How To Boost Your Brain Health

Austin Perlmutter, MD

Heather Sandison: It is an absolute pleasure to be back here with you to have this conversation.

Heather Sandison, ND

It is always a privilege. Let’s dive right into it. You’re doing a food medicine project, I can imagine the answer to this question. But the biggest threats to brain health today. Is it just diet, or is there more to it? If diet, what diet?

Austin Perlmutter, MD

What a good question, and what a great place to start. In general, as we have conversations around health, it is so easy to pick one villain and then make them the only villain. I do think the food that we eat is a major contributor to the rates of neurodegenerative diseases like Alzheimer’s around the world. I don’t think there’s too much debate about that. But if we were going to say, is it just the food? Is the food the problem? I would say the answer is no. Where maybe we should begin with this question: What is it that a human needs to thrive? What is it that a human needs to have a thriving brain? Certainly, you need the basic building blocks, right? You have to have the architecture of the brain. To have a brain that can thrive, it needs to be built out of high-quality materials. Those materials come from the food that we eat. I do think this is kind of a core scaffolding for all of the brain outcomes we care about—not just dementia, but mental health. But in the bigger conversation around things, maybe the most important variable that we tend to miss is that we need the right forms of brain connection for any of this to mean anything. I will sometimes say you could get perfect sleep, you could get perfect exercise, you could have the perfect diet, and you could do an hour of meditation a day. But if you don’t have a connection, it doesn’t matter. You just built a machine. If you want to have a machine, your brain, which not only functions well but also helps to bring you joy, will allow you to experience this life in the best way possible. Then it is also about the connection. To go back to your original question, though, food is a fundamental variable in this equation, and by and large, most people are building their brains out of junk food, which certainly relates to having a poorly performing brain.

Heather Sandison, ND

Where do you think people get off track as a start in utero? Does it start in school? Where do people get it wrong about brain health, and how do we change that?

Austin Perlmutter, MD

It’s in all the places. Unfortunately, we live in a world in which health is not the top priority. Brain health is pretty far down the list. Now, I would argue that the only priority that we should all be thinking about is mental health. Mental health is the thing that matters. Without mental health, you don’t enjoy life. There’s not a whole lot of point in going up, getting out of bed, and going about your day-to-day. If your mental health won’t let you enjoy the experience, we don’t act as though that’s the case, by and large, each day. What we do is based on a short-term kind of pursuit of pleasure. We’ve set up a society in which that is normalized, where the typical actions that we engage in in a typical day are things that, in the long run, completely take away from our brain health and from our mental health. This issue permeates every aspect of how we engage with each other and how we carry out our day-to-day lives. It all kind of comes down to what our top goals in life are.  If you were to tell somebody that eventually you would get to something along the lines of, I’d like to be happy. What that means is that I would like to have a brain that allows me to be happy. I would like a brain that is programmed toward contentment and satisfaction in life. But if you were to then look at that same person’s day-to-day and the actions they took, the foods that they ate, and the interactions they had with other people, you could ask, “Are these the things that have any correlation with what they’re saying they care about, which is long-term happiness”? I would say that the answer is probably no. 

At a very fundamental level, the thing that we get wrong about brain health is that we don’t live our lives in a way that does anything good for our brain health. Yet, if we were to push all of us, I believe we would say that brain health is the most important thing because brain health is mental health. Brain health is the ability to be in the moment and experience everything about life that is so incredible. What do we do instead? We spend our days on social media. Certainly, we pursue GDP. Certainly, we pursue financial validation. We pursue this kind of polarization that has become such a popular replacement for the interconnectedness that makes a whole lot more sense. Existing on opposite sides of the political spectrum doesn’t mean that people are evil. It means that people have different perspectives. So we kind of have fallen into this trap where we are spending our time day to day, engaging in interactions, and consuming things that we would say at the moment make sense but are directly the antithesis of everything good for our brain health. In that, I again include mental health.

Heather Sandison, ND

So we know from an Alzheimer’s perspective that social isolation, depression, and anxiety are modifiable risk factors that increase our rates of dementia. So if you had to pick maybe three things to optimize brain health from a mental health perspective, what would they be? What could people start doing today?

