Grain Brain: The Surprising Truth about Wheat, Carbs, and Sugar--Your Brain's Silent Killers

PART III

SAY GOOD-BYE TO GRAIN BRAIN

CHAPTER 10

A New Way of Life

The Four-Week Plan of Action

At home I serve the kind of food I know the story behind.

—MICHAEL POLLAN

HERE’S WHERE THE RUBBER MEETS the road. Some of you might be panicking at the thought of losing your beloved carbs. I realize that for some people, ditching bread, pasta, pastries, and most desserts (among other things) is going to be tough. Change is hard. And changing long-established habits is harder. I am often asked right off the bat, “What the heck am I going to eat?” Some worry about their withdrawal from sugar and wheat and insatiable hunger for carbs. They anticipate colossal cravings that they won’t be able to resist. They fear the body’s reaction to a dietary U-turn. And they wonder if this is truly doable in the real world if willpower isn’t in their vocabulary. Well, folks, let me be the first to say that yes—all of this is possible. You just need to take the initial plunge and experience the effects. Within a matter of days or just a couple of weeks I predict that you’ll have clearer thoughts, better sleep, and improved energy. You’ll suffer fewer headaches, manage stress effortlessly, and feel happier. Those of you who live with a chronic neurological condition, such as ADHD, anxiety disorder, or depression, may notice that your symptoms begin to wane or even vanish. Over time, you’ll watch the weight fall off, and specific laboratory tests will show vast improvements in many areas of your biochemistry. If you could peer into your brain, you’d also see that it’s functioning at its highest level.

It’s a good idea to check with your doctor about beginning this new program, especially if you have any health issues such as diabetes. This is important if you’re going to opt for the one-day fast, outlinedhere. Over the course of the next month, you will achieve four important goals:

1. Shift your body away from relying on carbs for fuel and add brain-boosting supplements to your daily regimen.

2. Incorporate a fitness routine into your schedule if you don’t already have one.

3. Work on getting restful, routine sleep seven days a week.

4. Establish a new rhythm and maintain healthy habits for life.

I’ve broken down the program into four weeks, with each week devoted to focusing on one of these specific goals. In the days leading up to the first week, you should see your doctor to have certain tests performed that will give you a baseline. You’ll also use this time to get your kitchen organized, start your supplements, begin to wean yourself from carbs, and consider a one-day fast to kick-start the program.

During week 1, “Focus on Food,” you’ll start my menu plans and execute my dietary recommendations.

During week 2, “Focus on Exercise,” I’ll encourage you to start a regular workout program and give you ideas for moving more throughout the day.

In week 3, “Focus on Sleep,” you’ll turn your attention to your sleep habits and follow a few simple tips to ensure that you’re achieving the best sleep possible every single night, weekends included.

During week 4, “Put It All Together,” I’ll help you put all the elements of this program together and equip you with strategies for permanently establishing these new behaviors in your life. Don’t second-guess your ability to succeed at this; I’ve designed this program to be as practical and easy to follow as possible.

PRELUDE TO WEEK 1: PREPARE

Determine Your Baseline

Prior to beginning the dietary program, have the following laboratory studies performed, if possible. I’ve included target healthy levels where appropriate.

Test

Ideal level

 fasting blood glucose

less than 95 milligrams per deciliter (mg/dL)

 fasting insulin

below 8 µIU/ml (ideally, below 3)

 hemoglobin A1C

4.8 to 5.4 percent

 fructosamine

188 to 223 µmol/L

 homocysteine

8µmol/L or less

 vitamin D

80 ng/mL

 C-reactive protein

0.00 to 3.0 mg/L

 gluten sensitivity test with Cyrex array 3 test

 

Upon completion of the four-week program, these laboratory studies should be repeated. Understand that it may take several months to see dramatic improvement in these parameters, especially the hemoglobin A1C, which is typically only measured every three to four months. But if you follow this program from day 1, you should nonetheless begin to see positive changes in your blood glucose and insulin levels within a month that will motivate you to keep going.

The fructosamine test, which is also a measurement of glycated protein and gives a great understanding of average blood sugar control, is something that changes quite rapidly, in two to three weeks. So while you may not see a huge change in hemoglobin A1C, you should absolutely see a change in fructosamine.

