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Diabetic Grain Brain

Later this month a renowned neurologist will publish an important book about how wheat, carbs, and sugar are destroying our brains. While all of us have some interest in our brains, what could this have to do with diabetes?

The connection is actually too close for comfort. Having diabetes doubles your risk for Alzheimer’s disease, the most dreaded form of dementia. In fact, many people, like Mark Bittman in The New York Times, are beginning to say that Alzheimer’s is type 3 diabetes. You may also want to read “Alzheimer’s Disease is Type 3 Diabetes” in the Journal of Diabetes Science and Technology.

Adding dementia to the well known list of complications of diabetes is enough to give anyone pause. But not to worry. Diabetes doesn’t cause anything, as I wrote here two years ago at “Diabetes Causes Nothing.” Well managing diabetes is the leading cause of nothing. Poor management causes all of these complications. Including Alzheimer’s.

The new book is, Grain Brain: The Surprising Truth About Wheat, Carbs, and Sugar — Your Brain’s Silent Killers. The author is David Perlmutter, M.D., is the president of the Perlmutter Health Center in Naples, Florida. This is his fourth book about how our brains work — or don’t work.

Dr. Perlmutter has a short YouTube video, which is well worth a couple of minutes of your time. In it he says, “I wrote the book as a response to my daily challenge in my medical practice, when people say, ‘Why didn’t I know this information?”

Hardcover, Kindle, and audio editions will come out on September 17. I reviewed the book courtesy of an unsolicited copy from Little Brown, and Company, a subsidiary of Hatchette Book Group.

Dr. Perlmutter’s new book builds not only on the experience of patients in his practice but also on published scientific findings that are slowly building the case against sugar, the so-called healthy grains, and the high-carb diet that our medical establishment has been preached to us on the basis of the most flimsy evidence. Ever since 1975 when William Dufty wrote Sugar Blues, we have known some of the dangers of sugar, particularly fructose, amply demonstrated by Robert Lustig, M.D.,in “Sugar: The Bitter Truth.”

William Davis, M.D., showed in his recent book Wheat Belly three excellent reasons for us to avoid eating any wheat. And Gary Taubes made the comprehensive and persuasive case for us to follow a very low-carb diet in his 2007 book, Good Calories, Bad Calories.

Now, Dr. Perlmutter pulls it all together in his new book, a tour de force that is destined to save many lives.

“The best diet focuses on good fats,” he told Baking Business what they clearly didn’t want to hear but reported anyway. “There are certainly plenty of bad fats out there — hydrogenated fats and trans fats — and I am surely not referring to them. Good fats from eating olive oil, avocados, nuts, seeds, fish, grass fed beef, goat cheese, and fish oils are fundamentals for health, while carb-derived calories as one might get from things like bread, pasta, potatoes, below-ground vegetables, fruit and fruit juices are really things that you want to do your very best to avoid for a brain-healthy diet.”

As I read this important and well-written book I found myself nodding my head vigorously in agreement at practically every page. Only one of Dr. Perlmutter’s recommendations brought me up short, that we eat yogurt only sparingly.

So I asked him. “Thanks for your question about yogurt,” he replied. “Overall, while full-fat Greek yogurt may be available, many people believe that they can choose any unflavored yogurt and they will be in the clear. Typically these yogurts, including full-fat Greek, may contain as much as 11 grams of sugar per serving, and while that may not seem like a lot, our endeavor is to keep total carbs between 60-80 grams daily. That’s why we recommend limiting but not necessarily abandoning their consumption.”

The Fage plain full-fat Greek yogurt that I keep in fridge has 9 grams of carbs per serving. However, it’s actually much less. “For a standard 8-ounce container of plain yogurt, which usually says it has about 12 grams of carbohydrates, you need to count only 4,” write Drs. Jack Goldberg and Karen O’Mara with my friend and colleague Gretchen Becker in their book The Four Corners Diet. “This is not just speculation. Dr. Goldberg has actually measured the carbohydrate content of yogurt in his own laboratory.”

