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

PART I

THE WHOLE GRAIN TRUTH

CHAPTER 1

The Cornerstone of Brain Disease

What You Don’t Know About Inflammation

The chief function of the body is to carry the brain around.

—THOMAS A. EDISON

IMAGINE BEING TRANSPORTED BACK to the Paleolithic era of early humans who lived in caves and roamed the savannas tens of thousands of years ago. Pretend, for a moment, that language is not a barrier and you can communicate easily. You have the opportunity to tell them what the future is like. From a cross-legged perch on a dirt floor in front of a warm fire, you start by describing the wonders of our high-tech world, with its planes, trains, and automobiles, city skyscrapers, computers, televisions, smartphones, and the information highway that is the Internet. Humans have already traveled to the moon and back. At some point, the conversation moves to other lifestyle topics and what it’s like to really live in the twenty-first century. You dive into describing modern medicine with its stupendous array of drugs to treat problems and combat diseases and germs. Serious threats to survival are few and far between. Not many people need to worry about crouching tigers, famine, and pestilence. You explain what it’s like to shop at grocery stores and supermarkets, a totally foreign concept to these individuals. Food is plentiful, and you mention things like cheeseburgers, French fries, soda, pizza, bagels, bread, cinnamon rolls, pancakes, waffles, scones, pasta, cake, chips, crackers, cereal, ice cream, and candy. You can eat fruit all year long and access virtually any kind of food at the touch of a button or just a short drive away. Water and juice come in bottles for transportability. Although you try to avoid brand names, it’s hard to resist because they have become such a part of life—Starbucks, Wonder Bread, Pepperidge Farm, Pillsbury, Lucky Charms, Skittles, Domino’s, Subway, McDonald’s, Gatorade, Häagen-Dazs, Cheerios, Yoplait, Cheez-It, Coke, Hershey’s, and Budweiser.

They are in awe, barely able to picture this future. Most of the features you chronicle are unfathomable; they can’t even visualize a fast-food restaurant or bread bar. The term “junk food” is impossible to put into words these people understand. Before you can even begin to mention some of the milestones that humans had to achieve over millennia, such as farming and herding, and later food manufacturing, they ask about the challenges modern people deal with. The obesity epidemic, which has gotten so much attention in your media lately, comes first to mind. This isn’t an easy matter for their lean and toned bodies to grasp, and neither is your account of the chronic illnesses that plague society—heart disease, diabetes, depression, autoimmune disorders, cancer, and dementia. These are totally unfamiliar to them, and they ask a lot of questions. What is an “autoimmune disorder”? What causes “diabetes”? What is “dementia”? At this point you’re speaking a different language. In fact, as you give them a rundown of what kills most people in the future, doing your best to define each condition, you are met with looks of confusion and disbelief. You’ve painted a beautiful, exotic picture of the future in these people’s minds, but then you tear it down with causes of death that seem to be more frightening than dying from an infection or being eaten by a predator higher up on the food chain. The thought of living with a chronic condition that slowly and painfully leads to death sounds awful. And when you try to convince them that ongoing, degenerative disease is possibly the trade-off for potentially living much longer than they do, your prehistoric ancestors don’t buy it. And, soon enough, neither do you. Something seems wrong with this picture.

As a species, we are genetically and physiologically identical to these humans that lived before the dawn of agriculture. And we are the product of an optimal design—shaped by nature over thousands of generations. We may not call ourselves hunters and gatherers anymore, but our bodies certainly behave as such from a biological perspective. Now, let’s say that during your time travel back to the present day, you begin to ponder your experience with these ancestors. It’s easy to marvel at how far we’ve come from a purely technological standpoint, but it’s also a no-brainer to consider the struggles that millions of your contemporary comrades suffer needlessly. You may even feel overwhelmed by the fact that preventable, non-communicable diseases account for more deaths worldwide today than all other diseases combined. This is tough to swallow. Indeed, we may be living longer than our ancient relatives, but we could be living much better—enjoying our lives sickness-free—especially during the second half of life when the risk of illness rises. While it’s true that we are living longer than previous generations, most of our gains are due to improvements in infant mortality and child health. In other words, we’ve gotten better at surviving the accidents and illnesses of childhood. We haven’t, unfortunately, gotten better at preventing and combatting illnesses that strike us when we’re older. And while we can certainly make a case for having much more effective treatments now for many illnesses, that still doesn’t erase the fact that millions of people suffer needlessly from conditions that could have been avoided. When we applaud the average life expectancy in America today, we shouldn’t forget about quality of life.

