The Gut-Brain-Thyroid Connection

Guest: David Perlmutter

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only and are not intended to be a substitute for professional
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does not provide medical advice, diagnosis, or treatment.
Always seek the advice of your physician or other qualified
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condition.

Dr. Myers: Hi, everybody. It’s Dr. Amy Myers. Welcome back to the Thyroid
Connection Summit: Why You Feel Tired, Brain-Fogged, and Overweight and
How to Get Your Life Back.

Today, I’m very excited to introduce Dr. David Perlmutter. He’ll be our guest
today, and many of you all likely know him from his number one New York
Times best-selling book Grain Brain that has been translated into 27 different
languages and has sold over a million copies which is just fantastic.
Congratulations.

Dr. Perlmutter: Thank you.

Dr. Myers: And also he is the author of Brain Maker as well as he has a new
book coming out this fall, The Grain Brain Whole Life Plan. In addition, Dr.
Perlmutter is asked to speak pretty much all over the world and has been on
many programs such as CNN and Fox News and Dr. Oz. And I’m just thrilled
to have you with us, Dr. Perlmutter.

Dr. Perlmutter: I am totally delighted to be with you today.

Dr. Myers: Well, great. As you know, this is a thyroid summit, and we know
that you are the expert on the brain. And what I’d like to talk about—as well
as you’re an expert in the gut and the gut biome—kind of that connection
between the gut, the brain, and the thyroid.
© Amy Myers MD. All rights reserved. 1

Dr. Perlmutter: I’m delighted. Let’s do it.

Dr. Myers: I think a lot of people have heard, particularly in reading your
books, about this gut-brain connection. How does the thyroid fit into that?

Dr. Perlmutter: That’s a great question. I did in Brain Maker talk about the
relationship between things that go on in the gut and this very distant place
called the brain and how they’re related. But the reality is that the gut
influences every inch of your body, and it isn’t certainly just confined to
influencing the brain but it’s the heart, the endocrine system, the thyroid,
metabolism, blood sugar regulation, set point of inflammation, and immunity.

The thyroid which is really a primary target of autoimmunity—and we’ll talk

about that more in a little bit—it really plays well into the importance of
understanding why the gut is so relevant. Because autoimmunity is a gut-
related issue primarily. Autoimmunity doesn’t begin in the thyroid, nor does it
begin in the joints, the skin, or the brain. The gut and specifically the integrity
of the gut lining plays a pivotal role in balancing the immune system. We want
to have an immune system that’s balanced.

If your immune system is underactive, then you’re at risk for deficiencies of

immune function that can set you up for everything from infection to even
cancer. If your immune system is overactive, then it needs something to do
and unfortunately that can lead to what we call autoimmune conditions where
your immune system is actually reacting against parts of your own body.

I think the thyroid is probably the number one target. We know that
Hashimoto’s or autoimmune thyroiditis is the most common autoimmune
condition globally, certainly a very common condition in Western cultures in
women especially. And I want to just make the case that we’ve got to stop
looking at the thyroid in order to try to understand what’s going on with that
issue. We’ve got to take a step back and say, “What is it that’s underlying this
disregulation of the immune system?” And it’s the gut that’s governing this.

When we begin to understand that leakiness of the gut stimulates the immune
system and basically causes the immune system to be unbalanced, that is the
cornerstone of Hashimoto’s thyroiditis or autoimmune thyroiditis. It’s a
stretch. When I talked about the gut and the various markers of inflammation
begin related to Alzheimer’s disease years ago, people scratched their heads
and said, “We thought the brain was in Houston and the gut was in Cleveland,
and there’s no communication.”

© Amy Myers MD. All rights reserved. 2

Again, what I’m saying is when we look at this whole notion of autoimmunity,
it relates to the brain of course. Inflammation relates to the brain, Alzheimer’s,
Parkinson’s, MS, autism. But in this one issue of autoimmune thyroid
disease, the gut is playing the pivotal role. So the maintenance of the integrity
of the gut is the job of the gut bacteria.

And when we compromise gut bacteria to indiscriminate food choices,

exposure to various medications—and we’ll talk about that as well—then we
set ourselves up for more permeability, more leakiness if you will, of the gut
lining which enhances this autoimmune predisposition. And that’s really the
cornerstone of this epidemic of autoimmune thyroiditis that we are seeing
globally.

Dr. Myers: Yeah, it’s quite amazing. I was obviously researching for my most
recent book, and Synthroid is the number one drug prescribed in the United
States. Pretty astounding considering that people like myself aren’t even on
Synthroid. We’re on either Tirosint or Armour Thyroid or one of the desiccated
thyroid medications. It’s pretty incredible the staggering number of people
with autoimmune thyroid disease.

Dr. Perlmutter: Again, the notion of taking a thyroid replacement, whether it

is pure T4 or a combination of T3 and T4, that’s symptomatic management. I
have no problem with that. You need to have thyroid hormone, for my
purposes for the brain as well. But I think we need to take a step back and
say, “Ok, that’s treating the smoke, the manifestations of the thyroid issue.
How did you get into that mess in the first place?”

Dr. Myers: Absolutely.

Dr. Perlmutter: Moving forward, and I’m know you’ve talked about it
extensively, we’ve got to take our focus off the thyroid for a minute and
recognize how did you get into this mess. You got into this mess because of
issues related to the gut. Who knew?

Dr. Myers: Right. That’s how I got into functional medicine as it was. I had
Grave’s disease, and conventional medicine had solved my Grave’s disease by
blowing it up like Hiroshima so I no longer have a thyroid. But then I started
thinking, “Well, how did I get here in the first place?” And then I of course
found functional medicine, and as I write about in the book and as you’ve
written about in your books, figuring out those underlying causes, primarily
the gut for sure, and then, as we’ve alluded to, foods and then there’s a role of
infections and toxins and stress.

