Fifteen years ago, the American neurologist David Perlmutter discovered an interesting connection among his patients. He determined that many of his patients with neurological problems also showed symptoms of stomach and intestinal problems. After he recommended a gluten-free diet to his patients for their digestive troubles, he started noticing gradual improvements in their neurological problems.

With this observation Perlmutter may well have hit on the most far-reaching discovery in health since the -discovery that smoking causes cancer: grain consumption affects the brain. Even eating “healthy” whole grains can lead to dementia, Alzheimer’s, ADHD, epilepsy, depression, headaches, migraines, multiple sclerosis, and much more.
When Perlmutter’s book Grain Brain came out in 2013, it quickly reached the top of the U.S. bestseller lists. This is not surprising, given the deep-rooted fear caused by the rapid increase in dementia and other forms of memory loss.

Alzheimer’s Disease International estimates the number of dementia patients worldwide at 45 million, and that number has been growing by 20 percent every year. This is not only a specter looming for the (future) elderly; it is also a problem for governments, which must wrestle with the out-of-control rise in costs of healthcare.
We interviewed Perlmutter via Skype. “It might sound dramatic,” he says, “but the best recommendation I can give is to completely stop consuming grains—with or without gluten.”

In established medical circles, Perlmutter holds a unique position. He was trained as a neurologist at the University of Miami, but he’s also a member of the American College of Nutrition, which makes him one of the few doctors who pay attention specifically to the connection between food and health. That combination of expertise makes Perlmutter’s view of the relationship between grains and neurological disorders particularly compelling.

In the introduction to his book, he points to the fact that grains have had the greatest impact on the human diet. The hunter-gatherer of 12,000 years ago ate meat, nuts and fruits and hardly any grains at all. Our ancestors of 100 years ago ate their daily bread, but not the airy confections and rolls we now think of as bread. Over the past century, grain has undergone considerable “reengineering.” As a result of the ongoing enriching of the gluten—the glue (the Latin meaning of gluten) that holds dough together for bread, pasta and pizza—we can’t even recognize the gluten of 1900 compared with the “super-gluten” of today. Our own genetic structure, our DNA, has not been able to keep pace with these changes in our food. And that is a problem.

With complete seriousness, Perlmutter writes in his book, “Gluten is the tobacco of our generation.”
Gluten intolerance is often equated with celiac disease, a fairly rare intestinal ailment. However, recent research shows the same correlation that Perlmutter observed in his patients. Scientists have known for some time that all physical degradation, all degenerative diseases—including brain problems—start with inflammation. Gluten causes inflammation in the body because the body has great difficulty breaking down the “glue.” The immune system is called in to help out, which can lead to intestinal complaints.

But the immune response—inflammation—can bypass the intestines and instead travel through the blood to other areas of the body, including the brain. A prominent researcher in the field of gluten sensitivity, Marios Hadjivassiliou, of the Royal Hallarshire Hospital, in Sheffield, England, concluded as early as 1996, in an article for The Lancet, that “gluten sensitivity can be in most cases, and sometimes exclusively, a neurological ailment.”

Research from the respected Mayo Clinic in 2006, published in the Archives of Neurology, showed that patients with widespread cognitive degradation made “significant improvements” in cognitive ability after switching to a gluten-free diet. Yet that does not make the link between gluten and brain damage a generally accepted scientific fact.

Perlmutter’s book is highly criticized in medical circles. The critique, in essence, is embodied in the idea that correlation does not imply causation. In other words: If the symptoms of memory loss are reduced or disappear entirely on a gluten-free diet, this does not mean that gluten caused the damage to the brain to begin with.

Undaunted by this criticism, Perlmutter puts the results from his patients front and center: “It’s breathtaking to see patients who could no longer operate a car or pay their bills suddenly have those cognitive abilities return. Not through medicines—because those don’t exist—but simply by giving the brain the food it craves.”

In addition, the threat to the brain doesn’t stop with gluten. Grains in general—even gluten-free ones like rice—are able to cause damage to the brain. This is because all grains, which are rich in carbohydrates, are easily turned into sugar in the body. Carbohydrates are long chains of sugar molecules that often raise blood sugar levels faster than sugar itself.

