The Wahls Protocol by Terry Wahls, M.D.

The Wahls Protocol by Terry Wahls, M.D.

I first heard of Dr Terry Wahls from the excellent Ted talk* she gave in 2011 called Minding Your Mitochondria. The talk caused quite a stir as Dr Wahls, who was diagnosed with Multiple Sclerosis in 2000, explained how nutrition and lifestyle changes helped her to radically transform her life. Her return to walking and even biking after being confined to a tilt-recline wheelchair is at once inspirational and fascinating. I had stumbled across the video shortly after starting Paleo in April 2012 as I was looking for every available resource on the lifestyle. Dr Wahls’ story was particularly relevant to me as I had suffered with ongoing gut issues for over 20 years, followed by neurological symptoms such as Trigeminal Neuralgia and Facial Palsy. My consultant had warned about keeping a look-out for symptoms of MS, so I was intrigued by Dr Wahls’ story. I had also read the brilliant Grain Brain by Dr Perlmutter and the link between the gut, neurological problems and auto-immune disease is a topic that I find fascinating. When I learned of Dr Wahls new book The Wahls Protocol, I ordered it immediately.

The book begins with Dr Wahls’ story of diagnosis and decline. A clinical professor of medicine and a previously active marathon runner, mountain climber and tae kwon do black belt, Dr Wahls was seemingly fit and healthy individual with a full (although at times stressful) career and loving family. She writes very movingly of her diagnosis and the realisation in hindsight that something was wrong many years ago; the clues that appeared but were not investigated, the warning signs, the niggling problems… Post-diagnosis, and as her condition declined, Dr Wahls discovered the work of Ashton Embry and Loren Cordain. She began to adopt a nutritional strategy based around the Paleo diet but sadly her decline continued. Undaunted and with a thirst to find out everything that she could about her disease, Dr Wahls went on to study MS in more detail – in particular the relevance of healthy mitochondrial function – and eventually devised a treatment plan that incorporates food as the core component, along with electrical-stimulation, targeted supplements, exercise and stress management. The Wahls Protocol outlines this plan in an easy to read, incredibly practical way.

‘When chronic disease is the result of a deficiency, drugs aren’t going to solve the problem.’

The importance of food and other lifestyle factors in the treatment and prevention of disease lies at the heart of this wonderful book. However, Dr Wahls’ message is bigger than this. There is a power that lies within each of us to overcome symptoms and to improve our condition, if we adopt the right methods. The Wahls Protocol is about reinstating that power to individuals. It is about giving control back. It is not about throwing away medication, or ignoring your doctor. It is about working gradually to reclaim health; seeing how things improve, how you feel, monitoring symptoms. It is about ensuring that your illness no longer controls your life. A reduction in medication may be part of this – or it may be not – and Dr Wahls makes it very clear to discuss this carefully with your doctor. Testimonies from ‘Wahls Warriors’ – people who have adopted the Protocol with excellent results – are placed throughout the book. These moving accounts stand as a reminder that things can improve, even when hope has been lost.

‘A genetic propensity may never come to anything if the body stays healthy and fully  nourished nourished.’

Dr Wahls stresses that tackling MS or any other major disease starts with the realisation that ‘Genes are not your destiny’ p.25. The importance of environmental factors in switching on genes for disease is huge. Although Dr Wahls discovered that she had a genetic vulnerability for MS, she reminds us that ‘scientists believe that environment determines 70-95% of the risk of developing autoimmune problems’ p.24. In the same way that environmental factors can ‘switch on’ these genes, so they can influence whether they remain ‘switched off’.  The lifestyle choices we make can mitigate our genetic propensity for disease and merely possessing the gene for a particular illness is not an automatic route to that disease.

‘Cellular nutrition is everything’

So how do we ensure that we make the correct choices that enhance our genetic make-up? Dr Wahls argues that healthy cellular activity should be at the root of all such choices. ‘Cellular nutrition is everything. It is the very basis of all health.’ p.26. Healthy cellular function is dependent upon the correct workings of our mitochondria, the energy power-houses within cells that also regulate cell signalling, cell death and cell growth. Their optimal function is of critical importance to cell health and mitochondrial breakdown leads to chronic disease. I was fascinated to read that the ‘the cells that do not die when their time is up will continually grow at the expense of all other cells, becoming cancerous tumours.’ p.29. Making sure that we do everything we can to look after our mitochondria – particularly when it comes to neurological conditions – will ensure that cells function properly. One of the most important ways we can achieve this is through our diet and Dr Wahls urges us to remember this vitally important piece of information: Our cells are ultimately fuelled by what we eat.