© Amy Myers MD. All rights reserved. 3

I don’t know if you want to go through any of those or what I’d also like to talk
about is just you are primarily a neurologist. And prior to getting into
functional medicine—I was just curious—did you see people who were being
diagnosed with these neurodegenerative disorders that actually had
underlying thyroid either as a standalone issue and once corrected…?

Dr. Perlmutter: Oh, yeah. The thyroid is certainly—in evaluating an

individual with dementia, thyroid is really almost on the top of the list in
terms of things that we want to look at. Because hyper or hypothyroidism is
what we call one of the very few treatable causes of dementia, meaning that
people can lose their marbles because their thyroid isn’t working well. So
we’ve really got to focus on that at the initial evaluation. Very important when
we’re seeing a patient with dementia.

I’d like to just take a moment to review a publication in the archives of

Neurology back in 2009 that looked at a large group of individuals, followed
them over time, and compared risk of developing full-blown Alzheimer’s
disease in comparison to the TSH marker, the measurement of thyroid
function. And found that at the very lowest end of TSH or the very highest end
of TSH, looking at those two quartiles was associated with a more than
doubled risk for Alzheimer’s disease.

The point is you’ve got to peg thyroid function. It’s got to be pretty much
where it needs to be, and that is to say too high or too low of function seems
to be associated with increased risk for developing Alzheimer’s. Now, that was
a correlative study. It certainly was not one of causality. But when you
understand the metabolic role of thyroid hormone in terms of its role as a
trophic hormone in the brain, then it becomes actually pretty easy to
understand why changes in thyroid hormone of various types can have an
impact upon brain function moment-to-moment and certainly long-term risk
for developing Alzheimer’s as well.

Dr. Myers: Given that, why do you think that thyroid disorders are so
underdiagnosed? I can say for myself, having been a patient on the
conventional side, it was a terrible experience for me. I came in with fairly
overt hyperthyroid symptoms, and yet the doctor brushed me off as telling me
I was a medical student making up in my mind that I had every disease that I
was learning about and it was simply stress. And I literally had to practically
beg for them to do a full workup, including my thyroid. And then of course,
got a call that I had an autoimmune disease of my thyroid.

© Amy Myers MD. All rights reserved. 4

But seeing that it’s so related particularly in your field to brain disorders and
so many other fields, why do you think conventional medicine is so poor at
diagnosing this.

Dr. Perlmutter: I think one of the reasons is because thyroid disease can
have so many different, seemingly unrelated, manifestations. There can be
neurologic issues that may be front and center related to the thyroid that
neurology would tend not to look at, would think of other things: edema,
swelling, heart issues, blood pressure issues, agitation as you experienced,
etc. Look how you were brushed off as an anxious and nervous medical
student.

I think it’s often that doctors try to explain these symptoms away, and I think
the older we all get the more we realize what a pivotal role the thyroid is
playing directly and indirectly in so many functions of the body and, therefore,
in so many presentations that we might see in the clinic.

Dr. Myers: Right. So kind of back to what we were talking about. You were
saying that really autoimmunity with the thyroid and most probably thyroid
disorders in the first place, many of them even non-autoimmune, probably go
back to the gut. And I know that you wrote extensively about this in your book
about the gut biome. So can you kind of define what is the human gut biome,
and then we’ll take it from there?

Dr. Perlmutter: So we stand in a place of discovery right now. Nothing that

we learned in medical school and in our training and in our practice prepared
us for this sudden paradigm shift, this sea change in our knowledge base, and
that is the incredible role that the 100 trillion organisms that live upon our
body and within our body are playing in regulating every parameter that you
can imagine as it relates to how our bodies work as well as our risk for
disease.

That said, these organisms, this relatively new discovery. About 90% of all of
the microbiome publications have only come out in the past five years. That’s
showing you that this is explosive. When you understand that these bacteria
are regulating the absorption of nutrients, the production of various
chemicals, the neurotransmitters by and large, regulating inflammation—the
cornerstone of all of our degenerative conditions—it really is sobering to
recognize that these organisms that outnumber Dr. Myers’ cells in her body
10:1 and that represent 99% of the DNA in our bodies, not that 23,000 gene
gift that we got from our parents. It’s a very sobering but at the same time
extremely empowering notion.

© Amy Myers MD. All rights reserved. 5

So that as we begin to develop the information and look at the data and we’re
in the very primordial stage of understanding what the implications here. But
I think it’s a brand new playing field that we never had before. For myself, as a
neurologist, my therapeutic options have been so limited for 30 years. We had
very little to offer people in terms of treatments for their problems. And by and
large what a neurologist and myself years ago included did and continues to
do these days is manage symptoms and really, for the most part, ignores the
underlying causes of the problems.

I mentioned earlier that Alzheimer’s is an inflammatory condition of the brain,

as is Parkinson’s, as is ALS and autism. These conditions are rampant. And
when we realize that the set point of that inflammation is characterized at the
level of the gut, is determined at the level of the gut based upon good versus
bad bugs living within us, it really makes us want to pay attention to those
factors that have such a huge influence on the health and the diversity of our
gut bacteria. And the number one thing we should be looking at is our food
choices.

Dr. Myers: So that being said, what are things that can disrupt this biome
and what are things that can help this biome?

Dr. Perlmutter: Well, in the food department, I think the biggest culprits are
the standard American diet, Western diet, that is so devoid of fiber and
specifically what we call prebiotic fiber. That’s the type of fiber that actually
nurtures the gut bacteria, allows them to reproduce, and allows them to do
the things that they do, to produce the chemicals that are so healing and
empowering for the human body.

