Nature’s Role In Mood Disorders and Brain Fatigue – With Dr. Austin Perlmutter

Dr. Mindy
absolutely love this idea around disconnection syndrome. And I don’t know why we have to call something a syndrome to bring attention to it. But it does seem to help us put some languaging around dysfunctional situations that might be occurring in our bodies or our brains. So can we start with just explaining, you know, I’ve read it in your book, but let’s bring my audience up to speed. What is disconnection syndrome? And how did you guys come up with this? Where did it? Where was this birthed from?

Dr. Austin Perlmutter
You know, I think we’re all looking at ways to understand what’s going wrong. There’s a really weird scenario where, in theory, we have everything, we think we should need to be happy to be healthy, and yet we aren’t right. We’re not that healthy, we’re not that happy. So something’s going wrong. And I spent a lot of time with my dad thinking through what is the breakdown here, what what is actually driving us to, to not to not achieve the things that in theory should be happening. And we looked at the brain, and we looked at decision making. And we looked at the larger ecosystem and disconnection was really the single best term we found to explain what was happening because it is literally a breakdown. It’s a breakdown a disconnection within our brains, that makes it hard for us to act with empathy makes it hard for us to make good decisions. But it’s also a disconnection from other people. And I think one of the things we’re going to talk about today is it’s a disconnection from nature. Yeah, disconnection from the outside environment. And, you know, you can go through everything, you can say, we’re disconnected from our bodies disconnected from our diet. And I think that, you know, again, as a terminology, it helps to, to use that as a term because then you can understand how the solution is reconnection. And you can do that in a variety of ways. And I want to be clear on this, I am not advocating for people to have to go out and do everything explicitly that I say, I think any form of connection is meaningful when the default is disconnection.

Dr. Mindy
Hmm. So okay, so if you had a, you know, play doctor for a moment, you know, I’m gonna pay a patient in your office, and I’m saying, you know, I’m depressed, I’m anxious, I’m lonely, like, and and you’re, you’re going to give me this label of disconnection syndrome. What are the classic signs? That tells me I have disconnection syndrome?

Dr. Austin Perlmutter
Sure. Well, I want to be clear, I mean, that we’re not using this as a diagnostic code. It’s not a DSM code. I think it is more a way of understanding, kind of, again, a syndrome, variety of different manifestations.

Dr. Mindy
Here’s what where my brain is going is, I appreciate that it’s not a syndrome, yet, it is helpful for us to like categorize our dysfunction. I don’t know another way to say it, which is why I loved in the book when it said, you know, disconnection syndrome, it was like, Yes, it allowed me to categorize some of the things I had been feeling. So how help us understand what falls into that category.

Dr. Austin Perlmutter
In the book, we talk about this idea of disconnection syndrome. And we go through and define these eight characteristics, the central characteristics of this condition. So we talk about impulsivity, instant gratification, chronic inflammation, chronic stress, loneliness, mindless activity, and narcissism and poor relationships. And we really feel like these are the, you know, the kind of best manifestations of how our thought patterns are distorted by this disconnection syndrome. So if you were to go through the day, and look at the things that you were doing, as far as how you were acting, how you were thinking, these are the ones where we really think that is evidence of this disconnection syndrome. And that’s kind of the the outward manifestation of it, right? You can say, here’s what I was thinking, here’s what I was doing. But what’s so interesting about this research behind the concept of disconnection syndrome, is that it is really grounded in what is happening within our brains. And how there is this disconnect, physical disconnection as far as the way the neurons are firing, and not talking to each other between these two regions of the brain. One brain being the more highly evolved, we think of region called the prefrontal cortex, which helps us to make reflective decisions helps us to engage in empathy helps us to, you know, think beyond the present moment. And then the other part of the brain, which is the limbic system, the reward system, that seems to be more fixated on the impulsive type thinking. And we really feel like so much of what’s going wrong can be seen as an imbalance between these two parts of the brain. What’s super cool about this, though, is that there are things that we can do to physically change the wiring of our brain to rebalance that. So we’re not always in this tug of war. Instead, we’re of above that looking down and able to make those changes.

Dr. Mindy
So okay, well now you have me curious. Before we go into some of the details of it, let’s stop at the prefrontal cortex, limbic system. So one of the things that I’m smile when you say, prefrontal cortex because I feel like I have been looking for every hack I can possibly find to strengthen my prefrontal cortex. Do you either operate from one one of these places, but you don’t operate from both of them at the same time? Is that how that works? Or is one strong? is one stronger and one weaker?

Dr. Austin Perlmutter
Yeah, it’s a really good question. And I don’t think that there is a global consensus as far as how this works. I mean, I think there’s the one story, the one that seems more appealing to tell, which is, you are either acting from one part of your brain or another part. And if you’re acting from this part, it’s good in this part, it’s bad. But what seems to be more important here is that all of these areas of the brain communicate in balance, that it’s a network effect of these integrated regions of the brain. And when we think about these two areas, again, the prefrontal area of the brain and then the limbic reward system, what seems to be increasingly seen in the literature and substantiated is that we want to have some degree of what is called top down control. And what that means is, you want to make sure you’re able to reflect on your choices, and not just act out of impulse. And if you think about the way that maybe many of us are acting in the course of a day, it tends to be the impulsive choices that get us into trouble. It’s when somebody says something unkind and you yell back at them, or you know, you bump into somebody on the subway, and then you push them back, or you decide to buy something on Amazon that you definitely don’t need, but the pop up ad was at the right time, or you spend three hours watching binge watching a TV show when you had planned to do something productive. These are more of these impulsive decisions and less reflective decisions. And I think what we can say is, in order to make more reflective decisions, more thought out decisions, we have to have the prefrontal cortex online. And you can see in the literature, what happens when that isn’t available. So we talk about this very famous case of a guy named Phineas Gage. Yeah, and we’ve we’ve kind of talked about this person in neuroanatomy. And the like, as this is what happens when a person gets a metal spike to the forehead, right? These, it kind of went in through here and came out and it took out part of the prefrontal cortex. And what we’re seeing is that this gentleman went from being a relatively, you know, compassionate and balanced person to being prone to these fits of rage and very impulsive. So it tells us that part of the brain there probably has something to do with allowing us to make more restrained decisions. And research like this enables us to solve for, are there parts of the brain that seemed to be specifically involved in specific processes. And so he was one of the first there have been many centers where people because of either damage from, let’s say, an accident or a tumor. Basically, we know that when that part of the brain isn’t available, people tend to make worse choices. There’s one other thing I’d say there, because I think this is really the most empowering part is that Phineas, as his life went on, he didn’t die as it turned out right after he received this steak through the face, which is shocking, because it was quite traumatic. He did, however, change the way that he acted over the years after that event. So while he was a little bit more impulsive, right afterwards, it seemed like he was able to just kind of change his brain function and become a relatively successful person after this accident. And that speaks to this idea that even if your brain is wired, for bad choices for low empathy for, for poor, General decision making in the world, there are things that you can do to enhance what’s called neuroplasticity. I’m sure it’s not new to listeners of this show, which enables you to literally modify that wiring in a positive way. So if phineus can do it, we can do it. And we can change our brains to make better decisions and better actions more likely. So I think it’s that is so important because what we put into our bodies, what we give our bodies, food or nature exercise provides the pathway to rewiring our brains. Oh, that was a lot of love.

