Neuroinflammation: How Inflammation Affects the Brain and What to Do About It

Introduction to Neuroinflammation 0:00

This is Doctor Talks, real talk from real doctors on the issues that matter to you most. Welcome to the Conquering Chronic Inflammation Summit. I'm your host, Dr. David Jockers, and today I'm joined by Dr. Austin Perlmutter, and we're talking all about neuroinflammation, how inflammation affects the brain and what you can do about it. Dr. Austin Perlmutter is a board certified internal medicine physician, New York Times bestselling author, published researcher and international educator. His mission is to help people improve their health by targeting the biological basis of stuckness in our brains and bodies.

Perlmutter.com. And again, today's all about neuroinflammation, how inflammation affects the brain and what to do about it. With that said, let's go into the interview. Dr. Austin Perlmutter, great to connect with you here. And we're talking about neuroinflammation, really hot topic now and really important topic. So let's go ahead and break that down. I would say this is one of the most important topics in the world. And obviously I'm biased, but let me explain my positioning. If you consider the things that make life worth living, how you think, how you act, and how you feel, we've historically looked at these as reflections of psychological state.

We'd say, oh, that person's feeling happy, feeling sad. That person is behaving well, is behaving in a strange manner. We'd say that these are things that are constructs related to a person's personality. And now what we're learning is that the immune system, specifically inflammation in the brain, is a major driver of how we think and how we act and how we feel. And specifically, if we have higher levels of brain inflammation, we are at higher risk for developing depression, higher risk for developing conditions like PTSD, higher risk for developing conditions like Alzheimer's, dementia.

And maybe the most important part of this entire thing is that when we have higher levels of inflammation, there's an association with more violent, aggressive behavior. So starting to unpack this and understand that inflammation in your brain is so much more than just brain fog and low mood. Yes, it can be those things, but this is something everybody should care about. Yeah, absolutely. I mean, it's a really big thing. Most of us have seen people that are dealing with neuroinflammatory conditions.

We've been around it. What are some of the major signs and symptoms that clue people in that they may be experiencing neuroinflammation or a family member maybe? Yeah, and I'd like to start by saying, even now when we think about how conventional medicine is practiced, inflammation in the brain is limited to a couple

Signs, Symptoms, and Brain Disease Links 2:53

of conditions. So we would think about inflammation in the brain if somebody has an infection, a really severe infection. Sometimes we would think about inflammation in the brain if somebody has an autoimmune disease, multiple sclerosis, lupus. These are conditions that can alter our brains. In most people and most of the time what inflammation in the brain may show up as is low mood social withdrawal some brain fog trouble thinking and that's really the first signal we should get that we should be paying attention to our immune state.

One of the examples I like to give is to think back to the last time you were sick. So that might have been a flu, a cold, some sort of a virus. Think about how your brain felt. And if you're like most people like me, you probably felt a little bit out of it. You weren't excited about seeing friends and family. You weren't excited about needing to do work. You probably just wanted to hang out in bed and maybe your thinking was a little bit foggy. And that actually has a definition it's called sickness behavior well characterized in both animals and in people this is the result of inflammation in your body getting into your brain and telling your brain let's not do things the usual way.

Why that is so important is if you think about what it does, inflammation tells your brain to withdraw from other people, to experience low mood, potentially even to be more aggressive towards other people. And then we think about the fact that people across the planet are experiencing more and more an inflammatory lifestyle through the food we eat, the stress we experience, the sleep we don't get through sedentary behavior. You can start to understand why people are feeling so crummy so much of the time.

So again, there's a spectrum of things that we might experience that could tell us that inflammation is a problem, ranging from mood issues to cognitive issues to everything in between. Yeah, it's important to understand. I know when I was originally going through college, I was told, for example, depression was a serotonin imbalance or a deficit or a neurotransmitter imbalance. And a lot of people are told this, but the new research is showing it's a neuroinflammatory condition. And so let's go into kind of some of these conditions, anxiety, things that a lot of people are dealing with, anxieties on the rise, depression, a lot of these mood disorders, brain fog, a lot of people are complaining of brain fog.

how is neuroinflammation impacting or how is neuroinflammation at the root? Like how does that contribute to those? Right. Well, many people are aware that when they have inflammation in their body, they can experience it as pain and dysfunction. So if you have an inflamed joint, it's maybe hard to bend that joint. It's red, swollen, it's painful. That's what inflammation looks like in the body. Maybe you have a rash on your skin. You can look at the redness and say, oh, there's some inflammation here.

Maybe you have gut issues. You could say, well, maybe there's some inflammation in my belly. But it's different in the brain because the brain, the tissue itself doesn't really have all those pain receptors. So thinking about what inflammation actually looks like in the brain, you might not experience it or you will not experience it the way you would in the body. What's really interesting to look at is, as you've alluded to, all of these conditions that historically we say, well, something just goes wrong in the brain, whether it's Alzheimer's disease or depression, it's easy to pin those on a singular pathway.