Sugar, or glucose, is the fuel for the 100 trillion cells of which our bodies are made up, but insulin is needed to process sugar so that our cells can take in the nutrients. Healthy cells are therefore receptive to insulin, but if there is a constantly high level of insulin in the body—for example, because the sugar levels are too high—it makes the cells less receptive to insulin, which can lead to insulin resistance.

The pancreas, the insulin producer for the body, responds to the constant influx of sugar by continuing to increase insulin production, and it can become “overheated.” If the pancreas goes dormant and produces too little insulin, or none at all, Type 2 diabetes will develop. People with Type 2 diabetes—according to the CDC, that number in the United States is almost 26 million—have a high blood sugar count because their bodies are no longer able to deliver sugar to their cells, where it can be stored as energy.

This delicate dance between sugar and insulin is a known process, one that is directly linked to the unhealthy Western lifestyle. But recent research done by Suzanne de la Monte, a neuropathologist at Brown University, in Providence, Rhode Island, shows a direct connection to Alzheimer’s.

In her laboratory, De la Monte disrupted the insulin intake ability in the brains of rats. As a result, she observed the same amyloid plaques that the German psychiatrist Alois Alzheimer discovered in the brain of a deceased patient almost 100 years ago. The rats’ memories became affected—they could no longer find their way out of a water maze and kept helplessly swimming in circles.

De la Monte’s research suggests that Alzheimer’s can be a result of insulin resistance in the brain.
Animal testing won’t tell us everything about human diseases, but research on the brains of dead people who had Alzheimer’s has indeed shown insulin resistance. That’s why Alzheimer’s is more and more often referred to as “Type 3 diabetes.” Also, research is showing that dementia stemming from insulin resistance can show up in people who don’t suffer from Type 2 -diabetes.

A recent study of 1,230 people between the ages of 70 and 89, published in the Journal of Alzheimer’s Disease, showed that those who consumed the most carbohydrates were twice as likely to have memory problems as those who consumed the least amount of grains. Interestingly, the group that consumed the most sugar had “only” a 50 percent greater chance of damage to their brains. “The notion that whole grain is good for you is completely absurd,” Perlmutter says. “We must begin to understand that this is very dangerous food. Whole wheat bread has a disastrous effect on blood sugar.”

The average Western diet today consists, according to Perlmutter, of more than half carbohydrates, which the body quickly turns into sugar. This holds true as well for popular gluten-free grains such as quinoa and amaranth. All carbohydrates have a high glycemic value, and this, according to Perlmutter, is the source of the dementia epidemic.

In his book, Perlmutter points to research in which people’s blood sugar levels were measured while, at the same time, their brains were scanned to measure the size of their memory centers. The research was repeated some years later, and the results showed a clear correlation: People with the highest blood sugar levels had the greatest shrinkage in their memory centers. Perlmutter concludes, “The message is that you have the ability to control your blood sugar through your dietary choices.”

We can feed our bodies in a different and healthier way by following the example of our hunter-gatherer ancestors. Their diet, which is again in the news as the Paleo—or “ancients”—diet (see The Intelligent Optimist, September/October 2013), consisted of three-quarters fat. The body can produce glucose from fat, but this—compared with energy production from grains and sugar—is a more complex and slower process, because the energy is gradually absorbed.

“You will burn fat like an oil lamp,” Perlmutter explains, “and throughout the day you will have a deep and consistent energy level, without the peaks and valleys so typical in people whose diet is based on -carbohydrates.”

The difference in the metabolism of grain and sugar, as opposed to fat, suggests that people in fact get obese from the modern grain-and-sugar diet and not from consuming fat. The excess of sugar in the blood gets parked in the body as fat, whereas when we eat fat, sugar is gradually released in the blood, where it can be used by the cells as energy. New research is showing a link between higher levels of blood sugar and a shrinking of the memory center in the brain.