Homocysteine is an amino acid–like chemical, now generally regarded as being quite toxic to the brain; as noted above, you want to see a homocysteine level at around 8 micromoles per liter (µmol/L) or less. Having a homocysteine level of just 14—a value exceeded by many of my patients when first examined—was described in the New England Journal of Medicine as being associated with a doubling of the risk for Alzheimer’s disease (an “elevated” homocysteine level is anything above 10 µmol/L in the blood). Homocysteine levels are almost always easy to improve. Many drugs can inhibit the B vitamins and raise homocysteine (see list at DrPerlmutter.com), but you can actively correct your level just by supplementing with some B vitamins and folic acid. Typically, I ask patients with a poor homocysteine test to take 50 milligrams of vitamin B6, 800 micrograms of folic acid, and 500 micrograms of vitamin B12 daily and retest after about three months.

Don’t be alarmed if your vitamin D level is abysmally low. The majority of Americans are deficient in this critical nutrient. Because it can take time for the body to shore up its levels of vitamin D upon supplementation, you’ll start with 5,000 international units (IU) of vitamin D once a day, and test your level after two months. If after two months your level is 50 nanograms per milliliter (ng/mL) or under, you’ll take an additional 5,000 IU daily and retest again in two months. It’s the level maintained in your body that matters, not the dosage. Normal is between 30 and 100 ng/mL, but you don’t want to be squeaking by with a 31. You want to achieve a level around 80 ng/mL. This reflects the ideal level of the so-called normal zone. Ask your health care practitioner to help you adjust your dosage to achieve an optimal level. Once you do, a daily dose of 2,000 IU will usually suffice to maintain a healthy level, but ask your doctor for specific recommendations.

An ideal level of C-reactive protein, a marker of inflammation in the body, is less than 1.0 mg/L. CRP may take several months to improve, but you may well see positive changes even after one month on the program.

Finally, I highly recommend that you ask for the Cyrex array 3 test, available to doctors from Cyrex Labs (see link at www.DrPerlmutter.com). It’s the best test on the market for gluten sensitivity. In my experience, routine laboratory tests for “celiac disease” are not sensitive enough to uncover gluten sensitivity in everyone, so don’t bother with them.

Start Your Supplements

You will be starting a daily supplement regimen for life. All of the supplements listed here with their daily recommended dosage can be found at health food stores, most drugstores and supermarkets, and online. You’ll find a list of some of my favorite brands at www.DrPerlmutter.com. Probiotics should be taken on an empty stomach, but the other supplements can be taken with or without food. Water-soluble supplements like turmeric and resveratrol are metabolized fairly rapidly, so it’s best to take these supplements twice daily. Vitamin D and DHA are oils, so taking them just once a day is perfectly fine. For more details about each of these, refer back to chapter 7.

If you have any questions about dosage due to personal health challenges, ask your doctor for help in making proper adjustments. All of the dosages listed are generally ideal for both adults and children, but ask your pediatrician for specific recommendations based on your child’s weight. At my clinic, for example, I prescribe 100 milligrams of DHA for children up to eighteen months and then 200 milligrams daily; for kids with ADHD, however, those dosages are usually higher—around 400 milligrams daily.

alpha-lipoic acid

600 mg daily

coconut oil

1 teaspoon daily, taken straight or used in cooking

DHA

1,000 mg daily (Note: It’s okay to buy DHA that comes in combination with EPA; opt for a fish oil supplement or choose DHA derived from marine algae.)

probiotics

1 capsule taken on an empty stomach up to three times daily; look for a probiotic that contains at least ten billion active cultures from at least ten different strains, including Lactobacillus acidophilus and bifidobacterium

resveratrol

100 mg twice daily

turmeric

350 mg twice daily

vitamin D3

5,000 IU daily

Clear Out Your Kitchen

In the days leading up to your new way of eating, you’ll want to take an inventory of your kitchen and eliminate items that you’ll no longer be consuming. Start by removing the following:

• All sources of gluten (here for the full list), including whole-grain and whole-wheat forms of bread, noodles, pastas, pastries, baked goods, and cereals.

• All forms of processed carbs, sugar, and starch: corn, yams, potatoes, sweet potatoes, chips, crackers, cookies, pastries, muffins, pizza dough, cakes, doughnuts, sugary snacks, candy, energy bars, ice cream/frozen yogurt/sherbet, jams/jellies/preserves, ketchup, processed cheese spreads, juices, dried fruit, sports drinks, soft drinks/soda, fried foods, honey, agave, sugar (white and brown), corn syrup, and maple syrup.

• Packaged foods labeled “fat-free” or “low-fat” (unless they are authentically “fat-free” or “low-fat” and within the protocol, such as water, mustard, and balsamic vinegar).

• Margarine, vegetable shortening, and any commercial brand of cooking oil (soybean, corn, cottonseed, canola, peanut, safflower, grape seed, sunflower, rice bran, and wheat germ oils)—even if they are organic.