When I was in medical school decades ago, my education revolved around diagnosing disease and knowing how to treat or, in some cases, cure each disease with a drug or other therapy. I learned how to understand symptoms and arrive at a solution that matched those symptoms. A lot has changed since then, because we are not only less likely to encounter easily treatable and curable illnesses, but also better able to understand many of our modern, chronic diseases through the lens of a common denominator: inflammation. So, rather than spotting infectious diseases and addressing sicknesses with known culprits, such as germs, viruses, or bacteria, doctors are faced with myriad conditions that don’t have clear-cut answers. I can’t write a prescription to cure someone’s cancer, vanquish inexplicable pain, instantly reverse diabetes, or restore a brain that’s been washed away by Alzheimer’s disease. I can certainly try to mask or lessen symptoms and manage the body’s reactions, but there’s a big difference between treating an illness at its root and just keeping symptoms at bay. Now that one of my own kids is in medical school, I see how times have changed in teaching circles. Doctors in training are no longer taught just how to diagnose and treat; they are equipped with ways of thinking that help them to address today’s epidemics, many of which are rooted in inflammatory pathways run amok.

Before I get to the connection between inflammation and the brain, let’s consider what I think is arguably one of the most monumental discoveries of our era: The origin of brain disease is in many cases predominantly dietary. Although several factors play into the genesis and progression of brain disorders, to a large extent numerous neurological afflictions often reflect the mistake of consuming too many carbs and too few healthy fats. The best way to comprehend this truth is to consider the most dreaded neurological ailment of all—Alzheimer’s—and view it within the context of a type of diabetes triggered by diet alone. We all know that poor diet can lead to obesity and diabetes, but a busted brain?

ALZHEIMER’S DISEASE—TYPE 3 DIABETES?

Flash back to your moment with those hunters and gatherers. Their brains are not too different from yours. Both have evolved to seek out foods high in fat and sugar. After all, it’s a survival mechanism. The problem is that your hunting efforts end quickly because you live in the age of plenty, and you’re more likely to find processed fats and sugars. Your caveman counterparts are likely to spend a long time searching, only to come across fat from animals and natural sugar from plants and berries if the season is right. So while your brain might operate similarly, your sources of nutrition are anything but. In fact, take a look at the following graphic that depicts the main differences between our diet and that of our forebears.

image

And what, exactly, does this difference in dietary habits have to do with how well we age and whether or not we suffer from a neurological disorder or disease?

Everything.

The studies describing Alzheimer’s as a third type of diabetes began to emerge in 2005,1 but the link between poor diet and Alzheimer’s has only recently been brought to light with newer studies showing how this can happen.2, 3 These studies are both convincingly horrifying and empowering at the same time. To think we can prevent Alzheimer’s just by changing the food we eat is, well, astonishing. This has many implications for preventing not just Alzheimer’s disease but all other brain disorders, as you’ll soon discover in the upcoming chapters. But first, a brief lesson on what diabetes and the brain have in common.

Evolutionarily, our bodies have designed a brilliant way to turn the fuel from food into energy for our cells to use. For almost the entire existence of our species, glucose—the body’s major source of energy for most cells—has been scarce. This pushed us to develop ways to store glucose and convert other things into it. The body can manufacture glucose from fat or protein if necessary through a process called gluconeogenesis. But this requires more energy than the conversion of starches and sugar into glucose, which is a more straightforward reaction.

