginning of this discussion, not eliminate the fiber, by definition a complex carbohydrate, from your diet, that dietary fat, if you’re
careful about what that fat is in terms of its type, is
fundamental to your health, understand the discussion, Dave, that you and I had earlier
with reference to meat and its quality, and beyond
that, look at the things like sleep and the
restorative nature of sleep and exercise, for example, as
broad stroke recommendations that we really need to engage. The main premise of “Grain Brain” and now with the revision has always been to appeal to the larger audience. Yes, we made a few
specific recommendations in terms of fasting
insulin, of vitamin D level, hemoglobin A1C, fasting blood sugar, amount of exercise to get,
looking at your sleep, getting a sleep study as it were as one type of study to
understand who you are and what your risks are, but by and large, it’s the broad strokes that
I believe everyone can do. And you know, one of the
recommendations I make in the book, and again with the revision that’s coming out next week, and that is you do have to buy something. I am wanting you to buy
something, and here’s the pitch. Here’s what you gotta buy. Oh, and people are saying
oh, I knew that was coming. Yes, you need to go out and
buy a new pair of sneakers. That’s it. I mean, if you have to do one thing and buy one thing, go out and
get a new pair of sneakers. It’s so undervalued that our
sedentarity is killing us. And people think, oh I’ve just got to get the project finished, I’ve gotta whatever it
is, and by and large, our work is done by sitting
and in front of the computer. You and I are doing it right now. This is the only time of
day that I’m gonna really be doing this, and I’ve
already had my aerobic workout for the day and gonna do
another one in just a bit, but that said, that’s a huge issue. And again, it’s something
that everybody can do. For me, I would say even if
it’s walking to the mailbox and coming back, that’s a start if you didn’t do that before. If you’re in a wheelchair,
you buy some free weights and you do something, but I think everyone should be really
cognizant of the fact that aerobic exercise and now we
know resistance exercise as well is a powerful way to change the expression of your life code, of
your DNA, for the better. And who wouldn’t wanna do that? – You talk about something
else in the new “Grain Brain” that wasn’t a big focus in the old one. You talk about ketosis and
we’ve also talked about these Goldilocks zones. At the beginning of this, you said what I think is gonna be
the title of the show, why you desperately need carbohydrates. Because like what? Well you do, it’s called– – Great idea. You should definitely do that,
with Dr. David Perlmutter. People are gonna really say
why that’s fantastic, WTF. Go ahead. – Totally. You’re gonna
have to listen to the show and realize that you’re actually correct! If you don’t have anything, if you do your gut bacteria wrong, but
there’s definitely people, it’ll cause a double take for sure, but and there’s an ideal
number for that stuff and clearly you and I are
not gonna be in the camp of high carbs ever. But also the zero carb
is maybe going too far. With ketosis, I see some
of the sort of stance of as long as it’s not a carb,
I’ll eat it type of ketosis, saying oh my blood levels
are two, three, four! My keto is higher than yours,
I took these non bio-identical exogenous ketones and look what happened. I have a belief based on the
studies I’ve seen and all about a good number of ketones for people, but I wanna know what you think after writing the new “Grain Brain”, because you’ve put a
lot more focus on keto ’cause you’re a neurologist,
’cause now five years after you wrote the first one, we
know way more about ketones in the brain, you know
there’s something going on. What’s the number that
people, what’s the max, what’s the min, what’s the
average, where should we be? – Well again, we wanna try
to find that Goldilocks zone, and I think it has to be contextual. I think we have to look
at not just ketones, and we’ll get there in just a moment, but in the context of also
your fasting blood sugar. So again, we want our fasting blood sugar, as I’ve said before,
in the 70s, in the 80s. I’m lower than that but I’m okay with it. So again, these are just
general recommendations, and I’d like to see people getting their beta hydroxybutyrate as a
specific ketone that is measured, which does require a finger prick, to be at least 0.5,
0.7, 0.8, in that range. – Hallelujah! I was gonna say .5 to .8, that’s
all the numbers I’ve seen. Okay, it is not one, it is
not three, it is not five. You might wanna spike it for something, but having it high all the time is bad. And okay, why those ranges? I mean, I know there’s two studies I love but you probably have more. – Well I think that that’s a heck of a lot of beta hydroxybutyrate floating around doing what it needs to
do, and to be clear, the research demonstrates a
absolute linear correlation between brain levels
of beta hydroxybutyrate emulating what we find in the blood. And these are research who demonstrate that these levels of beta
hydroxybutyrate in the brain are actually very active. And you know, this is some of the research that Dr. Bredesen has leveraged in terms of his recommendations which fall into the same range
as you and I just quoted, allowing people actually
the ability to recover, to recover from Alzheimer’s disease. So I take a big push from that. I also think that it is
achievable by the common man, that it certainly may be
enhanced by adding MCT oil or coconut oil to the regimen, but I think even with a fairly
well-defined ketogenic diet, to get that level most of
the time is a good thing. I also believe that the
hormesis, or the stress metabolically that is
imparted by a little bit lower blood sugar from time to time and therefore a slightly
higher one to 1.5 range of beta hydroxybutyrate, has got to have some downstream positive effects when you stress the body that way, mimicking fasting, that
brings up another idea, fasting mimicking, but
mimicking caloric scarcity. And I think the body goes
into a really protective mode, there’s no food, we’ve
gotta start changing what genes are expressing and
what genes are not expressing because we don’t have access
to a caloric resource here. At the same time, I would indicate that having a higher blood
sugar from time to time, not higher than normal,
but just letting it come up a little bit, and
so cycling through this looks like, based upon really
fairly recent research, to be more in line with mimicking our paleolithic environment
and also allowing genes to be more adept