• Non-fermented soy (e.g., tofu and soy milk) and processed foods made with soy (look for “soy protein isolate” in list of ingredients; avoid soy cheese, soy burgers, soy hot dogs, soy nuggets, soy ice cream, soy yogurt). Note: Although some naturally brewed soy sauces are technically gluten-free, many commercial brands have trace amounts of gluten. If you need to use soy sauce in your cooking, use tamari soy sauce made with 100 percent soybeans and no wheat.

Watch out for foods marked (and marketed) “gluten-free.” Some of these foods are fine because they never contained gluten to begin with. But many are labeled as such because they have been processed—their gluten has been replaced by another ingredient such as cornstarch, cornmeal, rice starch, potato starch, or tapioca starch, all of which can be equally as offensive, raising blood sugar enormously. Also, trace amounts of gluten can remain. The term “gluten-free” has no legal meaning at the moment; the FDA has proposed a definition but has not yet finalized it. Be extra cautious about gluten-free sauces, gravies, and cornmeal products (e.g., tacos, tortillas, cereals, and corn chips).

Restock

The following items can be consumed liberally (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, avocados, coconuts, olives, nuts and nut butters, cheese (except for blue cheeses), and seeds (flaxseed, sunflower seeds, pumpkin seeds, sesame seeds, chia seeds)

• Herbs, seasonings, and condiments: You can go wild here as long as you watch labels. Kiss ketchup and chutney good-bye but enjoy mustard, horseradish, tapenade, and salsa if they are free of 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.

• Low-sugar fruit: avocado, bell peppers, cucumber, tomato, zucchini, squash, pumpkin, eggplant, lemons, limes

• Protein: whole eggs; wild fish (salmon, black cod, mahimahi, grouper, herring, trout, sardines); shellfish and mollusks (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

The following can be used in moderation (“moderation” means eating small amounts of these ingredients once a day or, ideally, just a couple times weekly):

• Carrots and parsnips.

• Cottage cheese, yogurt, and kefir: Use sparingly in recipes or as a topping.

• Cow’s milk and cream: Use sparingly in recipes, coffee, and tea.

• Legumes (beans, lentils, peas). Exception: you can have hummus (made from chickpeas).

• 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.

• Sweeteners: natural stevia and chocolate (choose dark chocolate that’s at least 70 percent or more cocoa).

• Whole sweet fruit: Berries are best; be extra cautious of sugary fruits such as apricots, mangos, melons, papaya, prunes, and pineapple.

• Wine: one glass a day if you so choose, preferably red.

Egg-Citing

I am compelled to say a few kind things in defense of eggs, since they are among the most wrongly accused foods in our modern era. I’ll start by stating two important but seldom remembered facts: (1) Time and time again, science has failed to connect dietary fats of animal origin (i.e., saturated fats) and dietary cholesterol to both levels of serum cholesterol and risk for coronary heart disease; the belief that the cholesterol we eat converts directly into blood cholesterol is unequivocally false; and (2) when researchers compare serum cholesterol levels to egg intake, they note over and over again that the levels of cholesterol in those who consume few or no eggs are virtually identical to those in people who consume bountiful numbers of eggs. Remember that contrary to popular wisdom, dietary cholesterol actually reduces the body’s production of cholesterol, and more than 80 percent of the cholesterol in your blood that is measured on your cholesterol test is actually produced in your own liver.

To quote the authors of a cogent article (“Eggs and Dietary Cholesterol—Dispelling the Myth”) by British researchers in the British Nutrition Foundation’s newsletter: “The popular misconception that eggs are bad for your blood cholesterol and therefore bad for your heart persists among many people and still continues to influence the advice of some health professionals. The myth prevails despite strong evidence to show that the effects of cholesterol-rich foods on blood cholesterol are small and clinically insignificant.”1 The erroneous but strong messages about egg restriction that emanated primarily from the United States in the 1970s have unfortunately stuck around far too long. Scores of studies have confirmed the value of eggs, which are quite possibly the world’s most perfect food; the yolk is the most nutritious part.2In fact, in a 2013 study, researchers at the University of Connecticut demonstrated that people on a low-carb diet, eating whole eggs—even on a daily basis—improved insulin sensitivity and other cardiovascular risk parameters.3 In addition to their healthy cholesterol, whole eggs contain all of the essential amino acids we need to survive, vitamins and minerals, plus antioxidants known to protect our eyes—all for the low-low price of just 70 calories each. Moreover, they contain ample supplies of choline, which is particularly important for aiding healthy brain function as well as pregnancy. I cringe when I see an egg-white omelet on a menu. If only the people behind the old “incredible, edible egg” campaign would make some more noise!