The process by which our cells accept and utilize glucose is an elaborate one. The cells don’t just suck up glucose passing by them in the bloodstream. This vital sugar molecule has to be allowed into the cell by the hormone insulin, which is produced by the pancreas. Insulin, as you may already know, is one of the most important biological substances for cellular metabolism. Its job is to ferry glucose from the bloodstream into muscle, fat, and liver cells. Once there, it can be used as fuel. Normal, healthy cells have a high sensitivity to insulin. But when cells are constantly exposed to high levels of insulin as a result of a persistent intake of glucose (much of which is caused by an overconsumption of hyper-processed foods filled with refined sugars that spike insulin levels beyond a healthy limit), our cells adapt by reducing the number of receptors on their surfaces to respond to insulin. In other words, our cells desensitize themselves to insulin, causing insulin resistance, which allows the cells to ignore the insulin and fail to retrieve glucose from the blood. The pancreas then responds by pumping out more insulin. So higher levels of insulin become needed for sugar to go into the cells. This creates a cyclical problem that eventually culminates in type 2 diabetes. People with diabetes have high blood sugar because their body cannot transport sugar into cells, where it can be safely stored for energy. And this sugar in the blood presents many problems—too many to mention. Like a shard of glass, the toxic sugar inflicts a lot of damage, leading to blindness, infections, nerve damage, heart disease, and, yes, Alzheimer’s. Throughout this chain of events, inflammation runs rampant in the body.

I should also point out that insulin can be viewed as an accomplice to the events that unfold when blood sugar cannot be managed well. Unfortunately, insulin doesn’t just escort glucose into our cells. It’s also an anabolic hormone, meaning it stimulates growth, promotes fat formation and retention, and encourages inflammation. When insulin levels are high, other hormones can be affected adversely, either increased or decreased due to insulin’s domineering presence. This, in turn, plunges the body further into unhealthy patterns of chaos that cripple its ability to recover its normal metabolism.4

Genetics are certainly involved in whether or not a person becomes diabetic, and genetics can also determine at what point the body’s diabetes switch gets turned on, once its cells can no longer tolerate the high blood sugar. For the record, type 1 diabetes is a separate disease thought to be an autoimmune disorder—accounting for only 5 percent of all cases. People with type 1 diabetes make little or no insulin because their immune system attacks and destroys the cells in the pancreas that produce insulin, so daily injections of this important hormone are needed to keep blood sugars balanced. Unlike type 2, which is usually diagnosed in adults after their bodies have been abused by too much glucose over time, type 1 diabetes is typically diagnosed in children and adolescents. And unlike type 2, which is reversible through diet and lifestyle changes, there is no cure for type 1. That said, it’s important to keep in mind that even though genes strongly influence the risk of developing type 1 diabetes, the environment can play a role, too. It has long been known that type 1 results from both genetic and environmental influences, but the rising incidence over the last several decades has led some researchers to conclude that environmental factors could be more instrumental in the development of type 1 than previously thought.

SAD BUT TRUE

More than one hundred eighty-six thousand people younger than age twenty have diabetes (either type 1 or type 2).5 Just a decade ago type 2 diabetes was known as “adult-onset diabetes,” but with so many young people being diagnosed, the term had to be dropped. And new science shows that the progression of the disease happens more rapidly in children than in adults. It’s also more challenging to treat in the younger generation.

What we’re beginning to understand is that insulin resistance, as it relates to Alzheimer’s disease, sparks the formation of those infamous plaques that are present in diseased brains. These plaques are the buildup of an odd protein that essentially hijacks the brain and takes the place of normal brain cells. And the fact that we can associate low levels of insulin with brain disease is why talk of “type 3 diabetes” is starting to circulate among researchers. It’s all the more telling to note that obese people are at a much greater risk of impaired brain function, and that those with diabetes are at least twice as likely to develop Alzheimer’s disease.

This statement is not meant to imply that diabetes causes Alzheimer’s disease, only that they both share the same origin. They both spring from foods that force the body to develop biological pathways leading to dysfunction and, farther down the road, illness. While it’s true that someone with diabetes and another person with dementia may look and act differently, they have a lot more in common than we previously thought.

In the last decade, we’ve witnessed a parallel rise in the number of type 2 diabetes cases and the number of people who are considered obese. Now, however, we’re starting to see a pattern among those with dementia, too, as the rate of Alzheimer’s disease increases in sync with type 2 diabetes. I don’t think this is an arbitrary observation. It’s a reality we all have to face as we shoulder the weight of soaring health care costs and an aging population. New estimates indicate that Alzheimer’s will likely affect 100 million people by 2050, a crippling number for our health care system and one that will dwarf our obesity epidemic.6 The prevalence of type 2 diabetes, which accounts for 90 to 95 percent of all diabetes cases in the United States, has tripled in the past forty years. No wonder the U.S. government is anxiously looking to researchers to improve the prognosis and avert this catastrophe. And in the next forty years, more than 115 million new cases of Alzheimer’s are expected globally, costing us more than one trillion dollars (in today’s dollars).7, 8 According to the Centers for Disease Control and Prevention, 18.8 million Americans were diagnosed with diabetes in 2010 and another 7 million went undetected. Between 1995 and 2010, the number of diagnosed cases of diabetes jumped by 50 percent or more in forty-two states, and by 100 percent or more in eighteen states.9