In the case of Alzheimer's, we say, oh, well, amyloid plaque is the issue. Well, that's been challenged. In the case of depression, we say, well, serotonin, that's the issue. That has been challenged. And importantly, the drugs that are supposed to target those pathways in the case of Alzheimer's by removing amyloid plaque in the case of depression by targeting these serotonin receptors are really nowhere near as effective as they should be if that was the major pathway. At the first part of this, we're saying, well, the standard explanations don't make enough sense.

So we need to look at other ways of explaining these conditions. Then you start to look at what does make more sense. And I do want to be clear. It's not that inflammation explains everything, but it is a big part of the story. And one of the things that I've learned in the last little bit, it's not as though you have inflammation here and then metabolic function over here and they don't talk to each other. The immune system, the endocrine system, constantly speaking to each other. We know that when there's inflammation, it changes the way that our cells metabolize and vice versa.

And so when you start layering in this information, we see... One, that people around the world are experiencing higher levels of inflammatory diseases. So that includes brain diseases, but it actually includes seven to eight of the top 10 diseases that lead to death and disability around the world. These are chronic diseases for which there is a significant inflammatory component. Then we say as it relates to the brain, do we have data suggesting that higher levels of inflammation predispose people to brain diseases?

And we do. We know that people who have higher levels of inflammation as measured in their bloodstream are at a higher risk for developing depression and have more trouble getting therapeutic resolution with drugs like SSRIs. There's some really interesting work now being done to look at whether anti-inflammatory medications could be used for depression. And I'll just throw in a little curve ball here. There's actually a question as to whether psychedelics, a molecule that has historically been looked at as a serotonin-based molecule, may work in part by lowering inflammation in the brain.

And now they're asking whether psychedelics may actually be something we could consider for conditions like autoimmunity and for Alzheimer's for those same reasons. On that topic, when we look at Alzheimer's disease, we see not only that people who have diseases associated with inflammation being at higher risk for developing depression, but people who just have higher levels of inflammation are at higher risk of dementia. I think I said depression. So people who have higher levels of inflammation, higher risk for dementia.

So it's diseases like diabetes and cardiovascular disease, it's obesity and metabolic dysfunction. These are conditions associated with higher levels of inflammation in the body that are linked to concern for inflammation in the brain and diseases like Alzheimer's and depression, which are correlated with inflammation in the body. Now, that's kind of higher level association data. What's gotten really interesting in the last 10 or so years is we've started to see data looking at imaging scans of people's brains to see whether there's

Gut Microbiome and Brain Inflammation 9:13

evidence for immune activation. And this is something that I definitely didn't learn nearly enough about in my medical training. But the brain itself has its own immune system. So it has these cells. They're called microglial cells, and they are about 20 billion of them in your brain. You only have about 80 billion neurons. So that's a lot of microglial cells. These are immune cells that respond to and generate inflammation in the brain. And some of these new imaging tests, these MRIs and PET tests can actually look for activation of these microglial cells.

And there's evidence that they're activated in conditions that range from mental health issues to traumatic issues to cognitive disturbances like Alzheimer's disease. So really the sum total of this, what we're saying here is that to understand both what is going wrong in the brain and to understand our best opportunities, not just to prevent brain diseases like depression and Alzheimer's, but to optimize brain function right now, we need to be talking about inflammation because there's so much we can do to decrease our risk for brain inflammation problems.

Yeah, really well put. And when we think about inflammation, there's a huge amount of research. In fact, I know your father wrote a book called, I can't remember, Brain Maker, right? All about the gut, gut microbiome, and how that impacts inflammation, how that impacts brain health. In fact, they call the gut the second brain. And there's a lot of research about how the gut microbiome and how intestinal issues, right? A leaky gut, intestinal permeability, how that impacts brain function. Let's talk more about that.

Sure. I think it's such a fascinating topic. And if I was going to guess where we'll be in 10, 20 years, it's probably that we'll be able to explain a lot of human behavior by understanding the microbiome that we are probably less in control than we think, and the microbes are probably more in control than we think. There are a number of reasons why I believe that is the case. So just from a statistical perspective, we've got roughly the same number of microbes, specifically bacteria, living on and in us as we do our own cells.

I think the latest estimate is around 39 trillion microbes and 39 trillion of our own cells. Then when you expand that, there's actually a virome, which is 10 times more. We're just starting to learn about this. When it comes to the gut, the majority of the research has been done on these bacteria. When you think about the gut, it's this tube that runs from the top to the bottom. The majority of bacteria are concentrated in the large intestine or the colon. That's where the environment is best for them.