Yogurt remains an important part of my diet, although in almost every other respect I was already been following Dr. Perlmutter’s recommendations. However, I learned that some foods I eat from time to time do contain gluten. I was surprised to learn that blue cheese, imitation crabmeat, roasted nuts, and sausage are part of his long list on pages 68-69 of gluten-containing foods. I have already changed my eating habits.

I did a little better on his self-assessment of 20 risk factors for neurological problems, pages 15-19. I have only one of these “habits” that could be silently harming me right now. It’s my “habit” of having diabetes, something that I would love to change but at least I control. And well managed diabetes doesn’t cause anything.

This review is already too long. But I can’t quit without letting you know what kind of person Dr. Perlmutter is. This is how he defines what he does on his website:

“What is a doctor? This word derived from Latin doesn’t mean healer, it means teacher – one who gives people the knowledge they need to facilitate their own healing processes and achieve a state of well-being.”

His new book gives us what we need to know to be well again. Please read it.

This article is based on an earlier version of my article published by HealthCentral.

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  • Laura at

    Hello David,

    Regarding yogurt: Don’t give it up! Learn to ferment your own 24-hour yogurt and reduce the lactose to virtually nothing. Let the probiotic bacteria eat your milk sugars and convert it for you!

    The GAPS Diet (Gut and Psychology Syndrome Diet) and the SCD (Specific Carbohydrate Diet) are both aware of the need to alter the lactose in milk to lactase, as many children and adults react to or are allergic to either milk sugars and/or milk proteins. Allowing your yogurt to ferment for 24 – (max) 29 hours does just this; probiotic bacteria consume all the lactose and convert it to a user-friendly lactase AND the milk proteins are altered, reducing the possibility of allergies to milk proteins. In addition, you have an incredible supply of daily probiotics for pennies what it would cost in the store.

    Recommendation is to use organic, whole, pasteurized (not homogenized), grass-fed milk or organic, whole, grass-fed raw milk, if available and if you are comfortable with it and know the source.

    You can make a Greek-style yogurt by allowing your finished product to drain through cheesecloth for an additional 24 hours in the fridge, separating out the liquid whey (which can, itself, be used to make fermented vegetables and is a valuable food).

    Most commercial yogurts ferment their yogurt for a brief period (I’ve heard 1 hour or less is not unusual. (!!) I checked with a local organic dairy, a brand very popular here in the northeast, and they allow their yogurt 7 hours fermentation time.) Even at 7 hours, this means that the product still contains a significant amount of milk sugar. With 1 hour or less incubation time, hardly any milk sugar has been converted to lactase …making commercial yogurt (even plain, full-fat “organic, natural” yogurt) a very nice, sweet dessert with little food value and few, if any, probiotics.

    In addition, many commercial yogurts add milk powder, milk solids and milk protein (increases lactose even more) and fillers to make it APPEAR thick (gelatin) and (your favorite) sweetener, and some even re-pasteurize their yogurt after it has fermented, DESTROYING the probiotics!

    Finally, some commercial yogurts only use 1 probiotic strain or combinations of strains that are not ideal for a human gut.

    Do the companies regularly test their products on the shelf to determine if the probiotics are even alive? I don’t know.

    Make your own; it is easy and the quality is 100% better than anything you can buy in a store.

    Some yogurt science:



    Here are some GAPS / SCD yogurt recipes:





    Sensitive to cow’s milk? Try goats’ milk yogurt:

    For those of you who know full-fat is NOT bad for us, try this heavy cream yogurt (“sour cream”); this is unbelievably good!:


    David, it would be nice if you could do an article on commercially-made yogurts (include all the “organic, natural” brands, as well); get the truth out there about how inferior a product we are buying …at great cost …compared to what we can make in our own kitchens with the help of local, organic farmers and their cows and goats!

    Diabetics do NOT have to give up this wonderful food!

    • David Mendosa at

      Dear Laura,

      Great comment! Thank you so much for that.


  • Debra Bailey at

    Thank you!

  • Debra Bailey at

    Greetings, David

    I enjoy your blog and learn much from it. I was wondering if you knew of a source for calculating carbs for homemade Greek yogurt? I’ve recently started making my own to save money. I use Vitamin D milk and 2% Fage as a starter. Thank you!


  • ChandraShekar.r at

    Thanks for the valuable information.Nice review