‘The highest bioconcentration of toxins are in your fat, and remember that your brain is 60-70% fat’

Recognising that we can target our nutrition for brain health is one of the first steps in successfully applying the Protocol. Dr Wahls goes on to describe how MS is caused by a faulty immune system which attacks the myelin sheath (the fatty insulation that surrounds the nerve cells), resulting in damage to the nervous system. Dr Wahls looks at micronutrients that are essential for making myelin and for healthy neurotransmitter function, both of which contribute to brain health. Her exhaustive work in compiling this range of nutrients and her years of research, first upon herself and her own condition, then followed by her patients and Wahls Warriors, are brought together in an extremely detailed and easy-to-follow plan.

‘In a very real sense, we all have the same disease’

One of the most memorable passages of this book is when Dr Wahls explains the problem with naming and treating diseases based on symptoms. In reality, we are experiencing the same disease with different symptoms. Auto-immune diseases, along with the major diseases of Western societies are the result of ‘mitochondrial dysfunction, excessive inflammation, high cortisol levels and other markers of broken biochemistry. In a very real sense, we all have the same disease…’ p.47. I found this way of thinking about disease very interesting. By treating the various symptoms, conventional medicine names and classifies the disease yet fails to address the underlying cause. It treats auto-immune diseases by prescribing drugs which – in many cases – undermine the natural functioning of the body, and as a consequence inhibits the very immune system that needs help. An alternative, functional medicine approach which treats the whole person rather than the symptom, involves ‘optimizing the body’s environment to minimize immune hyperactivity’ p.55.

Just as we cannot separate ourselves from the world we live in, so we cannot isolate a disease from the functioning state of the whole person. If the environment we live in is polluted and sick, we cannot survive. If our bodies are sick, then disease takes hold. Our bodies are a microcosm of the world. We talk about environmental pollution and yet we find it so hard to look after our own bodies and give them what they need. If we cannot help ourselves, is it any wonder that we cannot help the world we live in? Symptom-based management will never solve the problem of our major Western diseases. At best it prevents a bad situation getting worse. Only through the optimization of health for the person as a whole can we begin to prevent some of these diseases taking hold in the first place. As you read The Wahls Protocol, there is a realisation that our whole medical system is based upon treating disease from completely the wrong angle – damage limitation rather than prevention. It’s depressing to think about, but maybe we can begin to turn things around.

‘Medications for autoimmune disease do not cure the disease. Their only purpose is to make you feel a little better, which might work, and possibly slow the progression, which also might work. Or not.’

The Wahls Protocol gives an excellent breakdown of the causes and characteristics of autoimmune disease, as well as explaining the conventional vs functional medicine approach. I found this to be an extremely fascinating part of the book. Dr Wahls explains the different types of MS and very interestingly looks at the CCSVI theory of Dr Paolo Zamboni, which suggests that MS is caused by a narrowing of the veins supplying blood to the brain. As Dr Wahls argues, if this is true then surely we need to examine the root cause of this narrowing. The inflammation that narrows the veins (don’t forget that inflammation is the body’s natural response to a problem) is triggered by things such as toxins, chronic infections, insufficient nutrients, food allergies/sensitivities, hormonal imbalance and sleep disruption. Dealing with these inflammatory triggers rather than operating to correct the narrowed veins (angioplasty or bypass) makes much more sense. The link between inflammation and disease is explored and we learn that ‘excessive inflammation is a factor in many if not all psychiatric disorders.’ P.65. Dealing with inflammation is at the heart of the Wahls Protocol and addressing this important issue is a must if we are to tackle diseases such as MS.

‘The root of optimal health begins with taking away the things that harm and confuse our cells while providing the body with the right environment in which to thrive.’