And we know that this is also a part of the gut where there are a lot of immune cells, where there are a lot of kind of receptors to learn from what is happening in this gut microbiome, all these bacteria hanging out in there. So these gut microbes, these bacteria that live in the GI tract have a ton of different roles, many of which directly relate to our brains. One of the roles that we're now understanding may be essential to both understanding risk for disease and ways to treat disease is the metabolites of microbes.

So let's break that down. When we have bacteria that live in our gut, they need to eat like everything else. And what they have access to to eat is either the food that we consume or some of them actually eat a part of our gut lining called mucin, which sounds a little bit gross. It's actually a good thing. One of the bacteria that actually eats this gut lining helps to regenerate the gut lining. It's called acromansia mucinophilia because it likes to eat that mucous, that mucin layer. So when bacteria eat whatever they're eating, they produce molecules from that.

One class of molecules that they produce are called short chain fatty acids. And now we know that these short chain fatty acids have a number of effects on our physiology. And one of these that have been suggested are effects both on the permeability of the blood brain barrier, So they can actually help to protect our brain, our barrier from what's happening in the bloodstream, which is a good thing. We don't want a leaky blood brain barrier, just like we don't want a leaky gut. But also these short chain fatty acids can influence neuronal health.

The health of the brain cells can help to promote neuroplasticity, the rewiring of our brain and can actually change what's called epigenetic regulation, which is a complicated idea. The bottom line being they may change the way we use our DNA. So here we have a system where the food that we eat changes what bacteria in our gut do and what bacteria in our gut produce changes our brains. That's just one pathway involved. And there are several others we can talk about, but realizing here that this is a constant communication system.

where our brains are sending signals to our gut, to the microbiome, to the immune system, and our gut is sending signals to our brain by way of these molecules like short chain fatty acids, by way of other molecules that wind up in our bloodstream, by way of the vagus nerve that connects the gut to the brain. There's really just no way to separate these two parts of the body, even though for a long time they were seen as so far away, they couldn't possibly have anything to do with each other. Yeah, really well said.

And when we have imbalances in our gut bacteria or like a condition called dysbiosis, if we have overgrowth of certain types of bacteria, I always say bad bacteria or bad microbes in our system, they eat nutrients and poop out toxins and then good bacteria eat toxins and poop out nutrients and metabolites and postbiotics that help bring down inflammation. So a lot of it has to do with the balance of our microbiome and then of course what we're feeding the microbiome as well. So what should we do as far as helping to support the gut?

What are some of your top tips here? Yeah, with anything I say, I will always say if you're really struggling, you know, go and see a practitioner. These things can get really complicated. I think you and I both have seen patients that have been really messed up from their gut and they need more than just a couple of lifestyle modifications. But I do think for most people and most of the time, the strategies that we're going to talk about here are going to be incredibly useful. By and large, what we find across the board is the people who do best are the people who do the boring, repetitive stuff day in and day out.

And what that means is deviating from what the average person does and doing what our bodies are used to doing, what we kind of have been doing for thousands and thousands of years. As it relates to the gut, as we've said, you have all of these bacteria living in there. And there was this idea, a very popular idea for a long time, which was that bacteria were bad. And I remember in elementary school, we had this photo of the germs in the bathroom. There were these scary monsters. You know, we don't want bacteria because they're going to cause disease.

The reality is we need these bacteria, but only the good ones and only in the right balance. So there are steps that we can and should be taking each day to feed and protect the healthy microbes in our gut. What are those things? Well, the first thing is fiber. And I know people have different perspectives on this. Not everybody can tolerate getting a couple of grams of fiber a day. Again, these are the scenarios where you really want to talk to a practitioner. You might have some gut stuff that requires more than just a dietary modification.

But by and large, we're talking about eating real plant-based foods that contain this fiber in the matrix. And I don't mean that in the Keanu Reeves model. I'm saying there is a matrix of food. When you eat real food, you get access to that matrix.

Diet Strategies for Gut and Brain Health 16:48

It's different from taking it in a supplement form. And I really think that's where most people should start. Now, you can take a fiber supplement. I'm not opposed to that at all. But by and large, the research suggests it's eating real food that is most beneficial. And fiber is just one element of what's good for your gut that you will find in real food. The other thing that I'm a huge fan of our class of molecules called polyphenols. And so these are named based on their chemical structure. They have kind of these carbon rings with these hydroxide groups for anybody who's nerdy out there who wants to look it up.

These are molecules that give plants their colors. They're actually molecules that protect plants from harsh environmental exposure. So they kind of act as a plant sunblock and they help defend off microbes in their own environment. And research shows that people who eat diet richer in these polyphenols tend to have better overall health and better gut health. Unfortunately, we've kind of lost a lot of what is valuable in the polyphenolic family by moving towards ultra processed food. So I think one of the top sources of polyphenols now in the human diet is actually coffee, which I'm not opposed to.

