The Empowering Neurologist Podcast

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Dr. Perlmutter’s groundbreaking new book, Brain Defenders, is now available for pre-order. Discover how to protect your brain and future health - reserve your copy today at https://www.braindefenders.com.
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On this episode of The Empowering Neurologist, I spend time with Dr. Trisha Pasricha, gastroenterologist and author of the provocative and important new book, You’ve Been Pooping All Wrong. Yes, the title makes you smile, but the science inside should make all of us pay attention.

Dr. Pasricha is part of a new generation of neurogastroenterologists exploring one of the most fascinating frontiers in medicine: the deep, bidirectional communication between the brain and the gut. Raised as the daughter of renowned gastroenterologist Dr. Pankaj “Jay” Pasricha and trained at Johns Hopkins, she brings both personal insight and rigorous science to a topic that too often lives in the shadows.

What makes this book so important is that it dismantles myths we’ve carried since childhood. For example, at one point in the book she describes how students taking an oral exam nearly doubled their intestinal permeability, simply from psychological stress. That single experiment powerfully illustrates how the brain can alter gut biology in real time.

And in another unforgettable section, she shares her early research showing that when subjects lied, their stomach’s electrical rhythm shifted into chaos, an arrhythmic pattern detectable on electrogastrogram. The stomach as a lie detector! That’s not just fascinating, it underscores how emotionally and neurologically integrated our digestive system truly is.

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00:00 Intro
03:05 Why We Need to Talk About Pooping
07:17 The Stigma Around Bowel Symptoms
09:31 Why Early-Onset Colorectal Cancer Is Rising
12:11 Should Screening Start Earlier?
14:59 Colonoscopy vs. Stool and Blood Tests
18:34 Ad: Optoceutics
20:35 Why Colonoscopy Still Matters Most
31:00 What “Leaky Gut” Really Means
34:42 What Worsens Intestinal Permeability
36:10 Ad: 3X4 Genetics
38:09 Gut Permeability, Inflammation, and Brain Disease
48:45 Could Fecal Transplants Help Parkinson’s?
56:52 The Different Causes of Constipation
1:02:23 The Myth of One Bowel Movement a Day
1:05:42 Final Takeaways on Gut and Brain Health
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Trisha Pasricha, MD, MPH is an instructor of medicine at Harvard Medical School and the “Ask A Doctor” columnist for The Washington Post where she translates complex medical topics into must-read insights—with a touch of humor—for millions each week. A graduate of Harvard College, Dr. Pasricha earned her medical degree from Vanderbilt University School of Medicine and a Master of Public Health from the Harvard T.H. Chan School of Public Health. Her training includes an internal medicine residency at The Johns Hopkins Hospital and gastroenterology and motility fellowships at Massachusetts General Hospital. Currently, Dr. Pasricha serves as director of the Institute for Gut-Brain Research at Beth Israel Deaconess Medical Center, leading an NIH-funded research laboratory at the forefront of gut-brain science. Her work has been published in The New England Journal of Medicine, JAMA Network Open, and Nature Reviews.

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====
Dr. Perlmutter’s groundbreaking new book, Brain Defenders, is now available for pre-order. Discover how to protect your brain and future health - reserve your copy today at https://www.braindefenders.com.
====
00:00 Intro
01:06 The Promise of Psychedelic-Assisted Therapy
05:16 Why Psychedelics Faced Decades of Pushback
09:40 Psychedelic Therapy Requires Guidance
11:27 The Failure of the “Pill Fixes Everything” Model
15:31 Risks of Unregulated Psychedelic Retreats
24:20 Psychedelics Within Integrative Medicine
25:30 Ad: Optoceutics
27:31 What “Integration” Really Means
30:08 Why Psychiatry Still Resists Psychedelics
38:52 Why Lifestyle Still Matters After Therapy
41:45 Psychedelics and Addiction Treatment
50:50 Microdosing vs Full Therapeutic Doses
53:52 Ad: 3X4 Genetics
57:28 The Rise of Ketamine Clinics
1:00:54 Ibogaine: Risks, Duration, and Safety
1:04:50 Final Thoughts on Psychedelic Responsibility
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Will Van Derveer, MD is a psychiatrist and author of Psychedelic Therapy: Restore Your Mental Health and Reclaim Your Life which will be published by ShambhalaPublications in the Spring of 2026.

He is co-founder of Integrative Psychiatry Institute, which has provided comprehensive training for 2500 mental health professionals in psychedelic-assisted psychotherapy several thousand professionals in other continuing education programs.

He is medical director of Integrative Psychiatry Center of Boulder, CO, providingintegrative psychiatry for a broad range of conditions and ketamine-assisted psychotherapy for treatment-resistant depression and PTSD.

In addition to his clinical practice and teaching, he has staffed clinical trials sponsoredby MAPS, investigating MDMA-assisted psychotherapy for chronic, treatment-resistant PTSD.

Dr. Van Derveer is co-host of the Higher Practice Podcast, where he explores what it takes to achieve optimal mental health.