So diets need to be lower in carbohydrate, lower in sugar, higher in fat, and

my plea is for everybody watching us today is to reconsider your position on
dietary fiber. You need a lot more, and not just dietary fiber but a specific type
of fiber called prebiotic fiber. And you get that in foods like garlic, onions,
leaks, dandelion greens, Jerusalem artichoke, jicama, as well as fermented
foods that are enriched already by the process of fermentation with bacteria.
Fermented foods are things like kombucha, kimchi, sauerkraut, cultured
yogurt, any fermented vegetable for example is going to be enriched with a
host of good bacteria.

I think, to be fair, what may also represent a huge threat to the microbiome
and, therefore, put people at risk for autoimmune thyroid disease are the
various medications that people are taking today willy-nilly. I know willy-nilly
is not necessarily a scientific term, but I think everybody knows what I’m
talking about. People are popping pills, either prescribed or over-the-counter,
© Amy Myers MD. All rights reserved. 6
left, right, and center these days. For example, we do know that the acid-
blocking drugs that are called the proton-pump inhibitors that everybody
thinks they have to take—you watch the commercial and a guy is trying to eat
a sausage and the sausage turns away and he’s okay. He can eat the sausage
because he’s taken some acid-blocking drug. There’s hell to pay when you
take those drugs. It profoundly disrupts the microbiome.

Stanford research recently published a study showing a significant increased

risk of heart attack in people on proton-pump inhibitors. And if you have that
heart attack, your chances of dying from it are doubled. They indicated in the
study that the likely cause of that was disruption of the microbiome. So when
you change the acidity in the stomach, it has an effect on the pH or the acidity
further down in the gut, and it changes the diversity of the gut bacteria.

Some very exciting research was just published that showed that the way the
bacteria are able to regulate their own pH within each bacterium is affected
when they’re exposed to these proton-pump inhibitors. So that, coupled with
antibiotics, wreak profound havoc on the microbiome. And I think there’s
long-term risk for disruption of the microbiome. Even one course of antibiotics
changes the microbiome permanently for the rest of a person’s life.

Now, I’m not saying you shouldn’t take an antibiotic, but I’m saying that we
are grossly overusing antibiotics. I don’t think there’s anyone who would
disagree with that. The World Health Organization characterized our over
usage of antibiotics as one of the top two health risks for this decade. And
recognize that we take antibiotics for the wrong reasons, for colds and sore
throats, when they’re not necessary. And 70% of the antibiotics used in
America go into our cattle and our poultry.

Dr. Myers: That’s what I was going to say. I think that’s where most people
don’t really think about it, that the vast majority is actually going into the food
supply and the foods that they’re eating. So certainly eating organic and
raised without antibiotics is a way to support the stopping of the usage of
that.

Dr. Perlmutter: I think when we start to look at all of these correlative studies
through the lens of the microbiome, it’s going to start to make sense. There
was a study published about two hours ago. It just came up on my newsfeed
that showed a fourfold increased risk of developing ALS or Lou Gehrig’s
disease in people at the higher levels of pesticide exposure. We know that
pesticides wreak havoc on the human microbiome.

© Amy Myers MD. All rights reserved. 7

As I read that study, they didn’t draw any conclusions, but my take is if you
take a step back and think about this very important influence that the
microbiome has on immunity and inflammation, then we’ll really gain some
understanding in terms of things like ALS. There was a study published in
2004 in the Journal of the American Medical Association that perfectly
correlated antibiotic exposure, the number of antibiotics a woman would take,
with her risk of developing breast cancer. Published in JAMA, in a well-
respected journal.

Dr. Myers: I was going to say I also just wonder about when I hear all of this
the detoxification capabilities of the microbiome. Not only is it the digestion
and the absorption and the interplay but also the detoxification to get many of
these toxins that we’re exposed to on a daily basis out of our system.

Dr. Perlmutter: It’s so true. I interviewed Dr. Stephanie Seneff from MIT
yesterday. We had that discussion. She’s in a lot of work in looking at
glyphosate which is the herbicide that is being sprayed around the world, 1.35
million metric tons now being used, and how that damages the gut bacteria
and, in and of itself, also damages our detoxification pathways, what are
called the CYP pathways.

Dr. Myers: Double whammy.

Dr. Perlmutter: It is. You depend upon these bacteria to help you detoxify
from the very chemical that you’re then exposed to that’s killing off a subset of
your bacteria. The idea of a more paleo lifestyle isn’t just eating more meat
and stopping the carbs. We think about our Paleolithic ancestors and they
lived in a very pure environment in terms of toxins and threats to their
microbiome.

Dr. Myers: For sure. When I think about just what is the greatest threat to us
right now, I think about GMOs. I really feel very strongly about that and what
it’s doing not only to the environment, to our crops, to small farms, but to the
microbiome and to our health frankly.

Dr. Perlmutter: It’s a really interesting thing that you bring up because I
think it’s sort of trendy to talk about GMOs and trendy to ask the grocer for
products that are non-GMO. The real question is why? Why would we object
to genetic modification of our food? Seems like a crazy thing anyway. I think
when you take a step back and ask yourself, “Why are foods genetically
modified?” By and large, the reason is so it allows farmers to spray the crops
with this herbicide, glyphosate, which is what we find in Roundup.

© Amy Myers MD. All rights reserved. 8

That’s the reason, interestingly, that last month the FDA finally called for a
panel of research scientists to start to study the foods that we eat and report
the residual glyphosate levels and letting us have that information. Last year,
the World Health Organization characterized glyphosate, this herbicide, as a
probable human carcinogen. And they didn’t do that lightly. That was a big
deal, published in the journal the Lancet, very well respected.

I’ve just gotten back from being virtually around the world and visited places
like New Zealand where they’re still using a lot of glyphosate. You think you’re
on an island and you’re way away from America. This is a global issue.