Dr. Mindy
No, I love that because I stumbled upon Phineas his story like five, six years ago, and I was that’s what got me totally fascinated by the prefrontal cortex. So then, here’s here’s one of the thoughts I’ve had for some time as the parent of a 19 year old and a 21 year old is, at what age does the prefrontal cortex fully mature?

Dr. Austin Perlmutter
Yeah, it’s a really good question. I’ve actually seen it variably reported, so I unfortunately can’t give you an age my my running number is somewhere in the mid 20s. That seems to be about the spot where the prefrontal cortex has hit some of those major developmental milestones. There’s so many other things to consider though, there’s something about dopamine where younger brains may have more sensitivity to and potentially even more dopamine, which increases impulsivity, when it’s in a certain part of the brain. And, and really, what you’re looking for with the prefrontal cortex is that the top down suppression using dopamine again, but to calm down the other parts of the brain. So it may not just be that the prefrontal cortex isn’t developed enough, but it’s more that the other parts of the brain develop so quickly, and so they get out of sync. So there’s a lot of interesting stuff going on. But I think, when you think of kind of the psychology, the philosophy of it, there’s so many, I think, fascinating correlates because we tend to kind of judge people as though they’re full people very early on, and we blame people for poor decisions. But if our decisions are an outgrowth of our brain structure, and our brains haven’t finished maturing, it just it I think it changes the way that we should be looking at the way people make choices throughout the lifespan, but especially in those formative years.

Dr. Mindy
So does that mean when you allow a 16 year old with a lower developed or not fully developed prefrontal cortex to get behind a car, that we may be putting them at more risk, because their choices may be different?

Dr. Austin Perlmutter
I think that’s, that’s definitely something to think about. I mean, again, there are so many kind of modern day correlates. So for example, a 16 year old today may be at a higher risk of texting while driving, which is an impulsive, bad decision, and is been associated consistently with more accidents and more deaths, right? We don’t want to be doing that. On the other end of the spectrum, you might have an elderly person who for other reasons, doesn’t have a prefrontal cortex that is as capable of making those quick decisions. Because what we know is, you know, younger people may actually have the better ability to react quickly to things that come up while they’re driving, whereas older people, for again, a variety of reasons, one is just potentially sight and hearing impairment may not be able to respond as quickly. So there are all of these correlates to it. You know, at the end of the day, we kind of make these relatively arbitrary distinctions as to here is the point at which we think you are capable now of making this choice, whether that’s being allowed to purchase cigarettes, alcohol, or getting behind the wheel of a car. And if you decide if I was the one to say, we should wait till we’re 26, I don’t think that would go over very well,

Dr. Mindy
you wouldn’t be very popular. I don’t think that’d be a good idea. What so what is going to deplete the prefrontal cortex? Are there habits that we should be aware of that will make it so that our prefrontal cortex is less effective?

Dr. Austin Perlmutter
Yeah, I think the answer to that question is yes. And I think it’s a very important question. There are kind of a couple of different ways that you can look at this. So one popular way is looking at the work of Roy Baumeister, which is something called ego depletion, basically, the idea that you have a finite amount of willpower. And if you use it up, then you’re no longer able to make prefrontal type decisions. So you know, people will say, make all your important choices early in the day while you have the reserve. So that later in the day, when you’re making worse choices, they don’t matter as much. There’s been some variable discussion as to how real that is. And there’s some interesting work, kind of apropos of, I think what you’re doing with fasting, that thinks about whether it’s glucose or fuel related, whether that’s kind of a cognitive metabolic reserve, that enables us to make good choices. But I would say I look at kind of these three major factors that we can use to either improve our decision making through helping the prefrontal cortex and on the other hand, that can damage our decision making through the prefrontal cortex. And those are sleep. I think, first thing I always say is, if you don’t get good sleep, your prefrontal cortex isn’t online. We’ve all been there, I could give stories, you could probably give stories, listeners could give stories when you don’t get good sleep, you can’t think clearly your prefrontal cortex just doesn’t work as well. We can’t focus as well, we don’t drive as well. There are so many good examples. The other two are going to be stress and inflammation. So I’ll pause there for a second. Stress takes the prefrontal cortex offline. It’s such an important distinction to make though, a little bit of stress can actually engage the prefrontal cortex, a little bit of positive stress, for example, maybe I’m a little stressed right now being on this podcast that can actually sharpen my thinking. It can shoot the right hormones and neurotransmitters to the neurons in the prefrontal cortex. And it what it does is it kind As it cuts out the external stuff, it helps you to not focus on what’s happening tomorrow gives you focus on the present moment, that can be a good thing, too much stress and for too long, appears to actually damage the neurons in the prefrontal cortex, which I think is super important to understand. If you look at brain scans of people under chronic stress, there’s atrophy in the prefrontal cortex, the part of the brain that enables us to make good choices. And we’ll go one level deeper on the research here. In animal models, when you subject animals to significant levels of stress. The neurons in the prefrontal cortex, they actually retract and get damaged, they atrophy, the neurons in the amygdala, which is one of the parts of the brain involved with impulsivity and fear, they actually expand because they are responsive to high levels of cortisol, they do well in that. So if you kind of generalize that to humans, what that means is, stress is a signal high, long doses of stress are a signal to bias your brain towards more limbic structures towards more stress centers, which is basically telling me that we wire our brains to continue to be stressed when we’re stressed for too much time. Really important, I know that we all are aware of stress being problematic, but there is this feed forward cycle that we need to be aware of, because when we’re stressed, we’re going to make worse decisions, those worse decisions are going to lead to worsening of our brain function can increase stress. And then the last thing I’ll mention and we can go into any of these in detail is inflammation. Which is super interesting, because, you know, we’ve thought for a long time, the food that we eat changes us, right changes our bodies, some people are talking about how the food we eat changes our brains. And the data here are pretty clear that if you eat a junk diet for decades, you have a higher rate of all the diseases, including Alzheimer’s disease, one of the mechanisms seems to be increases in inflammation. So high inflammation now predicts lower brain function later, years later. It’s why people like my dad, and myself, I guess they’re so big on people eating healthy food now to prevent brain dysfunction later, yeah, but what the research is now indicating, and this is only in the last few years, is that inflammation right now, just if I was to cause you to have inflammation, this moment, correlates with worse decision making correlates with more impulsivity. So if you were to have a dose of inflammation, that would probably change your decisions. For the worst, it seems like it might take the prefrontal cortex offline. And again, we can go into this in more detail. But why that’s so key is it means on a moment to moment basis, based on what you’re taking into your body, you are changing your brain function and biasing yourself towards either better thinking, good decision making, or worse decision making worse thinking. And it doesn’t take much to consider that the modern world is pushing us towards the second of those two options, which is really unfortunate.