There are three levels of diet to the Wahls Protocol, increasing in strictness: the Wahls Diet, Wahls Paleo and Wahls Paleo Plus. Paleo diet principles underlie all of these and Dr Wahls gives an excellent background to Paleo nutrition with thorough explanations of issues such as leaky gut: a potential disaster for health.  However, the Wahls Protocol is specifically tailored to address chronic disease and to maximise nutrients for mitochondrial function – taking Paleo principles to a whole new level. At all 3 stages, the diet centres around a diverse range of vegetables, together with pasture-raised meat, and wild-caught fish and eliminates gluten, dairy and eggs.  I could write that the Protocol increases in strictness, but instead I like to think of it as becoming increasingly liberating. Depending on which stage you choose to follow, additional foods (such as all forms of grains) are eliminated and others increased (coconut fats).  I was happy to see that those who experience difficulty digesting large amounts of raw vegetables can also scale the quantities down to suit and as the gut heals, reintroduce them.

At the Paleo Plus level, smaller quantities of vegetables are desirable. The highest stage of the Protocol takes the basics of a ketogenic diet but modifies it to include a slightly higher carbohydrate content from non-starchy vegetables. Staying in mild ketosis is possible due to the liberal use of ketone-producing MCTs from coconut products which are essential at the Paleo Plus stage. Some measurement of blood ketones may be desirable to track progress. At this stage of the Protocol, meals are also reduced to two per day (something that many Paleo followers find happens naturally), fat is increased, carbohydrates are decreased and protein limited.

As a Paleo devotee, I naturally slotted in to the Wahls Protocol. I had already eliminated all grains and dairy. After reading the book I cut eggs out too and I have got to say that I feel so much better for doing that. Eggs always made me feel slightly sickly – I can’t quite describe it – and I had read that they can provoke an immune reaction in some people. I hesitated for ages about eliminating them from my diet but when I read Dr Wahls’ book, I did it immediately and didn’t flinch. Likewise with dairy. We learn that ‘gluten and casein molecules have a similar amino acid sequence, and so to our immune cells they are often equivalent.’ P.129. I had cut dairy out completely before reading the book but the difference is that where I once found it hard to have it in the house or felt like I was missing it (definite opioid receptor response for me!), after reading The Wahls Protocol I am so completely resolved never to touch it again.

‘It provides more structure and guidance to help you maximise your nutrition, which is critical for those with any chronic disease.’

I have never found that following a Paleo eating template is hard, restrictive or unenjoyable. It is the complete opposite. However, sometimes I feel like I need help with structuring my food choices in a more systematic way to ensure I receive the full benefits of a wide range of foods. I have to say that this is one of the many things I found invaluable when reading The Wahls Protocol. Dr Wahls gives a very detailed explanation of the importance of foods such as seaweed, bone broth, organ meats and fermented foods and gives practical steps for integrating them into your diet on a regular basis. There are fantastically comprehensive lists of nutrients too. There are also full lists of the three vegetable groups that form an essential part of the Protocol (greens, sulphur-rich, colour), making it easy to plan shopping lists etc. as well as lists of foods permitted for each stage of the Protocol. There is even a handy recipe section. In addition, the book is filled with tips and advice for ensuring you get the full range and correct amounts of various foods. I have found this so helpful as I begin to implement changes. The Wahls Protocol is bursting at the seams with helpful information and the whole book is geared towards making your transition as easy as possible.

‘Brains depend on exercise for growth and maintenance.’

Of course the Wahls Protocol is about more than food. We are encouraged to keep a Wahls Diary in order to monitor progress, feelings, symptoms, etc. and to help us focus on the changes that we need to make. Dr Wahls also urges us to look at the toxins that surround us – in our home, even in our mouth – and look at ways to eliminate them. Natural detoxification through sweating and skin brushing is also encouraged. Exercise is a major part of the Protocol, in particular stretching, strength training (interestingly Dr Wahls explains that ‘strength training generates the largest gains in nerve growth factors’ p.234) and gentle cardiovascular. There are also many helpful illustrations of stretching exercises to supplement the text. Electrical stimulation is advised for MS sufferers to improve mobility and Dr Wahls also discusses when – and if – to reduce medication.

‘Vitamins and minerals act together to facilitate the chemistry of cells and must be kept in balance, but it is far better (if not easier) to achieve this balance through food.’