Dr. Myers: It’s so global. I was a Peace Corps in Paraguay and was back this
past Christmas with my husband. And a good friend of mine’s family is from
there, and they actually are cattle farmers but they also raise soy beans. And
was at dinner with them and of course it’s GMO soy beans, and the father was
asking my opinion and I was trying to tread lightly as I’m in their home on
Christmas Eve. They’re opening their home to me. How do I feel about this?
And very intelligent people, and the mother says, “We’re feeding the world.” I
thought, “That’s one of the biggest misconceptions about this is that people
think that all of this corn and soy is going to feed the world, this GMO corn
and soy. It’s not. It’s going to feed the cattle.”

We then drove to Brazil from Paraguay, and the fields that you’re passing of
just GMO soy and then going to my village where I had spent two-and-a-half
years, the farmers there had worked with it and had real-time reports of how
children were getting sick, how their cattle and how their pigs were getting
sick. And my farmers who were small farmers, a couple of acres apiece, will
not use the stuff. It was so disturbing to see a country that I love so much
being destroyed.

There was an article—I’ve forgotten in what publication, Discovery or

something—talking about the Chaco which is a big open area in Paraguay and
how Cargill had essentially destroyed all of the rain forest and forest there by
planting GMO soy and corn and how it had basically gone unrecognized by the
rest of the world because who even knows where Paraguay is. It’s quite
disturbing, for me in that moment, on a multitude of levels of a very intelligent
couple claiming to feed the world, to a country that I love so much being
destroyed.

Dr. Perlmutter: Well, the argument doesn’t work because the more
glyphosate you spray on the soil the more you kill the microbiome, the
microorganisms, in the soil and ultimately the less healthy will your plants
become and the more chemicals you’re going to have to supply and treat them
© Amy Myers MD. All rights reserved. 9
with. We’re watching that happen in Europe now. We’re watching it in
vineyards in Europe, and it’s pretty breathtaking.

You often wonder if somebody came down from outer space, if we had a
visitor, and they landed in their UFO. I think the first question would be,
“You’re spraying poison on your food?” And then it would be like a Dr. Phil
moment, “What were you thinking?” You wonder why people are sick. It’s
because we’re consuming poison. You can’t do that. We’ve not evolved
detoxification mechanisms, pathways, that can deal with this incredible
onslaught of toxins in our environment without virtually any regulation or any
research to indicate that these things are safe.

I think typically what you see is products are released and basically what’s
going on now is the field testing. And the field testing, according to the World
Health Organization, is telling us this is a probable human, not rodent,
carcinogen. You can still go to your Home Depot and buy the stuff right off the
shelf and spray it all over your yard if you want to.

Dr. Myers: We don’t even know how long all of this is going to last. I have a
friend who recently had fibroids and had them removed. Being that she’s in
functional medicine as well—I say geek in a fun way because I would probably
do the same if I were her—had them sent off to a laboratory and had them get
tested for what was in her tissue. Her family was from Vietnam. She was born
there and then came to the United States.

I don’t remember the pesticide, but it was something that’s been outlawed
here for 30 years but it had been used over in Vietnam. Her levels were
something like 100 times what anyone should have in their body, and it was
concentrated here in her fibroid which one would say a fibroid is really just
inflammation. It’s an inflammatory process. How long are these toxins sticking
around even after we’ve banned them? Or is this something that she got from
her mother in utero that passed through the placenta?

Dr. Perlmutter: It’s true. These are molecules that even in low concentration
can have significant effects, sometimes even at a higher concentration the
effects might not be as dramatic. I’m in Florida, and there’s all kinds of talk
about the next plague which is going to be the Zika virus carried by the Aedes
aegypti mosquito and the world’s going to come to an end.

What we’re seeing in Central and South America and I think soon to see here
are these massive fogging campaigns to get rid of these mosquitos. And they’re
using pyrethroids. Interestingly, the charge study from UCLA has shown that
pyrethroids—people exposed to them, mothers carrying babies exposed to
© Amy Myers MD. All rights reserved. 10
them, have a significant increased risk of that child having autism or being on
the spectrum. That’s what we’re spraying, so we do have to look at the
risk/benefit ratios of the interventions on the planet as well as the medicines
that we use.

Certainly, as it relates back to the microbiome in terms of regulating

immunity, and that takes us right back to autoimmune thyroid disease. It’s a
pretty complete circle, isn’t it?

Dr. Myers: For all the people out there that just got overwhelmed and scared,
why don’t we kind of recap what we talked about and then talk about things
that we can do because I, as do you, like to give people information so that
they’re empowered, but we don’t want people to be overwhelmed or scared
that there’s not something that can be done. So I don’t know if you want to
recap or I can recap kind of things that destroy the microbiome, how we can
rebuild the microbiome, and then our conversation went a bit outside of that.
So what can we do to protect ourselves?

Dr. Perlmutter: Well, I’d be delighted if that’s for me to do.

Dr. Myers: Sure. Absolutely.

Dr. Perlmutter: First, let me just take a step back and recognize that here Dr.
Myers and I are talking about the thyroid. And what I’m about to tell you
relates to the microbiome. What is this connection? And I think we made the
point that the thyroid is highly influenced by the events that occur in the gut.
And that’s why we have to pay attention to the health of the bacteria that live
there and other organisms.

The things that threaten the microbiome are of course indiscretions of our
diet: having too many carbs, too many sugars, not enough fat, and most
importantly not enough good prebiotic fiber. Those foods that are rich with
prebiotic fiber are things like Mexican yam, dandelion greens, garlic, onions,
leek, asparagus. These are foods that are really enriched with prebiotic fiber to
nurture your gut bacteria. You can go to the health food store and say, “I’d
like some prebiotic fiber, please.” And they’ll direct you to a whole array of
products that are prebiotic fiber.

