My guest this week is Dr. Austin Perlmutter, a board-certified internal medicine physician and New York Times bestselling author. He received his medical degree from the University of Miami and completed his internal medicine residency at Oregon Health and Science University in Portland Oregon. His focus is on helping others to improve decision-making and quality of life.
He is also interested in methods of understanding and reducing burnout in the medical field, and he is the co-author of Brain Wash. He writes for Psychology Today on his blog, The Modern Brain.
In this episode, Austin and I discuss how the inputs of our daily lives affect our brains. When you recognize that the brain is always evolving to better adapt to the environment, you start to look at the inputs in your life that change your life. Like screen time, food, sleep, movement, connectedness, and mindfulness. These are all rewiring our brain on a daily basis. It is only when your body and mind feel strong and able, that you are capable of making good decisions about your inputs. If you are looking for ways to improve your cognition, decision-making, and mood, Austin includes lots of examples of how to do that. Learn more about Austin Perlmutter.
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Transition from blame to curiosity and empathy
- When you look at decision-making, instead of saying “What was going on in the brain and the body?”, we tend to blame the identity itself
- Transition away from this identity-based, blame-based way of looking at what we do, to asking what we can do to support healthier decision-making
- Just relying on willpower is a really ineffective and inefficient way of going about decision making
- So much of a decision is predetermined because it is a reflection of the state of your body and especially the state of your brain
What makes someone successful in decision-making?
- It isn’t the amount of willpower, it’s the ability to use focus and motivation to plan for making things easier, which brings in concepts like habit formation
How our brains are being rewired
- Based on the food that you eat, the media you consume, your relationships with other people and the conversations you have, you are changing your brain
- When you recognize that the brain is always evolving to better adapt to the environment, you start to look at the inputs in your life that change your life
- In America, screens are one of the most time-consuming inputs in our lives. An average adult spends 11 hrs in front of some kind of screen each day
- It’s going to have differential effects depending on the quality of what is coming in
- Exposure to high stress through things like social media, polarized content, etc. is bad for our neuroplasticity
- The opportunity cost of spending so much time in front of screens is also concerning, that time could be used doing things that help our neuroplasticity like taking walks in nature, positive human connection, etc.
The best way to consume any media
- Use the Test of T.I.M.E. method with digital exposure
- Time-restricted – go in with a plan of how much time you will spend
- Intentional – have a plan for you intent, see how close family and friends are on social media for example
- Mindful – be mindful of the type of content you are exposing your brain to
- Enriching – look for ways to learn or something to take away from that exposure. Watching a documentary for example
What can we do to improve our cognition, decision-making, and mood?
- Ultimately we have the power to adjust our hormones, immune system, levels of inflammation in our bloodstream and in our brain
- Inflammation has been shown to inhibit neuroplasticity
- Sleep is essential in helping us to regulate emotions
- Develop good sleep hygiene
- Minimize blue light exposure in the hours before bed
- Try to create a bedroom that is relatively distraction-free
- Try to create a continuous schedule
- Food and movement
- Lower sugar intake
- Move your body in ways that bring you joy
- Mindfulness practice (best if done in nature)
- Nature lowers stress, nature can help to calm down the amygdala
Follow Austin Perlmutter
Episode Intro … 00:00:30
Transition from blame to curiosity … 00:07:30
How our brains are being rewired … 00:16:00
Pay attention to all of your inputs … 00:29:00
The body and brain are connected … 00:39:00
Improve cognition and decision making … 00:45:00
Episode Wrap up … 00:53:00
Dr. Nicole Beurkens:
Hi everyone, welcome to the show, I am Dr. Nicole, and on today’s episode, we’re talking about how the ever-increasing amount of information available to us and the ability to be connected to a 24/7 flow of input in our modern world might be causing some problems for us and our kids. In fact, it’s actually rewiring our brains in some fairly unhelpful and unhealthy ways.
But there are solutions that we can use, and that’s the hopeful part of this. So to talk with us about this, I’ve invited Dr. Austin Perlmutter on the show today. He’s going to help us explore how our brains are being manipulated and how that results in behaviors that actually can leave us more lonely, anxious, depressed, disconnected and physically unhealthy than ever before.
Let me tell you a little bit about him.
He is a board-certified internal medicine physician and New York Times bestselling author. He received his medical degree from the University of Miami and completed his internal medicine residency at Oregon Health and Science University in Portland Oregon. His focus is in helping others to improve decision-making and quality of life.
He is also interested in methods of understanding and reducing burnout in the medical field, and he is the co-author of Brain Wash. He writes for Psychology Today on his blog, The Modern Brain. Austin, welcome to the show!
Dr. Austin Perlmutter:
Dr. Nicole, thank you for having me. I’m really excited to have this conversation. I feel like it is a really important time to be thinking about these things as we go into, or at least, as for us we’re in another winter in the COVID season. I so appreciate what you do and again, very happy to be on your show.
Dr. Nicole Beurkens:
I think, when I reached out to you, that this topic is so important in general, but with COVID, with the ongoing pandemic situation, it’s even more important. And I think people are recognizing in ways that they maybe didn’t before, this last year how much this sort of hyper-connectedness to the digital world, how much this sort of isolation impacts us. So I think it’s a great time to be talking about it because people are more aware. I’d love to start with just a little bit of your story just for people to be able to connect to you and your experience a little bit of how you actually became interested in thinking about the impact of our modern world on the brain and overall health, because certainly as an internal medicine physician there are lots of directions you could have gone in your career and with your focus. What particularly led you to this?