Dr. Mindy
Yeah, I so well said I have really, especially over the last year have been, I call it locked and loaded. I’ve seen not my not only my patients, I can feel it in myself. I’ve seen it in interactions in the grocery store, that people are like locked and loaded in that amygdala. And even a little bit of stress seems to create these over exaggerated responses. And as the pandemic went on last year, I kept reminding myself, Hey, you got to exercise the prefrontal cortex, and get yourself out of locked and loaded so that you can be a better human. Is it that is it that simple? I mean, when I hear you say, lack of sleep, stress and inflammation, I’m like, well, there’s the human the problem with the human race.

Dr. Austin Perlmutter
Yeah, I mean, in some ways, it is simple. And in other ways, it is complicated. I would just say to your point, I recently published an article that looked at kind of the immune and stress effects of the pandemic. And your experience, I think, is unfortunately far from unique, that when you look at levels of stress in Americans, they have gone up dramatically during COVID. In addition, levels of depression, anxiety seems to have gone up as well. And so at the end of the day, you know, if your reserve is usually here on a good day, because you got good sleep, you ate good food, you had nice interactions with your friends and family and you’re economically doing okay, then there’s more buffer before you get to the point of lashing out at somebody. But now let’s say you know, you’re economically not as well off, you’re not eating quite as well. You’re not exercising as much, you’re not getting outside as much before you know it. It doesn’t take anything before you tap into that emotional circuit of the brain. And I want to be clear, this is kind of a preservation mechanism. When the chips are down, your brain just goes to a place of reactivity. Because it’s fight or flight, it’s basically do or die. And I think it is kind of one of the most amazing things that humans have that we can decide to kind of prevent that to try to bias our brains towards a little bit more buffer. I think there’s so many ways that you can do that, right, you can to counter the stress to counter the inflammation to get better sleep. But I don’t think people are aware of how quickly this happens, that giving yourself a couple hours of extra sleep tonight, is sufficient to change your brain function tomorrow. I love that, you know, we talk about exercise, we talk about food, these things matter, these things change brain function. But for many people, It’ll take a while right? It’ll take some time before the gut microbiome changes, the immune system changes before they’re actually experiencing perhaps some of those benefits that translate into better cognition. You know, some exceptions, for example, fasting, you might see benefits to having elevated ketones rather quickly. But as it relates to sleep, you go to sleep, give yourself good sleep, you will wake up the next day. And I know I and other people will experience better thinking that we can put our finger on immediately. Yeah, I think, you know, again, we’re all in this position where there’s a lot more stress, a lot more anxiety, and unfortunately, a lot more depression. I think that giving ourselves better sleep. I will say in full disclosure, I just heard Matthew Walker speak last week, and he’s always so inspiring. But I think getting better sleep is one of those great first steps in helping to reprogram our brains.

Dr. Mindy
Yeah, except getting better sleep isn’t always it’s not your said and done. I 100%. It’s like I whenever I hear that one, or I hear don’t stress, I’m like, I get that inflammation to me is a lot easier to handle because I can go Okay, well, I got to exercise got to change my diet, I got to fast things like that. Whereas stress, okay, when I look at that, I’m like, I need a toolbox to be able to create some kind of mental game where I don’t let stress get me. And then sleep is a whole nother ball of wax that a lot of people really struggle with.

Dr. Austin Perlmutter
You’re absolutely right. I think that is such a good point. And I would hate to think that I’m the type of person to get up here and say, just sleep better and stress last, because those are not actionable goals. Those are just me getting up on the podium and telling people just like, you know, I hate this. But this is the way many doctors work, which is basically telling people, here’s what you have to do. And if you don’t do it, I’m going to blame you because I gave you the information. So that’s actually a good segue into a couple of the actionable is if you’d like to please, please. So let’s go to the stress one first, the actionable there is you have to meditate two hours a day now. That’s another one that gets

Dr. Mindy
people there like off.