You’ll see that I recommend lots of eggs on this diet. Please don’t be afraid of them. They could be the best way to start your day and set the tone for blood sugar balance. There are so many things you can do with eggs, too. Whether you scramble, fry, poach, boil, or use them in dishes, eggs are indeed among the most versatile ingredients. Hard-boil a carton of eggs on a Sunday night and you’ve got breakfast and/or snacks for the week.

Optional Fast

Ideally, start week 1 after you have fasted for one full day. Fasting is an excellent way to set the foundation and speed up your body’s shift to burning fat for fuel and producing biochemicals that have astonishing pro-health effects on the body and brain. For many, it helps to do the fast on a Sunday (last meal is dinner Saturday night), and then begin the diet program on a Monday morning.

The fasting protocol is simple: No food but lots of water for a twenty-four-hour period. Avoid caffeine, too. If you take any medications, by all means continue to take them (if you take diabetes medications, please consult your physician first). If the idea of fasting is too painful for you, simply wean yourself from carbs for a few days as you prepare your kitchen. The more addicted your body is to carbs, the harder this will be. I prefer that my patients go cold turkey when it comes to nixing gluten, so do your best to at least eliminate sources of gluten entirely and cut back on other carbs. People whose bodies are not dependent on carbs can fast for longer periods, sometimes for days. When you’ve established this diet for life and want to fast for further benefits, you can try a seventy-two-hour fast (assuming you’ve checked with your doctor if you have any medical conditions to consider). I recommend that people fast at least four times a year; fasting during the seasonal changes (e.g., the last week of September, December, March, and June) is an excellent practice to keep.

WEEK 1: FOCUS ON FOOD

Now that your kitchen is in order, it’s time to get used to preparing meals using this new set of guidelines. In the next chapter, you’ll find a day-by-day menu plan for the first week that will serve as a model for planning your meals the remaining three weeks. Unlike other diets, this one won’t ask you to count calories, limit fat intake, or fret over portion sizes. I trust you can tell the difference between a super-sized plate and a normal quantity. And I won’t even ask you to worry about how much saturated versus unsaturated fat you’re consuming.

The good news about this type of diet is that it’s enormously “self-regulating”—you won’t find yourself overeating and you’ll enjoy feelings of fullness for several hours before needing another meal. When your body is running mostly on carbs, it’s being driven by the glucose-insulin roller-coaster ride that triggers intense hunger when your blood sugar plunges, and then short-lived satiety. But eating a low-carb, higher-fat diet will have the opposite effect. It will eliminate cravings and prevent those mental shutdowns in the late afternoon that often occur on carb-based diets. It’ll automatically allow you to control calories (without even thinking about it), burn more fat, put an end to mindless eating (i.e., the extra 500 calories or so many people unconsciously consume daily to bail out blood sugar chaos), and effortlessly boost your mental performance. Say good-bye to feeling moody, foggy, sluggish, and tired throughout the day. And say hello to a whole new you.

The only difference between this month and beyond is that you’re going to aim for the fewest carbs now. It’s imperative to lower carb intake to just 30 to 40 grams a day for four weeks. After that, you can increase your carb intake to 60 grams a day. Adding more carbs into your diet after the first four weeks doesn’t mean you can start eating pasta and bread again. What you’ll do is simply add more of the items listed in the “moderate” category, such as whole fruit, non-gluten grains, and legumes. How to know how much you’re getting? Use the food almanac on my website (DrPerlmutter.com), which lists grams of carbs per serving. If you follow the menu ideas and recipes in this book, you’ll soon gain an understanding of what a low-carb meal looks like.

What about your fiber intake? Many people worry that reducing all those “fiber-rich” wheat products and breads will cause a dramatic loss of important fiber. Wrong. When you replace those wheat carbs with carbs from nuts and vegetables, your fiber intake will go up. You will get your fill of essential vitamins and nutrients you were likely lacking previously, too.