As negative as the connection between dementia and grain/sugar is, there is an equally positive connection between fat and brain health. In 2007, the journal Neurology published a study of 8,000 people aged 65 and older, whose brains at the start of the research were in perfect working order. The study followed these people over a period of four years. During that period, about 280 people developed a form of dementia. Researchers then looked at their diets and concluded that the risk for dementia for individuals who never ate fish was 37 percent higher, while for people who ate fish regularly, the risk was 44 percent lower.

Another relevant conclusion dealt with butter. For people who consumed butter regularly, there was no significant shift in risk. People who consumed primarily vegetarian fats high in omega-3 (such as olive oil, flaxseed oil and walnut oil) had a whopping 60 percent lower chance of developing dementia. At the same time, it became clear that people with a high consumption of omega-6 fats—as found in fast food—and who had a shortage of omega-3 fats, had twice as high a risk of dementia.

“The more fat you eat, the healthier your brain will be,” states Perlmutter. “I say that with the greatest possible emphasis: We must eat more fat. Fat is the key to healthy brains, to losing weight, to a healthy heart, and to a stronger immune system, which helps protect you from cancer.”

But how does Perlmutter’s praise of fat fit with the long-standing concern about high cholesterol—particularly the so-called bad cholesterol—in relation to heart disease? Is fat consumption good for brains but bad for the heart? In his book, Perlmutter decisively deflates what he calls, the “cholesterol myth.” Among other things, he points to a Dutch study published in The Lancet that followed 624 elderly, aged around 89, for ten years. That study showed that the higher the overall cholesterol levels were, the lower the risk of dying. And the cholesterol appeared to have no influence on the risk of dying from heart disease.

Perlmutter concludes, “People with the highest cholesterol have a 70 percent less chance of developing Alzheimer’s. A high cholesterol level can lengthen their lives.” Dovetailing with this are newer studies showing a relationship between low cholesterol levels and depression.
Fat, then, in Perlmutter’s opinion, is all good—particularly fats from olive oil, coconut oil, eggs, nuts, seeds and wild-caught fish. He does, however, make two very important exceptions: modified fats and trans fats—aka the artificially fabricated fats that are most commonly used in fast food, chips and cookies. “Those fats,” says Perlmutter, “which are so prevalent in the supermarket, are extremely bad for your brain, your heart and the rest of your body.”

Meat, in moderation, can stay on the menu. Perlmutter: “You can cut out meat entirely, or have it as a small side portion no bigger than a deck of cards.” He points out that most meat these days is almost exclusively grain-fed—which increases the inflammation-forming omega-6 levels—and in addition is treated preventively with antibiotics. “I agree with the statistics that indicate that eating meat can be harmful,” says Perlmutter, “but it’s not right to extrapolate those results to all meats. These statistics are based on research that says nothing about the beneficial effects of consuming organic meat from pasture-raised animals.”

After reading Grain Brain and having a detailed interview with Perlmutter, who spoke almost without pausing for breath, running through his enormous repertoire of facts and (growing) evidence, my own diet choices have been thrown upside down. I realize that humanity has done quite well for some time without grains—our hunter-gatherer ancestors never found bread in the wild. I also imagine that a few thousand years of grain consumption is a drop in the bucket for DNA built on a few million years of fruits, nuts, seeds and vegetables. And I know the economic interests in grain are enormous. How many commercials tout the benefits of a diet high in grains? The grain industry is bigger than the tobacco industry ever was. So it might take a while before science puts grain back in its place.

I understand that Perlmutter, who wants to drastically change established dietary guidelines, carries the burden of proof. And I realize that in the past twenty years we’ve seen a considerable number of diets come and go … But on the other hand: Those diets were mostly concerned with losing weight. Perlmutter’s message goes directly to the core of our health.

As if he can read my thoughts through the webcam, Perlmutter asks, “If you’ve suffered for some time with headaches and migraines, then why wouldn’t you try a grain- and gluten-free diet?”
Indeed. If you look past headaches and migraines to the threat of dementia, which research says is looming more every year, the logical answer to that question should be that there is much to be gained from a grain- and gluten-free diet.
By Jurriaan Kamp, who misses Dutch“stroopwafels” the most.