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Brain dysfunction starts in your daily bread, and renowned neurologist Dr David Perlmutter is here to prove it.

It’s not the best time for the humble slice of multigrain. Every which way you turn – and every second post on social media – seems to be rejecting our daily bread. Paleo, gluten-free, caveman diet: these are the very hottest things in the world of nutrition right now. But is it fair? Are carbs really to blame for so many of our current ills?

According to the author of the New York Times best-selling book Grain Brain: The Surprising Truth about Wheat, Carbs, and Sugar – Your Brain’s Silent Killer – the answer is a resounding yes. Dr David Perlmutter is a recognised world leader in the science of brain nutrition, and in his book he argues that gluten, carbohydrates and sugar are not only destroying our waistlines, but our brains as well. And he’s not just talking about the high-sugar, processed, white bread variety of carbs, but the wholegrain ‘healthy’ ones, too.

With his years of treating brain disorders – coupled with the latest in scientific data – Perlmutter says that illnesses like ADHD, anxiety, chronic headaches, depression and Alzheimer’s disease can all be prevented by changing our addiction to carbohydrates. “I wrote this book in response to the daily challenge I see in my medical practice,” he says. “Typically, people would say ‘Why didn’t I know this information?’ ‘How come no one told me that my father’s Alzheimer’s could be prevented?’ It’s time people were able to get this information.” Now published in 28 countries around the world, and with a corresponding cookbook and an endorsement from the very influential Dr Oz TV show, Perlmutter’s message is certainly gaining attention.

It’s all in our biology

At the heart of the current anti-wheat, anti-carb focus is the argument that our bodies are just not made to consume these foods. “As a species, we are genetically and physiologically identical to the humans who roamed the Palaeolithic era of early humans,” explains Perlmutter. “We may not call ourselves hunters and gatherers anymore, but our bodies certainly behave as such, from a biological perspective. The change in human nutrition has only taken place during the past century when we have begun dramatically introducing sugar and carbohydrates into our diets, for which our physiology is ill equipped.”

This change, argue Perlmutter and other Paleo diet advocates, has not only created an obesity epidemic and a spike in illnesses such as diabetes, but it is fundamentally changing our DNA. “The food we eat should be looked upon as representing far more than simply macronutrients like fat, carbohydrates and protein, and micronutrients like minerals and vitamins,” says Perlmutter. “The foods that we eat are actually providing information for our DNA: every mouthful that we consume instructs the expression of our DNA, moment to moment. When you recognise that our DNA has changed very little at least in the past 50 to 70,000 years, the notion that we are challenging our DNA, our life code, with inappropriate signals based upon our food choices – well, it certainly frames the implications of our food choices in a whole new light. The diet described in Grain Brain is nothing revolutionary - it is simply returning to a diet that has sustained human beings for as long as we have walked this planet.”

Wheat-free for all?

It is this fundamental change in the way we eat that is behind the rise in brain disease and mental disorders, Perlmutter believes. While the popular view is that brain degenerative disorders like dementia and Alzheimer’s disease are all ‘just part of getting older’, Perlmutter disagrees.

“There are plenty of perpetual myths about the basket of brain-degenerating maladies, and that includes Alzheimer’s: It’s in your genes, it’s inevitable with age, and it’s a given if you live into your eighties and beyond. But I’m here to tell you that the fate of your brain is not in your genes. It’s not inevitable. And if you’re someone who suffers from another type of brain disorder, such as chronic headaches, depression, epilepsy, or extreme moodiness, the culprit may not be encoded in your DNA. It’s in the food you eat.

“Modern medicine is very good at treating the symptoms, but not the underlying disease process – and that’s pretty much like treating the smoke while ignoring the fire. We now understand – and in fact the best leading science tells us – that diet and lifestyle have a profound role to play in determining the destiny of a person’s health with respect to their brain function.”

So does that mean gluten, wheat and sugar free for us all? “I do believe that humans should not eat wheat, barley, or rye, as these are gluten-containing grains,” he says. “Non-gluten containing grains like rice, for example, are certainly reasonable foods to consume in limited amounts, keeping in mind that they are still fairly concentrated sources of carbohydrates.”

Sugar and your brain

A high-carbohydrate diet is a high-sugar diet. Bread, pasta, and any other source of concentrated gluten bring with it a high glycemic index (GI) – something which we may be aware is bad for our waistline, but we are now told is also damaging to our grey matter.

“Diabetes is known to enhance inflammation, and inflammation is indeed a cornerstone of Alzheimer’s type dementia,” explains Perlmutter. “Hyperglycemia describes an elevation of blood sugar, which has direct and toxic effects on brain cells, but also indirectly leads to damage by increasing inflammation as well as free radical activity through the process of protein glycation, meaning proteins binding to sugar.

“Furthermore, insulin resistance is also associated with type II diabetes, and insulin plays an important role as a trophic hormone in the brain – meaning it is important for the health and vitality of brain cells. And when the brain becomes insulin-resistant with type II diabetes, the function of insulin is compromised. Finally, it is well known that diabetes is associated with the compromise of vascular function throughout the body, and particularly in the brain. Vascular issues are associated with cognitive decline.”