The next thing is to recognize that so many of the drugs that people think they
need to take or are told to take actually can profoundly affect the microbiome
and you need to be very judicious. And those include the nonsteroidal anti-
inflammatory drugs, the ibuprofens that are in so many products that people
are taking for headaches or any kind of pain, the proton-pump inhibitors.
© Amy Myers MD. All rights reserved. 11
That sounds like a big term, but it simply means the bulk of these acid-
blocking drugs that are available over-the-counter.

Then, of course, probably the biggest culprit of all are the antibiotics that
everybody takes whenever they have a sniffle or a sore throat or pull on their
ear that are being given to our children with abandon and that threaten the
microbiome and can cause life-long changes to these bacteria. Make no
mistake about it. These bacteria have our future in their hands. I don’t know if
they have hands, but they wield the sword of Damocles. They determine
whether we’re going to live or die, basically. And we have to nurture them.

They say that when women are pregnant they have to be careful because
they’re eating for two. And I’d just like to say that each and every one of us is
eating for 100 trillion.

Dr. Myers: So then they’re eating for 200 trillion.

Dr. Perlmutter: Right. That’s true, but the child before it’s born doesn’t really
have a microbiome yet but will. And they’ll acquire that from mother which
leads me to my final point, and that is understand that we acquire the initial
microbiome that we carry, we are anointed with our microbiomes, if you will,
as we pass through the birth canal. Bacteria that live in mother’s birth canal
and nearby in other canals, not to be graphic, are implanted on the child’s
face, in his mouth, on her nose, etc., and then form the seeds from which that
microbiome will be born, will be created.

So when we see significant increased risk of things like celiac disease or type 1
autoimmune diabetes—70% increased risk for kids born by C-section. When
we see a dramatic increased risk for adult obesity in children deprived of
getting those bacteria because they were born by C-section. When we see an
increased risk of autism, for example, which is becoming epidemic, in children
born by C-section, we have to take a step back and ask ourselves, “What’s
going on here? What is this relationship?”

What I think a lot of researchers are talking about is the fundamental

importance of that initial microbiome being transferred from mother to infant,
to newborn. We call that horizontal information transfer to be contrasted with
what is called vertical transfer of information which is the acquisition of the
genes that we get from mom and dad. Yes, we get a blueprint from mom and
dad. We get 23,000 genes from our parents. It’s this code that’s been passed
down from generation to generation. But the final apps are loaded into the
computer at the moment of birth. The final software that is most up-to-date
and prepares that child, that newborn, for its environment, be it a rural
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environment, a cosmopolitan environment, one that’s far from the equator,
one that’s equatorial, those marching orders are given at the time of birth.

When a child is deprived of that event, in other words born by C-section, then
it paves the way for immune issues and inflammatory issues and even obesity.
Now, I’m not arguing that we shouldn’t do C-sections. Of course, we should.
This is a life-saving procedure. But as we have this discussion, in America
today one-third of all births are C-section. And it’s hard to imagine that a
third of all births are so complicated that they require a C-section that will
change that child’s health destiny.

Dr. Myers: Did you see recently the study where they were taking bacteria—in
a C-section baby, taking a swab from the vaginal cavity of the mother and
wiping it on the baby’s face and showing that it almost established the
microbiome as if the baby had gone through the birth canal?

Dr. Perlmutter: That was work done by Dr. Maria Dominguez-Bello at New
York University. And this is actually her second publication. The first one I
actually put in Brain Maker, the notion that if you have to have a C-section
because of fetal distress or mother having issues with blood pressure,
whatever it may be, that you inoculate a sponge in the birth canal and you
keep it moist and warm and then you inoculate the baby’s face with that after
he or she is born. And I think it’s a very, very powerful idea.

Dr. Myers: Absolutely. The irony of it at the end of the study was that they
wanted to find out which were the crucial bacteria so then they basically could
synthetically produce those bacteria and give it to the baby rather than what
they were doing in the study which costs no extra money, required no
additional researching, and it’s just right there. Super simple, all natural. Can
wipe the baby’s face. The end result of that study was we need to study this
further and then hopefully we could basically come up with a drug or a
probiotic that we could give to the baby.

Dr. Perlmutter: It’s all about how do you monetize the results. But having
said that, I think that the call here could be right now—the call to action—
which is where you and I were going, would be don’t have a C-section unless
it’s absolutely necessary.

Dr. Myers: Absolutely.

Dr. Perlmutter: When we look at the risk/benefit of C-section, typically what

a woman is told is, “Well, there’s no risk and the scar is going to be this long.
You might be in the hospital an extra day. And the benefit is you don’t have to
© Amy Myers MD. All rights reserved. 13
go through labor.” Notwithstanding there could be a very good reason for a C-
section, but I think in the risk column we have to add long-term risk to your
baby because that baby was deprived of that very important inoculation.

Dr. Myers: All right. Well, let’s move on. You had also discussed sort of the
role of fat and adding fat into the diet. Can we kind of talk about the role of fat
in both thyroid health as well as brain health?

Dr. Perlmutter: I’d be delighted to. Your brain is mostly fat, and I’m not
picking on you Dr. Myers. A person’s brain is 60-70% fat. You don’t get it from
the air. You don’t read about it and get it. You get it from the fat that you
choose to eat. So fat is an integral part of the diet as it relates to brain health
and as it relates to every aspect of human health and longevity. Humans have
always, always eaten high levels of fat and remarkably low levels of sugars and
carbohydrates.

When I say always, at least for a couple million years until just an hour ago,
which is, what, maybe two decades ago basically that we were told somehow
that fat was a bad thing. And everybody stopped eating fat, and when we did
we began eating many more carbohydrates in the diet. And rates of diabetes
skyrocketed.

High levels of carbs increase risk of diabetes, not only through the insulin
mechanism but also through the changes in the microbiome. So when we eat
more carbs, we increase the risk for immune issues and inflammation. And
again, the thyroid is a perfect target for those problems. Fat is, again, a
wonderfully concentrated source of calories. We’ve depended on fat to survive
for such a long time. The gut depends on good fats, certainly not the modified
fats that are so prevalent in our society.

