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The Gut-Brain-Thyroid Connection Guest: David Perlmutter The contents of presentation are for informational purposes only and are not intended to be a substitute for professional medical advice, diagnosis, or treatment. This presentation does not provide medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Dr. Myers: Hi, everybody. It’s Dr. Amy Myers. Welcome back to the Thyroid Connection Summit: Why You Feel Tired, Brain-Fogged, and Overweight and How to Get Your Life Back. Today, I’m very excited to introduce Dr. David Perlmutter. He’ll be our guest today, and many of you all likely know him from his number one New York Times best-selling book Grain Brain that has been translated into 27 different languages and has sold over a million copies which is just fantastic. Congratulations. Dr. Perlmutter: Thank you. Dr. Myers: And also he is the author of Brain Maker as well as he has a new book coming out this fall, The Grain Brain Whole Life Plan. In addition, Dr. Perlmutter is asked to speak pretty much all over the world and has been on many programs such as CNN and Fox News and Dr. Oz. And I’m just thrilled to have you with us, Dr. Perlmutter. Dr. Perlmutter: I am totally delighted to be with you today. Dr. Myers: Well, great. As you know, this is a thyroid summit, and we know that you are the expert on the brain. And what I’d like to talk about—as well as you’re an expert in the gut and the gut biome—kind of that connection between the gut, the brain, and the thyroid. © Amy Myers MD. All rights reserved.

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Dr. Perlmutter: I’m delighted. Let’s do it. Dr. Myers: I think a lot of people have heard, particularly in reading your books, about this gut-brain connection. How does the thyroid fit into that? Dr. Perlmutter: That’s a great question. I did in Brain Maker talk about the relationship between things that go on in the gut and this very distant place called the brain and how they’re related. But the reality is that the gut influences every inch of your body, and it isn’t certainly just confined to influencing the brain but it’s the heart, the endocrine system, the thyroid, metabolism, blood sugar regulation, set point of inflammation, and immunity. The thyroid which is really a primary target of autoimmunity—and we’ll talk about that more in a little bit—it really plays well into the importance of understanding why the gut is so relevant. Because autoimmunity is a gutrelated issue primarily. Autoimmunity doesn’t begin in the thyroid, nor does it begin in the joints, the skin, or the brain. The gut and specifically the integrity of the gut lining plays a pivotal role in balancing the immune system. We want to have an immune system that’s balanced. If your immune system is underactive, then you’re at risk for deficiencies of immune function that can set you up for everything from infection to even cancer. If your immune system is overactive, then it needs something to do and unfortunately that can lead to what we call autoimmune conditions where your immune system is actually reacting against parts of your own body. I think the thyroid is probably the number one target. We know that Hashimoto’s or autoimmune thyroiditis is the most common autoimmune condition globally, certainly a very common condition in Western cultures in women especially. And I want to just make the case that we’ve got to stop looking at the thyroid in order to try to understand what’s going on with that issue. We’ve got to take a step back and say, “What is it that’s underlying this disregulation of the immune system?” And it’s the gut that’s governing this. When we begin to understand that leakiness of the gut stimulates the immune system and basically causes the immune system to be unbalanced, that is the cornerstone of Hashimoto’s thyroiditis or autoimmune thyroiditis. It’s a stretch. When I talked about the gut and the various markers of inflammation begin related to Alzheimer’s disease years ago, people scratched their heads and said, “We thought the brain was in Houston and the gut was in Cleveland, and there’s no communication.”

© Amy Myers MD. All rights reserved.

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Again, what I’m saying is when we look at this whole notion of autoimmunity, it relates to the brain of course. Inflammation relates to the brain, Alzheimer’s, Parkinson’s, MS, autism. But in this one issue of autoimmune thyroid disease, the gut is playing the pivotal role. So the maintenance of the integrity of the gut is the job of the gut bacteria. And when we compromise gut bacteria to indiscriminate food choices, exposure to various medications—and we’ll talk about that as well—then we set ourselves up for more permeability, more leakiness if you will, of the gut lining which enhances this autoimmune predisposition. And that’s really the cornerstone of this epidemic of autoimmune thyroiditis that we are seeing globally. Dr. Myers: Yeah, it’s quite amazing. I was obviously researching for my most recent book, and Synthroid is the number one drug prescribed in the United States. Pretty astounding considering that people like myself aren’t even on Synthroid. We’re on either Tirosint or Armour Thyroid or one of the desiccated thyroid medications. It’s pretty incredible the staggering number of people with autoimmune thyroid disease. Dr. Perlmutter: Again, the notion of taking a thyroid replacement, whether it is pure T4 or a combination of T3 and T4, that’s symptomatic management. I have no problem with that. You need to have thyroid hormone, for my purposes for the brain as well. But I think we need to take a step back and say, “Ok, that’s treating the smoke, the manifestations of the thyroid issue. How did you get into that mess in the first place?” Dr. Myers: Absolutely. Dr. Perlmutter: Moving forward, and I’m know you’ve talked about it extensively, we’ve got to take our focus off the thyroid for a minute and recognize how did you get into this mess. You got into this mess because of issues related to the gut. Who knew? Dr. Myers: Right. That’s how I got into functional medicine as it was. I had Grave’s disease, and conventional medicine had solved my Grave’s disease by blowing it up like Hiroshima so I no longer have a thyroid. But then I started thinking, “Well, how did I get here in the first place?” And then I of course found functional medicine, and as I write about in the book and as you’ve written about in your books, figuring out those underlying causes, primarily the gut for sure, and then, as we’ve alluded to, foods and then there’s a role of infections and toxins and stress. © Amy Myers MD. All rights reserved.