The Protocol provides extensive information on supplements but Dr Wahls always maintains that the majority of nutrients should come from food first and foremost, listing the various food sources to increase. If supplementation other than the basics (Vitamin D, Magnesium etc.) is desirable, there is a wealth of information here regarding the research and recommended doses, but Dr Wahls stresses  that supplementation should be carefully individualised.

I found the section on alternative therapies extremely interesting and as someone who was previously rather sceptical of such things; Dr Wahls takes a measured and considered viewpoint on some of the treatments available. She provides a helpful list of questions to ask before embarking on such therapies but always stresses the underlying importance of healthy cellular function; maximise this first through food choices and lifestyle changes and then consider some alternative therapies as a helpful addition.

There are some great tips on stress management and the connection between stress and insulin resistance is explored. Reading this section made me realise how I was caught in a cycle of carbohydrate dependence that was inextricably linked to stress, with each feeding off the other and leading to all sorts of health problems over the years.  Quality sleep is also a vital component of the Protocol and Dr Wahls explains the effect of sleep deprivation on stress levels and general health.

‘I believe the public will soon be far ahead of the medical community when it comes to understanding the power of food to reclaim and maintain health.’

The depth of detail and the sheer amount of information contained in this book is fantastic. It really is a bible for brain health. I read it once and then went back and read it again. Everything is so clearly and comprehensively explained and you will find yourself referencing it time after time. In my opinion it is not only a ‘must read’ for anyone who suffers from MS or other auto-immune conditions, this book is for anyone who wants to do as much as they possibly can to avoid these conditions and live a healthy life  (that’s everyone right?).

The Wahls Protocol is also a testament to one woman’s determination to fight and transcend her disease and to help others do the same. Dr Wahls’ story, along with the story of her many Wahls Warriors, is inspirational and gives hope not only to those with MS, but to all of us. Taking control over our health and recovery begins with the Protocol set out in this book. Let’s pray that Dr Wahls gets the funding that she needs to expand her research even further and I look forward to reading more about her work in the future.

*This Ted talk now contains a warning: ‘This talk, which features health advice based on a personal narrative, has been flagged as potentially outside of TED’s curatorial guidelines. Viewer discretion advised.’ Hear Dr Wahls talk about this in this excellent inetrview with Robb Wolf here.


Grain Brain

Grain Brain

There are many great books that I have recommended – see over in the Resources section for further information – but I wanted to dedicate some time talking about Grain Brain as it is a relatively new and generated much debate in the ancestral health scene upon its release.

I first heard of Dr Perlmutter after listening to this fantastic discussion with Robb Wolf. I was very interested in what he had to say and like many others, I was intrigued to hear his advice to limit carbohydrates to around 60g per day for optimum brain health. Since eating a more traditional foods diet, I am always interested to read about the food/brain/gut connection as I have seen such fantastic improvements and want to find out more.

Of course in addition to this – and like many others – I am concerned about the rising number of people suffering with dementia. This is something that I not only find sad and worrying, but I am interested in the theory that dietary elements are significant in the sudden rise of this illness and that dietary intervention could at least improve the condition, and possibly help to prevent it.

‘The origin of brain disease is in many cases predominantly dietary.’

After listening to the podcast, I ordered Grain Brain immediately (not something I do often) and read it cover to cover. I have just finished a second reading and I would like to share some information on the book. As expected, Grain Brain did not get any publicity here in the UK, even as we struggle with soaring rates of diabetes, Alzheimers and obesity. Though some may disagree with Dr Perlmutter regarding the role of diet in causing these diseases or the amount of carbohydrates Dr Perlmutter recommends for brain health, Grain Brain remains an important book that is essential reading for anyone who has suffered from neurological disorders or indeed anyone that is concerned about protecting the health of their brain.


Dr Perlmutter is a practising Neurologist and also a fellow at the American College of Nutrition. His credentials are impressive – see his C.V. here – and he has devoted his career to working with patients who have neurodegenerative disorders. He has a particular interest in the role of nutrition in brain health and has written and presented widely on the subject.  Dr Perlmutter’s father also practised in the field of Neurology. A former Neurosurgeon and 96 at the time of the book’s release, he now suffers from dementia and Dr Perlmutter touchingly describes how he still dresses to see his patients every day. In both interviews and writing, Dr Perlmutter is passionate and persuasive.