And I would like to say that when we are reviewing the microbiome studies
that look at the changes in the microbiome that may not be favorable in
animals fed a high fat diet, you’ll find that these are animals that are also on a
high carbohydrate diet. So it’s a very good lesson for us and that is if you want
to reap the benefits that everybody’s talking about of eating more fat, you can.
But it’s not going to happen unless at the same time you cut the carbs and get
rid of the sugars. Otherwise, you are going to create a situation that’s bad for
your gut bacteria, and that’s going to ultimately be bad for you.

To be clear though, we’ve got to be super careful in terms of those fats that we
eat. Most of the fats that people are consuming are detrimental to health and
damage the microbiome. But the extra virgin olive oil, the coconut oil, the
avocados, the nuts, the grass-fed beef and wild fish, these are foods that
© Amy Myers MD. All rights reserved. 14
supply to our bodies wonderful, health-sustaining fat and emulate the diet
that humans have eaten for 99.6% of the time that we’ve walked this planet.

Dr. Myers: Also, we need fat for our thyroid. In addition, many of the fat-
soluble vitamins—vitamin A, vitamin D. You need vitamin K with that, vitamin
A with the vitamin D. So are necessary for the thyroid to function optimally.
Are there any other foods or nutrients that you can think of specific to the
thyroid that you’d recommend for people?

Dr. Perlmutter: Well, I will. Over the years, many of us had been proponents
of choosing organic foods, and I think now that we understand the GMO issue
and the glyphosate herbicide issue that becomes even more germane for a
couple of reasons. Glyphosate—this herbicide that is so prevalent on our food
now, the food that is genetically modified and wheat which is not necessarily
genetically modified. Glyphosate is sprayed on wheat to help it ripen more
quickly. One of the things that glyphosate does is it binds minerals. It’s a
chelating agent, and as such, various important minerals can be chelated out,
and vis-a-vie the thyroid gland, I think one of the most important minerals
obviously would be—aside from iodine—is of course selenium.

Our activation of thyroid hormone from T4 to T3, the cutting off of that iodine,
is dependent upon adequate levels of selenium. Selenium deficiency can really
be something that is quite common in people who are functionally
hypothyroid, who are not converting their T4 into T3. We even see it in people
who are taking a drug like Synthroid, which is pure T4, the notion being that
you’re taking T4, your body’s going to convert it into active thyroid hormone
which is T3. But again, that depends on adequate selenium levels. Any
person, in my opinion, who is being looked at for thyroid issues, being treated
for low thyroid function, should have an intracellular mineral panel and I
would say pay particular attention to the selenium level.

Dr. Myers: So you were doing that in your clinic. I know that there are certain
functional labs that we both work with that do those. Were you doing any of
that through any regular lab testing at all for those people who couldn’t?

Dr. Perlmutter: Generally, no. We can get a magnesium red blood cell test
from the regular lab, but the more extensive panel of minerals, intracellular
minerals, there are a couple of specialty labs out there that will do that and
are easy for a doctor to connect to and send the specimen to. So it’s really not
anything dramatic.

But I will tell you that if you’re looking just at serum levels of magnesium and
selenium and other minerals, you’re not going to understand what’s going on.
© Amy Myers MD. All rights reserved. 15
You really need to do a little bit more sophisticated test and that is the
intracellular evaluation.

Dr. Myers: Just so people understand, what’s in your serum, it has to get into
your cell which is where most of these reactions take place and where this
conversion of T4 to T3 is taking place. And also, particularly if you’re taking a
supplement, a multivitamin that has selenium, you might have plenty of it in
your serum, but it might not be able to get in.

Or not necessarily with selenium, but in the case with folates and B vitamins,
if you have certain mutations you might not be able to make those
conversions into the activated forms and you might need even more. So it
always is important when you’re looking at testing, and I talk about this in my
book, to make sure you’re getting the right type of testing for what you’re
looking for.

Dr. Perlmutter: I would give a plug for your book because one thing about the
way you write is it’s really actionable. And I’m not sure if I put that in the
blurb. I might have, but I was thinking about it that you write so well and the
information is great. It gives a great understanding, great explanation. You
gain that. But what’s most important is, ok, now that you have that, what am
I supposed to do? And I applaud you for doing that. That’s a great approach.

Dr. Myers: Thank you. I appreciate it. People can get overwhelmed. As many
of us who’ve gotten into functional medicine, I have a personal story and I’ve
been on the other end of it. And then also being in practice, as you know, you
have people in and out of your clinic every day. And so you see real life. Where
are the stumbling blocks? What is confusing for them? What seems
overwhelming? What needs to be explained better? And so being a clinician
and then writing, you know kind of where these places that people either get
overwhelmed; they’re not going to follow through because it seems too much
versus they don’t understand something.

I do, like this, like to empower people with information but then break it into
an easily, if possible, actionable step for them to move forward.

Dr. Perlmutter: That is the point. These are actions that are not going to be
purveyed on a prescription pad. You can’t take a pill to accomplish the things
that we’re talking about right now. It’s a lifestyle change. It has to do with
changing your food choices, choosing to eat more organically, choosing to
favor foods that are fermented foods that have a high prebiotic fiber content,
being super careful about the medications that you take. And, with all due
respect, I think generally people are not getting that information from their
© Amy Myers MD. All rights reserved. 16
general visit to the doctor’s office. That’s a quick in and out. You say high
blood pressure, and you get a pill. You say hypothyroidism, and off you go
with your pill. You’ve not treated the problem. You’ve only treated the
manifestations of an underlying problem that frankly has been neglected.