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I don’t know if you want to go through any of those or what I’d also like to talk about is just you are primarily a neurologist. And prior to getting into functional medicine—I was just curious—did you see people who were being diagnosed with these neurodegenerative disorders that actually had underlying thyroid either as a standalone issue and once corrected…? Dr. Perlmutter: Oh, yeah. The thyroid is certainly—in evaluating an individual with dementia, thyroid is really almost on the top of the list in terms of things that we want to look at. Because hyper or hypothyroidism is what we call one of the very few treatable causes of dementia, meaning that people can lose their marbles because their thyroid isn’t working well. So we’ve really got to focus on that at the initial evaluation. Very important when we’re seeing a patient with dementia. I’d like to just take a moment to review a publication in the archives of Neurology back in 2009 that looked at a large group of individuals, followed them over time, and compared risk of developing full-blown Alzheimer’s disease in comparison to the TSH marker, the measurement of thyroid function. And found that at the very lowest end of TSH or the very highest end of TSH, looking at those two quartiles was associated with a more than doubled risk for Alzheimer’s disease. The point is you’ve got to peg thyroid function. It’s got to be pretty much where it needs to be, and that is to say too high or too low of function seems to be associated with increased risk for developing Alzheimer’s. Now, that was a correlative study. It certainly was not one of causality. But when you understand the metabolic role of thyroid hormone in terms of its role as a trophic hormone in the brain, then it becomes actually pretty easy to understand why changes in thyroid hormone of various types can have an impact upon brain function moment-to-moment and certainly long-term risk for developing Alzheimer’s as well. Dr. Myers: Given that, why do you think that thyroid disorders are so underdiagnosed? I can say for myself, having been a patient on the conventional side, it was a terrible experience for me. I came in with fairly overt hyperthyroid symptoms, and yet the doctor brushed me off as telling me I was a medical student making up in my mind that I had every disease that I was learning about and it was simply stress. And I literally had to practically beg for them to do a full workup, including my thyroid. And then of course, got a call that I had an autoimmune disease of my thyroid.

© Amy Myers MD. All rights reserved.

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But seeing that it’s so related particularly in your field to brain disorders and so many other fields, why do you think conventional medicine is so poor at diagnosing this. Dr. Perlmutter: I think one of the reasons is because thyroid disease can have so many different, seemingly unrelated, manifestations. There can be neurologic issues that may be front and center related to the thyroid that neurology would tend not to look at, would think of other things: edema, swelling, heart issues, blood pressure issues, agitation as you experienced, etc. Look how you were brushed off as an anxious and nervous medical student. I think it’s often that doctors try to explain these symptoms away, and I think the older we all get the more we realize what a pivotal role the thyroid is playing directly and indirectly in so many functions of the body and, therefore, in so many presentations that we might see in the clinic. Dr. Myers: Right. So kind of back to what we were talking about. You were saying that really autoimmunity with the thyroid and most probably thyroid disorders in the first place, many of them even non-autoimmune, probably go back to the gut. And I know that you wrote extensively about this in your book about the gut biome. So can you kind of define what is the human gut biome, and then we’ll take it from there? Dr. Perlmutter: So we stand in a place of discovery right now. Nothing that we learned in medical school and in our training and in our practice prepared us for this sudden paradigm shift, this sea change in our knowledge base, and that is the incredible role that the 100 trillion organisms that live upon our body and within our body are playing in regulating every parameter that you can imagine as it relates to how our bodies work as well as our risk for disease. That said, these organisms, this relatively new discovery. About 90% of all of the microbiome publications have only come out in the past five years. That’s showing you that this is explosive. When you understand that these bacteria are regulating the absorption of nutrients, the production of various chemicals, the neurotransmitters by and large, regulating inflammation—the cornerstone of all of our degenerative conditions—it really is sobering to recognize that these organisms that outnumber Dr. Myers’ cells in her body 10:1 and that represent 99% of the DNA in our bodies, not that 23,000 gene gift that we got from our parents. It’s a very sobering but at the same time extremely empowering notion. © Amy Myers MD. All rights reserved.

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So that as we begin to develop the information and look at the data and we’re in the very primordial stage of understanding what the implications here. But I think it’s a brand new playing field that we never had before. For myself, as a neurologist, my therapeutic options have been so limited for 30 years. We had very little to offer people in terms of treatments for their problems. And by and large what a neurologist and myself years ago included did and continues to do these days is manage symptoms and really, for the most part, ignores the underlying causes of the problems. I mentioned earlier that Alzheimer’s is an inflammatory condition of the brain, as is Parkinson’s, as is ALS and autism. These conditions are rampant. And when we realize that the set point of that inflammation is characterized at the level of the gut, is determined at the level of the gut based upon good versus bad bugs living within us, it really makes us want to pay attention to those factors that have such a huge influence on the health and the diversity of our gut bacteria. And the number one thing we should be looking at is our food choices. Dr. Myers: So that being said, what are things that can disrupt this biome and what are things that can help this biome? Dr. Perlmutter: Well, in the food department, I think the biggest culprits are the standard American diet, Western diet, that is so devoid of fiber and specifically what we call prebiotic fiber. That’s the type of fiber that actually nurtures the gut bacteria, allows them to reproduce, and allows them to do the things that they do, to produce the chemicals that are so healing and empowering for the human body. So diets need to be lower in carbohydrate, lower in sugar, higher in fat, and my plea is for everybody watching us today is to reconsider your position on dietary fiber. You need a lot more, and not just dietary fiber but a specific type of fiber called prebiotic fiber. And you get that in foods like garlic, onions, leaks, dandelion greens, Jerusalem artichoke, jicama, as well as fermented foods that are enriched already by the process of fermentation with bacteria. Fermented foods are things like kombucha, kimchi, sauerkraut, cultured yogurt, any fermented vegetable for example is going to be enriched with a host of good bacteria. I think, to be fair, what may also represent a huge threat to the microbiome and, therefore, put people at risk for autoimmune thyroid disease are the various medications that people are taking today willy-nilly. I know willy-nilly is not necessarily a scientific term, but I think everybody knows what I’m talking about. People are popping pills, either prescribed or over-the-counter, © Amy Myers MD. All rights reserved.