You might find it helpful to keep a food journal throughout the program. Make notes about recipes you like and foods that you think might still be giving you trouble (e.g., you experience symptoms such as stomach upset or headaches every time you eat sesame seeds). Some people are sensitive to foods that are included in this diet. For example, about 50 percent of those who are gluten intolerant are also sensitive to dairy. Surprisingly, researchers are also finding that coffee tends to cross-react with gluten. If, after embarking on this diet, you still sense a glitch somewhere, you may want to have an additional Cyrex lab test done called the array 4, which can help pinpoint those foods that, for you, cross-react with gluten. It identifies reactions to the following:

amaranth

buckwheat

chocolate

coffee

dairy

eggs

hemp

millet

oats

quinoa

rice

sesame

sorghum

soy

spelt

tapioca

teff

whey

yeast

I recommend that you avoid eating out during the first three weeks on the program so you can focus on getting the dietary protocol down. This will prepare you for the day you do eat outside your home and have to make good decisions about what to order (here). The first three weeks will also eliminate your cravings so there’s less temptation when you’re looking at a menu filled with carbs.

During week 1, focus on mastering your new eating habits. You can use my recipes, including my sample seven-day meal plan, or venture out on your own as long as you stick to the guidelines. I’ve created an easy list of ideas categorized by type of meal (e.g., breakfast, lunch or dinner, salads), so you can pick and choose. Each meal should contain a source of healthy fat and protein. You can pretty much eat as many vegetables as you like with the exception of corn, potatoes, carrots, and parsnips. If you follow the first week’s plan, configuring your own meals in the future will be a cinch.

WEEK 2: FOCUS ON EXERCISE

Aim to engage in aerobic physical activity if you’re not already doing so for a minimum of twenty minutes a day. Use this week to establish a routine you enjoy that gets your heart rate up by at least 50 percent of your resting baseline. Remember, you are creating new habits for a lifetime and you don’t want to get burned-out easily. But you also don’t want to get too comfortable and shy away from challenging your body in ways that boost health and increase the brain’s longevity.

To reap the benefits of exercise, make it a goal to break a sweat once a day and force your lungs and heart to work harder. Remember, in addition to all the cardiovascular and weight-management benefits you’ll gain from exercise, studies show that people who exercise regularly, compete in sports, or just walk several times a week protect their brains from shrinkage. They also minimize the chance of becoming obese and diabetic—major risk factors in brain disease.

If you’ve been leading a sedentary lifestyle, then simply go for a twenty-minute walk daily and add more minutes as you get comfortable with your routine. You can also add intensity to your workouts by increasing your speed and tackling hills. Or carry a five-pound free weight in each hand and perform some bicep curls as you walk.

For those of you who already maintain a fitness regimen, see if you can increase your workouts to a minimum of thirty minutes a day, at least five days a week. This also might be the week you try something different, such as joining a group exercise class or dusting off an old bicycle in the garage. These days, opportunities to exercise are everywhere beyond traditional gyms, so there’s really no excuse. You can even stream videos and exercise in the comfort of your own home. I really don’t care which play you choose. Just pick one!

Ideally, a comprehensive workout should entail a mix of cardio, strength training, and stretching. But if you’re starting from scratch, begin with cardio and then add in strength training and stretching over time. Strength training can be done with classic gym equipment, free weights, or the use of your own body weight in classes geared toward this activity such as yoga and Pilates. These classes often entail lots of stretching, too, but you don’t need a formal class to work on maintaining your flexibility. You can perform many stretching exercises on your own, even in front of the television.

Once you’ve gotten a regular workout down, you can schedule your daily routines around different types of exercise. For example, Mondays, Wednesdays, and Fridays could be the days you take a one-hour indoor cycling class; on Tuesdays and Thursdays you hit a yoga class. Then, on Saturday, you go for a hike with friends or swim laps in a pool and take Sunday off to rest. I recommend getting out your calendar and scheduling in physical activity.

If you have a day during which there’s absolutely no time to devote to a continuous segment of formal exercise, then think about the ways you can sneak in more minutes of physical activity during the day. All the research indicates that you can get similar health benefits from doing three ten-minute bouts of exercise as you would from doing a single thirty-minute workout. So if you are short on time on any given day, just break up your routine into bite-size chunks. And think of ways to combine exercise with other tasks; for example, conduct a meeting with a colleague at work while walking outside, or watch television at night while you complete a set of stretching exercises on the floor. If possible, limit the minutes you spend sitting down. Walk around if you can while you talk on the phone using a headset, take the stairs rather than the elevator, and park far away from the front door to your building. The more you move throughout the day, the more your brain stands to gain.

WEEK 3: FOCUS ON SLEEP

In addition to continuing your new diet and exercise habits, use this week to focus on your sleep hygiene. Now that you’ve been on the protocol for a couple of weeks, your sleep should have improved. If you get fewer than six hours of sleep per night, you can start by increasing that period of time to at least seven hours. This is the bare minimum if you want to have normal, healthy levels of fluctuating hormones in your body.