The word “doctor” doesn’t mean “healer”; it means “teacher.” That is our call
to action. It’s really to teach and empower people with information so that they
can make the right choices and be healthier and not require medication that
might prove threatening.

Dr. Myers: And you are definitely the definition of that with all of the book-
writing that you’ve done and the speaking that you do and engaging in
summits like this. So I certainly appreciate that.

Dr. Perlmutter: I’m happy to do it.

Dr. Myers: One final kind of topic that’s a little bit off topic. So we’ve
discussed the role of the microbiome and gut and we haven’t used the word
leaky gut, but I think that that’s what we’ve been alluding to here with
opening up those tight junctions to lead to inflammation and autoimmunity.
We’ve talked about the diet.

Some of the other things I talk about in the book are also stress, infections,
and toxins. Is there anything you want to say on any of those topics? I know
at least probably with toxins you dealt with that, mercury toxicity, when you
were dealing in your clinic with patients with Parkinson’s and
neurodegenerative disorders. Anything that you’d like to say on any of those
topics?

Dr. Perlmutter: Sure. Well, you mentioned three: stress, infections, and
toxins. Let’s start with stress. Stress is more than just a brain-related event.
When we are stressed, our adrenal glands put out more cortisol, and cortisol
increases permeability or leakiness of the gut. It also changes the various
organisms, the diversity of the organisms, that live within the gut.

And that leads to increased inflammation that is not favorable for the brain,
and that can actually ultimately increase stress response, leading to more
cortisol. So you get into a feet-forward cycle. So I think stress is really
fundamentally important globally, not just involving the brain but the entire
body because it affects this gut permeability issue or the leakiness of the gut.

Infections are an event in which inflammation is amped up, and we see—and

the literature supports this as well—that individuals who are at a certain point

© Amy Myers MD. All rights reserved. 17

on the dementia scale, in other words they’re already experiencing issues,
oftentimes with an infection, whether it’s pneumonia or urinary tract
infection, will have a fairly dramatic drop in their cognitive performance. And
we see this all the time.

Again, it is a testament to the significant damaging effects that these

inflammatory chemicals called cytokines have upon the brain. In this day and
age, unfortunately every infection, even if it’s viral, seems to be treated with an
antibiotic. If you have a cold, you get an antibiotic. And as we’ve talked about
earlier, this has a huge damaging effect upon the microbiome and leads to
increased gut permeability.

Now the last issue you mentioned is toxins. And I think that there are many
things we could be talking about, but I’d like just to recap this notion that
glyphosate, the active ingredient in Roundup, this herbicide, is to me the
biggest toxic event on the planet, not just for humans but really for all living
things. Why would it be an issue for an olive tree, for example?

As I mentioned, I was in New Zealand. I took a picture of an olive grove, and

they don’t spray the olive tree with glyphosate. But they spray around it to
clear out the weeds. And that kills the bacteria that live in the soil, and now
the farmer’s telling me for the first time ever we have fungus in the olive trees.
We’re having to treat them with fungicide on the very food that they then make
olive oil out of. So it’s a very, very big problem.

The earth has its own microbiome. The atmosphere has a very rich
microbiome. Bacteria and other microbes that live in the air we breathe
actually play a role in controlling the weather of the planet. Georgia Institute
of Technology researchers went up to 36,000 feet and were sampling the
atmosphere. The ocean is rich with microbes that have a huge role to play in
the health and vitality of our oceans, and the soil is so rich with microbes as
well. It’s a much bigger picture than this anthropocentric view that what is the
human microbiome all about and how does it affect health? That’s a big topic.
That’s lifelong dedication there.

But we’ve got to understand that everything we do that is toxic affects not just
us but every living thing around us. Chief Seattle said that, “Man did not
weave the web of life. He is merely a strand of it.” My conclusion here is that
it’s a huge concept of our interrelatedness with everything on this planet that’s
alive, and these implications—when we’re using toxins like glyphosate—
transcend just what they do to humans. It’s a global event.

© Amy Myers MD. All rights reserved. 18

Dr. Myers: Yeah. I think back to an article. I believe it was about wine
making, and they were using the oak barrels for the wine. And someone had
come in and complained that—not the FDA, but a regulatory agency—that in
the oak barrels there were cracks. And in the cracks there were bacteria.

And that could potentially make somebody sick and were telling them they
needed to go to steel barrels. It has completely changed the dynamic of the
wine, and more people have actually gotten sick because the steel is almost
too clean and it harbors the bad bacteria. Whereas, the oak barrel had almost
like its own microbiome living within the cracks of the wood. It had these good
bacteria helping to ferment the wine and keeping out the bad bacteria.

I think back to when I was little. I unfortunately can’t tolerate diary now but
making yogurt with my mother when I was very little. Just homemade, organic
yogurt and talking about the microbiome and your gut bacteria way back
when which was well ahead of the times. I love water kefir now and actually
got back into that after your most recent book. I’d been kind of avoiding it
because I don’t do well with coconut, and I don’t do well with dairy. So I
thought, “Well, what am I going to do?” And I think you had a recipe for water
kefir, and I thought, “I’m going to get back into that.”

Dr. Perlmutter: I would say don’t give up either because I think as time goes
on as you continue to really keep the pressure on to improve your gut health
that your dietary tolerances will improve, and you’ll find that you’re going to
tolerate a lot more in terms of looking back at those things that you
traditionally had issues with. We see that all the time.

The idea that bacteria in the oak of the wine might present a problem—how do
you make wine for crying out loud? It’s made from things that are in the dirt.
We were in Corsica last year, and we were at one vineyard. And this
winemaker was explaining to us how vital not just yeast but all the organisms
that live in the soil are for the health of the vine and the taste and quality of
the grapes that make the wine. We had just stumbled in off the street, and he
didn’t know my interests.