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left, right, and center these days. For example, we do know that the acidblocking drugs that are called the proton-pump inhibitors that everybody thinks they have to take—you watch the commercial and a guy is trying to eat a sausage and the sausage turns away and he’s okay. He can eat the sausage because he’s taken some acid-blocking drug. There’s hell to pay when you take those drugs. It profoundly disrupts the microbiome. Stanford research recently published a study showing a significant increased risk of heart attack in people on proton-pump inhibitors. And if you have that heart attack, your chances of dying from it are doubled. They indicated in the study that the likely cause of that was disruption of the microbiome. So when you change the acidity in the stomach, it has an effect on the pH or the acidity further down in the gut, and it changes the diversity of the gut bacteria. Some very exciting research was just published that showed that the way the bacteria are able to regulate their own pH within each bacterium is affected when they’re exposed to these proton-pump inhibitors. So that, coupled with antibiotics, wreak profound havoc on the microbiome. And I think there’s long-term risk for disruption of the microbiome. Even one course of antibiotics changes the microbiome permanently for the rest of a person’s life. Now, I’m not saying you shouldn’t take an antibiotic, but I’m saying that we are grossly overusing antibiotics. I don’t think there’s anyone who would disagree with that. The World Health Organization characterized our over usage of antibiotics as one of the top two health risks for this decade. And recognize that we take antibiotics for the wrong reasons, for colds and sore throats, when they’re not necessary. And 70% of the antibiotics used in America go into our cattle and our poultry. Dr. Myers: That’s what I was going to say. I think that’s where most people don’t really think about it, that the vast majority is actually going into the food supply and the foods that they’re eating. So certainly eating organic and raised without antibiotics is a way to support the stopping of the usage of that. Dr. Perlmutter: I think when we start to look at all of these correlative studies through the lens of the microbiome, it’s going to start to make sense. There was a study published about two hours ago. It just came up on my newsfeed that showed a fourfold increased risk of developing ALS or Lou Gehrig’s disease in people at the higher levels of pesticide exposure. We know that pesticides wreak havoc on the human microbiome.

© Amy Myers MD. All rights reserved.

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As I read that study, they didn’t draw any conclusions, but my take is if you take a step back and think about this very important influence that the microbiome has on immunity and inflammation, then we’ll really gain some understanding in terms of things like ALS. There was a study published in 2004 in the Journal of the American Medical Association that perfectly correlated antibiotic exposure, the number of antibiotics a woman would take, with her risk of developing breast cancer. Published in JAMA, in a wellrespected journal. Dr. Myers: I was going to say I also just wonder about when I hear all of this the detoxification capabilities of the microbiome. Not only is it the digestion and the absorption and the interplay but also the detoxification to get many of these toxins that we’re exposed to on a daily basis out of our system. Dr. Perlmutter: It’s so true. I interviewed Dr. Stephanie Seneff from MIT yesterday. We had that discussion. She’s in a lot of work in looking at glyphosate which is the herbicide that is being sprayed around the world, 1.35 million metric tons now being used, and how that damages the gut bacteria and, in and of itself, also damages our detoxification pathways, what are called the CYP pathways. Dr. Myers: Double whammy. Dr. Perlmutter: It is. You depend upon these bacteria to help you detoxify from the very chemical that you’re then exposed to that’s killing off a subset of your bacteria. The idea of a more paleo lifestyle isn’t just eating more meat and stopping the carbs. We think about our Paleolithic ancestors and they lived in a very pure environment in terms of toxins and threats to their microbiome. Dr. Myers: For sure. When I think about just what is the greatest threat to us right now, I think about GMOs. I really feel very strongly about that and what it’s doing not only to the environment, to our crops, to small farms, but to the microbiome and to our health frankly. Dr. Perlmutter: It’s a really interesting thing that you bring up because I think it’s sort of trendy to talk about GMOs and trendy to ask the grocer for products that are non-GMO. The real question is why? Why would we object to genetic modification of our food? Seems like a crazy thing anyway. I think when you take a step back and ask yourself, “Why are foods genetically modified?” By and large, the reason is so it allows farmers to spray the crops with this herbicide, glyphosate, which is what we find in Roundup. © Amy Myers MD. All rights reserved.

