Book Review: "Brain Maker" by David Perlmutter, MD

David Perlmutter, neurologist, is the New York Times #1 bestselling author of Grain Brain, which came out a number of years ago. This year he released a new book, Brain Maker: The Power of Gut Microbes to Heal and Protect Your Brain - for Life, in which he delves into the human microbiome's impact on neurological health. However, I would say this book was more about the microbiome than about the brain.

Summary

In the book, he addresses the relation of the human microbiome to inflammation and the immune system, moods and anxiety, obesity and appetite, autism, autoimmune disease, and more. The focus of each of these topics is on the human gut and "bugs" that live there, regulating and impacting every body system.

The first half of Perlmutter's book is remarkably similar to the first half of NCM's Gut and Psychology Syndrome. However, being more recent, Perlmutter includes some fascinating new information about the human microbiome that has only developed in the past several years. After establishing the point that "you are what you eat,"Perlmutter discusses how our friendly microbes help and protect us throughout our life from birth to death. He emphasizes their many functions, including: aiding in digestion and absorption of nutrients; creating a physical barrier against invaders; detoxifying; influencing immune response; producing enzymes, vitamins, and neurochemicals; helping handle stress; assisting sleep; helping to control inflammatory pathways. Then he goes into more detail about how our microbes specifically impact our brain and neurological health. He addresses several more specific topics over several chapters, focusing on various body systems: the gut, immune system, endocrine system, etc. He discusses a number of case studies he has personally treated - a client with autism, one with MS, etc - who made remarkable recoveries just by changing their gut microbiology. He spends a chapter addressing various assaults to our microbiome: antibiotics, NSAIDS, the pill, environmental chemicals. In the last part of the book, he gives advice for how to rehabilitate a damaged gut. His recommendations are helpful, and in many ways, very similar to the GAPS diet, however, he doesn't take his healing protocols as far as NCM. He finishes the book with some helpful recipes, mostly for fermented foods, some of which look quite good.

The Long and the Short of It

Since Dr. Perlmutter's book is more up-to-date with recent research, I was interested to see if it added anything new to my GAPS knowledge. Here is my summary of the similarities and differences between his and NCM's book:

Similarities:

• Perlmutter and NCM both start at the same place: with the famous Hippocrates quote, "All disease begins in the gut." Their philosophy of disease and nutrition is pretty much identical. Their focus on the human microbiome for healing disease is the same.
• Perlmutter and NCM agree on the basics of what makes a healthy diet: healthy fat, low carb, moderate protein. 
• Perlmutter and NCM have very similar supplement recommendations: a good probiotic, DHA/EPA, coconut oil, ALA, vitamin D. Additionally, Perlmutter strongly recommends turmeric for its anti-inflammatory action.
• Perlmutter and NCM both recommend probiotic enemas.
• Perlmutter and NCM have similar opinions on natural birth, breastfeeding, and antibiotic use.
• Both books are well-documented - there is a long section of notes at the end with citations of research.

Differences:

• Perlmutter discusses a number of more recent developments and studies in the field of the human microbiome that are helpful. Since his book was written this year, it is obviously more up-to-date on its research.
• Brain Maker strongly recommends prebiotic foods, and discusses how research has shown prebiotics to increase levels of friendly flora while diminishing the "bad guys." This is slightly different from NCM, who recommends a specific carbohydrate diet to reduce prebiotic substances that she believes will feed the bad flora as well as the good.
• Perlmutter's dietary recommendations for healing the gut microbiome are far less intensive than NCM's protocols. For people who aren't yet very sick, this might work; but for those of us who's health is completely broken, it likely won't be enough.
• Perlmutter strongly recommends consumption of tea, coffee, chocolate, and red wine, while NCM is more cautious about adding these to the diet. NCM's protocols advise adding these only in small or weak amounts after some healing has taken place.
• One of the recent medical developments that Permutter champions is the FMT (fecal microbiota transplant). He describes several case studies where patients made remarkable recoveries from neurological diseases in response to FMT treatments.

All said and done, here's what I personally took away from the read:

• Use NCM's introduction diet protocols if you need to do some serious healing (I know I did! I still don't regularly consume all of the full diet foods 2.5 years later!).
• Be more open to adding prebiotic foods at the right time. Let your body tell you when it is ready. If prebiotic foods create symptoms, you aren't ready. But at some point, once you have detoxed a good number of the bad flora, your body needs them to establish and maintain a healthy microbiome.
• Be more open to tea, coffee, chocolate, and red wine as tolerated.
• Definitely incorporate probiotic enemas into your healing regimen.
• Consider FMT as a viable option when other means fail.
• Be encouraged that the science of human microbiome manipulation for healing of disease is developing rapidly. NCM is definitely not alone. There is significant research backing this approach to nutritional healing. Don't let your doctor tell you otherwise.

Conclusion

I highly recommend  Dr. Perlmutter's book, and am grateful to him and others who are championing human microbiome science and using natural nutrition to heal their patients. You can buy his book on Amazon, or if you are on a budget (like me) you can probably borrow it from your local library. Dr. Perlmutter also has a website with lots of information and summaries of his other books and cookbooks.