And I said, “I kind of know a little bit about what you’re talking about.” And he
said, “Well, if you’re interested in this, you must fly to France and meet Dr.
Claude Bourguignon and his wife Dr. Lydia Bourguignon. I said, “Great,”
because they’re experts in the soil microbiome.

I said, “Sure, we’ll get him on the phone and call him.” He said, “No. No one
can call him. You cannot call Dr. Bourguignon.” It was like that scene in the
Wizard of Oz when Dorothy knocks on the door and they say, “No one gets to
© Amy Myers MD. All rights reserved. 19
see the Wizard of Oz.” But I guess my wife was wearing the ruby slippers at
that point, so next thing you know we were having coffee with the
Bourguignons. And he was really laying it out in terms of how extensive
glyphosate is in terms of winemaking, that more than 80% of the wines made
in France, in Burgundy, the vineyards are treated with glyphosate. And it’s
especially prevalent in champagne.

So but there are people out there that are trying to light the single candle and
not curse the darkness. I think you have to curse the darkness a little bit to
get attention, so we do that. But I think at the end of the day we’ve got to light
the candle and give people, as you do, the answers in terms of what they can
do in a positive way. So that’s what I hope for, for moving forward.

Dr. Myers: Me, as well. We just bought a couple of acres and are moving
further out of town so I can have my organic garden.

Dr. Perlmutter: That’s terrific.

Dr. Myers: And whatnot again, getting back to my days of being a farmer in
Paraguay. Not to give up, but just to sort of empower myself that I don’t have
to…

Dr. Perlmutter: Set the example too.

Dr. Myers: And we’re building a mold-resistant and completely chemical-free

house, so I’m moving into other areas of health. That could be a whole other
topic in and of itself.

Dr. Perlmutter: For you, it’s not do as I do, not as I say. You’re walking the
talk. Again, as you continue to write based upon your personal experiences,
that has a lot of traction. A lot of people write books, “Here’s what my
thoughts are.” But when I write, for example, what it was like to lose my father
from Alzheimer’s disease and my own personal health issues, I think we’re all
on the same side. We’re all trying to be healthy and live a long life and be
disease-resistant. It’s a good perspective. No one’s immune from any of this
stuff.

Dr. Myers: No. And even if they think that they are, like my husband, one day
it will catch him. So luckily…

Dr. Perlmutter: Oh gosh. God forbid.

Dr. Myers: Well, no. Hopefully not because I’m doing all of these preventative
measures, right, with him. He’s the man of steel.
© Amy Myers MD. All rights reserved. 20
Before we part ways, I like to always leave our listeners with three take-home
points from your talk of how people can help themselves, help their thyroid,
help their microbiome, whatever you’d like to leave them with today.

Dr. Perlmutter: Ok. Well, point one is you’ve got to care for your microbiome.
That is fundamental for your health, through all the things that we talked
about today: the dietary issues, the avoidance of medication, having children
not born by C-section if that’s possible. So point one is to really focus on
gaining an in-depth understanding in terms of how valuable to you are these
microbes that live within you.

Step two, and this may be a bit of a surprise and I’m not ranking these. But
step two is you’ve got to resume aerobic exercise. There are so many gene
pathways that are activated when you are exposed to that level of energy
consumption, not the least of which are pathways that make a chemical that’s
fundamentally important for preserving your brain. So 20 minutes minimum
of aerobic exercise every day. Target heart rate would be 180 minus your age.
Of course, that depends on the condition you’re in.

And number three, and again they’re not ranked, is you’ve got to cut the carbs
and sugar. Eat more fat and eat more prebiotic fiber. If I could get people to do
those three things, I think it would have a huge impact on their health.

Dr. Myers: Real quick with the exercise because we didn’t talk about that
much. Is that continuous 20 minutes of your heart rate sustained?

Dr. Perlmutter: Sustained. Yes. Now, interval training I think is wonderful. I

think weight training is awesome. I think flexibility training is terrific, but the
main thing that has been demonstrated from research from the University of
Pittsburgh, for example, is that that sustained elevation of heart rate is really
what you need to accomplish.

Dr. Myers: And for those people who maybe are struggling with chronic
fatigue, fibromyalgia, severe hypothyroidism, [inaudible], multiple chemical
sensitivity and can’t get there, where do you recommend they start? I always
recommend sauna. I don’t know that they’re going to get their heart rate up
that high but at least to start people who can’t do much movement. Do you
have any recommendations?

Dr. Perlmutter: I would say what is that level of movement that you can do? If
you have just enough energy that you can get out of bed and walk to the
kitchen and you have to go back to bed, let’s just start there. Because
tomorrow I’m going to ask you to do that twice and go right back to bed. And
© Amy Myers MD. All rights reserved. 21
the next day we’re going to go three times, and by the end of the week I’m
going to say, “I want you to try to walk out to the mailbox and come back.” I
think that everybody can pick it up or at least can try. So many people kind of
resign themselves and say, “I just can’t do it. I’m not going to do anything
aerobic because I can’t jog three miles.” I’m not asking you to. I’m asking you
to walk to the end of your driveway and back if that’s the best that you can do.

I’d say anything that you can do to get the ball rolling is really going to break
the ice and get you started.

Dr. Myers: Great. Great advice. Dr. Perlmutter, it’s a pleasure as always.
Thank you so much for everything you’ve done for me. Thank you for what
you do for the world and thank you for being you.

Dr. Perlmutter: Well, Dr. Myers, I appreciate it. We always have terrific
conversations and I’m always thrilled to hear all the new things that you’re up
to so my pleasure.

Dr. Myers: Thanks everybody for joining the Thyroid Connection Summit:
Why You Feel Tired, Brain-Fogged, and Overweight and How to Get Your Life
Back. Thanks again for joining us and stay tuned for more talks tomorrow.

© Amy Myers MD. All rights reserved. 22