51: Dr. David Perlmutter | Grain Brain & Ketones

AIR DATE: October 24, 2013 at 7PM ETFEATURED EXPERT: FEATURED TOPIC: "Grain Brain & Ketones"

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The biggest breakthrough health book of 2013 contains a simple, yet profound message--the carbohydrates we are eating in our diet are directly leading us down the inevitable pathway to dementia, Alzheimer's disease and other neurodegenerative brain health ailments. It's the #1 New York Times bestselling book  (read ) by a Naples, FL-based neurologist named  (listen to Jimmy's interview with him in ). Dr. Perlmutter identifies in his book the key role that ketone bodies play in various aspects of our health, especially brain health. And that some of the most common foods consumed in our diet--namely whole grains, sugar, starch and other culprit carbohydrates--are the very things that are robbing our bodies of adequate ketone production to thrive as our bodies were intended. That's what we'll be addressing in Episode 51 of "Ask The Low-Carb Experts" this week when we take on the topic "Grain Brain & Ketones."

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Here are some of the questions we address in this episode:

LENI ASKS: What is the impact of a ketogenic diet on bone health? There’s a lot of information on the web that seems to indicate that a ketogenic diet creates an acid environment that leeches calcium and other minerals from the bones. Is this true?

ADAM ASKS: What has been your response to the emerging idea that saturated fat is the root cause of Alzheimer’s disease? And I’m curious about what would bring on Alzheimer’s faster: a high-carb, high fat diet or a high-carb, low-fat diet?

MARY ASKS: After reading Dr. Perlmutter's eye-opening book where he mentions fasting blood sugar levels are closely associated with cognitive function. Would that be the best thing for me to track or would it be more useful to track post-prandial blood sugar and/or blood ketone levels?

REBECCA ASKS: If a person already has moderate to severe Alzheimer's or signs of dementia, is it too late to reverse the damage by eating low-carb, high fat? Can there be any reversal in symptoms?

LINDA ASKS: In 1997, I underwent surgery for a benign, but fairly large brain tumor. The dietitian put me on the Food Pyramid diet and I ate that way until I read Dr. William Davis’ Wheat Belly in 2011. We don’t touch wheat and gluten anymore and happily eat low-carb. I wonder what effect grains have on the development of brain tumors. As a 63-year old, is it too late for me to achieve optimal brain health after a lifetime of eating grains?

SANDRA ASKS: Should my husband be worried that his cholesterol has risen from 208 to 267? He eats what I eat—a low-carb, moderate protein, high-fat diet. His doctor will undoubtedly want to put him on a statin and my hubby is kinda freaking out about all of this. Any words of comfort you can give us?

LISA ASKS: I loved Grain Brain and have already implemented many of your suggestions. I've heard it argued by people in the low-carb and Paleo community that it's the processed foods doing most of the metabolic damage to our health in modern society. However, the unifying factor in many of the world’s traditional cultures is that they're all eating real, whole foods. But Dr. Perlmutter seems to be saying that even real, whole food carbohydrate-based foods like fruits and tubers are poison. Does this apply to everyone, or just those who are metabolically challenged in some way? I think many will find it hard to swallow the "all carbs are poison for everyone" theory when there seem to be so many people eating real-food carbs while maintaining excellent health.

HILARY ASKS: If carbs are so bad for our health, then how do people like Michael Phelps and Dr. Oz perform so well for so long eating pasta, pitas and pancakes? And why don't football players drink olive oil and eat sticks of butter on the sidelines rather than a solution of sugar and electrolytes?

MARGARET ASKS: When I hit my early 40’s I started having occasional memory issues—it’s both annoying and embarrassing. I've been eating low-carb, high-fat with no grains or sugars and copious amounts of coconut oil for the past two years. I am an avid exerciser and at a normal weight, but I’m still insulin resistant. While my memory hasn’t gotten any worse, it hasn’t gotten any better either. Can I ever hope to see improvement if I continue with what I’m doing or are there other things I can do to help with this?

KIM ASKS: I am a 53-year old female who has been on a ketogenic diet for about a year. I am reading your book and now know that many of my problems are a direct result of inflammation. I have lost 90 pounds so far, but I still have a lot of belly fat and inflammation. My low-carb friendly doctor recommends that I stay on a 1,000-calorie-a-day fat fast for a while to see what impact that will have. What effect will all this have on my brain? And what can I do about my belly fat and inflammation since I now know it shrinks the brain?

WENDY ASKS: Can you explain why switching from a grain-brain to a ketone-brain is so important in light of menopause? All the books about this subject say to eat soy and flax, load up on the carbs, exercise them off doing cardio exercise, and somehow avoid stress—yeah right! Obviously these people have never had hot flashes! When I started eating ketogenic after reading a book by your fellow neurologist Dr. Larry McCleary called The Brain Trust Program, I noticed my hot flashes disappeared for a while, but then they came back. Why aren't medical professionals from various fields willing to offer any meaningful enlightenment on this issue? Is this something that neurologists like yourself will need to lead the charge on?

DELILAH ASKS: For an 80+ year old woman already showing signs of dementia, how helpful will a ketogenic protocol be at this point? Is there any expectation of improvements and/or reversals in neurodegeneration at this point?

TRISH ASKS: I inherited the ApoE 4 genotype from a relative who developed dementia at an early age. In light of this, is a low-carb, high-fat diet the best one for me to be consuming to support my brain health? Or should I consider cutting back on my intake of dietary fat as has been recommended for ApoE 4’s?

MEREDITH ASKS: I'm confused about your statement in your book and on “The Dr. Oz Show” that it's okay to eat certain grains such as rice. What is it about the non-gluten grains on your "eat in moderation list" that makes them acceptable? Thanks for clarifying. Loved your book!

ERIC ASKS: Are you aware of any animal or human studies on the effect of ketogenic diets on Alzheimer’s disease?

AMBERLY ASKS: When I have been pregnant, my doctors have told me that being in a ketogenic state is not healthy for a developing fetus, specifically for their brain development. What research is there to support or refute this position? If ketones are good for an adult's brain, why wouldn't they be good for a growing baby's brain?

DAVID ASKS: I've been reading your book and talking to my sister about it. She made the point that it wasn’t until grains were introduced into the human diet that there were great intellectual and artistic advances in our civilization. She can't think of one non-grain based population that has produced any great philosophers, artists, etc. She argues that a grain-based diet is what fueled all the great intellectual achievements in human history and thus will do the same for her. How do I respond to this assertion?

DAMON ASKS: I have struggled for a long time trying to increase my blood ketone levels to an adequate level and it has never happened while eating ~200g fat, ~60g protein, and less than 30g carbs daily for that past six weeks. Is it possible to do so much damage from consuming carbohydrates in the past that becoming ketogenic is now impossible?

KURT ASKS: I've eaten mostly the SAD diet for the 54 years I’ve been alive. I probably already have a huge backlog of AGE's to now overcome. At my age, can a ketogenic diet reverse and even repair the damage that’s been done from a lifetime of high-carb eating?

ANN ASKS: If I remove gluten and grains from my diet at 50 years old, am I able to prevent the onset of Alzheimer’s disease? Or has the proverbial damage already been done?