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That’s the reason, interestingly, that last month the FDA finally called for a panel of research scientists to start to study the foods that we eat and report the residual glyphosate levels and letting us have that information. Last year, the World Health Organization characterized glyphosate, this herbicide, as a probable human carcinogen. And they didn’t do that lightly. That was a big deal, published in the journal the Lancet, very well respected. I’ve just gotten back from being virtually around the world and visited places like New Zealand where they’re still using a lot of glyphosate. You think you’re on an island and you’re way away from America. This is a global issue. Dr. Myers: It’s so global. I was a Peace Corps in Paraguay and was back this past Christmas with my husband. And a good friend of mine’s family is from there, and they actually are cattle farmers but they also raise soy beans. And was at dinner with them and of course it’s GMO soy beans, and the father was asking my opinion and I was trying to tread lightly as I’m in their home on Christmas Eve. They’re opening their home to me. How do I feel about this? And very intelligent people, and the mother says, “We’re feeding the world.” I thought, “That’s one of the biggest misconceptions about this is that people think that all of this corn and soy is going to feed the world, this GMO corn and soy. It’s not. It’s going to feed the cattle.” We then drove to Brazil from Paraguay, and the fields that you’re passing of just GMO soy and then going to my village where I had spent two-and-a-half years, the farmers there had worked with it and had real-time reports of how children were getting sick, how their cattle and how their pigs were getting sick. And my farmers who were small farmers, a couple of acres apiece, will not use the stuff. It was so disturbing to see a country that I love so much being destroyed. There was an article—I’ve forgotten in what publication, Discovery or something—talking about the Chaco which is a big open area in Paraguay and how Cargill had essentially destroyed all of the rain forest and forest there by planting GMO soy and corn and how it had basically gone unrecognized by the rest of the world because who even knows where Paraguay is. It’s quite disturbing, for me in that moment, on a multitude of levels of a very intelligent couple claiming to feed the world, to a country that I love so much being destroyed. Dr. Perlmutter: Well, the argument doesn’t work because the more glyphosate you spray on the soil the more you kill the microbiome, the microorganisms, in the soil and ultimately the less healthy will your plants become and the more chemicals you’re going to have to supply and treat them © Amy Myers MD. All rights reserved.

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with. We’re watching that happen in Europe now. We’re watching it in vineyards in Europe, and it’s pretty breathtaking. You often wonder if somebody came down from outer space, if we had a visitor, and they landed in their UFO. I think the first question would be, “You’re spraying poison on your food?” And then it would be like a Dr. Phil moment, “What were you thinking?” You wonder why people are sick. It’s because we’re consuming poison. You can’t do that. We’ve not evolved detoxification mechanisms, pathways, that can deal with this incredible onslaught of toxins in our environment without virtually any regulation or any research to indicate that these things are safe. I think typically what you see is products are released and basically what’s going on now is the field testing. And the field testing, according to the World Health Organization, is telling us this is a probable human, not rodent, carcinogen. You can still go to your Home Depot and buy the stuff right off the shelf and spray it all over your yard if you want to. Dr. Myers: We don’t even know how long all of this is going to last. I have a friend who recently had fibroids and had them removed. Being that she’s in functional medicine as well—I say geek in a fun way because I would probably do the same if I were her—had them sent off to a laboratory and had them get tested for what was in her tissue. Her family was from Vietnam. She was born there and then came to the United States. I don’t remember the pesticide, but it was something that’s been outlawed here for 30 years but it had been used over in Vietnam. Her levels were something like 100 times what anyone should have in their body, and it was concentrated here in her fibroid which one would say a fibroid is really just inflammation. It’s an inflammatory process. How long are these toxins sticking around even after we’ve banned them? Or is this something that she got from her mother in utero that passed through the placenta? Dr. Perlmutter: It’s true. These are molecules that even in low concentration can have significant effects, sometimes even at a higher concentration the effects might not be as dramatic. I’m in Florida, and there’s all kinds of talk about the next plague which is going to be the Zika virus carried by the Aedes aegypti mosquito and the world’s going to come to an end. What we’re seeing in Central and South America and I think soon to see here are these massive fogging campaigns to get rid of these mosquitos. And they’re using pyrethroids. Interestingly, the charge study from UCLA has shown that pyrethroids—people exposed to them, mothers carrying babies exposed to © Amy Myers MD. All rights reserved.

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them, have a significant increased risk of that child having autism or being on the spectrum. That’s what we’re spraying, so we do have to look at the risk/benefit ratios of the interventions on the planet as well as the medicines that we use. Certainly, as it relates back to the microbiome in terms of regulating immunity, and that takes us right back to autoimmune thyroid disease. It’s a pretty complete circle, isn’t it? Dr. Myers: For all the people out there that just got overwhelmed and scared, why don’t we kind of recap what we talked about and then talk about things that we can do because I, as do you, like to give people information so that they’re empowered, but we don’t want people to be overwhelmed or scared that there’s not something that can be done. So I don’t know if you want to recap or I can recap kind of things that destroy the microbiome, how we can rebuild the microbiome, and then our conversation went a bit outside of that. So what can we do to protect ourselves? Dr. Perlmutter: Well, I’d be delighted if that’s for me to do. Dr. Myers: Sure. Absolutely. Dr. Perlmutter: First, let me just take a step back and recognize that here Dr. Myers and I are talking about the thyroid. And what I’m about to tell you relates to the microbiome. What is this connection? And I think we made the point that the thyroid is highly influenced by the events that occur in the gut. And that’s why we have to pay attention to the health of the bacteria that live there and other organisms. The things that threaten the microbiome are of course indiscretions of our diet: having too many carbs, too many sugars, not enough fat, and most importantly not enough good prebiotic fiber. Those foods that are rich with prebiotic fiber are things like Mexican yam, dandelion greens, garlic, onions, leek, asparagus. These are foods that are really enriched with prebiotic fiber to nurture your gut bacteria. You can go to the health food store and say, “I’d like some prebiotic fiber, please.” And they’ll direct you to a whole array of products that are prebiotic fiber. The next thing is to recognize that so many of the drugs that people think they need to take or are told to take actually can profoundly affect the microbiome and you need to be very judicious. And those include the nonsteroidal antiinflammatory drugs, the ibuprofens that are in so many products that people are taking for headaches or any kind of pain, the proton-pump inhibitors. © Amy Myers MD. All rights reserved.

