Ep. 656 Brain Health, Metabolism, and Alzheimer’s Risk with Dr. David Perlmutter | Brain Health, Metabolism, Alzheimer's Risk

Cynthia Thurlow (0:00)

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Welcome to Everyday Wellness Podcast. I'm your host, nurse practitioner, Cynthia Thurlow. This podcast is designed to educate, empower, and inspire you to achieve your health and wellness goals. My goal and intent is to provide you with the best content and conversations from leaders in the health and wellness industry each week and impact over a million lives.

Today, I had the honor of connecting for the third time with physician colleague and friend, Dr. David Perlmutter. He's a board certified neurologist and a six time New York Times bestselling author. He serves on the Board of Directors and is a fellow of the American Nutrition Association. He's also the most recent book out with Dr. Perlmutter is Brain Defenders. Today, we spoke at length about the microglia as the brain's immune cells that are involved in both immune regulation and metabolism, the role of immunometabolism, starting prevention for brain health decades earlier, environmental threats and emerging therapies including air pollution, the influence of lifestyle, especially alcohol consumption, and current research specific to brain health. This is a truly invaluable conversation, one you will listen to more than once. And I really loved Dr. Perlmutter's latest book, which is really speaking to the role of immunometabolism and how that intersects, especially in midlife.

Dr. Perlmutter, so good to have you back on the podcast. Welcome back.

David Perlmutter (2:10)

Well, I'm delighted to be back, Cynthia. It's good to see you again and got a lot of things have happened since our last time together, that's for sure.

Cynthia Thurlow (2:19)

Absolutely. Absolutely. Your new book is really talking about how the immune system and the brain intersect with one another.

I was mentioning before we started recording that the brain's immune cells are fascinating. There's a lot there that I think listeners will be able to take away. If listeners have never actually heard that word before, what exactly are the microglia and what is their job in a healthy brain?

David Perlmutter (2:44)

Well, that's an excellent question because these are the brain's immune cells. Right off the bat, that might raise eyebrows. The brain has immune cells. Yes, it actually has its own immune system. These are called the microglial cells. They were first discovered in the early 1900s. But the term is that micro, meaning small, glia, meaning glue.

The term really comes from the early observation that these are unique cells in the brain that looked like they were holding the neurons together, not really doing much else. Decades later when they began to look at living tissue, they realized that these microglial cells were moving around and doing things.

Now we recognize they are an intimate part of the immune system. But beyond that, we have to expand our idea about what the immune system does. Most people think, oh, my immune system is what kicks in when I've been exposed to a cold, or have a few cancer cells here and there, my immune system is going to find them and get rid of them.

Certainly in the time of COVID, everybody was doing everything they could to amp up their immune system. But now we recognize that in the brain and even in the body as well, not that the brain is not part of the body, but that said, that immune cells do other things that are good. They're not just there to respond to infections or trauma or cancer cells, they're actually doing housekeeping and making things better. So what you asked in your question was, what do they do in a good brain? Well, I think more importantly is, what do they do when they're good, when they're behaving themselves, and when they're in a certain configuration, which is what we want. They're supportive, I call them Brain Defenders, that's where the name of the book comes from.

They're keeping our synapses connected, they're keeping our neurons happy and firing, they're cleaning up debris, and they're strengthening what's called the blood-brain barrier. So these are great, wonderful cells. But what we've learned mostly just in the past five years is that these wonderful, supportive, nurturing immune cells can shift, and they can become the evil twin, as I describe it. And when they become the evil twin, then they destroy our synapses, and they create an environment that doesn't support the function of our brain cells, our neurons, and actually destabilize the very important blood-brain barrier. So we recognize that here's a much more expansive understanding of what the immune system does in the brain, number one. And number two, that it is somewhat polarized between being really supportive and nurturing to being very destructive. And again, the evil twin. But the take-home message that you and I are going to unpack today is that we are the determinants of what configuration our brain's immune cells are in. We determine whether they are friend or foe with powerful inputs like metabolism over which we have control, levels of inflammation over which we have control. And we'll talk about all the inroads and how they influence these microglial cells. But I think so important is to recognize that, again, just in the past five years, we've come to understand that it is the shift of these microglial cells from being supportive to being destructive, that is the main upstream underpinning event in Alzheimer's and Parkinson's, multiple sclerosis, progressive super nuclear policy, multi-system atrophy, PTSD, long COVID, and even major depression. So this understanding is really empowering, not just from a clinical perspective, in other words, what health care practitioners can do, but I think more importantly, what each of us can do now that we understand it to safeguard our brains moving forward.