Medical

20 Questions: David Perlmutter, MD, FACN, ABIHM – Neurologist

David Perlmutter

Neurologist David Perlmutter, Fellow of the American College of Nutrition and member of the American Board of Integrative Holistic Medicine, is an associate professor at the University of Miami Miller School of Medicine. Perlmutter received a degree in biology from Lafayette College (1976) and a Doctor of Medicine from University of Miami School of Medicine (1981), where he was a Leonard G. Rowntree Research Award winner. He completed residencies in general surgery at Mt. Sinai Hospital in Miami Beach (1981-1982), and both neurosurgery (1982-1983) and neurology (1983-1986) at University of Miami School of Medicine.
Dr. Perlmutter is a member of the American Academy of Neurology, American Medical Association, Physician’s Committee for Responsible Medicine, American Holistic Medical Association, Undersea and Hyperbaric Medicine Society, The Oxygen Society, and American Association for the Advancement of Science. He has been published extensively in peer-reviewed scientific journals including Journal of NeurosurgeryMicroneurosurgerySwedish Journal of Functional and Nutritional MedicineClinical NeurosurgeryNeurological ResearchSouthern Medicine JournalJournal of the American Medical AssociationArchives of NeurologyNeurosurgery, and Journal of Applied Nutrition. He is a frequent lecturer at symposia sponsored by such medical institutions as Columbia University, Scripps Institute, New York University, and Harvard University, and has been interviewed on many nationally syndicated television programs including 20/20, Larry King Live, CNN, and The Today Show. He is the recipient of the Linus Pauling Award for his innovative approaches to neurological disorders and was awarded the Denham Harmon Award for his pioneering work in the application of free radical science to clinical medicine. He is the recipient of the 2006 National Nutritional Foods Association Clinician of the Year Award and was awarded the Humanitarian of the Year award from the American College of Nutrition in 2010.
When did you first decide to become a physician? Why?
I made my decision midway through my freshman year in college. I was a business major and also had thought about pursuing meteorology. I cannot exactly pinpoint why I made the decision, but I am certain that trying to emulate my father, a successful neurosurgeon, probably had a lot to do with it.
How/why did you choose the medical school you attended? 
I chose to attend the University of Miami School of Medicine for two reasons. First, by the time I entered medical school I had a keen interest in neurology, and their neurology program was a top notch. Second, Miami was my home and where my family resided at that time.
What surprised you the most about your medical studies?
I was most surprised by the fact that my medical education provided almost no instruction or exploration in the area of lifestyle as it relates to health and disease. Unfortunately, we had no dedicated instruction in nutrition while great emphasis was placed on understanding and utilizing pharmaceutical interventions.
Why did you decide to specialize in neurology?
I chose to specialize in neurology as by the time I entered medical school I had already developed a keen interest in brain disorders. In the year before I started medical school, I had actually published several research papers in the area of neuroscience.
If you had to do it all over again, would you still become a neurologist? Why or why not?
I am still fascinated by the brain and brain disorders. Neurology remains incredibly interesting to me as we now are just beginning to understand how the brain is influenced by, for example, the gut, and specifically, the microbiome. This allows us to look upon the brain and brain disorders through a new lens as opposed to simply focusing on the brain itself. As such, there is no doubt that we will now see huge advances made in dealing with some of our most challenging brain disorders, for which we have basically been empty-handed when it came to having any meaningful therapeutic intervention.
Has being a neurologist met your expectations? Please explain. 
Truthfully, when I practiced mainstream neurology, I founded it to be incredibly frustrating due to the lack of meaningful interventions for so many of the issues I was dealing with every day in my clinical practice. However, with the fundamental changes that are happening in the field of neurology, which are revealing profound interactions and influences with other body systems, the practice is becoming more and more exciting as the science evolves.
What do you like most about being a neurologist?
Right now, being a neurologist, and especially one who is interested in the influences of lifestyle factors as well as the important role of the microbiome in brain health and function, is incredibly exciting. The scientific literature that is being generated on these new concepts is expanding dramatically. It is as if for the first time we are truly understanding how integrated the brain is in the general metabolic processes of the human body. And so, being a neurologist puts me front and center in terms of being able to utilize and incorporate the most leading edge science as it is being generated.
What do you like least about being a neurologist?