Dr. Austin Perlmutter:
For sure. So as you mentioned, I’m an internal medicine physician and the way that I describe that is more of a generalist. Internal medicine doctors can sub-specialize, become cardiologists, nephrologists, pulmonologists, gastroenterologists, but they’re also the doctors that you see if you go to a primary care clinic or if you go to the hospital coming in with something like chest pain. That will be the person who primarily looks after you.
So what I’m doing now isn’t really in sync with what most internal medicine doctors do, and my reasons for doing what I’m doing now really come down to two things: One, my interest and two, this is where I think I can be the most helpful to people. Those two things combined with decision-making and how our brains are being changed by the modern world, as you said.
What I realized in the last bit of my training and certainly over the last few years is that when we talk about preventive medicine, we tend to focus on telling people what to do to prevent poor outcomes. So whether that’s exercising more or eating healthy food to prevent heart disease and diabetes or telling them to maybe not engage in so much stressful media to prevent poor mental health, it’s mostly in these prescriptive recommendations, that’s what prevention is. And what I understand now is that when you look at how people make decisions, it isn’t all about having the information, and it certainly isn’t all about willpower.
So it requires us to get upstream a little bit further to ask how the brain takes the information from the outside world and then convert that into action. So again, the last couple of years have been all focused on understanding the signals that go into our brains, whether that’s hormones, immune system cells, digital inputs coming in from our smartphones, and how that modify our brain structure and function, and then how that translates into our decision, into our actions.
If we really want to help people to make healthier choices, we’ve got to move past this model of blame, of basically saying “You made a bad choice, that’s on you, you knew what you needed to do and you didn’t”, and instead say “What’s happening in the brain?”. So it’s been absolutely fascinating to me to see these connections increasingly in the medical literature and to see how when I talk to people about this they have this lightbulb moment where it’s like, “Wait a second, I ate unhealthy food. You’re saying there is more to it than just my lack of willpower?” I say “Yeah. Did you get good sleep the night before? What was your exercise like? What were you watching on the news? All of these things contribute.” So to bring this into where your audience might be most interested in, this relates to everyone. It’s not just about adults. It’s about children. Our brain functioning is a reflection of our inputs, whether that’s the food coming in or the social media coming in. That changes our brain function and determines the way that we make choices and by changing our decisions, it changes our health outcomes.
Dr. Nicole Beurkens:
So powerful and I think it really is the next frontier where we need to go in understanding how to help people truly become healthier, because as you said, we are not suffering from a lack of information. If you ask most people, most parents who come into my clinic, “What do you think are some things that would be healthy for your family?” People sort of know in general what they should be eating, what they should be doing as far as their kids’ sleep schedules. We know the things, but the disconnect between knowing and doing — that’s the piece. And people get so down on themselves about not being able to do those things, not having, as you said, the willpower, but there are so many other pieces that feed into that. So I’m excited to delve into that more because I think there are a lot of parents who beat themselves up, not only over the choices they’re making for themselves, but also “Ugh, I know I should be implementing this for my kids but I’m not.” So this idea of what those inputs in the decision-making are, I think that’s a really profound thing.
Dr. Austin Perlmutter:
Yeah, and you mentioned this thing about you kind of seeing your kids or you see yourself making poor choices, and what I really think needs to happen with this is a transition from blame to curiosity and empathy.
If your foot starts hurting, you’re not going to blame yourself because your foot hurts. If you measure your blood and one of the cells is too high or too low, you don’t immediately say “This is an issue because I’m a bad person”. And yet, when you look at decision-making, instead of saying “What was going on in the brain and the body?”, we tend to blame the identity itself.
We say “That person is no good because look, that person is eating junk food. How could they do that to themselves?”, or you say something like “I wanted to get off of my couch and exercise, but instead I watched 3 episodes of whatever show I’m watching on TV, therefore, bad person.” That’s an identity issue. “I’m a bad, lazy person”, instead of saying “What are the things happening in my brain that are leading to these outcomes?” So I see this as a complete transition away from this identity-based, blame-based way of looking at what we do, to asking what we can do to support healthier decision-making. I think the key to this is moving away from the moment of decision.
We have this idea that all you need to do is have enough willpower, and then when you get to that moment of decision, you put that willpower on the table and it moves you from option A to option B, where B is the healthier option.
At the same time, if you don’t have enough willpower, you go to option A. But the truth is so much of that decision is predetermined because it is a reflection of the state of your body and especially the state of your brain. So if you want to be more likely to make healthy decisions, you don’t want to be so focused on what you do right now at this moment. You want to think about “How do I use empathy for my future self? How do I plan for my future self so that tomorrow’s brain is set up for better decision-making?” And then you’re able to actually make sustainable changes. Otherwise, we’re chasing our tails. We’re constantly trying to exert enough willpower to change our decisions at the moment of choice, when again, most of that decision is off the table.