To ensure that you’re doing all that you can to maximize high-quality, restful sleep, below are some tips to getting a good night’s sleep:

1. Maintain regular sleep habits. Experts in sleep medicine like to call this “sleep hygiene”—the ways in which we ensure refreshing sleep night after night. Go to bed and get up at roughly the same time seven days a week, 365 days a year. Keep your bedtime routine consistent; it might include downtime, teeth-brushing, a warm bath, herbal tea, whatever you need to do to wind down and signal to your body that it’s time for sleep. We do this with our young children but often forget about our own bedtime rituals. They work wonders in helping us to feel primed for slumber.

2. Identify and manage ingredients hostile to sleep. These can be any number of things, from prescription medicine to caffeine, alcohol, and nicotine. Both caffeine and nicotine are stimulants. Anyone who still smokes should adopt a plan to quit, for smoking alone will increase your risk of everything under the medical sun. As for caffeine, try to avoid it after two p.m. This will give your body time to process the caffeine so it doesn’t impact sleep. Some people, however, are extra sensitive to caffeine, so you may want to back up this time to noon or move to less-caffeinated drinks. Ask your doctor or pharmacist about any potential sleep repercussions for medications you take on a routine basis. Be aware that lots of over-the-counter medications can contain sleep-disrupting ingredients, too. Popular headache drugs, for instance, can contain caffeine. Alcohol, while creating a sedative effect immediately upon consumption, can disrupt sleep while it’s being processed by the body; one of the enzymes used to break down alcohol has stimulating effects. Alcohol also causes the release of adrenaline and disrupts the production of serotonin, an important brain chemical that initiates sleep.

3. Time your dinner appropriately. No one likes to go to bed on a full or empty stomach. Find your sweet spot, leaving approximately three hours between dinner and bedtime. Also be aware of ingredients in foods that can be problematic to digest easily before going to bed. Everyone will be different in this department.

4. Don’t eat erratically. Eat on a regular schedule. This will keep your appetite hormones in check. If you delay a meal too long, you will throw your hormones out of whack and trigger the nervous system, which can later impact your sleep.

5. Try a bedtime snack. Nocturnal hypoglycemia (low nighttime blood glucose levels) can cause insomnia. If your blood sugar drops too low, it causes the release of hormones that stimulate the brain and tell you to eat. Try a bedtime snack to avoid this midnight disaster. Go for foods high in the amino acid tryptophan, which is a natural promoter of sleep. Foods high in tryptophan include turkey, cottage cheese, chicken, eggs, and nuts (especially almonds). Just watch your portion, however. A handful of nuts might be perfect. You don’t want to devour a three-egg omelet with turkey right before bedtime. Choose wisely.

6. Beware of imposter stimulants. You already know that regular coffee will keep you alert, but today caffeine-infused products are everywhere. If you follow my dietary protocol, you’re not likely to encounter these. Also, certain food compounds such as colorings, flavorings, and refined carbs can act as stimulants, so avoid these, too.

7. Set the setting. It should come as no surprise that keeping brain- and eye-stimulating electronics in the bedroom is a bad idea. But people still break this most basic rule. Try to keep your bedroom a quiet, peaceful sanctuary free of rousing hardware (e.g., TVs, computers, phones, etc.), as well as bright lights and clutter. Invest in a comfortable bed and plush sheets. Maintain dim lighting. Cultivate a mood for sleep (and sex for that matter, which can also prepare one for sleep, but that’s another story).

8. Use sleep aids prudently. The occasional sleep aid won’t kill you. But chronic use of them can become a problem. The goal is to arrive at sound sleep on a routine basis without extra help. And I’m not referring to earplugs or eye masks here, both of which I approve of as sleep aids; I’m talking about over-the-counter and prescription drugs that induce sleep. Examples include “p.m.” formulas that include sedating antihistamines such as diphenhydramine and doxylamine. Even if they claim to be non-addictive, they can still create a psychological dependency. Better to regulate your sleep naturally.

A Note About Bathroom Toiletries and Beauty Products

In addition to focusing on sleep, during week 3 you should overhaul your bathroom supplies. Gluten tends to find its way into many commercial products, and it can unintentionally end up in our bodies if we use these products on our skin—our largest organ. So pay attention to the beauty and makeup supplies you use regularly, including shampoos, conditioners, and other hair products. You may want to seek out new brands that offer gluten-free products. SophytoPRO (http://sophytopro.com) is one such company that specializes in a skin care line that is free of ingredients that can irritate not only your skin but your body and brain.