THE SILENT BRAIN ON FIRE

One of the most frequent questions I get at my clinic from families of Alzheimer’s patients is How did this happen? What did my mother (or father, brother, sister) do wrong? I am careful how I respond at such a heartbreaking time in a family’s life. Watching my own father wither away slowly day after day is a constant reminder of the mixed emotions that a family endures. There is frustration fused with helplessness, and anguish mingled with regret. But if I had to tell family members (myself included) the absolute truth given what we know today, I’d say that their loved one may have done one or more of the following:

·         lived with chronic high blood sugar levels even in the absence of diabetes

·         eaten too many carbohydrates throughout his or her life

·         opted for a low-fat diet that minimized cholesterol

·         had undiagnosed sensitivity to gluten, the protein found in wheat, rye, and barley

When I tell people that gluten sensitivity represents one of the greatest and most under-recognized health threat to humanity, the response I hear is pretty much the same: “You can’t be serious. Not everyone is sensitive to gluten. Of course, if you have celiac disease, but that’s a small number of people.” And when I remind people that all the latest science points to the bane of gluten in triggering not just dementia but epilepsy, headaches, depression, schizophrenia, ADHD, and even decreased libido, a common thread prevails in the response: “I don’t understand what you mean.” They say this because all they know about gluten focuses on intestinal health—not neurological wellness.

We’re going to get up close and personal with gluten in the next chapter. Gluten isn’t just an issue for those with bona fide celiac disease, an autoimmune disorder that strikes a small minority. As many as 40 percent of us can’t properly process gluten, and the remaining 60 percent could be in harm’s way. The question we need to be asking ourselves: What if we’re all sensitive to gluten from the perspective of the brain? Unfortunately, gluten is found not only in wheat products but also in the most unexpected products—from ice cream to hand cream. Increasing numbers of studies are confirming the link between gluten sensitivity and neurological dysfunction. This is true even for people who have no problems digesting gluten and who test negative for gluten sensitivity. I see this every day in my practice. Many of my patients reach me once they have “tried everything” and have been to scores of other doctors in search of help. Whether it’s headaches and migraines, Tourette’s syndrome, seizures, insomnia, anxiety, ADHD, depression, or just some odd set of neurological symptoms with no definite label, one of the first things I do is prescribe the total elimination of gluten from their diets. And the results continue to astound me.

Researchers have known for some time now that the cornerstone of all degenerative conditions, including brain disorders, is inflammation. But what they didn’t have documented until now are the instigators of that inflammation—the first missteps that prompt this deadly reaction. And what they are finding is that gluten, and a high-carbohydrate diet for that matter, are among the most prominent stimulators of inflammatory pathways that reach the brain. What’s most disturbing about this discovery, however, is that we often don’t know when our brains are being negatively affected. Digestive disorders and food allergies are much easier to spot because symptoms such as gas, bloating, pain, constipation, and diarrhea emerge relatively quickly. But the brain is a more elusive organ. It could be enduring assaults at a molecular level without your feeling it. Unless you’re nursing a headache or managing a neurological problem that’s clearly evident, it can be hard to know what’s going on in the brain until it’s too late. When it comes to brain disease, once the diagnosis is in for something like dementia, turning the train around is hard.

The good news is that I’m going to show you how to control your genetic destiny even if you were born with a natural tendency to develop a neurological challenge. This will require that you free yourself from a few myths so many people continue to cling to. The two biggest ones: (1) a low-fat, high-carb diet is good, and (2) cholesterol is bad.

The story doesn’t end with the elimination of gluten. Gluten is just one piece of the puzzle. In the upcoming chapters, you’ll soon understand why cholesterol is one of the most important players in maintaining brain health and function. Study after study shows that high cholesterol reduces your risk for brain disease and increases longevity. By the same token, high levels of dietary fat (the good kind, no trans fats here) have been proven to be key to health and peak brain function.