Dr. Nicole Beurkens:
So true, and in fact, the research has shown over and over that just relying on willpower is actually a really ineffective and inefficient way of going about that because at some point, willpower is a very finite thing. So people get actually exhausted from constantly trying to get through the day just on willpower. So what you’re talking about with this much more proactive and future-oriented way of thinking about it, I think, is so helpful. And when you used the word “lazy”, that’s what resonated with me around what so many families come in talking about.
Kids get labeled all the time as parents, teachers, other people will say “Well, he’s just lazy. He doesn’t want to do the right thing/He just wants to lie around” and I have yet to meet a kid in almost 25 years of practice where that’s true. It’s like that curiosity of saying “What’s getting in the way there? What’s the issue there?” That’s where we need to be oriented.
Dr. Austin Perlmutter:
I think “lazy” is kind of a fake word. It doesn’t tell you anything. It’s a blame word, that’s what it is. So you say somebody is lazy, maybe they’re just not interested, right? That’s a far better explanation. Or maybe they’re tired. I think a great example of how we’ve been off in our labelling of children is looking at their sleep schedules and then believing that the fact that they want to sleep in reflects laziness. And when you look at people’s chronotype, especially as they’re younger, children need more sleep. And beyond that, they’re just shifted where they stay up later and wake up later. So this is what the medical literature is telling us. We still have this block where it’s “Here’s what I believe a person should do: They should be going to bed early, they should be waking up early” and when somebody isn’t in sync with that, I’m going to call it laziness. No, it’s a biology issue, right?
So the more that we can start bringing in the science to that, again, you mentioned willpower as it relates to a finite resource. We had this idea for a long time that willpower was just something you could have more of or less of and it’s something you could deplete. But when you look at what makes people successful in decision-making, it isn’t this amount of willpower, it’s the ability to use their focus, their motivation to kind of plan for making things easier, which brings in concepts like habit formation. It’s not all a question of having the motivation to see something through, it’s a question of: Can you design it such that you don’t have to use up all your willpower and motivation? Make it so that the easiest thing is the thing that is healthiest for you. So it’s bringing in the science through disparate fields: Psychology, neuroscience, biology, chemistry even, molecular chemistry, and it is combining all of this so that we get a little bit of that understanding as to what’s actually happening in the brain. And when you do that, I think it is really hard to use these blame words like “Lazy”, because you say “Hey, there is more going on than I understand. How can I help this person or how can I help myself to optimize for those better decisions without falling back to this kind of lower energy state which is blame?”
Dr. Nicole Beurkens:
Yeah. It’s such a more productive and healthy way of thinking about that for ourselves and for our kids. And I think opens up possibilities then, especially when we think about our children, when we can view it in that way, it opens up way more possibilities, helps us to retain more optimism and hopefulness for what’s possible, and ultimately is more productive because it’s a solutions-focused thing, it sees it as a problem to be curious about, something to be interested in, and then oh, there are solutions. We can try different things, as opposed to just feeling like someone is this way and that’s the way it is.
Dr. Austin Perlmutter:
Yeah, you’re opening the door to more opportunities because if it’s an identity thing, then the person is kind of good or bad. It’s an absolute. They’re either lazy or productive. But when you get into biology, things don’t exist in absolutes. I could argue that nothing really exists in absolutes other than absolutes not being true. So then you can start seeing how people’s behaviors correlate with where they’re at on a spectrum of, let’s say, their glucose levels or let’s say how much sleep they’ve received or let’s say whether they had an opportunity to get out into nature. All of these things are these variables that exist on a spectrum, right? There is no black or white, it’s all grey. But the more of those things that you understand, the more that you’re able to say “Okay. My kid today has been a little bit high energy, a little bit distractible. I know that nature exposure is a great way to increase focus”. So there is research in children with ADHD that’s showing that just a short walk in nature can improve symptoms of ADHD at the same level as certain medication. So again, here is the behavior that I’m experiencing. Here is the behavior that my loved one is experiencing. What are some of the mechanisms in the brain? Is it an increased stress level? Is it something to do with the food that they are or are not getting? Is it a defect as far as not getting enough sleep, which has been shown to change our brain circuitry? And based on that, what is a good next step? Maybe it is eating something that is nutrient dense. Maybe it is going for a quick walk. Maybe it is doing a quick nap. Maybe it is doing some physical activity. The more that you have those things available to you and the more that you have that curiosity, the less you are relying on these outdated frameworks that really can just drive a wedge between you and other people as well as within yourself. That self blame that tends to actually exacerbate the types of stress that lead to unhealthy decisions.
Dr. Nicole Beurkens:
Love this. I want to get into some of those strategies and some of those particular inputs in a minute, but before that, let’s touch on this issue of how the world that we live in right now is actually rewiring our brain. And we’re seeing that on a level that I think is really fascinating, also concerning but fascinating with this generation of kids that’s growing up right now because this is really the first generation of kids to grow up in this 24/7 hyperconnected, constantly able to access information kind of world. So it’s interesting to watch the impact on them, but I’m curious about your thoughts, the research that you’re seeing, how do you conceptualize this as actually rewiring our brain and then also you have this term “Disconnection Syndrome” that ties into that, so I want to talk about that, and then we’ll get into the inputs and strategies.
Dr. Austin Perlmutter:
For sure. Well, let’s start with the backstory here as far as talking about rewiring and changing the brain. These are words that relate to a term called neuroplasticity, and I’m sure some of your viewers and listeners will know this term, but it basically means that the brain is constantly rewiring itself in response to the environment.