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That sounds like a big term, but it simply means the bulk of these acidblocking drugs that are available over-the-counter. Then, of course, probably the biggest culprit of all are the antibiotics that everybody takes whenever they have a sniffle or a sore throat or pull on their ear that are being given to our children with abandon and that threaten the microbiome and can cause life-long changes to these bacteria. Make no mistake about it. These bacteria have our future in their hands. I don’t know if they have hands, but they wield the sword of Damocles. They determine whether we’re going to live or die, basically. And we have to nurture them. They say that when women are pregnant they have to be careful because they’re eating for two. And I’d just like to say that each and every one of us is eating for 100 trillion. Dr. Myers: So then they’re eating for 200 trillion. Dr. Perlmutter: Right. That’s true, but the child before it’s born doesn’t really have a microbiome yet but will. And they’ll acquire that from mother which leads me to my final point, and that is understand that we acquire the initial microbiome that we carry, we are anointed with our microbiomes, if you will, as we pass through the birth canal. Bacteria that live in mother’s birth canal and nearby in other canals, not to be graphic, are implanted on the child’s face, in his mouth, on her nose, etc., and then form the seeds from which that microbiome will be born, will be created. So when we see significant increased risk of things like celiac disease or type 1 autoimmune diabetes—70% increased risk for kids born by C-section. When we see a dramatic increased risk for adult obesity in children deprived of getting those bacteria because they were born by C-section. When we see an increased risk of autism, for example, which is becoming epidemic, in children born by C-section, we have to take a step back and ask ourselves, “What’s going on here? What is this relationship?” What I think a lot of researchers are talking about is the fundamental importance of that initial microbiome being transferred from mother to infant, to newborn. We call that horizontal information transfer to be contrasted with what is called vertical transfer of information which is the acquisition of the genes that we get from mom and dad. Yes, we get a blueprint from mom and dad. We get 23,000 genes from our parents. It’s this code that’s been passed down from generation to generation. But the final apps are loaded into the computer at the moment of birth. The final software that is most up-to-date and prepares that child, that newborn, for its environment, be it a rural © Amy Myers MD. All rights reserved.

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environment, a cosmopolitan environment, one that’s far from the equator, one that’s equatorial, those marching orders are given at the time of birth. When a child is deprived of that event, in other words born by C-section, then it paves the way for immune issues and inflammatory issues and even obesity. Now, I’m not arguing that we shouldn’t do C-sections. Of course, we should. This is a life-saving procedure. But as we have this discussion, in America today one-third of all births are C-section. And it’s hard to imagine that a third of all births are so complicated that they require a C-section that will change that child’s health destiny. Dr. Myers: Did you see recently the study where they were taking bacteria—in a C-section baby, taking a swab from the vaginal cavity of the mother and wiping it on the baby’s face and showing that it almost established the microbiome as if the baby had gone through the birth canal? Dr. Perlmutter: That was work done by Dr. Maria Dominguez-Bello at New York University. And this is actually her second publication. The first one I actually put in Brain Maker, the notion that if you have to have a C-section because of fetal distress or mother having issues with blood pressure, whatever it may be, that you inoculate a sponge in the birth canal and you keep it moist and warm and then you inoculate the baby’s face with that after he or she is born. And I think it’s a very, very powerful idea. Dr. Myers: Absolutely. The irony of it at the end of the study was that they wanted to find out which were the crucial bacteria so then they basically could synthetically produce those bacteria and give it to the baby rather than what they were doing in the study which costs no extra money, required no additional researching, and it’s just right there. Super simple, all natural. Can wipe the baby’s face. The end result of that study was we need to study this further and then hopefully we could basically come up with a drug or a probiotic that we could give to the baby. Dr. Perlmutter: It’s all about how do you monetize the results. But having said that, I think that the call here could be right now—the call to action— which is where you and I were going, would be don’t have a C-section unless it’s absolutely necessary. Dr. Myers: Absolutely. Dr. Perlmutter: When we look at the risk/benefit of C-section, typically what a woman is told is, “Well, there’s no risk and the scar is going to be this long. You might be in the hospital an extra day. And the benefit is you don’t have to © Amy Myers MD. All rights reserved.

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go through labor.” Notwithstanding there could be a very good reason for a Csection, but I think in the risk column we have to add long-term risk to your baby because that baby was deprived of that very important inoculation. Dr. Myers: All right. Well, let’s move on. You had also discussed sort of the role of fat and adding fat into the diet. Can we kind of talk about the role of fat in both thyroid health as well as brain health? Dr. Perlmutter: I’d be delighted to. Your brain is mostly fat, and I’m not picking on you Dr. Myers. A person’s brain is 60-70% fat. You don’t get it from the air. You don’t read about it and get it. You get it from the fat that you choose to eat. So fat is an integral part of the diet as it relates to brain health and as it relates to every aspect of human health and longevity. Humans have always, always eaten high levels of fat and remarkably low levels of sugars and carbohydrates. When I say always, at least for a couple million years until just an hour ago, which is, what, maybe two decades ago basically that we were told somehow that fat was a bad thing. And everybody stopped eating fat, and when we did we began eating many more carbohydrates in the diet. And rates of diabetes skyrocketed. High levels of carbs increase risk of diabetes, not only through the insulin mechanism but also through the changes in the microbiome. So when we eat more carbs, we increase the risk for immune issues and inflammation. And again, the thyroid is a perfect target for those problems. Fat is, again, a wonderfully concentrated source of calories. We’ve depended on fat to survive for such a long time. The gut depends on good fats, certainly not the modified fats that are so prevalent in our society. And I would like to say that when we are reviewing the microbiome studies that look at the changes in the microbiome that may not be favorable in animals fed a high fat diet, you’ll find that these are animals that are also on a high carbohydrate diet. So it’s a very good lesson for us and that is if you want to reap the benefits that everybody’s talking about of eating more fat, you can. But it’s not going to happen unless at the same time you cut the carbs and get rid of the sugars. Otherwise, you are going to create a situation that’s bad for your gut bacteria, and that’s going to ultimately be bad for you. To be clear though, we’ve got to be super careful in terms of those fats that we eat. Most of the fats that people are consuming are detrimental to health and damage the microbiome. But the extra virgin olive oil, the coconut oil, the avocados, the nuts, the grass-fed beef and wild fish, these are foods that © Amy Myers MD. All rights reserved.