Austin Perlmutter, MD

It’s often tempting to say that we can fix our brains right now. At this moment, you’re going to take this supplement, you’re going to eat this superfood, and you’re going to have clear, smooth sailing for the rest of your life. That’s not quite how it works. However, there are things we can do that have rapid benefits for our brain health. The thing that I am most bullish on if a person is going to say, I’m going to do one thing for my brain today, is to prioritize your sleep tonight. I can’t say this enough because when I look at things that work, are readily available for the average person, and are enjoyable, sleep is absolutely at the top of the list. Eating a healthy diet will, for sure, have a good impact on your brain health. But it’s not always going to be fun. The food that tastes best to some people is the food that is worse for their brain health. Similarly, we know exercise is one of the most powerful interventions for better brain health, but it’s not always enjoyable. We need to be truthful about this. It’s not fun for certain people to go out and go on a long walk or go on a run. We see these things as doctors. Why don’t you just go exercise as though the reason the person wasn’t exercising is because I didn’t think of it? People know exercising is good for them. People know that going through the drive-through and getting junk food is not good for them. We do these things because they’re easy and because they’re enjoyable. This means staying on the couch and eating junk food as opposed to going for a walk and cooking a healthy meal. But with sleep. What I love so much about sleep is that it feels good to get a good night of sleep, and it immediately enhances brain function. The next day, after getting a good night’s sleep, you’re going to be more focused. You’re going to have a better memory. You may have better interactions with other people. You may make better decisions. This is what the research is telling us because we know that when people are sleep-deprived, the exact opposite occurs. I would say you’re going to hear a whole lot of hype if you go on social media. You’re going to hear about the latest products that are going to fix your brain. If you haven’t paid attention to your sleep, all of the other things should be secondary because empowering your brain with a night of better sleep is going to help you make better decisions around everything else. It is probably the most powerful feedforward mechanism. 

Heather Sandison, ND

We can all relate to this. This is such a relatable thing, like how nice it is to feel refreshed if you’re sleeping in on the weekend and how alert you feel compared to the difference between being, say, jet-lagged or having sleep deprivation from pulling in all-nighters for whatever reason. so that it’s just thank you for sharing that because it’s so relatable and something that people can take action to do right away. 

Austin Perlmutter, MD

I’ll just say that if you take one thing away from this conversation with me, it’s that you should prioritize your sleep tonight. I know some people have little children. Some people have night shift schedules, and some people have homework. They need to stay up late. I do appreciate that. In my residency and training, there were some nights when there was just no way that I was going to get enough sleep. Some nights I was working nights, and then I had to transition between day and night. I appreciate that. But what I will say is that despite that, it doesn’t change the fact that getting a good night’s sleep is the best thing you can do for better brain health. So this doesn’t have to be this incredibly complicated thing. I know people love to talk about this 95-step routine, but this is the exact opposite of some of what we’re going to see as far as, oh, you need to wake up at 4 a.m. and do three hours of meditation. What I’m saying is no. What I’m saying is that your goal is to get seven to nine hours of quality sleep. That is the first step and the first goal. To do that, it turns out that the tips that we can relate to here are very basic. What do you do? You cool down your bedroom habit, you turn off the lights, and you wind down for a couple of hours before bed. You’re not scrolling on your phone right before you get into bed and worrying about the news or your social media feed. Giving your brain the opportunity for a good night’s sleep doesn’t mean you’re going to get nine hours of deep sleep, but it does mean that you have done one of the most important things you can do to prioritize your brain health. That is me on my soapbox saying that I’m not financially incentivized to sell you sleep. I don’t have any sort of stake in how well you sleep tonight other than knowing that that is one of the best things that you can do for a better brain tomorrow.

Heather Sandison, ND

I’m curious about the brain’s immune system, which is certainly affected by how much sleep we get. How does that relate to dementia and dementia risk?

Austin Perlmutter, MD

When we look at things that are now believed to be some of the principal drivers of dementia, we’ll kind of stick with Alzheimer’s here because it’s the most common form of dementia. We talk about several different pathways within the brain, and historically, we’ve been talking about amyloid and tau. But now that the research has been expanded a little bit, I kind of like what we’ve seen around longevity. At one point, we had less than ten of these key drivers of aging and longevity. Now there’s 13, and next year they’ll be 22. But when we look at Alzheimer’s disease, I am a proponent of some of the models posed by Dr. Bredesen and others where we’re looking at several different factors. But one of the core factors that is thought to contribute to Alzheimer’s, dementia, and all kinds of neurodegenerative diseases is the idea that inflammation in our brain can become dysregulated. When that happens, we can damage our neurons. We can have a harder time allowing our neurons to rewire themselves and recover from problems within our brains. All of this centers around a couple of concepts. 