Why I think that’s so important to understand is there is this idea that your brain is your brain until something happens or whatever, but the brain is static. It just isn’t the case.
If you look at your bloodstream, you’re making millions of new cells every 10 seconds. When you look at your brain, you are changing the wiring of those neurons every moment. So the neurons change their connections to other neurons, those connections get weaker, stronger, you’re actually even growing new neurons throughout your lifespan. And these are things that are changed by the inputs going in. So based on the food that you eat, based on the TV consumption that you take in, based on your relationships with other people and the conversations you have, you are changing your brain. How do we know this? There’s a lot of research, but I think the best example is this: Are you the same person as the person who went to sleep last night? Do you know the same things as that person? A lot of the same things, but you have different experiences, you have different memories. The only way that can happen is if something has changed. So that’s neuroplasticity for me, it’s the ability to form new memories, it’s the ability to change who you are at a moment-to-moment basis. So understanding that, understanding that your brain is always changing, it’s always kind of evolving to better adapt to the environment. Then we appreciate that all of the inputs whether digital or again, food, relationships, so coming in through the nervous system or coming in through the GI tract, all of these inputs are shaping our brain function. And then I think about: What are the biggest inputs in our lives? And I realize that the average American adult is spending 11 hours in front of any screen, with about 4 hours of that time being spent in front of a TV screen, that Americans are spending 2+ hours a day on social media, a number that goes up in children, and that we’re spending, in between, tons of time on our other devices, our tablets, etc. So we’ve got to be thinking about what is coming in to us through these screens. And to be clear, I’m not an anti-technology person. We’re using technology right now, it’s a wonderful thing. But just like food, it’s going to have differential effects depending on the quality of what is coming in. So where I get concerned is both the potentially — let’s use the word “toxic” input coming in from things like echo chambers on social media that are creating these polarizing perspectives that are inducing stress. We can talk about this in a moment, but stress is probably one of the most terrible things, chronic, sustained stress, for the brain, for our thinking, for our decision-making, for our mood. So it’s the exposure to high stress through things like social media, polarized content. Also, you turn on the TV. If you’re an adult and you’re watching the news for a lot of your day or just reading the news, you are taking in a whole lot of high level stress, of sensationalized content. But the other big concern I have is just the opportunity cost of this. So if you’re in front of your screen and you’re just scrolling through social media, as so many of us do, that is mindless content, and it is replacing what is probably more valuable. And when I say probably, I mean if you look at studies conducted over the last decades, what is meaningful to people as it relates to their physical and mental health is stuff like nature exposure, exercise, and especially real life contact with other people. So I know we’re in an interesting time right now, real life contact isn’t as viable as it used to be. But we have to understand that in our brains, there is something that happens when we’re actually near people, when we have contact with other people. There are mechanisms that involve oxytocin, which is a hormone that the brain uses to help us bond with other people, that has roles far beyond just feeling that emotional connectedness. So these are the more general ideas.
Now we can talk about what happens as a result of consuming social media. There is some interesting research suggesting it’s not the use of social media, but the way that we use it that has negative correlations with our mental health, for example. So people who actively use something like Facebook actually did quite well versus passive users. Passive users are kind of the ones that lurk in the background, scroll through, don’t comment. We’ve all been there, right? Those are the people who have more negative mental health outcomes. So I think it is a lot to do with how we’re using it. And really, what I try to tell people is: The goal with any digital media is that you’re using it for your own benefit and not letting it use you. So we can talk about this Test of T.I.M.E acronym that we developed in brain wash, but people just need to appreciate that most of this media out there is not designed for our benefit. It’s designed to capture our attention, it’s designed to keep our eyes on the screen. How do you do that? You make it sensationalized. You make it stressful, you make it polarized. So for adults and children alike, I think that is the big concern. It’s that the quality of the inputs from our digital consumption tends to be, overall, low. We don’t know yet from the literature, because these things are relatively recent, what the long term effects will be on our cognitive health, on our emotional health, but we do know from early research that there are changes seen in the brain for children who spend more time in front of screens. It’s just not clear what the significance of that is yet.
Dr. Nicole Beurkens:
So many important things in what you just covered, and I think we’ve got some good studies now, particularly in the adolescent age range, of differences in social media consumption, how it’s used, the quality of it, the type of consumption makes a difference, even more so a lot of the time than the overall amount of time. How it’s being used. This is a whole new area. I’ve often said that those of us who are parenting children right now, we’re in the first generation of parents having to manage not only trying to figure out for ourselves how to regulate our use of technology and digital inputs and digital media, but then also to help our kids manage that, and it’s a tough thing and it’s one of the things I think, especially in the last year, with so many things going online because of the pandemic, that parents have had more questions about than anything else, at least in my experience with families.
But I think this idea of neuroplasticity, which I talk about a lot in my work and is so important for parents to understand, especially parents who have kids with challenges, it’s a very outdated, unscientific stance at this point to say that “Well, kids, if they have this problem, this is the way it is, they can’t change, they can’t grow and develop.” It’s like no, we’ve known now for decades that that’s not true. So the idea of neuroplasticity holds incredible hope and promise. There is also the peril side of it, right? that it has to do with the inputs that we are putting in, that we actually have control over that to a certain extent and that based on the decisions that we make and the inputs that we allow for ourselves and our children, that is going to influence the wiring of their brain, how their brain is functioning, and that’s a wonderful thing in that if we didn’t do so great yesterday, or if we have new information now that we didn’t have for the first however many years of our kids’ lives, we can make changes that will literally start to make changes in their brain right now. I think that’s an incredibly hopeful and important thing for all parents to understand.