WEEK 4: PUT IT ALL TOGETHER

By now you should be in the groove of this new way of life and feeling much better than you did three weeks ago. You can tell the difference between a grain-brain food and a healthier choice. Your sleep has improved and you’ve established a regular workout routine. Now what?

Don’t panic if you don’t feel like you’ve totally hit your stride yet. Most of us have at least one weak spot in our lives that requires extra attention. Perhaps you’re the type who has a hard time getting to bed by ten p.m. every night, or maybe your Achilles’ heel is finding time to work out most days of the week and avoiding the junk food that’s always lying around your office’s break room. Use this week to find a rhythm in your new routine. Identify areas in your life where you struggle to maintain this protocol and see what you can do to rectify that. A few tips that you might find helpful:

• Plan each week in advance. It helps to set aside a few minutes over the weekend to plan your upcoming week and take into consideration your agenda and appointments. Predict the hectic days when it will be harder to make time for a workout and see if you can build that into your schedule. Block out your sleeping zone every night and be sure to maintain the same bedtime; be religious about it. Map out the majority of your meals for the week, especially lunches and dinners. We tend to be pretty routine with breakfast, but can fall prey to last-minute decisions about lunch while at work, as well as dinner if we arrive home starving. Be on the lookout for those days when you know that you’ll get home late and won’t have energy to cook. Have a contingency plan in place. (I give you plenty of ideas in the next chapter for dealing with meals away from home and handling those moments when you need to have a little something to tide you over until you can eat a full meal.)

• Prepare shopping lists. Whether you shop for groceries every day or just once a week, you’ll want to have a list in hand. This will help you be more efficient and avoid impulse buying. It will also take a lot of the guesswork out of trying to figure out what’s a safe bet at the market to buy, cook, and eat. For the most part, stick to the perimeter of the grocery store, where the foods closest to nature are found. Avoid the middle aisles, which are overflowing with processed, packaged goods. And don’t shop while hungry; if you do, you’ll gravitate toward damaging foods of the sugary and salty variety. Keep in mind that fresh ingredients won’t last more than three to five days unless you freeze them. A monthly trip to a store that sells foods in bulk might be helpful if you have a family to feed and extra room in your freezer for large quantities of meat, poultry, and frozen vegetables.

• Create a few “non-negotiables.” If you have high hopes of getting to the farmers’ market on Thursday afternoon in your neighborhood, then write that down in your calendar and make it a non-negotiable. If you dream of trying a new yoga studio that opened up in town, set aside a specific time and make it happen. Creating non-negotiable goals will help you dodge those excuses that surface when you get lazy or thwarted by other tasks. They are also excellent ways to fortify your weak spots. Be clear about your priorities when you set the course for your week and stick to them!

• Use technology. We use technology every day to make our lives easier. So why not capitalize on Internet resources and high-tech apps that can help us stick to our goals and stay tuned in to ourselves? The market for self-tracking apps, for instance, has exploded in the last few years. You can use nifty devices to track how many steps you take a day, how well you slept last night, and even how fast you eat. Some of these work on smartphones while others require an actual device such as an accelerometer that tracks your bodily movements throughout the day. Granted, these tools are not for everyone, but you might just find a few programs that ultimately help you to maintain a healthy lifestyle. For a few ideas, go to DrPerlmutter.com. There, you’ll also find a list of apps that can help you maximize the information in this book, such as food almanacs that provide ingredient information about common foods and links to health-related services that can remind you to keep track of your habits. Google Calendar, for example, can be used as a comprehensive self-management application. If it works for you, use it.

• Be flexible but be consistent. Don’t beat yourself up when you momentarily fall off the program. We’re all human. You might have a bad day and find yourself skipping the gym in favor of a night out with friends at a restaurant where pretty much everything served is off-limits. Or perhaps it’s the holidays and a few indulgences are inevitable. As long as you get back on track once you catch yourself, you’ll be fine. Just don’t let a small slip derail you forever. To this end, remember to find consistency in your daily patterns. Consistency is not about rigidity. It’s about eating and exercising in ways that serve you without making you feel like you’re going to extremes or forcing yourself to do something you don’t like. Finding your own unique version of consistency will be key to your success. You’ll figure out what works best for you and what doesn’t. Then you can adapt this program to your life based on the general guidelines and maintain it on a consistent basis.

• Find motivators. Sometimes it helps to have motivators. A motivator can be anything from the desire to run your town’s 10K to planning a trip with your adult children to hike Mount Kilimanjaro. People who decide to focus on their health often do so for specific reasons, such as “I want more energy,” “I want to live longer,” “I want to lose weight,” and “I don’t want to die like my mother did.” Keep the big picture in plain sight. This will help you not only maintain a healthy lifestyle, but also get back on track even if you do occasionally cheat. Progress is sometimes better than perfection.