One of those concepts is that the immune system within the brain is a highly active and interwoven set of signals and cells that influence every aspect of brain function. When I was learning about the brain, even in pathology and histology, we almost exclusively focused on the neurons. That’s where most people’s conversation ends, as they’re thinking about the cells in the brain. Neurons are awesome. Don’t get me wrong, you have something like 80 billion neurons in your brain. Depending on the estimate, it goes up or down. But this is an interesting fact. Only half of the cells in your brain are neurons. Of all of those cells that we think about in the brain, this incredible galaxy of cells, only half of them are neurons. The other half are called glial cells. This comes from the word for glue because initially it was believed that these glial cells just held things together. They were just the glue. They didn’t participate. They were just there to kind of provide structural support for neurons. Now, we understand that these glial cells are incredibly important for every aspect of brain function, and one group of glial cells that are super interesting but also very relevant to conditions like Alzheimer’s disease is called microglial cells. Very interesting name, just meaning small glial cells. But the more important fact about these microglial cells is that they are immune cells that live in your brain and makeup around 15% of your total brain cells. Probably something like 20 billion of them. They are tasked with regulating your brain’s immune and inflammatory states. That’s a lot of background science to get us to the point of understanding that when your microglial cells are angry or inflamed, they create this feedforward cycle that creates more damage within the brain. It’s now been hypothesized that these types of changes in microglial cells may be one of the major drivers of Alzheimer’s disease. One of the kinds of questions and issues that have puzzled people for some time is, It’s one thing if you have inflammation somewhere else in your body; we might even say you could have inflammation in the gut, but how does that get to the brain? Because you have a blood-brain barrier, in theory, that is supposed to keep out things like microbes and unhealthy signals. They stay in the blood. They don’t get into the brain. That helped people to have this belief, this myth that the brain didn’t have an immune system, that the brain didn’t participate in immunity. It turns out that there are so many ways in which what happens in the body reaches the brain and can reprogram the brain’s immune system. Altering these microglial cells and, in doing so, altering the fate of our brain. There are pathways like the vagus nerve, which runs from the gut to the brain, that speak to these microglial cells. The blood itself can carry signals like short-chain fatty acids as well as those that are more concerning, like lipopolysaccharide, which can activate these microglial cells and, in doing so, promote inflammation in the brain. I do want to be very cautious here, because it’s often the case when we talk about inflammation that we go down a path of saying inflammation is bad, and that is not true. Inflammation is not only bad; it’s essential. It is a key pathway necessary for our survival. Without inflammation, you would cut your finger by walking down the street on a branch and succumb to a bacterial infection, and that would be it. We need inflammation. But the real key of this whole conversation is chronic inflammation, which is perpetuated by the change in the state of these microglial cells in the brain and is not only thought to be a major driver of conditions like Alzheimer’s disease but is modifiable by the lifestyle modifications that we make each day. This has kind of changed the game as it relates to: Why does food matter? Why does sleep matter? Why does exercise matter for the brain? A big part of it is that they act on these microglial cells. They change these pathways that the microglial cells act on. Doing so can either protect our neurons, promote healthy neuroplasticity, or have the exact opposite effect.

Heather Sandison, ND

So what I hear you describing is sort of this self-perpetuating thing. They get turned on, and then they stay on, potentially. So how do we reduce this microglial activation now, or do we want there to kind of hear both things in this conversation? 