Dr. Austin Perlmutter
So let’s talk about the stress piece. Let’s go from stressed to an intervention that we’ve alluded to here a little bit. But that is really not well utilized, and can be done in as little as 20 minutes once a week has been shown in studies to have benefit and that is nature exposure. You have all these delightful orchids behind you, I will say my orchids tend not to do nearly as well as yours. But, you know, just being around nature matters so much to our physical to our mental health. And it’s an intervention to lower stress, I’d say of all of the research around nature, that’s probably the most consistent finding. Unfortunately, and perhaps many of you out there listening can resonate with this, Americans are spending their day inside. And it’s not just Americans, people around the world, they’re spending their day inside. And I’m talking about in America, a survey showing that 87% of the day we’re inside, and then 6% of the day we’re in our cars, so it doesn’t leave that much time for the outdoors. Why does that matter is because exposure to nature has been consistently associated with better physical health. So looking at everything from cardio metabolic disease, to better mental health, anxiety, depression, stress levels, of course, as I mentioned, better immune function, better decision making, this stuff really matters. And it matters I think more now than ever, because nature is literally the antidote to the modern world. If you’re getting exposure to the outdoors to nature to these urban or sorry, rural environments, it is telling your brain that you can let your guard down a little bit and it is telling your body that it can relax that is kind of our forgive the pun, it is our natural environment. We have as a human species spent the vast majority of our evolutionary time in the outdoors, not in these urban environments that you know where we shut out the outdoors so that we can Make sure the lighting is good on our podcast. And I think that, you know, if there’s any recommendation I make as far as the de stressing techniques that people probably haven’t heard of, it’s getting a little bit of vitamin n in your day. So there’s a lot of ways you can make that happen. But I would just say, you know, research has shown and this was pretty recent study that salivary cortisol goes down in as little as 20 minutes of urban nature exposure. This isn’t driving out to the Tetons, Yosemite, Yellowstone, this is just going to, you know, some trees in the middle of actually Ann Arbor, Michigan, and getting 20 minutes that was sufficient to lower cortisol levels. So I’m not telling people that they have to go out and do a multi day camping trip, if you want to fantastic, right, this is this is a practical intervention that anyone can be taking advantage of.

Dr. Mindy
So sitting in my backyard with my favorite plants and trees around me, is that doing the same thing?

Dr. Austin Perlmutter
Yeah. So I mean, I don’t think Dr. Mindy, that anyone has studied your cortisol levels, my backyard goes in your backyard, but

Dr. Mindy
my backyard, my backyard is looking pretty good.

Dr. Austin Perlmutter
If that’s what I’m seeing through the window. It’s pretty amazing. But you know what I think? I think that yes, like, if I had to guess I would say that you are getting physiological benefit from being in your backyard. Especially if you know, the air quality is decent, especially if you’re not getting a ton of noise pollution. I mean, I think there are caveats to everything. And one of the things that’s quite unfortunate is now there’s a lot of air pollution in certain places, and especially in the West with wildfire season. And unfortunately, air pollution does kind of exactly the opposite of what we’re looking for here. It makes people’s decision making worse it increases inflammation. But if you have a backyard with decent air quality, and there’s some greenery in it, absolutely.

Dr. Mindy
Wow. Okay, and talk a little bit about I’ve heard you say before that the longer you stay, the more exposure to nature, like in a week’s time, the benefits continue to magnify it talk a little bit about what what those benefits are?

Dr. Austin Perlmutter
For sure. So let’s just go through and talk about, you know, what are the things that seem to be most consistently found as it relates to nature exposure, I’d say, number one is lowered stress. And then the other mechanisms would include improved immunity, lower immunity and lower inflammation, those are kind of the same thing. lower blood pressure, lower heart rate that’s related to the stress through probably lowering sympathetic tone. There’s also better recovery from illness where they looked at hospitalized patients, there’s lower risk of dying early, which is basically mortality improvement. But when you’re thinking about kind of the dose response, which is what we’re discussing here, there have been a number of studies, they tend to look at different variables. So like we discussed with the 20 minutes of cortisol, there’s another study looking at 90 minutes and how that decreases rumination, something that has been correlated with anxiety, depressive symptoms, changes, brain activation patterns that to ours in nature seems to correlate with better overall health outcomes. And then there’s some really interesting stuff around empathy, and doses of nature, how getting a higher dose of nature, in this case, sending kids out into the woods for a couple of days, compared to kids that stayed in the urban environment helped those kids to better recognize emotions on other people’s faces, they were better able to interpret what other people were feeling. So I think that there is this, you know, kind of continuum. And I think one thing that’s really important is, if you are somebody who is let’s say, working in New York, you never get outside, you may experience far more significant benefits to being outside for a continued number of hours than somebody who lives in, you know, rural Montana, and is already spending a lot of time outdoors just by virtue of where they live. So I think again, there is still that variability where I start to make recommendations to people is, start with the 20 minutes once a week, if that’s what you can do, if you can do more if you can get to around two hours of nature exposure a week. That’s fantastic. And I think to one of our earlier points. One of the nice things is just having some plants inside Hmm, yeah, you’re home. And I even tell people, photos, paintings of nature, there’s some data suggesting that that might help too. But it’s, it’s something to do with the fact that there are these different mechanisms, one being what we inhale, what we smell, so even certain essential oils, one being what we see. So looking at potentially the green or even the blue of nature seems to trigger some stuff in our brains and bodies. There’s something about what we hear so there’s even some research around listening to nature. Sounds kind of unsurprisingly. But I think it is trying to get those unconscious nature doses throughout the day, in addition to the time we spend consciously interacting with nature, that is key. And it’s a combination of those two that is going to set people up for the most success.

Dr. Mindy
That’s crazy. And I mean, it’s so simple this is what I’m as I’m listening to you I’m like, this is what I love about fasting is it’s free. And it doesn’t take time. You just takes knowledge. And when I’m listening to you, I’m like, this is so simple. Instead of shutting everybody inside last year, maybe we should have been sending them out into their county parks.