___________________________
Instagram: https://www.instagram.com/davidperlmutter/

Website: https://www.drperlmutter.com/

Subscribe to our channel:
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🧠 Stay ahead with the latest in science, nutrition, and wellness by subscribing to Dr. Perlmutter’s newsletter at: www.drperlmutter.com. ✉️🌱

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and the code perlmutter26 will be auto-applied to your order to get $200 off & free shipping (90 days risk-free).

Fresh Pressed Olive Oil - https://www.getfresh389.com
For a complimentary bottle of one of the greatest olive oils I've ever discovered.

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for a special offer when you sign up to decode your genetics and get personalized, science-backed health recommendations.

====
Dr. Perlmutter’s groundbreaking new book, Brain Defenders, is now available for pre-order. Discover how to protect your brain and future health - reserve your copy today at https://www.braindefenders.com.
====
00:00 Intro
04:49 Andrew Koutnik’s Story Obesity Type 1 Diabetes and Metabolism
09:44 Ketogenic Diets and Type 1 Diabetes
20:15 Sponsor Break - Optoceutics
21:28 Why This Goes Far Beyond Type 1 Diabetes
26:59 Why Low Carb Diabetes Care Was Abandoned
31:49 Ketosis vs Diabetic Ketoacidosis
35:10 Sponsor Break - Fresh Pressed Olive Oil
37:04 How to Measure Ketone Levels
39:13 Are Breath Ketone Tests Reliable
40:15 What Beta Hydroxybutyrate Actually Does
42:39 Exogenous Ketones and High Altitude Performance
45:49 Sponsor Break - 3X4 Genetics
48:33 MCT Oil and Ketone Production
52:52 The Carb Loading Myth in Sports Performance
1:00:06 Metabolic Flexibility and Keto Adaptation
1:03:17 Rethinking Hypoglycemia in Keto Adapted Athletes
1:07:19 How Carbohydrates Shut Down Fat Burning
1:09:58 Body Fat vs Glycogen as Fuel
1:14:34 What This Means for Endurance Athletes
1:16:17 Fat Metabolism as a Survival Mechanism
1:18:09 The New USDA Dietary Guidelines
1:20:46 Ultra Processed Food and Alzheimer’s Risk
1:22:40 Final Thoughts on Metabolic Flexibility
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Dr. Andrew Koutnik is a research scientist focused on how nutrition, metabolism, and lifestyle can optimize human health, performance, and resilience. Living with type 1 diabetes for over 17 years, his work bridges personal experience with cutting-edge science across chronic disease and extreme environments.

He earned his PhD in Medical Sciences from the University of South Florida and has led research funded by organizations including NASA, the Department of Defense, and the NIH, contributing to over 100 scientific publications and presentations. His work spans exercise physiology, cardiometabolic health, and therapeutic nutrition.

At Florida State University, Dr. Koutnik studies dietary strategies for diabetes, obesity, and performance under metabolic stress, collaborating with leading institutions worldwide. His mission is to advance evidence-based approaches that empower individuals to improve metabolic health and performance.

___________________________
Instagram: https://www.instagram.com/davidperlmutter/

Website: https://www.drperlmutter.com/

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🧠 Stay ahead with the latest in science, nutrition, and wellness by subscribing to Dr. Perlmutter’s newsletter at: www.drperlmutter.com. ✉️🌱

Thank you to our sponsors:
EVY - https://www.optoceutics.com/perlmutter
and the code perlmutter26 will be auto-applied to your order to get $200 off & free shipping (90 days risk-free).

Fresh Pressed Olive Oil - https://www.getfresh389.com
For a complimentary bottle of one of the greatest olive oils I've ever discovered.

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for a special offer when you sign up to decode your genetics and get personalized, science-backed health recommendations.

====
Dr. Perlmutter’s groundbreaking new book, Brain Defenders, is now available for pre-order. Discover how to protect your brain and future health - reserve your copy today at https://www.braindefenders.com.
====

If you’ve followed my work for any length of time, you know that one of the central themes we return to on The Empowering Neurologist is this: your brain is far more adaptable, resilient, and improvable than conventional wisdom ever allowed us to believe.

This week, I’m thrilled to share a conversation with someone who has spent more than three decades proving exactly that. Dr. Majid Fotuhi, neurologist, neuroscientist, Harvard- and Johns Hopkins-trained physician, and now author of the new book The Invincible Brain, has dedicated his career to helping people reclaim their cognitive potential. His message aligns powerfully with the philosophy behind my upcoming book, Brain Defenders: that the trajectory of your brain is not predetermined, and that meaningful change is possible at any age.

In our interview, we explore the groundbreaking ideas that shaped The Invincible Brain. Dr. Fotuhi lays out why intelligence is not fixed, how memory can be strengthened through surprisingly simple practices, and why Alzheimer’s disease is not the single, linear condition we once imagined, but rather a complex “soup” of abnormalities with multiple entry points for intervention.

