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March 05, 2019


The premise of this book is how wheat, carbohydrates and sugar contribute to a variety of disorders including Alzheimer's, diabetes and other maladies that affect how the brain functions and its ability to fend off disease. Perlmutter explains that eating carbohydrates stimulates insulin production, which leads to fat production, fat retention, and a reduced ability to burn fat, all of which affect our cognitive abilities. He goes on to explain how carbohydrates increase blood sugar, which in turn increases insulin release. The resulting high insulin can lead to insulin resistance which affects the bodies cells ability to absorb glucose, so glucose remains in the blood causing inflammation. Perlmutter links insulin resistance and the resulting inflammation to the formation of plaques that are common in diseased brains, particularly in Alzheimer’s disease.


That’s an extensive chain of cause and effect events, but Perlmutter breaks down the different causes throughout the book along with the various effects they have on the brain. Perlmutter argues that the causes of Alzheimer's, epilepsy, chronic headaches, depression and other brain disorders aren’t genetic, but rather dietary. The book goes on to explain how all the grains that many of us consider healthy, like whole wheat, multi-grain, etc., are actually health hazards that wreak havoc on our brain and accelerate our body’s aging process.

Inflammation, Gluten and Brain Disease

This section goes into detail about how the causes of many brain disorders are predominantly dietary. Broken down to its most basic components, this dietary cause and effect can be easier understood:

Carbohydrates cause increased inflammation and increased inflammation can cause brain disorders.

While inflammation is a natural reaction to a stressful occurrence like a sprained knee or a  mosquito bite, this inflammation creates toxic chemicals that circulate through the bloodstream. These toxic chemicals are pretty harmless when the inflammation is temporary, but if the inflammation is persistent, it creates a process known as oxidative stress that is linked to chronic diseases such as ADHD, Alzheimers and other brain disorders.


Too much carbohydrate consumption in the form of sugar leads to overproduction of insulin in the bloodstream, creating an irritant that causes inflammation. An over-abundance of sugar causes the body’s cells to become desensitized, so the body produces more insulin to get sugar into the cells, further increasing the level of desensitization. The result is a vicious cycle that can culminate in Type 2 Diabetes, and eventually, a variety of brain disorders.

Since carbohydrates contain gluten, over-consumption can create an allergy known as Celiac disease. Perlmutter argues that it’s not just people with Celiac disease who are sensitive to gluten and makes a case that, from a neurological standpoint, gluten allergies are predominant in the worlds’ population. To further exasperate the problem, gluten is addictive. Perlmutter explains that gluten connects to the same receptors as opioids and other sedative drugs.

That’s why we feel so euphoric after eating a delicious, gluten-laden donut and why we can’t seem to stop at just one. 


The Ketogenic Diet

This section continues to elaborate on the gluten and inflammation factors and introduces us to the benefits of a ketogenic diet. Using Alzheimer's as an example to explain the overall process of how, particularly in Western cultures, gluten consumption leads to inflammation and brain disorders, Perlmutter clearly explains this unhealthy domino effect. The increased inflammation that is so prevalent in Western cultures is shown to be a fundamental cause of the morbidity and mortality resulting from coronary artery disease, cancer, diabetes, and numerous other chronic diseases. The answer, according to Perlmutter, is to consume an extremely low-carb and high-fat diet.

“By far the most important fat for brain energy utilisation is beta-hydroxybutyrate (beta-HBA). This is why the ketogenic diet has been a treatment for epilepsy since the early 1920s and is now being reevaluated as a very powerful therapeutic option in the treatment of Parkinson’s disease and Alzheimer's.”

Because a high level of carbohydrate consumption leads to poor glucose control, which has been shown to produce a decline in cognitive functions, corrective measures must be taken. These measures specifically include a high-fat, low-carb diet with a focus on special fats called ketones. This specific focus on consuming ketones is at the heart of a ketogenic diet. The reduction of carbohydrates and increase of ketones results in ketosis. When the body goes into a ketosis metabolic state, the body becomes very efficient at burning fat for energy. Coming full circle, ketosis also includes a process where the liver turns fat into ketones to supply energy for the brain so it can build and maintain those healthy neural pathways that keep brain disorders at bay.  

Grain Brain Rehab

The second section of "Grain Brain" focuses on how to reverse the damage caused by the over-consumption of carbohydrates and how to maintain a healthy brain. To support the health and function of the brain, there are three key factors that must be addressed. Not surprisingly, these beneficial factors are ones that many of us are familiar with from a variety of sources about healthier living: Diet, exercise and sleep.

“Brain disease can be largely prevented through the choices you make in life.”


Having established the benefits of a low-carbohydrate, high-fat diet and explaining how the typical Western diet contributes to brain disorders, Perlmutter focuses on the necessity of including fasting as a part of rehabilitating the effects of a poor diet. Fasting capitalizes on the bodies mechanism to convert fat into vital fuel during periods of starvation. Fasting helps our bodies break down fat into those specialized molecules known as ketones. In particular, the ketone beta-hydroxybutyrate is a powerful resource for the development and maintenance of a healthy brain.


The benefits of exercise for the body and the brain are widely-researched and widely accepted as fact. Exercise has numerous positive health effects on the body with which most of us are familiar. Perlmutter makes a point to show that exercise is more beneficial to brain health than many of us may realize. The key takeaway here is that when you exercise, you literally give your genetic makeup a workout.  Aerobic exercise not only turns on genes linked to better health and longevity but it also targets the gene that codes for BDNF, the brain’s “growth hormone.” In addition, aerobic exercise and the increase in growth hormones in the brain have been shown to reverse memory decline in the elderly and increase the growth of new brain cells.


The benefits of proper amounts of sleep are well publicised and most of us can vouch for this tenet from our own experience. Perlmutter elaborates on this familiar premise by explaining how, in addition to better overall health, proper amounts of sleep maintain proper levels of leptin. Leptin, much like insulin, influences all other hormones and is responsible for your body’s rhythmic cycles and many physiological functions. When your stomach is full, leptin tells your brain to stop eating. This explains why people with low levels of leptin are prone to overeating, especially when it comes to high-carbohydrate foods, which in turn lead to excess inflammation and potential brain disorders.

Final Notes

The remainder of the book goes on to help us put everything together and develop a plan of action for reducing our intake of potentially harmful carbohydrates. Perlmutter includes a 4-week action plan and a good selection of meal plans all designed to create a healthier brain and body.

The most important takeaways of Perlmutter's book include the importance of adopting a ketogenic diet, maintaining a healthy body through exercise and getting proper amounts of sleep. The combined benefits of implementing these changes in our own lives can prevent brain disorders and possibly repair damage already present.

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