A Recipe For a Best Selling Health Book. Review of Grain Brain

My dream is to write a book on health that will sell millions of copies. I’ll introduce a great new dietary solution. I already have a strategic plan. Firstly, I am going to select a target group. Obviously, it has to be a large group of people.


I’m going to write exactly what my target audience wants to hear. I’m pretty sure what it is. I am going to refer to the scientific literature (when it suits me). This will be expected of a doctor. However, I’ll only cite papers that support my dietary solution. Otherwise, I might confuse my readers.

I’ll definitively challenge mainstream medicine and public health guidelines because I know my readers will love that.

My target will probably be Paleo and low carb enthusiasts, mainly because this is a huge and rapidly growing group. Furthermore, these people are often very interested in nutrition and how to improve health. I know that for a fact because I often consider myself to be among them.

There are certain issues I know my readers will love to hear. I’ll tell them that many of the things government and official guidelines say about nutrition is wrong. I’ll tell them that eating lots of fat is good and will protect them from getting dreadful diseases like heart disease, depression, Parkinson’s disease and Alzheimer’s. I’ll tell them that if they eat carbs, grains in particular and even fruit, their brains will get sick. I’ll tell them that gluten is dreadful. I’ll tell them that cholesterol is good and that statins (cholesterol-lowering pills) are bad.


Carbs and Brain Disease

Carbohydrate restriction has now been accepted as an effective method to lose weight among obese individuals. A year ago I wrote a blog article pointing out several health benefits of such a diet. In my dream book, I will take this a step further. I will suggest that eating lots of fats and very few carbs will protect your brain. Although there are no studies available to confirm this, I will be able to create an angle to prove my point.

It’s a scientific fact that diabetes is a risk factor for getting Alzheimer’s disease. More interestingly, a recent publication in the highly respected New England Journal of Medicine suggests that higher blood sugar levels may be a risk factor for dementia, even among persons without diabetes. Furthermore, a study published last year suggested that a dietary pattern with relatively high caloric intake from carbohydrates and low caloric intake from fat and proteins may increase the risk of mild cognitive impairment or dementia in elderly persons.

In one study, subjects with Alzheimer’s and vascular dementia had a high predilection for sugar and sweet foods. In the National Health and Nutrition Examination Survey, a dietary pattern with a high percent fat was associated with better processing speed, learning, and memory; in contrast high percent carbohydrate was associated with poor processing speed .

This is all highly interesting. Having diabetes and high blood sugar is a risk factor for dementia. So possibly, eating less sugar and more healthy fats might cut the risk of dementia. It’s certainly a hypothesis that deserves to be tested. However, I will need some real stuff for my book. Something more provoking. Nobody wants to read about an unproven hypothesis. If I could claim that all carbs are bad for the brain I might get noticed.

So, I will claim that avoiding all grains and eating lots of fat will protect your brain. I will provide citations to support my case. I’ll not make any distinction between refined grains and whole grains. My readers will accept that. It’s all sugar molecules anyway. I’ll tell my readers that sugar and carbs cause inflammation. Inflammation is an essential part of dementia and many other neurological disorders.

I know whole grains are rich in fiber, B-vitamins, Vitamin E, and often omega-3 fatty acids. They are important sources of minerals. Whole grains are one of our most important source of magnesium. Magnesium consumption has been associated with less inflammation in post-menopausal women. However, I will not confuse the readers of my book with this information.

Diets with a relatively high glycemic index (GI)were found to be associated with inflammation in a large group of women participating in the Harvard Women’s Health Study.

Fiber consumption was associated with less inflammation in seven different studies. Although the mechanisms underlying the associations between GI and inflammation are not fully clear, some data shows that  rapid changes in blood sugar levels may increase free radicals and pro-inflammatory cytokines, leading to inflammation.

In general, whole grains are associated with less inflammation than refined grains. This may be due to one or many of  the active constituents of whole grain which may include dietary fiber, minerals, vitamins and phytochemicals. Again, I will not include this information in my book because I want my message crystal clear.

The health effects of the Mediterranean diet have been intensively studied. This diet contains fruit and whole grains. A recently published systematic review of eleven published papers addressing cognitive function and dementia found that greater adherence to Mediterranean diet is associated with slower cognitive decline and lower risk of developing Alzheimer’s disease.

However, I will probably not mention this in my book. If I decide to do it I will tell my readers that my diet solution is indeed quite similar to the Mediterranean diet. Of course this will be a bit misleading, but I guess the end justifies the means.