Austin Perlmutter, MD

This is still kind of at the forefront of medical exploration, which is what’s going on with the microglial cells and what we want to have going on with our microglial cells. One of the reasons for this is that it’s kind of hard to see what’s happening to our microglial cells in real-time. Most of the research here is either done on animals or it’s done as a kind of postmortem. There are various markers you can look at, like TSPO, that can give us a sense of what’s happening with our microglial cells. But what we’re trying to find out is what happens to our microglial cells in real-time in response to, either for the better or for the worse, what we’re doing in our lives. What I will say is that the consensus seems to be that we do not want our microglial cells to switch on an inflammatory state and stay in that state for too long. We do want them to be able to switch back and forth from an inflammatory to an anti-inflammatory state to respond to whatever threat is in our environment. This is like the immune system as a whole, which is kind of what we want. We want an immune system that responds to you and reacts to a threat but doesn’t go overboard, because going overboard if you’re an immune system isn’t just inflammation; it’s an autoimmune disease; it’s allergy. We want an immune system that is well-balanced and able to handle the threat and then go back to a state of readiness. What do we know about microglial cells? As far as what kind of pushes them towards an unhealthy state? Some of the more important variables would be environmental exposures, specifically environmental toxins. A lot of research has been done recently on air pollution and how it might contribute to Alzheimer’s. Recent reports, including one from The Lancet, have now described air pollution as one of the major contributors to Alzheimer’s disease. It may be that the reason for this is the unhealthy activation of microglial cells. This is one example of one side of the equation: how do we reduce the number of things we’re taking into our body that are teaching our microglial cells to get inflamed and stay inflamed? This is at the core of this conversation. It’s one thing to say: How do we bring them back into balance? But some of the more powerful strategies to use are to decrease the things we’re feeding them that are knocking them out of balance. One of the things that you can do is to reduce your exposure to air pollution. We can go into that in detail, but that’s a hugely overlooked variable specific to brain health that all of us can do a better job at, especially in our homes. 

Another one is going to be the food. Generally speaking, there is mostly preclinical data at this point suggesting that certain dietary patterns may activate a proinflammatory microglial state. What we’re talking about here is the standard American diet, a diet that is rich in ultra-processed foods. Eating a diet that contains more real foods is a great way to not only give your microbial cells better signals but also reduce the amount of these inflammatory signals that will then create more inflammation in the brain. Another variable that is hugely overlooked is that when we are consuming things that can influence our brain, maybe we focus a lot on the food. Certainly, that’s one. But what we consume through our eyes and our ears is a direct conduit to our microglial cells. Think about this. When you are watching a piece of stressful content, when you are hearing about something incredibly scary, this is telling your brain, including your microglial cells, that there is a threat on the horizon. There is danger on the horizon. Your brain responds to that by revving up inflammation, which is a practical thing to do because, going back to the example about what inflammation does, it is a protective mechanism, but our brain can’t necessarily differentiate between real or just a kind of out-of-this-world stress. It still sees those two things the same way. Chronic stress within the brain is linked to the activation of these microglial cells. Anything we can do to reduce unnecessary chronic stress, and I’ll be clear, there are chronic stressors that are necessary, is a good step. We talked about a couple of things here. One is the air that we breathe, what we inhale through our nose and, I guess, through our mouths. If we’re mouth breathing, then we’ve talked about what we consume through our eyes and our ears. Then, of course, the major variable that I’ve just described kind of tangentially is the food that we consume. But to that end, we should decrease our consumption of ultra-processed foods and bring in variables and specific foods that could potentially quell and even switch our microbial cells towards an anti-inflammatory state.

Heather Sandison, ND

That makes a lot of sense. What you just described are things that come in through our cranial nerves. Cranial nerve roots, which are our sense organs, our ears, our eyes, our nose, and our mouth, That’s part of our brain; those sense organs are this extension of our brain. so it makes a lot of sense. There’s a direct path into the brain that can either turn on the immune system and occasionally get out of or potentially get kind of self-perpetuating and overrun the immune system. Or it can send good signals that promote health and wellness, good sleep and recovery, and all of the other things that help reduce our risk for dementia. That makes a ton of sense. I thank you for organizing that in that way. I never thought of it that way.

Austin Perlmutter, MD

There’s more to it too. Just to be clear, you can have things that come in through your skin that could impact your brain. You can have things that you smell that, even though they don’t consciously create stress in your body, could still be interpreted by your brain as dangerous signals. I’ve been playing with this a bit, and a very helpful organizational principle around this is that the immune response, and in particular inflammation, is triggered by the belief that there is danger either imminently or on the horizon. If we can just think about it, what are the things that we’re putting into our bodies that are telling our brains there is danger either now or coming? These are things that, if we reduce them, tend to decrease our risk of developing chronic inflammation. When we take away more of those, our brains are no longer thinking that there is extreme danger on the horizon. That is a signal to our microglial cells and other cells like astrocytes and our neurons, to say we can now focus on things like repair and making new connections, as opposed to just kind of dealing with the concern for this potential threat on the horizon.