Say what? I realize you may doubt these statements because they run so contrary to what you’ve been taught to believe. One of the most prized and respected studies ever done in America, the famous Framingham Heart Study, has added volumes of data to our understanding of certain risk factors for disease, including, most recently, dementia. It commenced in 1948 with the recruitment of 5,209 men and women between the ages of thirty and sixty-two from the town of Framingham, Massachusetts, none of whom had yet suffered a heart attack or stroke or even developed symptoms of cardiovascular disease.10Since then, the study has added multiple generations stemming from the original group, which has allowed scientists to carefully monitor these populations and gather clues to physiological conditions within the context of myriad factors—age, gender, psychosocial issues, physical traits, and genetic patterns. In the mid-2000s, researchers at Boston University set out to examine the relationship between total cholesterol and cognitive performance, and they looked at 789 men and 1,105 women who were part of the original group. All of the individuals were free of dementia and stroke at the beginning of the study and were followed for sixteen to eighteen years. Cognitive tests were performed every four to six years, evaluating things like memory, learning, concept formation, concentration, attention, abstract reasoning, and organizational abilities—all the features that are compromised in patients with Alzheimer’s disease.

According to the study’s report, published in 2005, “There was a significant positive linear association between total cholesterol and measures of verbal fluency, attention/concentration, abstract reasoning, and a composite score measuring multiple cognitive domains.”11 Moreover, “participants with ‘desirable’ total cholesterol (less than 200) performed less well than participants with borderline high total cholesterol levels (200 to 239) and participants with high total cholesterol levels (greater than 240).” The study concluded that “lower naturally occurring total cholesterol levels are associated with poor performance on cognitive measures, which placed high demand on abstract reasoning, attention/concentration, word fluency, and executive functioning.” In other words, the people who had the highestcholesterol levels scored higher on cognitive tests than those with lower levels. Evidently, there is a protective factor when it comes to cholesterol and the brain. We’ll be exploring how this is possible in chapter 3.

The research keeps coming from various labs around the world, flipping conventional wisdom on its head. As I write this, researchers with Australian National University in Canberra just published a study in the journal Neurology (the medical journal of the American Academy of Neurology) showing that people whose blood sugar is on the high end of the “normal range” have a much greater risk for brain shrinkage.12 This ties directly into the story of type 3 diabetes. We’ve known for a long time that brain disorders and dementia are associated with brain shrinkage. But knowing now that such shrinkage can happen as a result of blood sugar spikes in the “normal” range has tremendous implications for anyone who eats blood sugar–boosting foods (i.e., carbohydrates). So often my patients will tell me that they are fine because their blood sugar is normal. But what is normal? The lab test may indicate that an individual is “normal” by established standards, but new science is forcing us to reconsider normal parameters. Your blood sugar may be “normal,” but if you could peek into your pancreas, you might be aghast at how much it’s struggling to pump out enough insulin to keep you on an even keel. For this reason, getting a fasting insulin test, which is done first thing in the morning before eating a meal, is critical. An elevated level of insulin in your blood at this time is a red flag—a sign that something isn’t metabolically right. You could be on the verge of diabetes, already depriving your brain of its future functionality.

The Australian study involved 249 people age sixty to sixty-four who had blood sugar in the so-called normal range, and who underwent brain scans at the start of the study and again an average of four years later. Those with higher blood sugar levels within the normal range were more likely to show a loss of brain volume in regions involved with memory and cognitive skills. The researchers even managed to factor out other influences, such as age, high blood pressure, smoking, and alcohol use. Still, they found that blood sugar on the high end of normal accounted for 6 to 10 percent of the brain shrinkage. The study suggests that blood sugar levels could have an impact on brain health even for people who do not have diabetes.13

Blood sugar and insulin imbalances are epidemic. Within the next decade, one in two Americans will suffer from diabesity—the term now used to describe a range of metabolic imbalances from mild insulin resistance to pre-diabetes to full-blown diabetes. The hardest fact of all to accept is that a breathtaking 90 percent of these people will not be diagnosed. They will carry on and come to learn of their predicament when it’s far too late. My mission is to interrupt such an unfortunate destiny. We want to focus not on calling all the king’s horses and all the king’s men, but on coaxing Humpty Dumpty down from the wall before disaster strikes. This will require a shift in a few daily habits.