I love coffee. But the issue is that when people are consuming these molecules, along with a ton of added sugar and preservatives, you're kind of at the very least you're coming out neutral, but probably you're coming out in a bad spot for gut health because it turns out that when we eat foods that contain a lot of added sugars, we're actually changing the relative balance of the immune cells and the microbes in our gut, and that can lead to long-term concerns. So to go back to some of these dietary components, really what we're talking about here is eating a diversity of plant foods that have been minimally processed and specifically colorful plant based foods.

Another great way to get these polyphenols, which what's interesting about them is not only do they act kind of as food for microbes, but there's some preclinical data showing that they preferentially increase the populations of healthy microbes and decrease the populations of unhealthy microbes. So it's kind of a selective food for healthy microbes. Polyphenols, as I said, colorful plants, but also they're found in spices and herbs. These are some of the most concentrated sources of polyphenols.

So we've talked about things like turmeric for a while, curcumin as a great source of antioxidants. That's really a conversation about polyphenols. And I think going beyond antioxidants and saying, this is a gut specific intervention is where we should go. So spices and herbs, virgin olive oil to extra virgin olive oil is known for a number of reasons to be protective for the brain. It may help to preserve the lining of the blood brain barrier and it's rich in polyphenols. So another great example.

And then the last ones will just bring up here two things to think about. So one is your beverages. coffee and wine. Yes, they have polyphenols. In my personal opinion right now, I would say you're not getting a net benefit from drinking alcohol because alcohol is in many ways neurotoxic and increases inflammation. So if your goal is polyphenols, don't convince yourself that the resveratrol and the red wine is going to outweigh the alcohol consumption. Coffee is a great one. There's a plant that I've been involved with called Himalayan Tartary Buckwheat, which is an example of one of the things that I think is really important, which is substituting out the low nutrient versions of everyday food like white bread, for example, or white rice that have very little polyphenol and replacing them with those forms that do.

And a nice way to test whether your food has a high polyphenol content is actually, is it bitter? because bitter foods tend to be bitter because of the polyphenol content, molecules like quercetin and rutin that give it that taste. So bland food, usually lower in polyphenols, a little bit bitter food, coffee being another good example, you're actually tasting that polyphenol content. So from a dietary perspective, just to kind of recap here, diversity of plant-based foods, rich in fiber, rich in polyphenols, decrease exposure to sugars, specifically added sugars.

And I'll expand this by saying, by and large, artificial sugars are not a good call. We don't have a ton of human data, but the animal research would suggest that artificial sugars, first of all, don't provide much of a benefit as far as weight loss and also may disrupt the gut microbiome. So highly recommend you minimize those. Last thing I'll just say on this front, I know it's not accessible to everyone, but when you can, I actually choose to eat organic food. One of the reasons for that is it's potentially less exposure to molecules that are used pesticides, herbicides, which again, mostly preclinical data suggests could disrupt the gut microbiome and cause gut issues.

So from a food perspective, I guess that's where I'd start. Yeah, that's great. I always recommend trying to get food that has maximal nutrients, minimal toxins. And so we want to lean towards organic grass fed animal products, wild caught fish. So we're getting more nutrients, less toxins and those kinds of foods. So yeah, that's a great tip. Now you mentioned the glial cells. earlier when we were talking about brain inflammation. And we know that when we sleep, we activate the glymphatic system.

And so in our society, most people are sleep deprived or their circadian rhythm is disrupted where they're not sleeping at the right times of day that are optimal for glymphatic function. And so let's let's talk about that sleep stress, some of these other lifestyle factors. For sure, I think they cannot be overstated the importance of the basics if you want to decrease neuroinflammation and improve your brain health. I actually think sleep is the single most important recommendation that I can make to a person if they're trying to improve their brain health.

And the reason is that when we think about what changes human behavior, people do things they enjoy. And I believe that you can have an amazing time eating really healthy food. But I've also spent many years kind of going through the motions, both of understanding why that's important and learning how to prepare delicious, healthy food. And if you're just starting out on your journey and you're eating a bunch of junk food and I tell you what you really need to do is eat a giant bowl of kale three times a day, you're going to say, you're crazy.

It's not going to be fun. It's not going to taste good. However, sleep is something that everyone immediately enjoys, and it has a direct, tangible effect on brain health. I mean, skip a night of sleep, and then go take a test, and then go for a long drive. And you will see immediately that there is a direct effect of sleep on your brain health. Some of this relates to what you've described as it bears on the glymphatic system. This is pretty recent research. We're talking just since the year 2000 that researchers actually at OHSU initially discovered this system, which they called the glymphatic system, which is a perivascular or along the vascular system.