Heather Sandison, ND

Got it. Speaking of new connections, one of the areas of research that is known for neuroplasticity is psychedelic research. Tell us a little bit about the last time you were here. We talked about there being a paper that was talking about psychedelic research for dementia. Since then, there have been some updates to that and some new studies. I know that they’re currently recruiting for a handful, but tell us about the updates and solutions in terms of using psychedelics for dementia.

Austin Perlmutter, MD

One of the aggregating principles that I’ve started to believe in more and more is the idea of food as medicine. that people can have issues with this for several reasons. If you eat a piece of kale, it’s not going to have the same effect as if you were to take a beta-blocker. If a person’s coming into the hospital with an unstable cardiac rhythm, you’re better off giving them an antiarrhythmic drug than you are to, I don’t know, pull out a carrot. But one of those antiarrhythmic drugs might be digoxin, which comes from the foxglove plant and occurs naturally. There’s overlap as it relates to brain health. We can certainly talk about food as medicine in the context of preventing Alzheimer’s disease and potentially even reversing some of those symptoms once we start talking about moving somebody from an ultra-processed diet to a Mediterranean or a mindset diet. 

To expand this conversation a little bit, if we think about what psychedelics are, these are kind of an interrelated set of molecules that have occurred naturally for, probably millions of years, but have been used by humans for thousands of years. They’ve been used for these ceremonial and ritualistic instances because they have a direct and pretty objective effect on brain chemistry and, therefore, on cognition and mental state. Where do these molecules come from? They occur naturally in certain plants. They occur naturally in certain animals, and they also occur in fungi. What makes that interesting is that often these molecules are consumed along with the plant or fungus that they were originally found in. This is the case with ayahuasca, which is kind of a combination of two plants from the Amazon. This is the case with psilocybin, which comes from a host of different mushrooms. These are foods that, when consumed, happen to contain these highly active psychedelic molecules. Now, that is interesting to me because it changes the dynamic as it relates to this bifurcation of what is food and what is medicine. We now find ourselves in an era where, unsurprisingly, everyone is trying to commercialize psychedelics and trying to isolate molecules and create variants on them for which they can get a patent. But the truth is, just like one of the reasons why it’s a supplement is generally not my first go-to if you can get it from food. Some things are lost when you pull them out of their natural setting. I don’t mean just taking away the plant or fungus that a psychedelic is found in, but also the context. The sudden setting matters a lot. Now, with all that said, what’s very interesting about Alzheimer’s and about neurodegenerative diseases and brain function in general as it relates to psychedelics is that we appreciate that the effects of psychedelics on the brain are long-lasting and have effects beyond just mental state. They change how people see the world. They can change how we think about things, which speaks to the fact that something is going on beyond just the short-term drug high which some people would kind of try to boil down these molecules into. So if something happens to our brains, which seems to in many cases have a positive effect on people’s lives, 

Now, coming back to the point I just made here, as far as the duration of the effect, historically, when I look at the most powerful medications we have available for Alzheimer’s, depression, and so on, these are things that people have to continue to take. They are either taking a daily pill or they’re coming in for an injection once a month. But the expectation is that for these things to have an effect, you need to make sure you have enough in the system to get to a level of clinical efficacy. So with conventional antidepressants like an SSRI, it might be three to six weeks before we know if these are even working. On the flip side, with the psychedelic molecule, you can see pretty quickly that something is happening in these placebo-controlled trials where they give people niacin. I’ve always just kind of gotten a little bit of a kick out of it because there’s a pretty big difference between psilocybin and niacin.  We could probably guess who’s on which of those two molecules. These are molecules, these psychedelics, where after a single dose we will see an enduring response and a sizable percentage of people as it relates to their mental state.

We’ve seen this in particular in the end-of-life research that’s been done with psilocybin in the collaboration between researchers at NYU and Hopkins, showing that years after that single dose, people still had an enduring antidepressant response. With all of this background in context, it speaks to the fact that we’re not just talking about the activation of a serotonin receptor for an hour or two, meaning until that molecule goes out of the bloodstream. What is happening with psychedelics, and how will that map onto some of the things that we’ve just scratched? We now know that psychedelics can act on immune-related pathways, which means that psychedelics may act on these microglial cells in the brain. That’s interesting in and of itself. Psychedelics may have anti-inflammatory or immune-modulating effects. That’s interesting because psychedelics are, in fact, a stressor that could be seen as a danger signal, but through a process called hormesis, they may, in the aggregate, just like exercise, have an anti-inflammatory effect on our brains, and in doing so, act on some of the pathways that are driving conditions like depression or Alzheimer’s disease. 