Brain disfunction is not normal

Grain Brain argues that the obesity and Alzheimers epidemic is predominantly due to a diet that is high in carbohydrates but low in essential fat and cholesterol. This diet has starved the brain of its necessary nutrients and overdosed it with sugar which, together with the ever-increasing use of statins to lower cholesterol even further, is causing a brain health disaster. This is not meant to happen. Something is seriously amiss and Dr Perlmutter states that ‘We are designed to be smart people our entire lives. The brain is supposed to work well until our last breath.’ So what has gone wrong?

Gluten – a ‘silent germ’

Dr Perlmutter argues that the presence of gluten in our foods has had an insidious effect on brain health, causing inflammation and infiltration of the blood-brain barrier. He describes it as a nervous system ‘irritant’ and gluten sensitivity as the ‘most under-recognised health threat to humanity’ .

‘one of the largest and most wide-reaching events in the ultimate decline of brain health in modern society has been the introduction of wheat grain into the human diet’.

Gluten is linked to a range of illnesses including dementia, diabetes, depression, inflammatory diseases, schizophrenia and ADHD (the list is much longer). Dr Perlmutter uses examples of patients such as Kurt, whose distressing symptoms (in the case of Kurt, convulsive tremors) were greatly improved – if not cured – by the elimination of gluten from their diet. There is a wealth of information on the internet regarding the possible link between gluten and brain disorders and I am surprised at the lack of attention this receives outside of research/medical/dietary circles.

One of the most important things that Dr Perlmutter stresses is that gluten damage is not necessarily experienced through stomach problems but can often be undetected for many years as it silently affects the brain: ‘99% of people whose immune systems react negatively to gluten don’t even know it’.

Blood sugar chaos

Along with the problem of gluten, Dr Perlmutter stresses that high blood sugar levels and the ensuing insulin resistence cause mayhem within the body over time. High blood sugar should be avoided as much as possible to limit the deleterious inflammatory effect on the brain.

Dr Perlmutter tells us how vascular dementia, which occurs with the hardening and subsequent narrowing of arteries in the brain cause ‘blockages and strokes which kill brain tissue’. The oxidation and inflammation which leads to this state of atherosclerosis is a direct result from high blood sugar levels and it is essential to do everything we can to prevent this occurring. In order to achieve this we need to cut carbohydrates.

‘the link between sugar and oxidative stress cannot be overstated.’

Grain Brain explores the links between diabetes and dementia and quotes research that suggests diabetes doubles the risk for Alzheimers. It is the production of Advanced Glycation Endproducts (AGEs) that links the two diseases and we read an excellent description of how these ‘deformed proteins’ are able to wreak havoc on the body. Dr Perlmutter argues that a high sugar diet ‘speeds up’ the glycation process (itself a natural part of aging) and that the best way to reduce AGEs is to reduce the amount of sugar in the diet.

Cholesterol is critical

We learn that cholesterol is essential for brain health and low levels of cholesterol are potentially dangerous for the brain. Dr Perlmutter explains the myriad ways in which cholesterol is used by the body and argues that people with low cholesterol levels are at much greater risk from diseases such as dementia and other neurological problems as the brain is unable to function properly. He quotes studies that point to high levels of cholesterol being associated with better memory function and increased longevity, while other studies show that low levels of LDL are linked to an increased risk of Parkinsons disease. Dr Perlmutter stresses that cholesterol – in particular the so-called ‘bad’ LDL – should not be feared. It is only when this becomes oxidised (as a direct result of a high carbohydrate diet) that problems occur.

Fat: ‘our brain’s secret love’

Fat is extremely important for brain health and Dr Perlmutter discusses the massive error that our governments have made by advocating low-fat diets. The hysteria surrounding fat and heart health is examined, as well as the history of our fat phobia and the erroneous lipid hypothesis that spurned decades of low-fat diets. Dr Perlmutter quotes a study ‘involving more than 340,000 subjects followed from periods of five to 23 years’ which failed to show that saturated fat intake was associated with ‘an increased risk of coronary heart disease, stroke or cardiovascular disease’.  Good fats that are high in Omega-3s reduce inflammation, boost the immune system and transport essential vitamins. There is an excellent overview of the importance of fat in just about every area of the human body. However, it is the brain where the consequences of our lack of dietary fat is felt so acutely.

