Book Review: Grain Brain by David Perlmutter.
Background: It was published in 2013 by Dr. Perlmutter, who is a neurologist.
Synopsis: Dr. Perlmutter provides a rigorous scientific review of 
brain metabolism, particularly of destructive effects of grain-based carbohydrates (including whole grains), but also includes fruit, alcohol (specifically beer), any gluten-containing products, and more. It is complete with a recommended ketogenic-inspired dietary plan at the end. Many claims of cured diseases were made throughout the book, as well as sweeping claims of improved quality of life measures (better sleep, more energy, etc).
Strengths: We wholeheartedly agree that many neurological conditions may be linked to chronic diseases and dietary choices, and this is an epidemic which plagues modern society. In many ways, we’ve traded quality for convenience of food, and there does appear to be a price to pay. In this book, Dr. Perlmutter focuses on this point, and takes a deep dive into his proposed mechanisms for disease states, accompanied by discussion of available supporting scientific basis. There is much molecular biological background for his hypothesis, which he explores thoroughly. I appreciate the discussion regarding the oxidative effects and aging properties thereof, as this is accurate and much research is being conducted in this direction presently. In fact, Anti-Aging Medicine is a rapidly expanding branch of lifestyle medicine. This is directed towards addressing those underlying ROS and oxidative damage, and is a topic of interest at MIND.
Recent literature has supported some of his claims regarding limitation of carbohydrates for certain populations, with encouraging results within these populations. In the general population, recent literature suggests the ketogenic diet may be useful as a short-term weight loss option, but is not routinely suggested long-term. There are many reasons for this, and I appreciated his discussion about a few of the disease states which may benefit from this type of diet. He discusses an exhaustive list of which foods may not be “allowed” on a ketogenic diet, and I appreciated his addition of an instructional diet plan.
We appreciated his review of prior dietary recommendations: the High Carb-Low Fat recommendations of decades past. We agree that modern scientific data does not support Low Fat options; instead, we favor a whole food approach, including a diet in whole-food, plant-based healthy fats, in moderation.
Weaknesses: The supportive literature is now a bit outdated; it seems there was some selection bias with regards to the literature presented- it was heavily biased toward his hypothesis; much research has taken place since Grain Brain was published, which provides physicians with more evidence on which to base further dietary claims (this is to be expected, as such is the dynamic and ever-changing nature of medicine). Certainly, there is literature in support of a ketogenic-like diet, but there is much evidence supporting other, less restrictive diets as well, such a the ever-popular DASH and Mediterranean Diets, or the new darling of the dietary world- the Whole Foods Plant Based Diet. There is evidence supporting specific diets for disease populations, as well, suggesting that a one-size-fits-all ketogenic diet may not be the best approach.
The sweeping claims of “cured” disease is a dangerous claim, in our opinion. There was inadequate data to support such a claim within the book; presentation of the claims and the cases within a peer-reviewed paper or conference would lend credibility to these claims. From a physician’s perspective, it feels as though the book is carefully crafted to sell one particular product (his Diet Plan, showcased in subsequent books). If it sounds too good to be true, it may be too good to be true.
With regards to the dietary plan, it seems too restrictive for most people. I find it odd that he spends so much time discussing how high fat foods were wrongfully demonized in years past (I would agree with this statement), only to demonize another large food group (similar hasty generalization with sweeping claims- another logical fallacy). He recommends a large gluten sensitivity panel (may not be covered by insurance), but we also think that the chemicals and pesticides may be another culprit (or the bigger culprit) of development of some neurological diseases given recent literature.
How does this align with the MIND practice? At MIND, we believe that a diet plan should be individualized based on patient preference, feasibility, sustainability, and evidence of success for that specific disease population.
Bottom Line: The best diet is the one which you can follow long-term. In other words, the best diet is the one you can “stick with.” If Dr. Perlmutter’s proposed diet seems intolerable to you, do not despair. There are many other attractive options!