Everyone’s daily schedule will be different, but patterns should exist. Below is a sample of what a day might look like:

Wake up, walk the dog:

6:30 a.m.

Breakfast:

7:00 a.m.

Snack:

10:00 a.m.

Bagged lunch:

12:30 p.m.

After-lunch walk for twenty minutes:

1:00 p.m

Snack:

4:00 p.m.

Gym:

5:45 p.m.

Dinner:

7:00 p.m.

Walk the dog:

7:30 p.m.

Lights out:

10:30 p.m.

Eating Out

Toward the end of week 4, work on the goal of being able to eat anywhere. Most of us eat out several times a week, especially while we’re at work. It’s virtually impossible to plan and prepare every single meal and snack we eat, so make it a goal to navigate other menus. See if you can return to your favorite restaurants and order off the menu while still following this protocol. If you find it too challenging, then you may want to test new restaurants that cater to your needs. It’s not that hard to make any menu work for you as long as you’re savvy about your decisions. Baked fish with steamed vegetables is likely to be a safe bet (hold the potatoes, fries, and bread basket, and ask for a side salad with olive oil and vinegar). Watch out for elaborate dishes that contain multiple ingredients. And when in doubt, ask about the dishes.

In general, eating out should be minimized because eliminating all sources of bad ingredients is impossible. On most days of the week, commit to consuming foods that you prepare. Keep snacks on hand, too, so you don’t get caught famished while at the gas station’s convenience store. There are plenty of snack and “on-the-go” ideas in the next chapter, many of which are portable and nonperishable. Once you’ve gotten a handle on this way of eating, see if you can go back to your old recipes and modify them to fit my guidelines. You’d be surprised by what a little experimentation in the kitchen can do to turn a classic dish filled with gluten and inflammatory ingredients into an equally delicious but brain-friendly meal. Instead of regular flour or wheat, try coconut flour, nut meals like ground almonds, and ground flaxseed; in lieu of sugar, find ways to sweeten your recipe with stevia or whole fruits; and rather than cook with processed vegetable oils, stick with old-fashioned butter and extra virgin olive oil.

And when you’re faced with temptation (the box of doughnuts at work or a friend’s birthday cake), remind yourself that you’ll pay for the indulgence somehow. Be willing to accept those consequences if you cannot say no. But keep in mind that a grain-brain-free way of life is, in my humble opinion, the most fulfilling and gratifying way of life there is. Enjoy it.

THE BALANCING ACT

As with so many things in life, discovering and establishing a new habit is a balancing act. Even once you’ve shifted your eating and exercise behaviors and changed the way you buy, cook, and order food, you’ll still have moments when old habits emerge. I don’t expect you to never eat a slice of crusty pizza or stack of steaming hot pancakes again, but I do hope that you stay mindful of your body’s true needs now that you have the knowledge, and live out this newly found sensibility every day as best you can.

Many people have applied the famous 80/20 principle to diet—eat well 80 percent of the time and save that last 20 percent for splurges. But some of us find ourselves living the reverse! It’s too easy to let an occasional splurge become a daily habit, like eating a bowl of ice cream several times a week. You should remember that there is always an excuse for not taking better care of yourself. We have parties and weddings to attend. We have work to address that leaves us high on stress and low on energy, time, and the mental bandwidth to make good food, exercise, and sleep choices. This is life, and accepting a certain give-and-take is okay. But see if you can stick to a 90/10 rule. For 90 percent of the time, eat within these guidelines and let the last 10 percent take care of itself, as it inevitably does in life. Then hit re-boot whenever you feel like you’ve fallen too far off the wagon. You can do this by fasting for a day and committing again to the same four weeks of restricting carbs to 30 to 40 grams a day. This protocol can be your lifeline to a healthier way of living that supports the vision you have for yourself—and your brain.

Life is an endless series of choices. This way or that way? Now or later? Red sweater or green one? Sandwich or salad? The whole point of this book has been to help you learn to make better decisions that will ultimately allow you to participate in life at its fullest. My hope is that I’ve given you plenty of ideas to at least begin to make a difference in your life. I see the value that being healthy—and mentally sharp—brings to people every day in my practice. I also see what sudden illness and chronic disease can do, regardless of people’s achievements and how much they are loved. For many, health may not be the most important thing in life, but without it, nothing else matters. And when you have good health, pretty much anything is possible.