If the thought of going on a low-carb diet is terrifying (you’re already biting your nails at the thought of nixing all the delicious foods you’ve come to love), don’t give up yet. I promise to make this as easy as possible. I might take away the bread basket, but I’ll replace it with other things you might have avoided under the false idea that they were somehow bad for you, such as butter, meat, cheese, and eggs, as well as an abundance of wonderfully healthful vegetables. The best news of all is that as soon as you shift your body’s metabolism from relying on carbs to relying on fat and protein, you’ll find a lot of desirable goals easier to achieve, such as losing weight effortlessly and permanently, gaining more energy throughout the day, sleeping better, being more creative and productive, having a sharper memory and faster brain, and enjoying a better sex life. This, of course, is in addition to safeguarding your brain.

INFLAMMATION GETS CEREBRAL

Let’s get back to this idea of inflammation, which I’ve mentioned a few times in this chapter without a full explanation. Everyone has a rough idea what is meant by the term “inflammation” in a very general sense. Whether it’s the redness that quickly appears after an insect bite or the chronic soreness of an arthritic joint, most of us understand that when there is some kind of stress in the body, our body’s natural response is to create swelling and pain, hallmarks of the inflammatory process. But inflammation isn’t always a negative reaction. It can also serve as an indication that the body is trying to defend itself against something it believes to be potentially harmful. Whether to neutralize the insect’s toxins or reduce movement in a sprained ankle to allow healing, inflammation is vital to our survival.

Problems arise, however, when inflammation gets out of control. Just as one glass of wine a day is healthy but multiple glasses every day can lead to health risks, the same holds true for inflammation. Inflammation is meant to be a spot treatment. It’s not supposed to be turned on for prolonged periods of time, and never forever. But that’s what’s happening in millions of people. If the body is constantly under assault by exposure to irritants, the inflammation response stays on. And it spreads to every part of the body through the bloodstream; hence, we have the ability to detect this kind of widespread inflammation through blood tests.

When inflammation goes awry, a variety of chemicals are produced that are directly toxic to our cells. This leads to a reduction of cellular function followed by cellular destruction. Unbridled inflammation is rampant in Western cultures, with leading scientific research showing that it is a fundamental cause of the morbidity and mortality associated with coronary artery disease, cancer, diabetes, Alzheimer’s disease, and virtually every other chronic disease you can imagine.

It’s not much of a stretch to appreciate how unchecked inflammation would underlie a problem like arthritis, for example. After all, the common drugs used to treat the condition, such as ibuprofen and aspirin, are marketed as “anti-inflammatories.” With asthma, antihistamines are used to combat the inflammatory reaction that occurs when someone is exposed to an irritant that elicits an allergic response. These days, more and more people are beginning to understand that coronary artery disease, a leading cause of heart attacks, may actually have more to do with inflammation than it does with high cholesterol. This explains why aspirin, in addition to its blood-thinning properties, is useful in reducing risk not only for heart attacks but also for strokes.

But the connection of inflammation to brain diseases, although well described in the scientific literature, seems somehow difficult to embrace—and it’s largely unknown by the public. Perhaps one reason people can’t seem to envision “brain inflammation” as being involved in everything from Parkinson’s disease to multiple sclerosis, epilepsy, autism, Alzheimer’s disease, and depression is that unlike the rest of the body, the brain has no pain receptors, so we can’t feel inflammation in the brain.

Focusing on reducing inflammation might seem out of place in a discussion of enhancing brain health and function. But while we are all familiar with inflammation as it relates to such disease states as arthritis and asthma, the past decade has produced an extensive body of research clearly pointing the finger of causality at inflammation when considering a variety of neurodegenerative conditions. In fact, studies dating back as far as the 1990s show that people who have taken nonsteroidal anti-inflammatory medications such as Advil (ibuprofen) and Aleve (naproxen) for two or more years may have more than a 40 percent reduced risk for Alzheimer’s and Parkinson’s disease.14, 15 At the same time, other studies have clearly shown dramatic elevation of cytokines, the cellular mediators of inflammation, in the brains of individuals suffering from these and other degenerative brain disorders.16 Today, new imaging technology is finally allowing us to see cells actively involved in producing inflammatory cytokines in the brains of Alzheimer’s patients.