Dr. Austin Perlmutter
Yeah, obviously a lot to think about as far as the risk benefit reward there. But to your point, I I’m in complete agreement, I think that there is such a tendency right now for people to get hopped up on the latest biohacking solution that is, you know, a couple 100 to a couple $1,000, whether it’s a supplement, or some sort of a new, wearable, or whatever. And what fasting and nature have in common is, these are things people have been doing for 1000s and 1000s, probably hundreds of 1000s of years, basically being exposed to nature, and going periods of time when they weren’t inundating themselves with calories, let alone the highly processed calories of the modern day. And it turns out that our bodies are really smart. And if you give them what they’re used to having, and what’s good for them, they will equilibrate, they will actually do better, they will adapt. And, you know, you could even think about the hormetic stressors of it. And obviously a little bit more so as it relates to fasting, but being outside where the thermo regulation sensors have to kick in and where your body has to think about, you know, what else is going on here where it has to focus and pay attention to these things. Because God forbid, there might be some weather you’ll have to deal with. I think this is really good for us because it activates parts of our brains and bodies that are otherwise stifled when we’re spending our time indoors and snacking constantly. So yeah, definitely some some nice correlates between those two things. And the most important thing is they’re both free. Right? Right. Don’t eat food. You’re not paying for that. If Yeah, nature. Depending on where you go, you’re probably not paying for that. Yeah, of course, depending on the plants you buy, you might be spending

Dr. Mindy
Maybe, yeah, and I’m sure you already know, but I want to make sure our listeners know that if you google plants, NASA advisory on indoor plants that help with air pollution, NASA has put together a list of plants that if you put them inside your house, they actually clean up the air within your house. Do you think that know best? Yeah. Right? Who’s gonna go against NASA? It seems like they would know best.

Dr. Austin Perlmutter
So yeah, they’ve been paying attention to that for a little while, I guess they actually have to know what helps in space.

Dr. Mindy
Yeah. And to your point. You know, one of the things that tugs at my heart is just how many chronically suffering people we have in our world, whether it’s mental or physical, I recently went to the CDC website, and I, and they have a statistic right there. 60% of Americans have one chronic disease and 40% of Americans have two or more than 90% of our health care costs are spent on chronic disease. And yet, when I look at a tool like nature and fasting, and we just combine those tools, two tools together, we start to make a huge dent in the health of Americans and people worldwide. But but but people aren’t acknowledging those as legitimate treatments.

Dr. Austin Perlmutter
But who’s going to be excited about those, right? Who’s making money off of fast, right? I mean, there are those right, but I think, to conceptualize these two things, what they have in common is that they are taking away the junk that we are constantly consuming. And unfortunately, most calories people are eating today are empty junk calories. So basically, not eating is the only way to ensure in some people’s cases, that they’re not putting this garbage into their system, they’re not forcing their bodies to constantly break down and try to assimilate what really shouldn’t be in their systems. And similarly, nature, if you’re getting nature exposure, it means you’re not taking in, you’re not on ideally, social media, you’re not watching the news. You’re not sitting in your your apartment on a couch and you know, twiddling your thumbs, you’re not at a highly stressful job. And it’s basically just the absence of the modern day junk that may be such a benefit. I mean, I think there’s there’s a lot more to it than that don’t get me wrong, but I think a big piece of what makes interventions like fasting and nature exposure so efficacious is that it forces people to go outside of what it is that they tend to do, which we unconsciously tend to do, which is basically suck in through our senses through our food, a whole bunch of things that our bodies don’t tolerate all that well. You know, you can use the word toxins, whether it’s like toxic food we’re eating, or toxic media we’re consuming. All of these things require us to process them, and they become assimilated into our thoughts and our actions. So putting a brief break on that, going outside where the data you’re taking in, is maybe no processed food, and some experiencing the wind or looking at an animal as opposed to, you know, frantically scrolling on social media to see how many likes you have. I think that that is so important. And I don’t mean to take away I mean, this isn’t talking about placebo effect, we’re basically just talking about the fact that a lot of what’s going wrong is the result of inputs that are really bad for us. And anything that breaks that cycle of consuming this garbage is going to be so good for us.

Dr. Mindy
How do you think we’re going to get the medical community to start to acknowledge therapies like this, because, again, I put myself in the shoes of the people listening and you can listen to a podcast like this, you get really excited, your science is really clear. And yet I go into my medical doctor’s office, and I say I have depression and anxiety, and I come out with a pharmaceutical is there is there a way we can undo that and unify this idea that there is a lifestyle that can heal? And we don’t always need to go to medicine for the solution?

Dr. Austin Perlmutter
I would say yes, I would say that one of the big problems that you are describing is that, by the time a person shows up, especially at their allopathic, doctor’s office, these things have been going on for a long time. You know, it’s like metabolic disease, you show up a lot of the times I was testing and a one C, and it was already eight, and this person didn’t even know the term pre diabetes, right? The cats out of the bag. And similarly, a lot of the times people were coming in and they were screening positive for major depression, we’re not in the pre depression phases, depressive symptoms, I mean, sometimes you’re at the stage where the next best step is to give an anti depressant medication, not because that’s going to solve all the problems that led up to it. But because you’re so far along that, you know, and also because of unfortunately, terms like compliance and adherence, that it’s just not going to work to do anything beyond that. Now, where we should be going is to acknowledge this fact that in the modern day, if you do nothing, if you go with the flow, you are going to probability speaking have a really bad time, you already mentioned these statistics, you’re going to on average, develop at least one chronic disease, you’re going to be on at least one prescription medication, you are going to probably have poor mental health in one way or another, whether that’s depression or anxiety. And so this is the default reality, and any sort of intervention that you know, comes in your, by the time you’re in your 20s 30s 40s, these things have really set in. So what I have found is that a lot of people coming into the doctor’s office, they’re there because things have gotten so bad that they’re kind of forced to do something extreme, and at least a medication is that extreme thing that doesn’t require much on their end, it doesn’t require behavior change, it just requires taking this drug that messes with some neurotransmitter or messes with some metabolic function. So I think the key here is yes, to acknowledge that these other things work, but to try to look at how we could implement this upstream. I think that means when people are coming in, who don’t have depression, who don’t have overt anxiety, we should still be talking about those things and saying, hey, look, tons of people are going to experience depression. Similarly, metabolic disease person comes in, they don’t have diabetes, fantastic. But you tell them, hey, by the way, a third of Americans are going to develop diabetes, that’s a one in three chance, what can we do to prevent that from happening, and that’s where you can start including these interventions. And we mentioned toolkit earlier on, I think that is key. Because what I have done many times, and I think I’ve messed up is to tell somebody, here are all the things I want you to do. Exercise, eat like this, sleep like this, meditate for 20 minutes a day, stop watching so much TV. And almost every time they would fail to do those things. That’s not how human behavior has changed. We have to look at what people care about. everyone cares about something, right? It might be their knee pain, it might be spending time with their granddaughter, it might be photography, right? Being able to go out and take pictures of the waves. That isn’t so important. What’s important is that we help people to get there that we synchronize our goals with their goals. And so if a person is saying, you know, my mood isn’t great, then I can’t just assume that the next step for them is to say, Oh, well, you should exercise they might hate exercise. But if we can work, something along the lines have, their mood isn’t great. We both want to work on their mood. Let’s think about sleep. Let’s think about you know, getting some nature exposure. Now you have a collaborative desire to get to that outcome that you both about where you’re not boxing yourself into whatever intervention you think is necessarily the first round is the best round. The one other point I wanted to make, which I think is really evident in the book brainwash that we talked about is that we so often focus on the physiology outside of the brain as central and changing patients, you know, we’ll talk about insulins going to change their, their diabetic control, we’re going to talk about an ACE inhibitor to improve their blood pressure. But what we don’t talk about is that if you don’t change the brain, how do we expect for behavior to change? How do we expect for thoughts to change for mental health to change, and so any intervention, especially lifestyle interventions, that can help improve brain function, I think have to be first in our line. Because if you change the engine of change, you’ve now opened the door to all of these other opportunities. If you change the way that you think you can, then get yourself to do the other things. If you’re, if you hate exercising, but you’re willing to get better sleep, better sleep improves brain function, you may then later on, be more willing to exercise. And so you’re not forcing your brain to do the stuff it doesn’t want to do. You’re literally changing your brain to make it more likely that it will go in line with what you care about.