Dr. Austin Perlmutter:
I think that’s absolutely correct, and coming back to the earlier conversation about identity, humans have this really weird tendency to see themselves apart from the universe. If you look at the universe and ask, “What about the universe is static? What about it is unchanging?” I think you’d be hard pressed to come up with anything. You could maybe say some of the laws of physics, but even those, we are questioning exactly how far they go and what the situations are in which they are not exactly right. So again, we are part of the universe, we are constantly changing, your cells turn over, you’re not the same physical makeup that you were yesterday, let alone a few years ago. And the brain is the same thing. So the brain that you woke up with this morning is different from the brain you went to sleep with, and exactly as you say, the things that kind of influence whether the brain that you wake up with today is better or worse than the brain that you went to sleep with are the quality of our inputs in conjunction with how it interacts with our DNA, with our genetic expression.
Now there’s one thing I want to say about that because there is this idea of genetic determinism, where it’s like you’ve got the genes, you can’t change the genes. But you can maybe change some other things. But now we understand through the science called epigenetics that based on what inputs you put in — so the food you eat, if you get exercise, if you stare at a screen all day or not, that you’re changing the way that the genes are expressed. And it’s probably more important for many things, the way that the genes are expressed compared to the way the genes are written. So yes, your genes are kind of what they are, but the way that they are expressed, whether in a positive or a negative way is something that you can influence. So you’re thinking about trying to create an empowering message here. What we’re saying is you can influence who you are at every level based on the inputs you’re putting in. And what I think people need to understand though, is in order to get the outcome that I believe most people want — You want to be a healthier, happier person, you want to help other people, let’s say your children to become healthy, happy people, you’ve got to understand that the baseline inputs, the status quo inputs are not setting us up for success. That if you do what most people do, which is kind of go through life and stick to the path that is already outlined in front of you, you’re going to wind up with at least one chronic disease. We know that most American adults have at least one chronic disease. We know that things like depression affect 300+ million people around the world, anxiety disorders affect between 10% and 20% of people. And I’m not saying all of that is preventable, but what I am saying is we can do a lot better than that, and it requires us to start paying attention to all of the inputs. And I think that to our earlier point, if you consider that 10, 11 hours of your day is interacting with a screen, that is a huge amount of your inputs. And it’s not just a question of social media, reading people’s posts, watching too much news, listening to sensationalized content, especially in the age of COVID, where our connections with even friends and family are digital, we’ve got to be thinking about the quality of those interactions too. I think in general, it’s a good thing to interact with other people, friends, family, to make those connections, but there is a tendency to perseverate on the things that are terrible and to get into these loops where you’re not actually making any sort of productive conversation, you’re just saying “Things are so terrible, aren’t they? Yeah. Here’s how things are so terrible for me. Here’s how things are so terrible in another country.”
And I get it. These are interesting things to talk about. Our brains have a tendency to focus on the negative. That’s a negativity bias, but even though we don’t think about a conversation with another person as maybe as significant as eating a junk food meal, it can be the exact same thing, as it relates to the way that it changes our brains. All of these inputs from our food, from our conversations, from our social media content, they converge upon our neurons and they shape the way those neurons are wiring with other neurons. They actually can change how the neurons are activated. So I don’t want to overwhelm listeners, this is a lot of things. We can talk about practical methods to shape that in your favor, but it’s just appreciating that the way that you consciously experience reality is a sum, it’s an amalgam of all these sources of information. So the more that we can be conscious of the quality of those sources, the more we can produce a brain, a body that enables us to enjoy life without being trapped in these negative cycles of poor health, physical and mental.
Dr. Nicole Beurkens:
It’s such an important foundational concept to understand, and I’m glad that you brought up the genetics piece of it, especially in the context of many of the parents who are listeners of this show have children who have been diagnosed with one or more of either neurodevelopmental or mental health issues, many of the parents themselves have been diagnosed with something that we would maybe classify as a mental health disorder: Depression, anxiety, a variety of things. And I think, unfortunately, in the realm of mental health and these kinds of brain-based disorders or diagnoses that we give people, there is this idea that there is a genetic predisposition, these are genetically-oriented things, and so “If you have the genetics for this, you just can’t help it, like you’re depressed and that’s just how it is. Take your Prozac or go to therapy” or whatever. And what most people don’t understand is that while there have been decades now of research aimed at trying to isolate and identify these specific genes that lead to these kinds of conditions, we’ve yet to identify them. There are so many different genes that are components of this, and while we understand, generally speaking, that there is some genetic predisposition, there is some aspect of family history, we have yet to, and probably will not, identify the specific genes that lead to these things. and here’s the good thing that we need to understand about that, that these are malleable things. These are experiences or things that happen to us, that as you said, these epigenetics. We can have family history, family predisposition, genetic predisposition to something like depression or ADHD or anxiety, or even more profound kinds of challenges like schizophrenia or bipolar or autism spectrum disorder. And still, the quality of the inputs, the things that we are doing, what we’re putting into our brain, how we’re living our life makes a very profound difference in how those conditions are expressed and how we experience the symptoms of those things or whether we experience that.