I want to go back to that point there for just a minute, talking about exercise. Exercise is a potent anti-inflammatory intervention. When people exercise, they increase levels of inflammation as measured in their bloodstream, specifically interleukin-6. We would say that’s bad. that interleukin6 is an inflammatory molecule, and inflammation is bad. Yet, in aggregate, what seems to happen is a net anti-inflammatory response. There’s an interesting thing whereby our brains and bodies have adapted to short doses of stress, which can, in aggregate, be distressing and may suppress chronic inflammation. That’s one part. There’s more to this story. There’s a sigma-one receptor that’s located in the endoplasmic reticulum that can be activated by molecules like DMT, kind of a core constituent of multiple classic psychedelics that appears to have both metabolic and immune outcomes when activated. There’s also a whole lot being studied now as it relates to how psychedelics may act on neuroplasticity, the rewiring of our brain. This is believed to be one of the most powerful ways in which psychedelics can create these enduring effects. That’s interesting for Alzheimer’s, a disease in which it’s been shown that there are issues with neuroplasticity, both in the creation of new neurons and in the rewiring of our brains towards more adaptive patterns. If we can act on that using psychedelics, that could be a powerful way to have some positive effects and potentially even reverse certain aspects of what makes Alzheimer’s so challenging.

The last thing I’ll say, and I know I’m saying a lot on this topic, is that when we look at the overlap between conditions like depression and Alzheimer’s, it is significant. That speaks to the idea that there are shared pathways. Maybe it is the problems with neuroplasticity; maybe it is the increases in inflammation, which are seen in both depression and Alzheimer’s disease. But psychedelics appear to have the ability to act on some of these shared pathways. It isn’t as though a person gets depression and has one set of brain cells that are involved and another person gets Alzheimer’s and its different cells. Our brains are a whole lot more interwoven than that. Psychedelics seem to be one of these interventions that have the possibility of acting on a large group of these pathways. This is what gives me a whole lot of hope around these things because we’re now seeing that they’ve not only been stigmatized in conversations around the dinner table, but in many states and many counties and increasingly around the world, we’re seeing that they have been decriminalized, and now we’re even seeing legislation in certain places to study how these molecules can be used primarily for mental health right now. But I would imagine that in a couple of decades, these could be part of an Alzheimer’s prevention and treatment protocol.

Heather Sandison, ND

I’ve seen recently that there are big institutions like Johns Hopkins and several others and Pacific Neurosciences that are recruiting for trials here in California using psychedelics. Primarily, what I see as the connection with Alzheimer’s, as you mentioned, is around mental health—treating the depression and anxiety that comes with it and that sense of isolation that comes with dementia. Now it goes both ways. It’s kind of this two-prong thing. We see that depression, anxiety, and social isolation put you at risk for dementia. But then, once you have Alzheimer’s or dementia, you have a higher risk of social isolation, depression, and anxiety. That’s where I see psychedelic research at the moment in terms of the studies that people are recruiting and institutions are recruiting for. That makes a ton of sense. But then, to hear you put it in the context of, the immune system plus the neuroplasticity, there are a lot of ways that this one intervention could potentially benefit people who are at risk for or struggling with dementia.