So, we now are forced to regard inflammation in a whole new light. Far more than just the cause of your painful knee and sore joints, it underpins the very process of brain degeneration. Ultimately, the key downstream effect of inflammation in the brain that is responsible for the damage is activation of chemical pathways that increase free radical production. At the center of chronic inflammation is the concept of oxidative stress—a biological type of “rusting.” This gradual corrosion happens on all tissues. It’s a normal part of life; it occurs everywhere in nature, including when our bodies turn calories (energy) from food and oxygen from the air into usable energy. But when it begins to run rampant, or when the body can’t keep it under healthy control, it can become deadly. Although the word oxidation implies oxygen, it’s not the kind we breathe. The felon here is simply O because it’s not paired with another oxygen molecule (O2).

Let me take you one step further in describing the oxidation process. Most of us have heard about free radicals by now. These are molecules that have lost an electron. Normally, electrons are found in pairs, but forces such as stress, pollution, chemicals, toxic dietary triggers, ultraviolet sunlight, and ordinary body activities can “free” an electron from a molecule such that it loses its social graces and starts trying to steal electrons from other molecules. This disorder is the oxidation process itself, a chain of events that creates more free radicals and stirs inflammation. Because oxidized tissues and cells don’t function normally, the process can render you vulnerable to a slew of health challenges. This helps explain why people with high levels of oxidation, which is often reflected by high levels of inflammation, have an extensive list of health challenges and symptoms ranging from a low resistance to infection to joint pain, digestive disorders, anxiety, headaches, depression, and allergies.

And, as you probably can guess, reduced oxidation lowers inflammation, which in turn helps limit oxidation. Antioxidants are important for this very reason. These nutrients, such as vitamins A, C, and E, donate electrons to free radicals, and this interrupts the chain reaction and helps prevent damage. Historically, antioxidant-rich foods such as plants, berries, and nuts were part of our diet, but the food industry today processes a lot of nutrients out of our diets that are sorely needed for optimal health and energy metabolism.

Later in this book I’m going to show you how to turn on a particular pathway in your body that not only directly reduces free radicals naturally, but also protects the brain by reducing excess free radicals produced by inflammation. Interventions designed to reduce inflammation using natural substances like turmeric have been described in medical literature dating back more than two thousand years, but it is only in the past decade that we have begun to understand this intricate and eloquent biochemistry.

Another upshot of this biological pathway is the activation of specific genes that code for the production of enzymes and other chemicals that serve to break down and eliminate various toxins to which we are exposed. One might wonder why human DNA would contain codes for the production of detoxification chemicals, because we tend to assume that our first real exposure to toxins began with the industrial era. But humans (and, in fact, all living things) have been exposed to a variety of toxins for as long as there has been life on the planet. Aside from toxins that naturally exist in our external environment, like lead, arsenic, and aluminum, as well as powerful toxins created as a form of protection by variously consumed plants and animals, our bodies produce toxins internally during the normal processes of metabolism. So these detoxification genes—now needed more than ever—have gratefully served us for a very long time. And we are just beginning to understand how natural substances you can buy at your local grocery store, such as turmeric and the omega-3 docosahexaenoic acid (DHA), can act as powerful detoxification agents by enhancing genetic expression.

It is not just what we eat that can change the expression of our genes and, therefore, help us manage inflammation. You’re going to learn about the latest studies demonstrating the ways exercise and sleep come into play, as these are important regulators (read: remote controllers) of our DNA. What’s more, you’ll learn how to grow new brain cells; I’m going to show you how and why neurogenesis—the birth of new brain cells—is under your control.

THE CRUEL IRONY: STATINS

Diet and exercise can boost our body’s natural methods to manage inflammation, but is there also a case for drugs? Far from it. Ironically, cholesterol-lowering statins, which are among the most commonly prescribed drugs (e.g., Lipitor, Crestor, Zocor), are now being touted as a way to reduce overall levels of inflammation. But new research also reveals that statins may lessen brain function and increase risk for heart disease. The reason is simple: The brain needs cholesterol to thrive, a point I’ve already made but will repeat to make sure you don’t forget it. Cholesterol is a critical brain nutrient essential for the function of neurons, and it plays a fundamental role as a building block of the cell membrane. It acts as an antioxidant and a precursor to important brain-supporting elements like vitamin D, as well as the steroid-related hormones (e.g., sex hormones such as testosterone and estrogen). Most important, cholesterol is looked upon as an essential fuel for the neurons. Neurons themselves are unable to generate significant cholesterol; instead, they rely on delivery of cholesterol from the bloodstream via a specific carrier protein. Interestingly, this carrier protein, LDL, has been given the derogatory title of “bad cholesterol.” In reality, LDL is not a cholesterol molecule at all, good or bad. It’s a low-density lipoprotein (hence its acronym), and there is absolutely nothing bad about it. The fundamental role of LDL in the brain, again, is to capture life-giving cholesterol and transport it to the neuron, where it performs critically important functions.