The idea here is that we have these canals within our brain that allow our brain to flush out metabolic waste, the things that build up in our brains over the course of the day. So that was the first discovery. And then it was discovered that this system seems to open up dramatically in the context of sleep. So that when we lay down, when we go to sleep, the system opens up and it seems like the clearance, meaning the waste clearance of our brain spikes up around 50% when we sleep as opposed to in the daytime.

So why does that matter? Well, one reason is if you think about it just at a very basic level, you want to clean out the garbage from your brain. You don't want to leave that in overnight because when it piles up, bad things might happen. One of the examples that is often given is looking at this protein called amyloid. There's a lot of nuance here. You know, I think amyloid has been kind of seen as the villain in the story, maybe not so much. But there is data suggesting that amyloid may enhance inflammation in certain respects, and that when we sleep and open up the glymphatic system, we get much better removal of this amyloid from the brain.

So I think There are a number of reasons why sleep is important. One of those is you're literally cleaning out these brain toxins, some of which may be inflammatory.

Sleep, Glymphatic Clearance, and Sleep Apnea 24:58

And that's for me more than enough reason. But if you need more, sleep is probably the most important thing you can do to improve your memory. People who don't sleep have trouble remembering things. People who get more sleep tend to have better testing on memory and cognitive tests. We know that people who get poor sleep Importantly, around one-third of Americans are consistently getting not enough sleep. We also know that obstructive sleep apnea is a huge issue, but these are things that relate to inflammation and to conditions like depression and dementia.

I think if you have obstructive sleep apnea, your risk of having depression is 300-fold higher or 300% higher if you're a man and 400% higher if you're a female. And we know that it dramatically enhances your risk of having inflammation in your body. And here's the interesting thing. If you put somebody on a CPAP, which is a machine that in essence counters the problem in obstructive sleep apnea, their inflammatory markers come down. So basically suggesting here that there is a direct relationship between quality of sleep and inflammation.

So I think sleep is absolutely essential. We can go through some of my top tips for better sleep if that's helpful, and then otherwise we can go over to stress. I definitely want to do that. First off, what are some signs and symptoms that somebody may have obstructive sleep apnea? Because it's one of the most under-diagnosed conditions. Yeah, it's such a good question. So I would say if you are a person who is having a lot of trouble sleeping, who is basically very sleepy during the day, who finds that you're waking up during the night, who finds that you are kind of nodding off or fatigued, You should go talk to somebody about your sleep.

It is that important. We have this weird thing in society where there are certain things we think are worth seeing doctors about. You know, you cut yourself. You say, oh, I definitely need to go see a doctor about this injury. But you have poor sleep. I say, oh, well, I guess I just have poor sleep. I'll go take an over the counter and I'll take some Benadryl to knock myself out. It's so unhealthy. So I would say, if you are somebody who is struggling with your sleep, who has a lot of daytime fatigue, take it seriously.

And one of the things you should consider is being evaluated for obstructive sleep apnea. Now, there are various scoring systems. One you can look up is the stop bang system. It's kind of criteria that would make a person think, you know, maybe I should be evaluated. Some of these are. If you have a larger neck size, if you've been told that you snore, if you are overweight, if you are incredibly fatigued during the day, I mean, these are things that you should consider as major glaring signs that you might have sleep apnea.

And we know now that this isn't a disease for older people. This is a condition that is affecting people across the age spectrum. So there's no clear definition as to who needs to be screened and who does not need to be screened, but I would always side for if you're having trouble sleeping, if you're fatigued during the day, if you're told that you snore, if you wake up, your partner tells you, you wake up kind of gasping for air. These are great reasons to be seen by a doctor. The other thing I'll just say is there are other conditions, you know, there's restless leg syndrome, there's narcolepsy, there are other sleep issues that can only be diagnosed if you go and have a sleep study, so there's more reason than just sleep apnea to see a doctor about being evaluated, but...

One thing I think is really important is there's a lot a person can do independent of having a sleep study that can significantly improve their quality of life. And I can't tell you how many people, myself included, fall victim to these things, these habits that destroy our sleep quality. A good example is drinking caffeine in the afternoon. It's such an easy one to allow ourselves to have that second or third cup of coffee. Caffeine has a six-hour half-life. So if you drink a cup of coffee at 6 p.m., then at midnight, half of that caffeine is still floating around in your system, keeping you awake and destroying your quality of sleep.

Some other ones to think about, alcohol. Some people use alcohol as a way to get to sleep. But basically, being unconscious is not the same thing as quality sleep. And we know that alcohol dramatically impacts the sleep architecture and leaves you, I mean, maybe you've had this experience, but leaves you feeling incredibly unrested and leaves your brain in a bad spot. And let me just throw in a quick fact here that I recently learned that I think is a very important consideration. So there's a lot of data each side of this argument around should we be drinking alcohol?

