Grain Brain – Take It With a Grain of Salt

During the last couple of decades Alzheimer’s disease and other types of dementia have become increasingly common. Today it is estimated that about 34 million people suffer from Alzheimer’s disease worldwide and the number is increasing rapidly.

It is expected that the number of individuals with Alzheimer’s disease will triple over the next forty years. Therefore, preventing or reducing the risk of this incurable disease is one of the biggest challenges facing modern healthcare.

15612550_mA couple of years ago a paper written by two US researchers on how reducing modifiable risk factors might cut the prevalence off Alzheimer’s disease was published in The Lancet Neurology.

The authors pointed out seven of the most important risk factors for Alzheimer’s disease: diabetes, midlife hypertension, midlife obesity, smoking, depression, cognitive inactivity or low educational attainment, and physical inactivity.

They  concluded that a 10—25% reduction in all seven risk factors could potentially prevent as many as 1.1—3·0 million cases of Alzheimer’s disease worldwide and 184.000—492.000 cases in the USA. Most importantly, the authors highlighted that to a certain degree, Alzheimer’s disease is a preventable disorder.

In his recently published book Grain Brain, renowned US neurologist David Perlmutter points out that for years the brain has been excluded from discussion about preventive medicine. He believes that lifestyle choices play a fundamental role in determining the brains destiny. Alzheimer’s disease, depression, Parkinson’s disease and ADHD are all preventable. Perlmutter believes that the fate of our brain is in the food we eat.

In the first chapter of Grain Brain you get a feeling of where Dr. Perlmutter is going. “Brain dysfunction starts in your daily bread, and I’m going to prove it”….. “Modern grains are slowly destroying your brain”….. ” I’m referring to all the grains that so many of us have embraced as being healthful – whole wheat, whole grain, multigrain, seven-grain, live grain, stone-ground and so on. Basically, I am calling what is arguably our most beloved dietary staple a terrorist group that bullies our most precious organ, the brain”….. ” I will demonstrate how fruit and other carbohydrates could be health hazards with far-reaching consequences”….. This isn’t science fiction; it’s now documented fact”….. “This is not just another diet book or generic how-to guide to all things preventitive health. This is a game changer.”

Although it is admirable when experts deliver such a simple and clear message, this is also where we should get suspicious. Biologic science is very rarely so black and white.

Perlmutter writes: “This book is about those lifestyle changes you can make today to keep your brain healthy, vibrant, and sharp, while dramatically reducing your risk for debilitating brain disease in the future”.

Is this a sales rep talking or a medical doctor? Either way, I’m quite amazed by Dr. Perlmutter’s conviction and persuasiveness.

Sorry, but before I go further I have to tell you about a psychological phenomenon called cognitive dissonance. I believe it deserves a mention here because I think it often seriously affects how we interpret scientific data and how we present them, or decide not to present them, to other people.


Cognitive Dissonance

In December, almost sixty years ago, Dorothy Martin (alias Marian Keech) and her followers believed they would be celebrating christmas far away from planet earth. Keech claimed to have received a message from a planet named Clarion revealing that the world would end in a great flood before dawn on December 21, 1954. Her group of believers, located in Michigan, had taken strong behavioral steps to prepare for this moment. They had left jobs, college, and spouses, and had given away money and possessions to prepare for their departure on a flying saucer which was to rescue the group of true believers.

Cognitive dissonance is the distressing mental state that people feel when they “find themselves doing things that don’t fit with what they know, or having opinions that do not fit with other opinions they hold.” This produces a feeling of discomfort leading to an alteration in one of the attitudes, beliefs or behaviors to reduce the discomfort and restore balance. You can imagine the stress imposed on Marian Keech and her group when they realized that they were not going to be rescued by a flying saucer, and the second shock when realizing that Apocalypse was not imminent.

Later, psychologist Leon Festinger wrote his famous book “When Prophecy Fails: A Social and Psychological Study of a Modern Group That Predicted the Destruction of the World“. Festinger and his associates had read an interesting item in their local newspaper headlined “Prophecy from planet Clarion call to city: flee that flood.” They recruited a team of observers, joined Marian Keech’s group, and watched it from within. The story and the psychological reaction of the group members lead to the definition of the term “cognitive dissonance”.

Ok, I know what you’re thinking. Now the Doc’s gone completely mad. Telling a sixty year old story about UFO’s and Armageddon. Then trying to explain a psychological phenomenon he knows nothing about.

So, I’ll try to get back on track. One of the biggest problems with many books being written about health issues is information bias. If I have a belief or a point to make, I’m already biased. That’s quite obvious isn’t it? However, if I understand and respect scientific methods, I will present data that support may view as well as data that don’t support it. That’s honest. If I can’t make my point by doing this, I probably don’t have a case.