Austin Perlmutter, MD

I do think that in the context of the conversation around connection as a whole, there’s so much that can be said about not just psychedelics but other kinds of interventions that help us to connect. As you’ve just said, social isolation is a major risk factor for both dementia and depression. If we were just going to get to the core of it, we would need to be almost all of us. There are people for whom this is not true, but almost all of us need to be in a social network—not the digital version, but a real social network—to enjoy life to the fullest. This is also evidenced by the fact that people who are lonely or die earlier get more heart disease. Our bodies just kind of start shutting down when we don’t have that meaning, that purpose, or that social connection. So it’s very interesting to me that certain psychedelics can dramatically increase empathy for and social connection with other people and with nature, which is super interesting. What’s happened in particular? It’s been shown that people who use a single dose of psilocybin or people in general who use psilocybin feel more connected to the natural world, which is hugely missing in our day-to-day environment. The connectedness piece seems to be a major kind of throughline to what we’re describing here. It is incredibly protective when we feel connected. Yet, despite all of our digital connections, people feel more disconnected than ever. Psychedelics offer one opportunity for certain people to be able to become more connected to themselves and feel more in community with others. One of the things that I appreciate about the culture that’s developed around psychedelics—granted, there are pros and cons to this—is that there is this deep line of connection with people that you can both understand and resonate with, and you can also very quickly drop into meaningful discourse around these types of transcendent states. In some ways, it’s kind of democratized what has been historically only allowed to be possessed by some people, but it also allows us to connect with something bigger than ourselves, to connect with other people, and to connect with the natural world. All of that is interesting and independent of what it’s doing to the immune system. Because, by the way, loneliness may create inflammation. It is super powerful. I would also just like I’d like to say one thing here. I am not trying to advocate for everyone to run out and use psychedelics. What I’m saying is that certain pathways seem to be at play that are important for all of us to pay attention to. Psychedelics are one of the interventions that seem to act on that. Let me just provide something completely unrelated to psychedelics but also acts on some of these pathways, and that is having a pet-provided connection. Several studies just published in the last year show that there is a protective effect of pet ownership on dementia. That’s important because I may ruffle some feathers here. Interestingly, in one study, it was only shown for dogs and not for cats, which suggests there may be certain types of connection that are more meaningful than other things not to take away from cats. They’re wonderful in their way. The study showed any type of pet, so there is that kind of buffer for those who are worried that their cockatiel or snake may not be as efficacious. But the point is here, there are many ways to find a connection. Psychedelics seem to be one way for certain people.

Heather Sandison, ND

I wanted to sort of echo that and say that if you don’t have access to psychedelics, it’s not something that feels right for you. Go for a walk with a friend outside and have a meal. Have a healthy meal with someone that you’ve been wanting to connect with and can consider ways where you can increase connection and make healthy choices. There’s a lot that we do have access to. So although we’re discussing those things on the very cutting edge that we need more research around, we want to keep you all abreast of that and excited about it. But don’t worry if you don’t have access; there’s a lot of them. You can get the benefits of this type of thing, even mushrooms, dietary mushrooms, and lion’s mane. Some things may not be the entire psychedelic effect, but these nootropic effects, these brain-healing effects, that you can start today. 

Austin Perlmutter, MD

I would say on that front, and granted, I’m hugely biased because it’s something I love. Foraging for edible mushrooms safely is an amazing way to connect with the community as well as with nature because you go out there and you have to start reading the signs, the trees, and the bushes. You have to know about these relationships—these symbiotic relationships between trees and mushrooms, the fungi, and the mycelial network.

Mushrooms are an amazing entry point for people to go in many different ways, but it doesn’t have to be the psychedelic way. Foraging for mushrooms is an absolute joy, and it’s an incredible way to connect with an audience of people who are maybe a little bit quirky but can provide some amazing social connection, which is something I’ve personally enjoyed.

Heather Sandison, ND

I love that you said that my mom watched the movie Fantastic Fungi, and then she got into a foraging group and made a ton of friends. It’s just been a blast for her. She loves it. I love that you offered that. Please tell our audience where they can find out more about you. I know you have a book and I please share.

Austin Perlmutter, MD

My website is austinperlmutter.com, and if you’re interested in learning more about what I’m doing with Big Bold Health, this is a medicine company. It’s bigboldhealth.com. I guess the easiest way to keep up with what I’m doing is to go to my website, austinperlmutter.com, and check out my newsletter. I try to put out something every week, and it’s usually a take on some of the more recent evidence around an interesting topic. Last week’s topic was How Pets May Help Prevent Dementia And Top Of Mind.

Heather Sandison, ND

 Also, you have Brainwashed, which is a phenomenal book for anyone interested in digging more into how our behaviors affect our mental health.

Austin Perlmutter, MD

It’s also true.

Heather Sandison, ND

I can’t let you get away without sharing that deal. Thank you so much, Austin. It’s been an absolute pleasure having you. I’ve learned a lot, and I know that our audience has as well. Thank you for your time.

Austin Perlmutter, MD

Heather. It is always a pleasure to be with you having these conversations, and I’m looking forward to the next one.