Dr. Mindy
Oh my god, I love that. So do you think let’s say I want to make a diet change. But I’m struggling, I’m addicted to sugar. I know the standard American diet. It’s not great for me, but I just can’t get myself past that moment of change. Would it make sense then I love what you said you can’t you got to change the change agent, can you all of a sudden say well, okay, what I can do is go hike in nature. I can go to bed an hour early. And let me try that for a couple weeks. And let me see come back to the changing my food behavior and see if it’s more effective. Can we use it that way?

Dr. Austin Perlmutter
You absolutely can. And, you know, I think these are things better worked on with a provider where you can kind of choose the outcome you care about and then work backwards and say, what decisions do I need to make to get me there, you’ll find that there are many different decisions that can get you there. So if your goal is, let’s say, a person wants to lose weight, or let’s say they just want to eat less sugar, the first step might just be to say, Okay, well, I’m your doctor, and I told you to eat less sugar. So that should get you to your goal. But it misses everything and misses all the important variables. Now you get to the second level and start saying, Well, what are the decisions that led to you eating that sugar that lead to you eating that sugar? What are the situations in the course of a day in which you feel most compelled to eat that sugar? And then you start understanding Oh, it’s actually in times where I’m stressed. Or it’s I find myself eating it when I’m at work, and somebody has brought, you know, doughnuts in the morning. And so then you take another step back and say, Well, what are the things leading to that stress? And how do I avoid that situation where I feel compelled to eat the doughnut. And then you can think about those variables like sleep. So the people who don’t get enough sleep, eat on average hundreds of calories more in the subsequent day. So it’s not just that, but when you put them at a buffet, they will preferentially choose junk foods over healthy foods. And really important because then again, you have that person that’s eating too much sugar, you might walk them back to do you find yourself eating more sugar, more calories on the days after you get bad sleep. And they might say, Oh my gosh, I do. So your intervention for this person is now four steps earlier than just telling them not to eat more sugar, you’re telling them, let’s say what I want you to do is lower the temperature in your bedroom by three degrees, because people who sleep in cold environments tend to get better quality of sleep. Now you’re personalizing that and you’re using science. And I think that these now you get so far away from Well, you just need to have more willpower and instead you’re leveraging biology, which I think excites people because everyone wants to be a little bio hacker they might not want to go full bore but you start saying oh actually try 67 degrees ah 67 so number that’s our number by the way and our home is gonna

Dr. Mindy
say do you have Do you have a chili pad I 67 is my chili pad number.

Dr. Austin Perlmutter
Yeah, we just we have actually central AC which is kind of rare in Portland. Okay. Yeah, it’s that’s we again, we just saw Matthew Walker speak. And so we’re we we also started with the red light or the blue blockers, red goggles, trying to optimize for sleep. But to the point here again, it’s it’s basically getting curious and being willing to experiment with variables that you’re excited about and not just the ones that you’re constantly told to do, like exercise, 30 minutes, five days a week. Everyone’s heard that that’s just not going to motivate people. You have to make it personal.

Dr. Mindy
I love that. One last thing that if you can touch on that is really emerging in the biohacking world and I’ve been trying to understand it. You probably know what I’m going to ask you and I know you don’t. Okay, well I’ve we have a biohacking center here. So we have like hyperbaric oxygen and things like that. But the one thing that’s fascinated me more Right now is psychedelics. And when I first heard about psychedelics, I was like, yeah, it’s just an excuse for people to go be, you know, to go use drugs. But as I started to understand the mechanism behind it, it sounds like psychedelics and micro dosing amounts can actually rewire our brain for the positive. Is that true?

Dr. Austin Perlmutter
Okay, so obviously, a topic with a lot of baggage. But yes, increasingly with some science. I’d love to go back to where you started this, where you were feeling like people who were talking about psychedelics, were just using drugs. As far as it seemed like there was a negative sense. For sure. Right? And so I just love if you’re willing to go into a little bit more detail as to what was what was the concern you had? Or what was the negative feeling around? Let’s say, there’s somebody who said, I just want to do drugs? What does that bring up for you

Dr. Mindy
that it changes the brain for the worse, okay. And permanently?