However many books on medical issues are written by individuals who tend to seek out information confirming their point of view and reject information on the contrary. This may be done on purpose, but it may also be done “unwillingly” to reduce the discomfort of cognitive dissonance. Okay, there you have the connection with the UFO’s.

Both medical writers and their readers suffer from cognitive dissonance. The reader usually prefers to read books or articles that support or confirm his own beliefs. Keep in mind though, that cognitive dissonance is not a disease. It’s quite normal indeed.

Remember the story about the Fox and the Grapes. It’s a classic example of cognitive dissonance. In the story, a fox sees some high-hanging grapes and wishes to eat them. When the fox is unable to think of a way to reach them, he decides that the grapes are probably not worth eating, with the justification the grapes probably are not ripe or that they are sour.

Dietary Habits and Brain Health

Let’s get back to the grains and the brain. Dr Perlmutter provides historical and scientific evidence indicating that a diet rich in carbohydrates may damage our brains. Consequently, a diet rich in fat, and low in carbohydrates will protect our brain.

In a radio interview following the publication of his book he said: “It turns out that humans have never eaten grain. In 99.9 percent of our time walking this earth we have never eaten grain. What is wrong with wheat barley and rye is that it contains this very powerful protein called gluten”…. “Grain brain was written based upon my review of about 250 peer reviewed scientific journals with specific articles dealing with gluten issue”….. “We’ve never in 99.9 percent of our time on this planet eaten carbohydrates. They weren´t available”.

How about fruit? Dr. Perlmutter must know that our ancestors were not only “hunters”, they were “gatherers” as well. The “gatherers” found their food in what came out of the ground. They ate carbohydrates and proteins in the form of fruit and vegetables. So, apparently his historical argument doesn’t hold.

A number of studies have shown that a Mediterranean type diet has favorable effects when it comes to cardiovascular prevention. Actually, Dr. Perlmutter mentions the Mediterranean Diet once in his book: “In March 2013, the New England Journal of medicine published a large landmark study showing that people age fifty-five to eighty-five who ate a Mediterranean diet were at lower risk of heart disease and stroke by as much as 30 percent – than those on a typical low fat diet. The results were so profound that scientists halted the study early because the low-fat diet proved to damaging for the people eating lots of commercially baked goods rather than sources of healthy fats. The Mediterranean diet is famous for being rich in olive oil, nuts, beans, fruits and vegetables, and even wine with meals. Although it does allow room for grains, it’s very similar to my dietary protocol. In fact if you modify the traditional Mediterranean diet by removing all gluten-containing foods and limiting sugary foods and non-gluten carbs, you have yourself the perfect grain-brain-free diet.”

Okay, if this isn’t cognitive dissonance I must have completely misunderstood the term. The Mediterranean diet contains whole grains, including gluten, and lots of fruit. These are exactly the things Dr. Perlmutter wants us to skip to protect our brains. But still, he believes it’s very similar to his dietary protocol. Doesn’t make sense to me. Anyway, why should someone switch from a Mediterranean style diet which is supported by a lot of scientific evidence to a grain-free Perlmutter type diet that is based on limited evidence.

A recipe for a best selling health book
Click on the picture for another Grain Brain review: “A Recipe For a Best Selling Health Book”

We don’t have to look further than the most recent issue of the American Journal of Clinical Nutrition to find a paper contradicting Dr. Perlmutter’s claims. The study addresses the associations between The DASH diet and Mediterranean-style dietary patterns and age-related cognitive change in a prospective, population-based study. Higher levels of accordance with both the DASH and Mediterranean dietary patterns were associated with consistently higher levels of cognitive function in elderly men and women over an eleven year period. Whole grains and nuts and legumes were positively associated with higher cognitive functions.

Don’t misunderstand me though. I’m not saying that Grain Brain is necessarily a bad book, although personally I had huge problems with it. It touches on a number of important issues relating to obesity, diabetes, brain disease and heart disease, and there certainly are some good healthy tips on nutrition and lifestyle in general. However, in my opinion, it is too biased to be taken seriously. I would have preferred if Dr. Perlmutter had addressed his issues in a more balanced manner. In my opinion “Grain Brain” should definitively be taken with a grain of salt.

Remember that Alzheimer’s disease has many risk factors, some are known and some are unknown. Maybe a grain-free high fat diet according to Dr. Perlmutter is more likely to prevent Alzheimer’s disease than a Mediterranean type diet or a typical “heart healthy diet” low in fats. However, until a scientific study comparing these diets has been performed, we don’t have they answer. Until then, nobody can claim to know what’s right or wrong.


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