at expressing themselves. But again, I think that
you bring to mind these as long as it’s not a
carb, I’m gonna eat it. You can absolutely have
a very detrimental effect on your ability to get into ketosis and lower your blood
sugar if you’re eating lots and lots of meat for example or just protein in general. And I think that’s such
an important concept through the notion that
high levels of amino acids, the breakdown products of protein can be reassembled through
a process in the liver called gluco, sugar, neo, new, genesis. Making new sugar, is
enhanced in that scenario where you’re eating, you go ahead and say if it’s meat I’m gonna eat
it, and basically again Atkins redux, apart from
this MTOR consideration where you’re activating a pathway that really is profoundly detrimental, leading to cellular death,
pre-programmed death and leading to mitochondrial failure. So maybe what we’re
saying seems complicated but again, I think that people should, based on current data and let’s be clear, you and I may get together
five years from now and say we learned
through current research that the world is flat, and
we’re gonna say we were wrong. The world, it wasn’t round, it’s flat. I guess I could be open to
that, it’d be a stretch. But what we understand now,
and again it’s bolstered as I mentioned by two million years of being tested on the racetrack, that a diet that doesn’t
have simple carbohydrates, that has let’s of carbs,
Perlmutter’s saying eat a lot of carbs, the
title of this podcast. But these are carbs that are fiber, that are nurturing your gut bacteria that isn’t eating meat and eggs
and cheese and milk products all day, no that’s not what we’re saying. Mostly plant-based but not
entirely, if that is your choice. – And plant-based does not mean eating basically flour all the time, grains, only beans, rice, starch. So we almost say mostly
plants, but not plant babies. I don’t know exactly how
to express that to people. You’re talking about green vegetables when you say mostly plants,
not so much potatoes that are also plants. – That’s right, and we say basically above ground vegetables, above ground because these are vegetables
that by and large, aside from their seeds, that
we’ll get to in a moment, by and large don’t store carbohydrate in the form of starch. So having a couple of
potatoes, not potatoes, but a few pieces of potato or carrot, which does grow under the
ground, turnips, whatever, they’re not unreasonable. But we certainly want to
avoid the seeds of grass because the products derived therefrom are generally going to
spike your blood sugar and if it’s wheat, barley, or rye, and now even oats of course,
you’re going to get exposed to gluten, and specifically
a part of it called glyodin. And we really spoke about in
“Grain Brain” five years ago the work of a British researcher,
Marios Hadjivassiliou, who I think was really the pioneer in terms of the notion
that gluten can have extra-intestinal effects, meaning effects outside of the digestive
system, what a notion. And so he was even very clear
that neurological conditions, issues, manifestations, can occur in response to being
sensitive to this protein called gluten. And that was resounded,
the rejection of his, although he published in the
journal Lancet, I might add, but there was a resounding rejection of his concepts, which I
felt were very, very valid, and since that time as you well know, this notion of non-celiac
gluten sensitivity has been absolutely supported globally by literature to the extent
that even the Journal of the American Medical
Association in 2017 published a very extensive review with Harvard researchers
contributing to this review, in fact Dr. Alessio Fasano was
a contributor to this study, absolutely affirming for
us the notion of non-celiac gluten sensitivity and the notion that gluten sensitivity
can have significant extra-intestinal manifestations
that may involve the brain. So when we talked five years
ago about movement disorders, about ADHD, other issues with cognition, headache for example, possibly,
possibly being related to gluten sensitivity because
science supported that, yeah there was pushback,
but now my goodness, now it’s really becoming
much more accepted and I am really grateful for
the degree of validation. When I published a study several years ago with a Dr. Aristo Vojdani,
where we demonstrated markers in the blood demonstrating gluten sensitivity without celiac disease in a patient with about 28
years of intractable headaches, having to take opioids to control his pain and going gluten free and
finally coming off opioids after more then two decades. – Wow. Dr. Perlmutter, this is
why your work matters and for people listening, you don’t have notes in front of you. You know these studies
’cause you write books and because you read
these so you can be better in the clinic every day. And all the science is
real, it’s all out there. So if you’re still stuck in that I’ve gotta have my sticky
white bun on my cheeseburger or something, just know, it is not free, and the idea that I’m going
to spend less on my food as long as it tastes good is
not actually spending less because you’re probably
gonna not like how you feel. So, I just have to say thanks. Thanks for the new “Grain Brain”, thanks for your decades
of work in the field. It has made a big difference, and I appreciate it and
if you loved today’s show, you should check out
the new “Grain Brain”, and if you happen to order it on Amazon at the same time you
order “Game Changers”, they’ll be stuck together
for other people– – Oh, there you go. Forever. – Exactly. Thanks again for being on the show. Thanks for being such a great friend and such a big, dare I say, game changer? – Well, I will tell you that
I was very, very honored not only to be spoken
about in terms of my work in your book, but to be
supportive of the book in general, because it’s really a great resource. Because you know, we
must learn from others, and you’ve cultivated an
incredible cadre of individuals who absolutely by definition
have been game changers and are helping moving
the ball down the field, challenging the status quo. Ronald Reagan reminded
us, well didn’t remind us, but he told us that the term status quo is Latin for the mess we’re in. And so to make changes and challenge the accepted dogma allows
us to make progress. So I appreciate the fact that you do that and everything that you
do because it’s really, is it disruptive? Yes, and that’s a really,
really good thing. – If you liked today’s episode, well I already told you what to do. Go ahead and read something good. You know the good stuff to read. Thanks for listening. (chimes ringing) (heartbeat)