To me, that shift in understanding is needed so much in the field of mental health, and it is a message that is not getting to people who have these conditions or have a family history of these conditions, and it’s an empowering message. That you can, through the kinds of things that you physically put in your body, through the experience that you have through those inputs, you can shift and change how you experience those types of things, and I just think that is such an important message for people to hear.
Dr. Austin Perlmutter:
Yeah. There are a lot of important points that you made in that, you know, I don’t want to discount the role of genetics. If you look at something like the APOE4 or the allele and how it relates to Alzheimer’s. If you have that allele, if you have homozygous, which means that you have two copies of that allele, you are at a much higher rate of developing Alzheimer’s. But does everybody who has those two copies get Alzheimer’s? No.
**And then there are genetic diseases where pretty much everybody who has that genetic difference compared to the common version is going to get a certain outcome. But I would say the majority of conditions are far more nuanced. So you brought up depression. I think it’s such a great example because even compared to other conditions like bipolar, depression and schizophrenia, unipolar depression is very, very common. As I mentioned before, it’s very common worldwide, and there is, unfortunately, research suggesting that there are higher rates of depression in our youth, especially in our young girls. So then you think about — well why is this happening? And I look at these patterns, these trends. You look at trends in obesity and say, “Oh well, look at how many more people are obese today, compared to where they were a couple of decades ago.” Obviously that’s not a genetic things. Everyone’s genes didn’t all of a sudden change such that the majority of the American population is overweight or obese. Something happened in the environment. So there is always that factor of the environment.
But then you say, “Okay, so do certain serotonin changes predispose to depression?”
Certain changes in serotonin genes, maybe. But in the majority of the cases, it doesn’t seem to be the case. That is the triggering factor. It kind of, for me, reminds me of when I was treating patients in the VA hospital and they would come in with something terrible that had happened in their lives. A spouse might have died, they might have become estranged with a child, they might have had to move in a traumatic circumstance and they hit all the criteria for depression. Then the next step is to provide them with an antidepressant drug, an SSRI, right? That was the first line, in addition to trying to get them engaged with psychotherapy and it’s just such a strange thing that we assume that because something traumatic happened in their life, that it is now a serotonin issue. No, there’s more going on than that. It’s not that they have a serotonin deficiency and it was just unmasked by the fact that their spouse passed away.
There’s a lifestyle factor in this, or I should say there is an environmental factor that is really important here. So coming back to: What are the mechanisms behind this? How can we get curious about it? That’s an area that I spent a lot of time in recently, which is asking: What is happening in depression? It’s not a serotonin-specific issue. Why do I know that? Because when you give people SSRI’s, a lot of people don’t get better. So you could ask, well maybe SSRI’s don’t always improve serotonin levels, but it’s not that simple. We know that the stress axis is involved, so we know that hormones like cortisol are involved.
We know that the gut microbiome might be involved. And really, what excites me is that there is increasing evidence that one of the central roles or one of the central mechanisms in depression is a deficit in neuroplasticity, which is such an interesting thing because if you think about what neuroplasticity is, it’s the ability to change your brain. We all have it, we have it through our lifespans, but it can change, the amount of neuroplasticity. So depression is a condition characterized by more rigid, pessimistic, negative thinking. That is a state of having less plasticity in our thoughts.
So when you see that there is actually evidence for less plasticity in the hippocampus, in the prefrontal cortex, that tells me there is a mechanism there that we can potentially change through our diet, through exercise.
So when you look at studies on exercise and depression, they’re increasingly showing that this is an effective treatment. When you look at some of the other therapies like, for example, SSRIs, there is research showing that they may work through increasing neuroplasticity. So you pool all of this together and you realize you’ve got, again, this situation where there is this condition which we call depression, which we diagnose with a set of criteria, but it’s not just those criteria, it’s a whole lot more in the grey area. And when it comes to treatment, it’s not a lock and key mechanism where there is a drug that fixes this problem.
It’s understanding that all of these things may be involved. So it may be exercise. It may be dietary change. It may be medications, it may be psychotherapy. It may be some of the other things.
This is a slightly controversial, but certainly increasing area of research, the role of things like ketamine and psilocybin, which may work through increasing neuroplasticity, by the way. It just opens the door to the nuance that I think helps us to start understanding all of the solutions instead of what we’ve been told is a very oversimplified situation where this causes this.
Dr. Nicole Beurkens:
Totally. And I think it opens the door to understanding what we know to be true at this point through the scientific literature, which is that what we conceptualize as mental health disorders or brain-based disorders, they’re whole body disorders. The brain and the body are completely connected. We still have this outdated artificial distinction between what is mental health and what is physical health. The reality is it’s all about our interconnected health. And so as we think about inputs, which is where I want to go next, is giving people a few tangible things that through your work you find can be really foundational and important when we think about inputs to our brain and body system that help support this neuroplasticity, that help support us changing our brain in ways that move us towards who we want to be, who we want out kids to be. What do you feel like are some of these really foundational inputs?