Diet, Cholesterol and Health

I am going to put a lot of weight on the cholesterol issue. I have to convince my readers that cholesterol does not cause disease. In fact, I want to tell them that cholesterol is good. My arguments will be based on the important role cholesterol plays in our bodies. My main conclusion will be that eating fats, including cholesterol, will prevent brain disease.

We recently learned that statins increase the risk of diabetes by approximately 9 percent. Here, I can cite recent studies and more importantly, I can have an attack on the pharmaceutical industry which my readers will love.

I’ll explain how diet affects our cholesterol levels. When we measure blood cholesterol it is important to understand that 75-80 percent of the cholesterol measured is manufactured by our body, primarily by the liver. In fact, foods that are high in cholesterol tend to decrease the body’s own production of cholesterol. However, despite the body’s great capacity to produce cholesterol, I am going to convince my readers that our body prefers that we “spoon feed” our cholesterol from the foods we eat. Then we don’t have to unnecessary strain our liver. Of course I don’t have to provide any scientific citations here. My readers will know I know what I’m talking about.

I am going to explain what happens if you restrict your cholesterol intake. Then the body sends out an alarm to indicate crisis. The liver starts to use carbohydrates from our diet to produce an excess supply of cholesterol. In a recently published book (Perlmutter D, Grain Brain, p.99) this was called a Molotov cocktail in the works. When you consume high amounts of carbs, and avoid eating cholesterol, you force the liver to over-produce cholesterol, which is really bad. Okay, I’m suggesting that cholesterol is bad for the body if you don’t eat it, but good for your body when you consume lots of it.  So cholesterol is good and bad….. ough…

Of course this does not make sense, but the only solution to stop this terrible and uncontrolled overproduction of cholesterol is to back of the carbs and eat more cholesterol (Perlmutter D, Grain brain, p.99). Obviously, I am not going to cite any scientific studies in relation to these magical explanations.


Studies have indicated that there is an inverse relationship between blood levels of total cholesterol and depression. This implies that people with depression generally have lower cholesterol levels than those without depression. I will use this to convince my readers that low cholesterol causes depression. Of course they will know that correlation does not imply causation, but I believe they will accept my claims because it fits into our general concept.

Of course, I will not confuse my readers by telling them that there are several non-mutually exclusive explanations for the negative association between depression and total cholesterol. Depression is known to impair appetite in some individuals. In addition, depression is associated with cytokine activation, which can impair cholesterol synthesis.

A review of randomized clinical trials concluded that we do not have sufficient evidence that cholesterol-lowering therapies increase the risk of depression and suicide. Clinical trials with cholesterol-lowering drugs have not found any mood decrements. However, I will stick with the explanation that fits my picture and my claim that low cholesterol causes depression


One of the most effective ways to apply to male readers is to touch on the problem of impotence, how to avoid it and how to improve sexual performance.

I will devote a chapter to the issue. I’ll write that one of the most common reasons for impotence is “abysmally low cholesterol levels” (Perlmutter D, Grain Brain, p. 101). Low testosterone levels may prevent both women and men from having a hot sex life. Testosterone is made from cholesterol, so obviously higher cholesterol is better than lower when it comes to sexual performance. This is a logical assumption and easy to understand so I don’t have to refer to any scientific studies. I’ll point out that decreased libido is common among individuals taking statins. I am not going to mention that this might in many cases be due to underlying vascular disease. I will assume the problem is due to low cholesterol. I might actually provide a couple of references to support my view.

I will definitively not refer to a paper from 2012 which is a critical summary of current evidence on cholesterol, statins and impotence.  The authors of this paper point out that epidemiological studies have shown that elevated cholesterol and reduced high-density lipoprotein cholesterol levels are associated with an increased risk of erectile dysfunction (ED). They highlight that although it appears that statins may sometimes cause ED, other studies have demonstrated that statins can lead to an improvement of erectile function.

Statins improve the function of the endothelium (the innermost layer of the artery) and restore endothelium-dependent relaxation which may improve blood flow and ED. Furthermore, the authors also point out that studies on the relationship between statins and testosterone production in males show contrasting results.

A randomized study of men with ED published earlier this year showed no clinically significant change in erectile function as a result of statin treatment compared with placebo. However, simvastatin significantly improved the sexual health related quality of life.

So, the association between cholesterol, statins, and impotence is complicated and not entirely clear. However, I will make it easy for my readers: low cholesterol causes low testosterone which causes impotence. Simple and very easily sold and bought.

 My Dream Book

At the end of the day, I realize that my dream book will not be published. I have two unsolved problems. Firstly, somebody came up with the idea before I did. And secondly, I didn’t really enjoy that particular product, mainly because it is plagued with information bias. So I’ll have to live with the fact that my best seller will never hit the shelves.


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