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supply to our bodies wonderful, health-sustaining fat and emulate the diet that humans have eaten for 99.6% of the time that we’ve walked this planet. Dr. Myers: Also, we need fat for our thyroid. In addition, many of the fatsoluble vitamins—vitamin A, vitamin D. You need vitamin K with that, vitamin A with the vitamin D. So are necessary for the thyroid to function optimally. Are there any other foods or nutrients that you can think of specific to the thyroid that you’d recommend for people? Dr. Perlmutter: Well, I will. Over the years, many of us had been proponents of choosing organic foods, and I think now that we understand the GMO issue and the glyphosate herbicide issue that becomes even more germane for a couple of reasons. Glyphosate—this herbicide that is so prevalent on our food now, the food that is genetically modified and wheat which is not necessarily genetically modified. Glyphosate is sprayed on wheat to help it ripen more quickly. One of the things that glyphosate does is it binds minerals. It’s a chelating agent, and as such, various important minerals can be chelated out, and vis-a-vie the thyroid gland, I think one of the most important minerals obviously would be—aside from iodine—is of course selenium. Our activation of thyroid hormone from T4 to T3, the cutting off of that iodine, is dependent upon adequate levels of selenium. Selenium deficiency can really be something that is quite common in people who are functionally hypothyroid, who are not converting their T4 into T3. We even see it in people who are taking a drug like Synthroid, which is pure T4, the notion being that you’re taking T4, your body’s going to convert it into active thyroid hormone which is T3. But again, that depends on adequate selenium levels. Any person, in my opinion, who is being looked at for thyroid issues, being treated for low thyroid function, should have an intracellular mineral panel and I would say pay particular attention to the selenium level. Dr. Myers: So you were doing that in your clinic. I know that there are certain functional labs that we both work with that do those. Were you doing any of that through any regular lab testing at all for those people who couldn’t? Dr. Perlmutter: Generally, no. We can get a magnesium red blood cell test from the regular lab, but the more extensive panel of minerals, intracellular minerals, there are a couple of specialty labs out there that will do that and are easy for a doctor to connect to and send the specimen to. So it’s really not anything dramatic. But I will tell you that if you’re looking just at serum levels of magnesium and selenium and other minerals, you’re not going to understand what’s going on. © Amy Myers MD. All rights reserved.

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You really need to do a little bit more sophisticated test and that is the intracellular evaluation. Dr. Myers: Just so people understand, what’s in your serum, it has to get into your cell which is where most of these reactions take place and where this conversion of T4 to T3 is taking place. And also, particularly if you’re taking a supplement, a multivitamin that has selenium, you might have plenty of it in your serum, but it might not be able to get in. Or not necessarily with selenium, but in the case with folates and B vitamins, if you have certain mutations you might not be able to make those conversions into the activated forms and you might need even more. So it always is important when you’re looking at testing, and I talk about this in my book, to make sure you’re getting the right type of testing for what you’re looking for. Dr. Perlmutter: I would give a plug for your book because one thing about the way you write is it’s really actionable. And I’m not sure if I put that in the blurb. I might have, but I was thinking about it that you write so well and the information is great. It gives a great understanding, great explanation. You gain that. But what’s most important is, ok, now that you have that, what am I supposed to do? And I applaud you for doing that. That’s a great approach. Dr. Myers: Thank you. I appreciate it. People can get overwhelmed. As many of us who’ve gotten into functional medicine, I have a personal story and I’ve been on the other end of it. And then also being in practice, as you know, you have people in and out of your clinic every day. And so you see real life. Where are the stumbling blocks? What is confusing for them? What seems overwhelming? What needs to be explained better? And so being a clinician and then writing, you know kind of where these places that people either get overwhelmed; they’re not going to follow through because it seems too much versus they don’t understand something. I do, like this, like to empower people with information but then break it into an easily, if possible, actionable step for them to move forward. Dr. Perlmutter: That is the point. These are actions that are not going to be purveyed on a prescription pad. You can’t take a pill to accomplish the things that we’re talking about right now. It’s a lifestyle change. It has to do with changing your food choices, choosing to eat more organically, choosing to favor foods that are fermented foods that have a high prebiotic fiber content, being super careful about the medications that you take. And, with all due respect, I think generally people are not getting that information from their © Amy Myers MD. All rights reserved.