Dr. Austin Perlmutter:
I love what you said there, and I just want to emphasize this point. It’s not like you have a disease of the mind and then a disease of the body and those are these separate systems. I don’t know what the mind is. I think it’s a nice concept, but where does the mind live? These are these ideas we use to describe things we poorly understand. So what I would say is forget all of these artificial barriers. What happens in your gut, what happens in your bloodstream influences your brain, influences your cognition, influences your mood. So that really dovetails nicely into the question you’ve asked as far as: What are the things that we can start doing that are going to help us to improve our cognition, to improve our decision-making, to improve our mood? A lot of this relates to the fundamental systems in the body. So adjusting our hormones, adjusting our immune system, specifically lowering levels of inflammation in our bloodstream and our brain. Inflammation has been shown to inhibit neuroplasticity, so we don’t want too much inflammation. Working on, back to the hormones, the stress system that tends to play a really big role in our cognition, in our mood.
So what are the things that we can do in our day to day that are going to change that. I’m not going to probably put out revolutionary information here. It turns out we’ve known for a long time the things that we can do that are going to improve those systems. The question is finding the ones that are best for you. I guess I’ll kind of go here in sequential order as far as what I recommend.
We mentioned sleep before. And I mentioned sleep as it relates to children maybe having a different sleep schedule compared to adults. What people don’t understand about sleep is not just that it’s essential for cognition. So I guess any adults out there who have done a long road trip and tried to drive without sleep know that it’s miserable to try to stay focused when you haven’t had enough sleep. But it’s not just about the focus piece. Sleep is essential in helping us to regulate emotions. Poor sleep has been implicated in both worse cognition and worse mood. Poor sleep blocks us from creating strong memories, and as it relates to our brain circuitry, there is a fundamental mechanism we talk about in the book Brain Wash, which is you need to have connection between what’s called the prefrontal cortex, the frontmost part of your brain, and the amygdala. Those two parts of the brain really need to talk. Prefrontal cortex is kind of the adult, amygdala is kind of the scared child. And when they are not communicating, you get an increased risk for conditions like PTSD, anxiety, even depression and also just worse decision making. So we don’t have to get into that too much, but recognize that sleep, getting good sleep has been associated with improving the connection between these two parts of the brain, which you really want. So getting sleep and really focusing on creating good sleep hygiene, so minimizing blue light exposure in the hours before bed, trying to create a bedroom that is relatively distraction-free, trying to create a continuous schedule where you’re sleeping as much as possible at the same time and waking up as much as possible at the same time, all of those things are great first strategies for improving cognition, decision-making, and in many cases, mood.
The next thing I would say is kind of on the same level would be food and exercise. There is obviously a lot of nuance to both of these, probably more so food. But I would say as it relates to food, you’re going to hear a lot of people saying you have to be very specific about your nutrition for yourself and for your children. I think the biggest thing is to work on the inclusion of real foods. So as much as you can, try to get away from things that have a ton of ingredients that you don’t know about, especially when there is added sugar. Sugar is added to so much. There is a recent study that showed you’re looking at about 70% of the food and drink in the American diet, which has added sugar. This is a problem for a whole lot of reasons. It increases inflammation, activates reward circuitry in a negative way. I think that doing the best you can — It’s not going to be perfect, trust me. If it’s not perfect for us, we can’t expect it to be the same for our kids, but trying to reduce reliance on processed food and added sugars, trying to eat real, whole foods as much as you can. For exercise, in adults, people in these biohackery situations care so much about getting the right high-intensity training. For kids and for most people, I think just movement is the key, whatever that might mean. Whether it’s walking around the block, even playing Wii — I don’t care. Just something that moves the body. Movement, exercise increasing neuroplasticity. It’s a really good thing for your brain.
Then the other things that I think are really relevant would be including mindfulness practices, whatever that might be. There is a lot of research around mindfulness for children. I’m not an expert at that, but there are a lot of resources that you probably have available for parents. So I think as much as possible, whether that’s just paying attention to breath, actual meditation, whatever that might mean. And then thinking about nature exposure. Why nature exposure? Because nature lowers stress, nature can help to calm down the amygdala, and nature has actually been associated with increased empathy. It is basically the antidote to what the modern world is putting in front of us. So if you can just get outside for a walk, even in an urban setting, nature exposure is associated with decreased stress, decreased cortisol levels in the saliva. And then the last piece I’ll just mention here. I know this is a kind of longer list, but it’s the use of some strategies around digital exposure.
And I alluded to this earlier, but one thing that we found very helpful is called the Test of T.I.M.E, and it’s a very simple acronym, but it just means that as it relates to digital exposure, you want to make sure that you are using it, it’s not using you, that you get a net benefit. So it’s making sure that it’s T, Time-restricted, that you set an amount of time for your digital exposure. If you want to watch a TV show, great, set it for 45 minutes. If you want to go on social media, great. Try 20 minutes. But basically you’re creating the plan so it doesn’t plan for you. I is for Intentional. You want to have a purpose. So if you’re going to go on social media, it means you want to check in on your aunt’s children, whatever, that’s great. You want to check in and see what your friend from high school is up to, fantastic. But you don’t necessarily want to see what your third cousin twice removed’s daughter is doing with her politics — you want to have a plan. M is for Mindful. So just to be more aware of what the technology is doing to you, what the digital exposure is doing to you so you don’t wind up two hours after watching the news getting in a big fight with your spouse because you didn’t realize that you were getting increasing levels of stress throughout the entire duration of that news exposure, and then E, finally, is for Enriching. You want that content to provide you with a net benefit. You watch Discovery Channel, you learn about the rainforest, that’s fantastic. You watch, I don’t know, the Real Housewives for 3 hours, probably not getting a whole lot. So again, T.I.M.E. The goal here is just to have a framework so that you’re ensuring that you are gaining from your digital exposure and it’s not taking something away from your health.