I can’t say there’s anything negative for me at this time. I would indicate that early in my career what I found most frustrating was the overriding lack of meaningful interventions that were available to us as clinicians.
Describe a typical day at work—walk me through a day in your shoes. 
I have been on sabbatical from my clinical practice for the last several months. Currently, I spend part of my day interacting with other clinicians as a consultant. I am deeply involved in writing, both for social media as well as books like Grain Brain and Brain Maker. I lecture extensively, around the world, and generally spend some time each day preparing for these presentations. The number of journals that are required reading (self imposed) is expanding, so I dedicate time for that each day as well. Exercise is fundamentally important, and I reserve at least 90 minutes for this pursuit each day.
On average, how many hours a week do you work? How many hours of sleep do you get per night? How many weeks of vacation do you take annually?
I spend approximately six hours “working” each day, seven days a week. Nonetheless, over the past several months, I have certainly been taking time off to travel, as well as to lecture and to attend academic meetings. I sleep seven to eight hours nightly. I take six to eight weeks off each year, at the minimum. That said, as time moves forward, I am now able to build a vacation time around my travel that relates to lecturing.
If you have family, do you feel you have enough time to spend with them? Why or why not?
I made a dramatic change in my work situation 20 years ago when our children were still quite young, specifically to be available for both them as well as for my wife. I decided to sever my hospital affiliation in favor of an office practice that allowed me to be present as a father and husband, to the best of my ability.
How do you balance work and your life outside of work?
For me, my “life outside my work” emulates my life work. What I mean by that is simply that the current focus of my work is deeply involved in recognizing and popularizing the notion that lifestyle factors including sleep, exercise, diet and so many others strongly influenced both brain functionality as well as brain health. So when I am not actively “working,” I am still involved in pursuing, on a personal basis, those lifestyle issues that are the focus of my research and publications.
Do you feel you are adequately compensated in your field? Please explain.
I am not compensated in a way that is typical for a neurologist. My practice did not involve any insurance remuneration. This allowed us great flexibility in terms of being able to care for individuals who lacked the means to be cared for otherwise. Further, I am involved in other pursuits that provide supplemental remuneration such as my work as an author.
If you took out educational loans, is/was paying them back a strain? Please explain.
When I took out student loans, the repayment interest rate was extremely favorable. So once I completed residency and entered private practice, paying back my student loans didn’t represent a hardship.
In your position now, knowing what you do, what would you say to yourself back when you started your medical career?
I spent the first 10 years in neurology practice pretty much toeing the line and maintaining the status quo. I would have said to myself, knowing what I know now, to be more open minded to alternative explanations and ideas, and be less accepting of the standard dogma.
What information/advice do you wish you had known prior to medical school?
It would have been nice to receive advice from somebody telling me to buy stock in Apple back in those days.
From your perspective, what is the biggest problem in health care today? Please explain.
The way this question is presented actually characterizes the problem perfectly. I am being asked about “health care today.” In point of fact, precious little economic and manpower resources are dedicated to maintaining or caring for “health.” There is hardly any emphasis on disease prevention and the critically important role of lifestyle choices as they relate to illness.
Where do you see neurology in five years?
I doubt we will see any significant changes in how mainstream neurology is practiced in five years or even 10 years. I do believe that the emerging science related to the powerful influence of the human microbiome on the brain will gain traction over time as the groundwork research evolves.
What types of outreach/volunteer work do you do, if any?
Currently, I serve on multiple advisory boards for various organizations involved in health care. I dedicate time to raising financial support for our local free neighborhood mental health clinic, as well as our local Public Broadcasting television affiliate.
What’s your final piece of advice for students interested in pursuing a career in neurology?
Neurology is a specialty at a pivot point. We are just at the beginning of a new era in understanding brain health and disease as we embrace the powerful influence, for example, of the human microbiome as it relates to the nervous system. This information, coupled with the incredibly expanding understanding of the role of lifestyle choices in terms of brain health, will make the field of neurology extremely interesting, fulfilling and rewarding.

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