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00:00 Intro
01:44 Choices influencing brain trajectory and resilience
04:25 Redefining intelligence beyond IQ
08:20 Synergy of memory and habit change
13:09 Challenging genetic determinism with epigenetics
18:00 Ad Break: Optoceutics
20:23 Alzheimer's as a metabolic and inflammatory soup
29:45 Ad Break: Fresh Pressed Olive Oil
38:04 Exercise and metabolism in brain health
43:45 Ad Break: 3x4 Genetics
49:38 Brain training and five pillars of brain health
54:55 Mindset as key to becoming a superager
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Dr. Majid Fotuhi earned his PhD in Neuroscience from Johns Hopkins University in 1992 and his Medical Degree from Harvard Medical School in 1997. Currently, he serves as an adjunct professor at the Mind/Brain Institute at Johns Hopkins University, while also teaching at George Washington University and Harvard Medical School. With 37 years of experience in teaching, clinical practice, and neuroscience research, Dr. Fotuhi has pioneered a multidisciplinary approach to enhancing brain vitality and cognitive performance at any age.

His groundbreaking “Brain Fitness Program” combines a comprehensive baseline “Brain Portfolio” assessment with 12 bi-weekly brain training sessions. This program targets lifestyle optimization and cognitive stimulation to improve memory, focus, and overall brain health. Dr. Fotuhi’s program has delivered measurable success for patients dealing with memory loss due to aging, concussions, and ADHD, as documented in several peer-reviewed journals.
___________________________
Instagram: https://www.instagram.com/davidperlmutter/

Website: https://www.drperlmutter.com/

Subscribe to our channel:
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🧠 Stay ahead with the latest in science, nutrition, and wellness by subscribing to Dr. Perlmutter’s newsletter at: www.drperlmutter.com. ✉️🌱

Thank you to our sponsors:
EVY - https://www.optoceutics.com/perlmutter
and the code perlmutter26 will be auto-applied to your order to get $200 off & free shipping (90 days risk-free).

Fresh Pressed Olive Oil - https://www.getfresh389.com
For a complimentary bottle of one of the greatest olive oils I've ever discovered.

3x4 Genetics - http://3x4genetics.com/DrPerlmutter
for a special offer when you sign up to decode your genetics and get personalized, science-backed health recommendations.

====
Dr. Perlmutter’s groundbreaking new book, Brain Defenders, is now available for pre-order. Discover how to protect your brain and future health - reserve your copy today at https://www.braindefenders.com.
====

On this episode of The Empowering Neurologist, I’m joined by Dr. Sarah Marzi, a neuroscientist at King’s College London and a principal investigator at the UK Dementia Research Institute, whose work is transforming how we understand neurodegenerative disease risk.

Dr. Marzi’s research focuses on gene regulation in the human brain, particularly within microglia, the immune cells that orchestrate inflammation, synaptic pruning, and repair. Her studies show that genetic risk for diseases like Alzheimer’s is concentrated not in protein-coding genes, but in regulatory regions of the genome, epigenetic switches that control immune behavior in the brain.

This conversation with Dr. Marzi is not just about disease. It’s about agency. Understanding epigenetics helps explain how lifestyle, environment, and immune balance can influence brain destiny. It’s science that empowers prevention, resilience, and hope.

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00:00 Intro
03:12 Epigenetics and Neurodegenerative Disease
04:49 Why Alzheimer’s Is Not a Single Gene Disorder
09:18 Protein Aggregation and Brain Cleanup Failure
10:55 Microglia vs Neurons in Alzheimer’s
19:04 Blood Brain Barrier and Inflammatory Signaling
20:39 ApoE Genetics Explained
23:37 Human Microglia Transplanted Into Mouse Brain
30:02 Vitamin D Receptor and Protective Gene Programs
38:18 Environmental Toxins and Parkinson’s
44:59 C1q Activation and Synapse Loss
49:33 Why Substantia Nigra Is Uniquely Vulnerable
51:39 Paraquat, Mitochondria and Converging Toxic Pathways
53:00 Epigenetic Memory of Toxic Exposure
54:09 Histones and Gene Regulation in Alzheimer’s
57:41 Oligodendrocytes as a Hidden Player
59:32 Why Single Target Drugs May Fail
01:02:10 Detecting Disease Through Blood and Machine Learning
01:04:41 Can Lifestyle Modify Epigenetics
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Dr Sarah Marzi is a Senior Lecturer in Neuroscience at King’s College London and a Group Leader at the UK Dementia Research Institute. Her work focuses on how our genes and environment change cellular processes in the brain and can predispose us to neurodegenerative diseases such as Alzheimer’s, Parkinson’s and motor neuron disease.

An expert in epigenetics – the chemical switches that turn genes on and off – Dr Marzi uses cuttingedge genomic techniques on human brain tissue as well as cell and animal models. Her team combines these experiments with advanced statistics, bioinformatics and AI to map the earliest molecular changes that make brain cells vulnerable to disease, particularly in immune cells of the brain called microglia. This work aims to reveal how both genetic variants and environmental exposures, including pesticides, contribute to disease risk and to uncover new avenues for therapy.

___________________________
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