And now we have the evidence in the scientific literature to prove that when cholesterol levels are low, the brain simply doesn’t work well; individuals with low cholesterol are at much greater risk for dementia and other neurological problems. We need to change our attitudes about cholesterol and even LDL; they are our friends, not foes.

But what about cholesterol and coronary artery disease? I’m going to tackle that very conundrum in chapter 3. For now, I want to implant in your brain the idea that cholesterol is good. You’ll soon see that we’ve been barking up the wrong tree—blaming cholesterol, and LDL especially, when coronary artery disease has more to do with oxidized LDL. And how does LDL become so damaged that it’s no longer able to deliver cholesterol to the brain? One of the most common ways is through physical modification by glucose. Sugar molecules attach themselves to LDL and change the molecule’s shape, rendering it less useful while increasing free radical production.

If what I just described to you raced past your head, don’t panic. I’m going to take you by the hand through all of these biological events in the upcoming chapters. I’ve broadly touched upon a lot of issues in this chapter as a prelude to the balance of the book, which will take you deeper into the story of Grain Brain. The chief questions I want you to think about are: Have we accelerated our brain’s decline by following a low-fat, high-carb diet with fruit on the side? Can we really control the fate of our brains through lifestyle alone despite the DNA we’ve inherited? Is there too much invested interest in Big Pharma to consider the fact we can naturally prevent, treat, and sometimes cure—without drugs—a spectrum of brain-based ailments such as ADHD, depression, anxiety, insomnia, autism, Tourette’s syndrome, headaches, and Alzheimer’s disease? The answer to all three of these questions is a resounding yes. I’ll go even further and suggest we can prevent heart disease and diabetes, too. The current model of “treatment” for these maladies pays too much attention to the symptomatic smoke and ignores the smoldering fire. Such an approach is ineffective and unsustainable. If we’re ever going to push the boundaries of human longevity, live long past 100 years old, and really have something amazing to report to our prehistoric ancestors, then we’re going to have to change our whole MO.

The goal of this chapter was to explain the story of inflammation and introduce you to a new way of thinking—and looking—at your brain (and body). We take it for granted that the sun rises in the east every morning and sets in the west at night. The next day, the sun does the same thing again. But what if I told you that the sun isn’t moving at all? It’s us who are spinning and moving around the sun! I trust you already knew that, but the takeaway from the analogy is that we tend to get mentally wedded to ideas that are no longer valid. After lectures, people frequently approach me to say thanks for thinking outside the box. With all due respect, that’s not the point. It does the world no good for me to be seen as someone whose ideas are “outside the box.” My mission is to make the box bigger so that these concepts are part of our culture and way of living. Only then will we be able to make serious, meaningful headway with our modern afflictions.

FROM BRAIN HEALTH TO TOTAL HEALTH

The inescapable fact is that we have evolved into a species that requires fat for life and health. The massive amounts of carbs we eat today are fueling a silent firestorm in our bodies and brains. And I’m not just talking about the manufactured, refined stuff that we all know is not going to win prizes for us at the doctor’s office (much less on the scale). I love how Dr. William Davis puts it in his seminal work Wheat Belly:17

Whether it’s a loaf of organic high-fiber multigrain bread or a Twinkie, what exactly are you eating? We all know that the Twinkie is just a processed indulgence, but conventional advice tells us that the former is a better health choice, a source of fiber and B vitamins, and rich in “complex” carbohydrates.

Ah, but there’s always another layer to the story. Let’s peer inside the story. Let’s peer inside the contents of this grain and try to understand why—regardless of shape, color, fiber content, organic or not—it potentially does odd things to humans.

And that’s exactly where we’re going next. But unlike Davis’s brilliant account of the modern grain and the battle of the bulge, we’re going to go one step further to see how it can inflict harm where we never imagined before: the brain.