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general visit to the doctor’s office. That’s a quick in and out. You say high blood pressure, and you get a pill. You say hypothyroidism, and off you go with your pill. You’ve not treated the problem. You’ve only treated the manifestations of an underlying problem that frankly has been neglected. The word “doctor” doesn’t mean “healer”; it means “teacher.” That is our call to action. It’s really to teach and empower people with information so that they can make the right choices and be healthier and not require medication that might prove threatening. Dr. Myers: And you are definitely the definition of that with all of the bookwriting that you’ve done and the speaking that you do and engaging in summits like this. So I certainly appreciate that. Dr. Perlmutter: I’m happy to do it. Dr. Myers: One final kind of topic that’s a little bit off topic. So we’ve discussed the role of the microbiome and gut and we haven’t used the word leaky gut, but I think that that’s what we’ve been alluding to here with opening up those tight junctions to lead to inflammation and autoimmunity. We’ve talked about the diet. Some of the other things I talk about in the book are also stress, infections, and toxins. Is there anything you want to say on any of those topics? I know at least probably with toxins you dealt with that, mercury toxicity, when you were dealing in your clinic with patients with Parkinson’s and neurodegenerative disorders. Anything that you’d like to say on any of those topics? Dr. Perlmutter: Sure. Well, you mentioned three: stress, infections, and toxins. Let’s start with stress. Stress is more than just a brain-related event. When we are stressed, our adrenal glands put out more cortisol, and cortisol increases permeability or leakiness of the gut. It also changes the various organisms, the diversity of the organisms, that live within the gut. And that leads to increased inflammation that is not favorable for the brain, and that can actually ultimately increase stress response, leading to more cortisol. So you get into a feet-forward cycle. So I think stress is really fundamentally important globally, not just involving the brain but the entire body because it affects this gut permeability issue or the leakiness of the gut. Infections are an event in which inflammation is amped up, and we see—and the literature supports this as well—that individuals who are at a certain point © Amy Myers MD. All rights reserved.

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on the dementia scale, in other words they’re already experiencing issues, oftentimes with an infection, whether it’s pneumonia or urinary tract infection, will have a fairly dramatic drop in their cognitive performance. And we see this all the time. Again, it is a testament to the significant damaging effects that these inflammatory chemicals called cytokines have upon the brain. In this day and age, unfortunately every infection, even if it’s viral, seems to be treated with an antibiotic. If you have a cold, you get an antibiotic. And as we’ve talked about earlier, this has a huge damaging effect upon the microbiome and leads to increased gut permeability. Now the last issue you mentioned is toxins. And I think that there are many things we could be talking about, but I’d like just to recap this notion that glyphosate, the active ingredient in Roundup, this herbicide, is to me the biggest toxic event on the planet, not just for humans but really for all living things. Why would it be an issue for an olive tree, for example? As I mentioned, I was in New Zealand. I took a picture of an olive grove, and they don’t spray the olive tree with glyphosate. But they spray around it to clear out the weeds. And that kills the bacteria that live in the soil, and now the farmer’s telling me for the first time ever we have fungus in the olive trees. We’re having to treat them with fungicide on the very food that they then make olive oil out of. So it’s a very, very big problem. The earth has its own microbiome. The atmosphere has a very rich microbiome. Bacteria and other microbes that live in the air we breathe actually play a role in controlling the weather of the planet. Georgia Institute of Technology researchers went up to 36,000 feet and were sampling the atmosphere. The ocean is rich with microbes that have a huge role to play in the health and vitality of our oceans, and the soil is so rich with microbes as well. It’s a much bigger picture than this anthropocentric view that what is the human microbiome all about and how does it affect health? That’s a big topic. That’s lifelong dedication there. But we’ve got to understand that everything we do that is toxic affects not just us but every living thing around us. Chief Seattle said that, “Man did not weave the web of life. He is merely a strand of it.” My conclusion here is that it’s a huge concept of our interrelatedness with everything on this planet that’s alive, and these implications—when we’re using toxins like glyphosate— transcend just what they do to humans. It’s a global event.

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Dr. Myers: Yeah. I think back to an article. I believe it was about wine making, and they were using the oak barrels for the wine. And someone had come in and complained that—not the FDA, but a regulatory agency—that in the oak barrels there were cracks. And in the cracks there were bacteria. And that could potentially make somebody sick and were telling them they needed to go to steel barrels. It has completely changed the dynamic of the wine, and more people have actually gotten sick because the steel is almost too clean and it harbors the bad bacteria. Whereas, the oak barrel had almost like its own microbiome living within the cracks of the wood. It had these good bacteria helping to ferment the wine and keeping out the bad bacteria. I think back to when I was little. I unfortunately can’t tolerate diary now but making yogurt with my mother when I was very little. Just homemade, organic yogurt and talking about the microbiome and your gut bacteria way back when which was well ahead of the times. I love water kefir now and actually got back into that after your most recent book. I’d been kind of avoiding it because I don’t do well with coconut, and I don’t do well with dairy. So I thought, “Well, what am I going to do?” And I think you had a recipe for water kefir, and I thought, “I’m going to get back into that.” Dr. Perlmutter: I would say don’t give up either because I think as time goes on as you continue to really keep the pressure on to improve your gut health that your dietary tolerances will improve, and you’ll find that you’re going to tolerate a lot more in terms of looking back at those things that you traditionally had issues with. We see that all the time. The idea that bacteria in the oak of the wine might present a problem—how do you make wine for crying out loud? It’s made from things that are in the dirt. We were in Corsica last year, and we were at one vineyard. And this winemaker was explaining to us how vital not just yeast but all the organisms that live in the soil are for the health of the vine and the taste and quality of the grapes that make the wine. We had just stumbled in off the street, and he didn’t know my interests. And I said, “I kind of know a little bit about what you’re talking about.” And he said, “Well, if you’re interested in this, you must fly to France and meet Dr. Claude Bourguignon and his wife Dr. Lydia Bourguignon. I said, “Great,” because they’re experts in the soil microbiome. I said, “Sure, we’ll get him on the phone and call him.” He said, “No. No one can call him. You cannot call Dr. Bourguignon.” It was like that scene in the Wizard of Oz when Dorothy knocks on the door and they say, “No one gets to © Amy Myers MD. All rights reserved.