Paleo = heart risk?

The Paleo diet is never far from its critics. In Australia, as well as in the United States, the national standards do not advocate removing whole grains altogether. In fact, the Australian Dietary Guidelines (ADGs) use “the best available scientific evidence” on the types and amounts of food groups and diet patterns healthy Australians should be consuming – in which whole grains play a significant role. And they also warn against a high fat diet, such as Paleo-style eating.

What does Perlmutter say to these concerns? “The diet that we carefully outline in Grain Brain is indeed free from risk. Yes, the diet welcomes back to the table higher levels of fat, but keep in mind that the fat that we recommend is healthful, nutritious, and fundamentally critical for general health, and brain health in particular. The notion that somehow a low-fat diet is something we should pursue is fundamentally wrong on two counts. First, current science absolutely refutes the notion that low-fat diets are healthful, as has been recently published in both the New England Journal of Medicine as well as the Journal of the American Medical Association. And second, a higher fat diet has sustained humans for at least the past 2 million years.”

So, is it really as simple as cutting out carbs and sugar? Is eating like a caveman really the cure all? There have been criticisms of Perlmutter’s simplistic approach to such a variety of ailments – a “magic bullet” solution. “People tend to be down on what they are not up on!” he says. “Grain Brain was written after a review of more than 200 highly respected scientific references. There are no ‘magic bullets’ for brain issues, or any other medical problem for that matter.

“What Grain Brain has revealed, however, is the clear-cut understanding that our lifestyle choices, including the very foods that we choose to eat, have a huge impact on overall brain health as well as our risk for disease. Unfortunately, in Western cultures, the overriding dogma is one that would have us believe that we can live our lives, come what may, and then when we suddenly experience disease, our scientists will have a readily available fix for our ills. The reality is that this situation hardly ever exists, and therefore we've got to focus on prevention. And prevention starts with our food choices.”

Boost brain power

According to Grain Brain, the following items can be eaten liberally on your Gluten Free Diet. Go organic and local with your whole-food choices wherever possible; flash-frozen is fine, too:
* Healthy fat: Extra virgin olive oil, sesame oil, coconut oil, grass-fed tallow and organic or pasture-fed butter, ghee, almond milk, avocadoes, coconuts, olives, nuts and nut butters, cheese (except for blue cheeses), and seeds (flaxseed, sunflower seeds, pumpkin seeds, sesame seeds, chia seeds).
* Protein: Whole eggs; wild fish (salmon, black cod, mahi mahi, grouper, herring, trout, sardines); shellfish and molluscs (shrimp, crab, lobster, mussels, clams, oysters); grass-fed meat, fowl, poultry, and pork (beef, lamb, liver, bison, chicken, turkey, duck, ostrich, veal); wild game.
* Vegetables: Leafy greens and lettuces, collards, spinach, broccoli, kale, chard, cabbage, onions, mushrooms, cauliflower, Brussels sprouts, sauerkraut, artichoke, alfalfa sprouts, green beans, celery, bok choy, radishes, watercress, turnip, asparagus, garlic, leek, fennel, shallots, scallions, ginger, jicama, parsley, water chestnuts.
* Low-sugar fruit: Avocado, capsicums, cucumber, tomato, zucchini, squash, pumpkin, eggplant, lemons, limes.
* Herbs, seasonings, and condiments: You can go wild here as long as you watch labels. Kiss ketchup and chutney goodbye but enjoy mustard, horseradish, tapenade, and salsa if they are free from gluten, wheat, soy, and sugar. There are virtually no restrictions on herbs and seasonings; be mindful of packaged products, however, that were made at plants that process wheat and soy.

The following can be used in moderation, which means eating small amounts of these ingredients once a day or, ideally, just a couple times weekly:
* Non-gluten grains: Amaranth, buckwheat, rice (brown, white, wild), millet, quinoa, sorghum, teff. (A note about oats: although oats do not naturally contain gluten, they are frequently contaminated with gluten because they are processed at mills that also handle wheat; avoid them unless they come with a guarantee that they are gluten-free.) When non-gluten grains are processed for human consumption (e.g. milling whole oats and preparing rice for packaging), their physical structure changes, and this increases the risk of an inflammatory reaction. For this reason, we limit these foods.
* Legumes (beans, lentils, peas): With one exception - you can have hummus, made from chickpeas.
* Carrots and parsnips.
* Whole sweet fruit: Berries are best; be extra cautious of sugary fruits, such as apricots, mangoes, melons, papaya, prunes, and pineapple.
* Cow’s milk and cream: Use sparingly in recipes, coffee, and tea.
* Cottage cheese, yogurt, and kefir: Use sparingly in recipes or as a topping.
* Sweeteners: Natural stevia and chocolate - choose dark chocolate that’s at least 70 percent or more cocoa.
* Wine: One glass a day if you so choose, preferably red.