Should we have wine? Is it healthy? Is it harmful? And there's data, like I said, on both sides of this spectrum. But I think one thing that I would hope most people would agree on is at a certain point, it becomes a clear toxin to the brain and to the body. And so the study that I'm alluding to, it's a 2020 study where they reviewed additional research. And what they found is that the level of being hung over the next day, so hangover symptoms, you know, foggy headed, GI upset, feeling out of it, correlated directly with levels of inflammation.

So here they're looking at some cytokines. These are immune markers like TNF alpha, interleukin 6, C-reactive peptide or protein. The bottom line here being, There may be some debate as to whether alcohol long-term, but definitely not before bed, and definitely not to the point at which you're feeling hungover. So I think that's a really important consideration. Part of the reason inflammation goes up because of alcohol consumption is probably because you ruin your sleep. And we know that people who get poor sleep tend to have higher levels of inflammatory markers.

So that's coffee and alcohol. I'd also just say, as it relates to things that we consume before bed, stressful content is just, it's so bad because it tells your brain, we can't go to sleep right now, there's something to deal with. So listen, I'm not saying not to be informed, but if you're going to be consuming the news, the worst time to do so is right before bed. Your brain will see these signals, even if it's across the world in another country, and it is still pretty primitive and it'll say, this is a danger, so of course I'm not going to go to sleep.

Things are scary out there in the world. So it's not just that, it's also the blue light exposure, but I'd say really try to limit things that activate your brain before bed, of which coffee is a good example, caffeine, and stressful news is another good example. Yeah, it's really well said, and you know, I always tell people, don't have goals after 9 p.m., because also if you have a lot of goals, like even if it's like, I gotta fold the laundry, I gotta do this, that will activate more excitatory neurotransmitters in your brain and more stress hormones that inhibit melatonin and your natural sleep cycle so better to start winding down I usually say nine o'clock it's wind down time dim the lights maybe some herbal tea read a book right casual conversation with your your spouse or partner but yeah try to try to wind down and is there like has research shown kind of a best time for sleep and what about the sleep environment that somebody's in because i've had clients where You know, I didn't find this out till later, but they they fall asleep with the TV on in their bedroom.

Yeah, don't you? I mean, it's really easy, though, for me to say this is good. This is bad. I understand everyone's in a different spot. And, you know, you kind of make do with what you've got. I was in New York last week for a conference. And, you know, I was really high up in this building. I think I was on the 41st floor. And yet, despite all my attempts to make sure that everything was closed, I was still hearing taxis honking at each other. And we know that actually exposure to noises at night is a huge disruptor for sleep.

I don't think people realize this, even if you don't actively wake up and say, oh my gosh, what was that loud noise? It still pulls you out of getting good sleep. And this is especially relevant in the second half of the night. The reason is we kind of build up a sleep pressure during the day, meaning we get more tired as the day goes on. And that pressure starts to go down over the course of the night. So we sleep less deep. in the second half of the night, which means that when we are exposed to these noises, it can actually pull us out of quality sleep, even if we don't wake up.

So I would say one thing to consider is decreasing noise. And there's the basic stuff. For example, if it's loud outside, close your window, right? You might consider having a carpet or a rug in your room to help absorb some noises. You might put something underneath your door, but one of the interventions that I take advantage of is a sound machine. I think standardizing with white noise is an amazing solution if you can't control for all the other noises in your environment. So sound is definitely one.

Another one is light. I mean, this is pretty obvious, but you don't want to go to sleep in a room that is light because it actually does not tell your brain that you should go to sleep. for both the stress reason and for this other reason, this light exposure reason, is why I highly recommend that you just don't have a TV in your bedroom. And I get it. Listen, I have had a TV in my bedroom. It's delightful to be laying there in bed and watching your favorite show. I think it's a bad plan. I also think it's a bad plan to have your phone in your room for similar reasons.

I think with the phone, it's a little bit more psychological, right? As long as it's there, you can check it right before you go to sleep. And you're going to want to check it first thing in the morning. And if somebody texts you at 2 AM, you're going to see the screen light up. It's going to wake you up. So don't have electronic devices in the bedroom, specifically those with screens, I think is a very reasonable piece of this puzzle. I mean, there are other things to consider, so temperature regulation.

One area that's been really interesting is to see that the human body is, or this has been shown in the research, the human body tends to do best with sleep when we lower our core body temperature. So we can help to promote that process by sleeping in a room that is a little bit cooler. And so the research would suggest somewhere in the neighborhood of between 65, 68 degrees Fahrenheit being a good temperature for the room. But that might mean for certain people turning off the heat a little bit earlier in the day.

It might mean opening the windows for some people. I lived in Florida for a long time. That might mean using the air conditioner. And there are pros and cons to all of these things. You know, if you have terrible quality air in your home and you're circulating it with a fan, That maybe isn't great. We know that polluted air in the bedroom may damage quality of sleep. But if you're able to bring down the temperature, I think that is a great plan. So again, somewhere between 65 to 68 degrees Fahrenheit seems to be that ideal window.