Dr. Austin Perlmutter
Yeah, this is such a good conversation. This is the same thing that I learned in my medical training. And I think that was kind of was inherited by the the social group that I grew up in. You know, it’s drugs are bad. I went to dare when I was a kid, and they told me that if you tried drugs, you’re basically going to turn into a monster something. And as I got older, the narrative was very much in line with what you just said, which is that drugs will alter your brain function for the worse. And I heard these stories of MDMA or ecstasy, causing people’s brains to liquefy, heard stories of methamphetamine leading to people’s psychosis, and then they are attacking other people. And a lot of things kind of came together to make me question that I did decide to use a psychedelic at one point. And it was an incredibly powerful and positive experience for me. And I only did that because I had reviewed the literature ahead of time that basically showed that number one side effects have been overblown. As far as the dangers associated with these drugs when used in the right ways. And to that there are a number of really positive outcomes that have been seen, especially around mental health diagnoses. So long story short on that, it made me question a lot of what I had thought to be true as far as drugs, bad, especially psychedelics, bad. And, you know, to your point, there’s increasing information as to how psychedelics may be able to positively influence physiology. So certainly you get this transcendent experience, or at least most people do when they experience higher levels of some of these molecules like psilocybin MDMA. But that’s kind of the psychology of it. It’s saying, Oh, well, I had this wonderful experience, and now I feel better, my mood has lifted the bio Physiology or pharmacology of it. And what it does on a molecular level is really interesting to me. And one of those mechanisms that you touched on, is that it seems like psychedelics may augment positively neuroplasticity, they may actually help to improve brain function through increasing connectivity and plasticity, especially in the prefrontal cortex and the hippocampus. So why is that so important? These are regions of the brain that seem to have impaired neuroplasticity in conditions like depression. So I posted about this a while ago, because I thought it was so interesting is that in conditions of depression, where you have a decrease in plasticity, or the ability to change the brain, this is, for me, it’s a physical embodiment of what I call stuckness, the brain becomes stuck in certain patterns of thinking, becomes less able to change itself, in no way shape, or form, in response to the environment. And so certain psychedelics so research in LSD, Ayahuasca, psilocybin, and certainly in ketamine appear to augment neuroplasticity. And there’s actually a study I think just came out in the last week. This is an animal study showing that psilocybin had a positive effect on neuroplasticity. And so, again, this is all very early, and I want to be it’s not like this has been out there and established. It’s not like we have massive sample sizes. But I think the first stage to this is asking pros cons to psychedelics, as far as what they’ve shown in the literature, and as far as what we’re worried about, as it relates to what happens to people if they use these molecules that are, they’re really not addictive, and in many cases may actually help to mitigate addiction. I haven’t been convinced that there have been any long term large effects as far as downsides to people using these even recreationally and then from a more medical and interventional perspective. I think There’s a lot of literature showing that when done in the right set and setting, those are the correct terms. As far as having the right mindset and being in the right location in the right context. These can be the most meaningful spiritual and positive experiences of a person’s life. so fascinating. Yeah, and you know what I think all of us, you know, are still fighting this urge to say drugs bad.

And to basically tell people stay away. But the fact of the matter is, as we’ve said, many times, the modern life is doing no one any favors. Most people are having a pretty rough go, they are having a rough go because they are stuck because they are disconnected. They are trapped in patterns of bad thoughts and bad actions. And these molecules coming from various species plants, let’s say so fungi, Iosco, potentially even the cane toad, these are molecules that are naturally derived, that appear to help people get unstuck. And I think there is this kind of natural extension of the work that is done with nature exposure with nature intake, so I’m in that I’m going to put in, you know, eating plants, let’s say with phytonutrients, that might influence our physical and mental function. And then talking about these really intense molecules that can also do that. But at a much higher level. This is the part where I say the general disclaimer, I’m not endorsing these for the average person, I think that there’s still a lot to be said, for doing them in the right way. And I think that you should go through legal channels as much as we can, because that’s hopefully going to be the way in which these are done most safely. But I do have to say, like, there is this piece of me, and that is, I’m not a countercultural kind of guy, I guess. But the average person’s doing so poorly, like, why are we so concerned about keeping people away from these drugs, when we give people drugs that do so much worse, where we have legalized alcohol and cigarettes that are killing millions of people? I don’t know that there is any real good data that these have been a major deficit for people as far as lowering quality of life. And even if it was a net neutral, it just seems like our government’s priorities should be placed on other conflicts, as opposed to, you know, ensuring that somebody doesn’t get access to one of these mind altering substances. Yeah.

Dr. Mindy
So well said, and thank you for opening my mind on it. I hear more and more people talking about it, and experts like yourself, and it just has me intrigued. And I always say, as somebody who has an addictive personality, and I can get obsessed about certain things, I of course, want to research at all and understand it all to make a decision, is it feel right for me or not, which is really what I hear you advocating for too, is that we all need to really dive in and understand the risk benefit costs. And if it’s a right path for us to take.

Dr. Austin Perlmutter
Yeah, and I think that so Oregon recently decriminalized most drugs, but also they set up an initiative to kind of study protocols for the use of psilocybin in clinical settings by trained therapists. It seems like in the very near future, these molecules will be available to people with mental health diagnoses. So right now, ketamine is legal, you can go to a ketamine clinic, you can get it if you have treatment, refractory depression, or treatment resistant depression, but you can’t go out on side of the road and you know, pick up some ketamine, that’s still illegal. But the bigger picture for me here again, is we have diseases where we have a diagnostic code. So for depression, if you meet five of these criteria for two weeks, you can be diagnosed with major depression. And then you can qualify for various interventions. But I think the upstream piece of this all is to say, look, maybe people don’t have major depression as diagnosed by meeting these specific criteria. But it doesn’t mean that they’re in a good spot. It doesn’t mean they aren’t trending towards depression doesn’t mean they don’t still have depressive features. And I think that is now the default, where it’s just like, You’re, you’re fine, until you hit a diagnostic code, and then all of a sudden, you have a disease and here’s what to do about it. And I think what’s super interesting about psychedelics is that it changes our mind changes the brain, it changes the way we perceive the world, and seemingly in a good way. Let’s just bring this back with one more little bit of research people who use psychedelics have more nature, connectedness and have more empathy compared to others. It is it is a molecule that takes you out of the EU, it removes a little bit of the ego, it takes you out of that trap. What’s been called the default mode network in the brain correlates with ego and activation of this network is thought to underlie certain aspects of mental health issues and it kind of shuts that down. So it It connects you with the bigger picture with other people with the natural environment. It takes you out of this need to constantly be trying to you know better than me Me, and whether it’s through psychedelics or other means I can’t help but feel like that is something that we really need a dose of. And you can get that from nature, little nature exposure increases empathy increases social connection. But psychedelics do shake things up in a more significant way.