Dr. Nicole Beurkens:
It’s great and I think that acronym, that T.I.M.E is something that we can talk about even with younger kids. To think about the time, what is our intention with what we’re doing. Are we being mindful? Is it enriching? Those are things that even elementary age kids, we can think through and give them that framework. So I think that’s awesome and it’s interesting, as you covered these core things, they really summarize the themes of everything we cover on this show. So it’s so great because there are parents who are listening and I’m like, yeah, this is what they’re hearing over and over about the food that we put in, and I love your focus on: Let’s just look at what’s practical here. You don’t need to be on a 25-step complicated diet, although for some people that is beneficial, but in general, my message to families is just focus on practical steps like doing a little bit better in the area of reducing processed foods or added sugars and we’ve had some great episodes on that.
The exercise connection, which I prefer to call it movement too because exercise is such a dirty word for so many people, it’s like just move your body, right? Move your body. And the connections that we are making interpersonally with people, the sleep thing, which for kids is profound. We really underestimate how significantly sleep factors into kids’ development into their brain-function, into their mood, their behavior. So these things, you’re right. They’re not new revelations. They’re the things that we sort of know and yet, how you describe them as being those key inputs for literally supporting the neuroplasticity of our brain, that’s the why piece that I really think gets to the root of this and is so helpful and helps our decision making, because I think when we have a strong why, when we really understand why something is important, that creates much more of a push for us to then look at how we could implement it.
Dr. Austin Perlmutter:
Yeah. I think you did an amazing job summarizing that. The last thing I would just add to this is that there is this pervasive myth and it is incredibly damaging to our brain function, which is we are conditioned to believe in instant gratification as a lasting satisfaction with pleasure and satisfaction being the same thing, and they’re not. So when you look at what happens with social media, with highly-processed food, with watching the news, it is an instant gratification. And we’re replacing that instant gratification, we’re replacing long-term satisfaction with instant gratification. So when we find ourselves unhealthy and unhappy, we got there because we pursued instant gratification. We got there because we chose the easy, unhealthy food over the healthy one. We got there because we chose to sit on the couch instead of getting up and exercising, we got there because we chose to send the message as opposed to calling up or seeing a friend in person. And then we tried to fix that with the same thing that caused the problem. So now you’re feeling crummy because you’ve made a whole bunch of bad choices. What do you do? You go buy something you don’t need on Amazon. You go watch a bunch of junk TV. These are the things that, in essence, perpetuate the problem. So the reason that this is so relevant is when you talk about the role of sleep, of exercise, of diet, of valuable interpersonal connection, there has to be an understanding that you can’t fix a problem that is compounded over years with a pill, with an overnight intervention. It’s the same thing with investing. Everyone is trying to get in on the latest stock and thinking that’s going to change their financial futures. That is proven time and time again not to be the best strategy. So the more we can just support each other in this idea of: We want to build by compounding the interest, good health, good happiness, through the basic stuff. Through exercise, through the dietary changes that are going to improve our brain wiring the better. But everyone is out there trying to advocate for this incredible new superfood or whatever it might be. It’s just not what the science shows. Science shows that it’s about creating healthy habits. It’s about sticking to the basics.
So finding ways to make that exciting for you, I think is absolutely key. That’s why I recommend to people to not try to do all of this. Pick something that you can find that you will enjoy, that you can stick to day in and day out and that will help to build your brain in such a way that you will be able to add that next step to your plan for better health.
Dr. Nicole Beurkens:
So true, and it reminds me of an episode that we did with BJ Fogg out of Stanford, back in probably spring of last year, talking about tiny habits. And I think that dovetails nicely with this in terms of how we start to actually implement these basic things on a sustainable basis. So if you’re listening and you didn’t hear that episode, I would recommend you go back and check that out because it sort of gives some practical steps for how we implement this stuff in our lives in a meaningful and sustainable way. We could just have a conversation all day about this, there are so many other things on my mind. I know we need to wrap up, but I want to make sure that you share with people where they can find out more about you and your work and about the book Brain Wash.
Dr. Austin Perlmutter:
The easiest is probably on my website, which I came up with a very original name, it’s austinperlmutter.com. The other places you can find me on are Instagram @austinperlmutter and I’ve been doing some work with an app called Clubhouse for people who are there. I’ve just been doing a weekly room with my dad on brain health at 1PM Pacific and 4PM Eastern, so you can check out what’s new in my life and what’s new in the medical research around brain health on Clubhouse.
Dr. Nicole Beurkens:
Fantastic. Dr. Austin Perlmutter, thank you so much for being with us today. This was an amazing and valuable conversation and we really appreciate your time.
Dr. Austin Perlmutter:
Thank you, Dr. Nicole.
Dr. Nicole Beurkens:
And thanks to all of you for listening. We will catch you back here next week for our next episode of The Better Behavior show.