So we talked about noise, light, and then we just talked about some of these other things that everyone should be doing as it relates to trying to create this sleep sanctuary, which I think is great terminology to try to create a place where sleep is most likely to happen.

Sleep Environment and Nighttime Habits 35:48

Let me give you one more tip here that I actually learned from Michael Bruce. So one thing many people have experienced, I believe, because I have, is anxiety in going to sleep at night. So you lay there and everything else might be fine. It might be quiet. It might be dark. It might be cool. And you might have everything set up, the nicest blankets, the nicest bed. But your brain says, no. Your brain says, what about that thing that person said at work? I have this thing I need to take care of tomorrow.

So and so I didn't get back to them with the phone call I was supposed to give them. What Michael Bruce suggested is get a note card or just get a little journal next to your bed and keep a pencil there or a pen. And as you're going to sleep and as you are having these thoughts run through your head, write them down. Because now they exist in a place that your brain will feel comfortable knowing they're not going to be forgotten. But you don't need to keep spinning on them. And I've tried this a couple of times and it's great because you can tell your brain say, It's taken care of.

We're going to handle it tomorrow. This is very rare, at least for me, that some of these things are important enough to actually get me out of bed to do something about it. It's more just my brain saying when everything else in the day finally shuts down, oh, you forgot to do X, Y, or Z. And it's a nice thing to kind of offload that to the journal or to the note card. yeah my wife's done that and also she likes to take well I have her on magnesium of course and then also like little gaba chews and she knows she feels like man that has helped her sleep so much doing the journaling ideally actually she'll do it before she goes but she already kind of knows like hey this is a stressor right she'll do it even before bed which once you kind of get to know yourself that's a great practice so by the time you get to bed you've already kind of worked through that and then gaba type called pharma gaba right as a as a chewable she'll she'll take that before bed and she notices that that for her that really helps for me i've noticed actually taking melatonin for her she gets no no real benefit and we track our sleep for me melatonin i get a lot better deep sleep and rem and also years ago i started mouth taping I don't do that every night, but maybe a few times a month just to kind of make sure that nasal breathing at night.

And I found that to be extremely helpful. And I wear an eye mask as well. I'm very light sensitive. She's very noise sensitive. So she'll even put in earplugs and we have the white noise. I'm very light sensitive. So the moment the sun comes out, I'm up. Like I can't sleep in. But and I and I wear an eye mask and that has helped me a lot over the last decade or so. So these are just some great. I love this. And again, it can be a super simple thing, right? In your case, it sounds like you're tracking your sleep.

So you have a better sense of this maybe than most people, but You know, a lot of these things are very cheap to do. I can't imagine the eye mask cost that much. And if you're a person who's perpetually waking up because of light, that's a good one. Or the earplugs. That's what I learned for next time in New York. I mean, I wound up downloading an app on my phone to do a white noise, but it was not sufficient. So the earplugs, an amazing thing to travel with. Just simple things. Yeah, hotels can be really loud.

So yeah, that's true. You don't think about it when you book the trip, right? You know, you got the elevator, you got all this stuff going on, so. Totally. Yeah, cool. Well, let's finish with stress. What's the impact of stress on neuroinflammation? Yeah, stress is bad. Don't be stressed. What else is there to say? Listen, this is one of these topics where I always want to be cautious because I'm not trying to tell somebody don't experience stress. That's the least helpful thing. It literally creates more stress when people know stress is bad, and I'm told not to have stress.

It is true, unfortunately, that when stress is left unchecked, it elevates levels of inflammation. And it's kind of a little bit paradoxical because anybody who's ever used cortisone cream or steroids knows they've used it to basically suppress inflammation, to calm down the immune system. I look at everything through the lens of what is the data that our bodies are getting. And when our brains are constantly sensing stress, it's telling us that this is not a safe place. And so activating the immune system is actually an adaptive mechanism.

It makes sense because it's getting ready to fight off some sort of a threat. Historically, the idea is if you were stressed, it meant that there was a danger on the horizon and your body needed to be ready for that. So sure, you're going to ramp up your sympathetic tone. You're going to have higher levels of heart rate, higher blood pressure. You're going to shut down digestion because you need to be ready to fight off some sort of an issue as we leave that alone for too long. It actually creates incredible imbalance in the immune system because I think the immune system just trying to respond to what it perceives as the issue, but.

it increases our chances of dying early so chronic stress we know heart disease increases risk for diabetes as it relates to the brain chronic stress is linked to all all the problems i mean i can go through it's the mental health it's the cognitive health obviously anxiety ptsd i mean these are kind of the prototypical stress related conditions but also depression. So the data that came out of adverse childhood experiences shows us that people who experience significant childhood stress are at higher risk for a host of mental health issues.