Dr. Mindy
Yeah, awesome. Well, thank you for entertaining that question. This is I enjoyed this so much, I feel like I could keep chatting with you. And I feel 100% in alignment with your mindset around, we need to start to make different choices because the world has changed. I really, really resonate with that with that I and I want to get that message out. So thank you so much for so eloquently articulating that I think it’s just a message people need to hear so appreciate you. I have five questions for you. That I want to finish up with a couple of them one, I’m actually really intrigued to hear what you have to say. But let me start off with we’re starting a book club. And the list of every every one of our guests favorite book, what one book changed your life, or do you feel like you everybody should read?

Dr. Austin Perlmutter
Yeah, I’m gonna say a book here that I’m going to go on and limb and assume that somebody else may have said, Okay, go singers untethered soul?

Dr. Mindy
Oh, yes. It’s so funny to say that we just discussed this it with my team, and I just got everybody a copy of untethered soul because I was like, we have to start getting people to see the voice in their head. So I love it. That was that was you, you actually are the first guest to say that. That was awesome. Okay, what is your favorite brain hack? When you feel like you’re operating in a state of anxiety? What what’s your go to?

Dr. Austin Perlmutter
Hmm, it’s a good question. I have. So there’s two things that I can do. One is to try to channel it because if you look at anxiety is energy that is just being put in the wrong direction. Sometimes I’m able to convert that into action. So sometimes when I’m anxious, the right thing to do is actually just to do a job to put on some motivational or not motivation, but just intense music and do work. And I can relieve the anxiety because I’ve actually accomplished it, I’ve converted it into action. Let’s say it’s anxiety for something I can’t do anything about. You know, I think a little mindfulness will go somewhere. But for me, I think exercise is more effective. Again, it’s kind of the converting it into something else, in this case, physical activity. So you know, I’ll find that either run or some other anaerobic exercise as well, for me, mindfulness meditation. Yeah, I do it every day. But I don’t use it acutely, as much as a way of calming down the breathing exercises. I will do sometimes,

Dr. Mindy
yeah. I love that love that. What kind of breath work do you like? Do you have a style?

Dr. Austin Perlmutter
You know, I just I’m, so I listened to James Nestor, actually, a couple of weeks ago, as well. And he’s talking about box breathing and all the like, but I used to do a lot of free diving. And so a lot of that was just kind of the breathing exercises to prepare yourself for holding your breath and like and I will still find that doing just deep breathing. And as well as holding my breath a little bit, or even hyperventilating a little bit, which I don’t recommend to people are good ways to help me to clear my head. And I love that I don’t call myself a breathing expert. So I would highly recommend you listen to people who who do more with that.

Dr. Mindy
So a lot of our guests do breath work. And that’s why and they there’s a lot of different styles. So that’s why I was curious. If you were to be put in the position that Mark Zuckerberg is in right now. And you got to make some changes to social media, Facebook, what changes would you make?

Dr. Austin Perlmutter
Yeah, I guess the first question would be does it still have to be financially profitable? Or can I just if I didn’t know, you can do whatever you want? Great. So I mean, the first thing I do is get rid of ads, I’d get rid of tracking. And then ideally, I just set it up more so that people were benefiting others for their mental health. I mean, I think so much of what’s on there now is not so subtle, as far as it being commercially, a commercial intent, either ads or just attempting to get people pulled off site for clickbait. So I think I would try to bring in aspects of what has been successful in clubhouse. Not that I’m necessarily saying that platform will endure, but people do want to get together and have interactions, social interactions, and I think setting up some way of having more quality, potentially even moderated interactions on a platform like Facebook would be an amazing way to pull people back into that platform and to ensure connection, but I think it can’t be monetized commercialization at least would have to be more along the way of podcasts. were used. explicitly, this podcast is brought to you by blink. And then you go into your non sponsored content. So I think, yeah, more more group based setting and more of the actual connecting with other people. And then I guess there would be if I had all the funds, educational content, great, free educational modules, bring in the world’s best experts and teach them you know, have people come in and teach you how to sleep people come in, teach you how to exercise, put up the videos, we already know, it’s super engaging. But again, make that free to audiences. Because, you know, I don’t know if you follow Andrew Huber men at all, but yeah, so so he’s done this wonderful thing, where he’s just putting out this really phenomenal scientific content on his podcast. And I just feel like even though, you know, there are tons of people out there doing this, it just hasn’t been done in such a way that it’s accessible to people in this bite sized format. So the more we can democratize making the basics of scientific understanding known to the world, the better, I think Facebook would be an awesome opportunity to do that, if the resources exist.

Dr. Mindy
Love that. Okay, if you could go back to your self before medical school, your pre med self, and give him some advice, what would you give them?

Dr. Austin Perlmutter
Yeah, so again, I kind of have two things. One is to start doing the self investment earlier, it’s all kind of like, I wouldn’t be the person I am today, if it wasn’t for things happening exactly as they did. But to start asking certain questions about you know, who you are, what you care about earlier. And then the second piece of advice would be to say, you’re not going to do anything like what you think you’re going to do. So just don’t get too Don’t get too stuck on making sure you that you’re doing everything perfectly.

Dr. Mindy
I think a lot of that a lot of 20 something year old should be given that advice, how many different career changes as we start to age do we have and different paths that show up for us? So I absolutely agree.

Dr. Austin Perlmutter
I think they should also be told even earlier than 20s that most adults are pretty miserable, even though they can sometimes hide it. And being serious isn’t the mark of success, it’s just the mark of losing fun. And so when you’re looking out there to all these adults that seem to have it together, it’s not really the case. So don’t be so hard on yourself and you know, appreciate that there’s more to the picture than meets the eye.

Dr. Mindy
I love that. Okay, last question. If you had one message for the world, that you could get into everybody’s brain, what would that message be?

Dr. Austin Perlmutter
How complicated can the message be?

Dr. Mindy
As long as it can stick in their brain? It can be as complicated as you want it

Dr. Austin Perlmutter
Alright, I’m gonna go something a little bit cheesy. But yeah, I think the the you are enough you are loved to be so meaningful for people to understand. I think so many people are out there just trying to find a way to feel loved. If that already existed, I just can’t imagine how much better our interactions would be with others where we’re not desperately striving for attention and for validation.