Statin madness

Dr Perlmutter discusses the rise in the use of statins to lower cholesterol. It is this phenomenon, combined with a typical low-fat, high carbohydrate diet comprised chiefly of gluten-containing grains that has, according to Dr Perlmutter, created the ‘perfect storm’ for brain health and contributed to the dementia and diabetes epidemic (diseases that he argues are inextricably linked). We read about the deleterious effects that statins have on brain function and Dr Perlmutter states that statins ‘may cause or exacerbate brain disorders or diseases’. For instance, by inhibiting the production of cholesterol, statins affect the release of neurotransmitters which are directly linked to memory function. Statins also inhibit the production of Enzyme Q-10, deficiency of which is linked to a host of problems, especially fatigue and muscular pain (common complaints of statin-users) and even heart failure and Parkinson’s disease. These are just some of the many problems brought about by statin use that Grain Brain highlights.

Anyone who has watched ‘Statin Nation’ will agree that the proposed mass-medication with these drugs is downright scary – see recent UK headlines here. Any favourable outcome they do show with people that have already suffered heart attacks is down to the fact that they are anti-inflammatory, a preventative effect that could be replicated through diet – and without drugs with the ensuing harmful side-effects – if there existed the impetus from the medical profession (and without the pressure from pharmaceutical giants).

The argument that people are not able to follow dietary advice and so need to be pumped full of drugs instead crumbles when we know that the dietary advice churned out for decades has been not only been downright wrong (low-fat, high carbohydrates, margarines instead of butter, trans-fats…) but has led to even further deterioration in our nations’ health. As Dr Perlmutter argues, because cholesterol is essential for so many processes within the human body and especially the brain, using statins to reduce cholesterol is not only madness, it is downright dangerous.

Inflammation: silent and devastating

As we know, inflammation is a symptom of many of the major diseases of mankind. Rather than the underlying cause of disease, inflammation is a natural response by the body when something is wrong but itself acts as a trigger for further damage. Irritants to the nervous system such as gluten and high sugar diets turn on the inflammation response and this is constantly maintained throughout a lifetime, leading to a reduction of cellular function.

We read how oxidative stress and the ensuing creation of free radicals which generate further inflammation leaves us open to a wide range of diseases. Remember that it is the oxidized LDL that causes the problems in our arteries. Inflammation is the body trying desperately to cope with a problem and can be triggered by the body’s immune system trying to deal with a foreign ‘invader’ such as gluten.

 ‘No organ is more susceptible to the deleterious effects of inflammation than the brain.

The problem that Dr Perlmutter stresses throughout the book is that unless we experience neurological problems or headaches, it is difficult to find out what is wrong until late into the condition. Inflammation cannot be ‘felt’ by the brain and so by the time we experience symptoms, the damage may already be well advanced – a worrying thought.

The gut: ‘our second brain’

The chapter on the role of gluten in mood disorders and neurological problems such as persistent headaches is particularly fascinating. I do believe that what we eat has a profound effect on our mental state both in the short and long-term and I have read about the links between schizophrenia and gluten/leaky gut (I first read about this in Dr Loren Cordain’s Paleo Diet book), so I was very interested in hearing Dr Perlmutter talk about this in detail.

The increasing rates of depression and the prescription of anti-depressants in both the US and UK is a worrying trend, along with the increased use of drugs to treat disorders such as ADHD. Recent headlines such as this in the UK suggest that in the case of depression, targeting potential sufferers with drugs at an earlier age will become increasingly common. Dr Perlmutter argues that often, these problems can be alleviated by the removal of gluten from the diet.

I was surprised to read that autism has also been linked to gluten sensitivity and Dr Perlmutter states that ‘As much as celiac is an inflammatory disorder of the gut, autism is an inflammatory disorder of the brain.’ I was also surprised at the link between depression, low cholesterol and celiac disease. As the gut lining is damaged by gluten, the absorption of nutrients essential for brain health is inhibited, setting off a chain-reaction of adverse effects. Dr Perlmutter also tells us that the nerve cells in the gut manufacture ‘an estimated 80 to 90% of our body’s seratonin’ (our ‘feel-good’ neurotransmitter). I had no idea about this. The role of the gut in our brain health (and happiness) cannot be over-estimated and I felt that this was one of the strongest chapters in the book.