So stress is not good in a chronic sense for our brains. I think that's clearly established.

Stress, Nature, and Mindfulness 41:18

The more helpful part of this equation, in my opinion, is to say, what can a person do about it? And here again i'll bring in this caveat for all these lifestyle interventions which is you're having a really hard time with this you know yeah we could talk about meditation and yeah we could talk about maybe some dietary changes but go see a person who can help you through this because. We know that at the extremes of psychological problems, people have real issues. And I just want to say, as somebody who spends a lot of time in the lifestyle modification space, there are people who need to see a doctor and be given a prescription.

As much as I don't want that to be the default state, when it comes to mental health issues, there are people who really would benefit from being seen by and treated by a physician in that way. With that said, again, for most people and most of the time, we should be focused on prevention and strategies that we can take to help mitigate the effects of chronic stress, not get rid of them. We're always going to have some stress. Otherwise, what's the point of this whole thing? Turns out little stress is good for us.

But one of my favorite strategies and one that I always recommend is nature exposure. And the reason for that is when we look at the kind of risk benefit and part of the risk is cost for these interventions, it is so well balanced towards the benefit in the case of nature exposure. People who engage in nature exposure for as little as 20 minutes once a week have lower levels of cortisol measured in their saliva. We also know that people who spend more time in nature have a decrease in their sympathetic activation, their heart rate, their blood pressure come down.

There's something naturally restorative about being in nature. So I think that's always close to the top of my list for people. Just get outside. Be somewhere that you're not taking in the incredibly stressful modern world and where you're benefiting from the anti-stress of just being in nature. Another one is the mindfulness meditation practices. And I know people have heard about this before, but it really does work. We know from large scale trials that people who engage in mindfulness meditative practices and faith-based practices can have an anti-stress kind of component on their brain health.

And we see this from imaging studies. We see this from a number of different markers of stress And I don't have a very specific thing that I would say, you've got to do this, right? You need to do 20 minutes of transcendental meditation. I don't think it works that way. I think what works is taking some time each day to kind of give your brain a chance for reflection. That's really it. You could take a mindful walk where you're just paying attention to your walking. You could focus on your breath for 10 minutes.

That's what I do each day. But this is the kind of antidote to the hectic modern world that is so stressful. There are a number of other things Things we could talk about too, so there's some interesting work being done again in psychedelics as it relates to helping to potentially reprogram some of these stress-related pathways. It's hypothesized that in the case of MDMA use, specifically for post-traumatic stress disorder, that you're actually doing some amazing rewiring of the pathway between the prefrontal cortex and the amygdala, which is kind of the key stress-mitigating pathway.

Again, for most people and most of the time, I would say focus on the basics. So without going into every person specifics as to what is causing their chronic stress, some of these things are unnecessary, right? Watching two hours of cable news is a stressor. Unless you are a news reporter, unless this is part of your job, you're probably doing yourself less of a service than you think by being quote informed. So yes, you can mitigate some of that by just not engaging as much. But on the flip side, I think nature, mindful and meditative types of practices are amazing.

Yeah, that's great. Some great information today. I really appreciate your time, Dr. Austin. And you also have a great book called Brainwashed that people can find. And that's New York Times bestselling book. A lot of great research in there. And people can find out more about you at draustinpearlmutter.com. Any last words of inspiration for our audience here? Yeah, just Austin Perlmutter.com made it straight forward. But yes, I do have one. So I would just say, whoever you are out there who is listening to is watching this, as it relates to brain health in particular, I think it's important to understand that if you don't start taking steps to protect your brain today, You are, based on the laws of probability, not going to like where you wind up.

And so one of the most important things in my life is this question of, where is my energy coming from that sustains me in making consistent,

Final Takeaways on Protecting Brain Health 45:48

healthy choices in my relationship, around my food, around my sleep? I have family members, two grandparents, who I lost to Alzheimer's disease. I have seen firsthand what it is to work with patients who are experiencing brain problems, mental health issues, cognitive issues. It's not good. And the amazing news is that each of us have the power to dramatically lower our risk for brain-related issues if you feel like that is important to you. So I really hope that you feel that this is important to you, because I think it is the most important thing.

But I'll just say the power is in your hands. Do not wait until you have to see a doctor to start taking agency over your brain health. Very empowering message. Thanks again for your time, Dr. Austin Perlmutter. Guys, check him out, austinperlmutter.com, and we'll see you on a future interview. Be blessed, everybody. Thank you for tuning in to Doctor Talks. We hope today's episode has enlightened and inspired you on your path to optimal health. Each day is a new opportunity to make choices that empower your well-being.

For more insights and strategies, subscribe to our podcast and visit our website, www.doctortalks.com. Stay connected, stay healthy, and join us next time on Doctor Talks, real talks from real doctors on the issues that matter to you most.