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see the Wizard of Oz.” But I guess my wife was wearing the ruby slippers at that point, so next thing you know we were having coffee with the Bourguignons. And he was really laying it out in terms of how extensive glyphosate is in terms of winemaking, that more than 80% of the wines made in France, in Burgundy, the vineyards are treated with glyphosate. And it’s especially prevalent in champagne. So but there are people out there that are trying to light the single candle and not curse the darkness. I think you have to curse the darkness a little bit to get attention, so we do that. But I think at the end of the day we’ve got to light the candle and give people, as you do, the answers in terms of what they can do in a positive way. So that’s what I hope for, for moving forward. Dr. Myers: Me, as well. We just bought a couple of acres and are moving further out of town so I can have my organic garden. Dr. Perlmutter: That’s terrific. Dr. Myers: And whatnot again, getting back to my days of being a farmer in Paraguay. Not to give up, but just to sort of empower myself that I don’t have to… Dr. Perlmutter: Set the example too. Dr. Myers: And we’re building a mold-resistant and completely chemical-free house, so I’m moving into other areas of health. That could be a whole other topic in and of itself. Dr. Perlmutter: For you, it’s not do as I do, not as I say. You’re walking the talk. Again, as you continue to write based upon your personal experiences, that has a lot of traction. A lot of people write books, “Here’s what my thoughts are.” But when I write, for example, what it was like to lose my father from Alzheimer’s disease and my own personal health issues, I think we’re all on the same side. We’re all trying to be healthy and live a long life and be disease-resistant. It’s a good perspective. No one’s immune from any of this stuff. Dr. Myers: No. And even if they think that they are, like my husband, one day it will catch him. So luckily… Dr. Perlmutter: Oh gosh. God forbid. Dr. Myers: Well, no. Hopefully not because I’m doing all of these preventative measures, right, with him. He’s the man of steel. © Amy Myers MD. All rights reserved.

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Before we part ways, I like to always leave our listeners with three take-home points from your talk of how people can help themselves, help their thyroid, help their microbiome, whatever you’d like to leave them with today. Dr. Perlmutter: Ok. Well, point one is you’ve got to care for your microbiome. That is fundamental for your health, through all the things that we talked about today: the dietary issues, the avoidance of medication, having children not born by C-section if that’s possible. So point one is to really focus on gaining an in-depth understanding in terms of how valuable to you are these microbes that live within you. Step two, and this may be a bit of a surprise and I’m not ranking these. But step two is you’ve got to resume aerobic exercise. There are so many gene pathways that are activated when you are exposed to that level of energy consumption, not the least of which are pathways that make a chemical that’s fundamentally important for preserving your brain. So 20 minutes minimum of aerobic exercise every day. Target heart rate would be 180 minus your age. Of course, that depends on the condition you’re in. And number three, and again they’re not ranked, is you’ve got to cut the carbs and sugar. Eat more fat and eat more prebiotic fiber. If I could get people to do those three things, I think it would have a huge impact on their health. Dr. Myers: Real quick with the exercise because we didn’t talk about that much. Is that continuous 20 minutes of your heart rate sustained? Dr. Perlmutter: Sustained. Yes. Now, interval training I think is wonderful. I think weight training is awesome. I think flexibility training is terrific, but the main thing that has been demonstrated from research from the University of Pittsburgh, for example, is that that sustained elevation of heart rate is really what you need to accomplish. Dr. Myers: And for those people who maybe are struggling with chronic fatigue, fibromyalgia, severe hypothyroidism, [inaudible], multiple chemical sensitivity and can’t get there, where do you recommend they start? I always recommend sauna. I don’t know that they’re going to get their heart rate up that high but at least to start people who can’t do much movement. Do you have any recommendations? Dr. Perlmutter: I would say what is that level of movement that you can do? If you have just enough energy that you can get out of bed and walk to the kitchen and you have to go back to bed, let’s just start there. Because tomorrow I’m going to ask you to do that twice and go right back to bed. And © Amy Myers MD. All rights reserved.

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the next day we’re going to go three times, and by the end of the week I’m going to say, “I want you to try to walk out to the mailbox and come back.” I think that everybody can pick it up or at least can try. So many people kind of resign themselves and say, “I just can’t do it. I’m not going to do anything aerobic because I can’t jog three miles.” I’m not asking you to. I’m asking you to walk to the end of your driveway and back if that’s the best that you can do. I’d say anything that you can do to get the ball rolling is really going to break the ice and get you started. Dr. Myers: Great. Great advice. Dr. Perlmutter, it’s a pleasure as always. Thank you so much for everything you’ve done for me. Thank you for what you do for the world and thank you for being you. Dr. Perlmutter: Well, Dr. Myers, I appreciate it. We always have terrific conversations and I’m always thrilled to hear all the new things that you’re up to so my pleasure. Dr. Myers: Thanks everybody for joining the Thyroid Connection Summit: Why You Feel Tired, Brain-Fogged, and Overweight and How to Get Your Life Back. Thanks again for joining us and stay tuned for more talks tomorrow.



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