Additional brain boosters

Dr Perlmutter also covers calorie restriction and the benefits of a ketogenic diet for patients with cognitive decline. He also talks about the importance of exercise and intellectual stimulation for brain health.

I was also interested in his discussion of anti-oxidants. Dr Perlmutter stresses that we need to stimulate the body’s production of anti-oxidants such as Glutathione (which fight oxidative damage and free radicals) rather than consume anti-oxidants through diet. This boosting of anti-oxidants is possible via the Nrf2 pathway which triggers cells into anti-oxidant production. Dr Perlmutter highlights the importance of foods such as oily fish (high in DHA or Docosahexaenoic acid which is essential for brain health), turmeric, green tea extract, broccoli and coffee which can all activate the Nrf2 pathway. Dr Perlmutter also gives us lots of advice on supplements, recipes, and sleep to ensure optimum brain health.

Final thoughts

I found this book absolutely fascinating and I have to say that I couldn’t put it down. I do understand the issue that some have with Dr Perlmutter’s recommendations for only 60g of carbs a day, particularly for those who are healthy, with no signs of metabolic syndrome and who exercise vigorously, although Dr Perlmutter states that in the case of athletes, ‘pushing your daily allowance to 90 or 100 grams of carbs/day is certainly acceptable.

Along with others, I am reluctant to think that consuming 100g of carbs a day – we are talking vegetables, sweet potatoes, limited fruit – when seen in the context of a traditional diet would be dangerous in terms of brain health but of course this depends on the individual.  For someone coming from a standard UK/USA diet, following Dr Perlmutters recommendations but eating 100g of ‘good’ carbs may indeed produce dramatic improvements, but is it too much? As Dr Perlmutter states throughout Grain Brain, the problem is that when it comes to the brain, how can we know before it’s too late?

I do feel that people have to find what carb level works for them. The lower end of the scale is definitely the place to start for those with neurological disorders such as those discussed in the book but it is important to remember that Dr Perlmutter makes it clear that he believes all people should err on the side of caution and cut carbohydrates to the 60g level (apart from athletes as mentioned). However, if this level really doesn’t work for the individual and they feel like they cannot function, then perhaps it needs to be revised.

The elegant simplicity of traditional diets appeals to people on an instinctual level and the personal experimentation needed to tweak the diet is central to its success. What works for someone in their 60s who has spent a lifetime consuming carbs with all the signs of metabolic syndrome compared to someone in their 20s who works out and is super-fit may be different. But in the scheme of things – and in comparison to the average UK or US diet – these tweaks (40-odd grams of carbohydrates?) are ‘small-fry’. The similarities of two such approaches outweigh any differences by miles. Many of us have a history of problems or with a background of family illness so we have to weigh up the pros and cons of Dr Perlmutters advice on carbs and tailor our diets to our profiles.

I do think it is a shame that for many people, the ‘take-away’ from this book is centred around the carbohydrates issue, when really most people would agree with Dr Perlmutter on many things – the need to keep blood sugar in check, the importance of fat, the unfounded fear of cholesterol etc. The book is full of excellent explanations of what are – to many people – fairly complicated topics and the research papers that Dr Perlmutter references are fascinating. Of course, some of the issues have been covered elsewhere but they are necessary to explain and support the central thesis of the book regarding brain health. It is when Dr Perlmutter explores the complex and fascinating relationship between diet, gut health and brain disease that this book really shines and where it becomes so thought-provoking. I do think that the link between these will become ever-more apparent and perhaps Grain Brain is one of many steps towards bringing the issues to the public. Because of that – and despite the heated debate over carbohydrate levels – for many people this is a must-read book.

For further discussion see the following blog posts and comments:
Robb Wolf, Low Carb and Paleo: My Thoughts Part 1
Robb Wolf, My Thoughts on Low Carb and Paleo, Part Deux
Robb Wolf, My thoughts on Low Carb and Paleo Episode 3: A New Hope
Chris Kresser, Do Carbs Kill Your Brain?