Skip to main content

At Places of Healing.com , we are thrilled to introduce Dr. Austin Perlmutter—a board-certified internal medicine physician, New York Times bestselling author, and one of today’s leading voices in mental health and brain wellness. Dr. Perlmutter’s mission is to empower individuals to improve their health by addressing the biological foundations of what he calls “stuckness” in our brains and bodies.

Through his extensive work as an international educator, health investor, and researcher, Dr. Perlmutter has reached millions with his insights into how environmental factors influence our cognitive and mental states. Whether in his bestselling book Brain Wash, his captivating podcast, or his cutting-edge research, Dr. Perlmutter highlights practical, science-backed strategies for brain health—from the power of nature and quality sleep to the transformative potential of lifestyle and diet changes.

In our conversation, we’ll dive into his work on the intersection of mental health and effective interventions, including the growing interest in plant medicine like ayahuasca.

Join us as we explore how ancient practices and modern science converge to offer profound pathways for healing, growth, and mental clarity with Dr. Austin Perlmutter.

Your journey into wellness began as an internal medicine doctor. What inspired you to shift your focus toward brain health and mental wellness? Did you follow in your father’s footsteps?

 

I think it’s a combination of factors. Certainly, it was significant that my father is a neurologist, and his dad, my grandfather, was a neurosurgeon. So there’s definitely a slant toward brain focus on that side of the family. But the real fundamental part of it was the realization that all the things I was seeing in the clinic related to heart disease, diabetes, and obesity—the most common diseases of the day—were all connected to decision-making and the state of brain health, particularly mental health.

I had this moment of understanding that everything I was trying to do to change people’s behavior so they would become healthier wasn’t working because their brain wasn’t in agreement that these changes mattered. Simultaneously, I was personally experiencing the significant impact of training on my brain, particularly my mental health.

It was the combination of all these factors that led me to recognize that the biggest driver of disease in the modern world is our brain state—and, in particular, our mental state—not being in a good place. If we couldn’t figure that out, none of the other stuff would matter at all because the most significant outcome for humans in terms of health is mental health. Everything else is just a surrogate for it.

This realization drove me to want to better understand what is influencing our brain state: what’s making it biased toward being unwell, what aspects of the modern world are pushing us toward poor decision-making and worse mental health, and what we can do to help reverse the trend. Not only is it fascinating to me to understand, but it also feels like the most meaningful work to do.

Mental health has become a trending topic in recent years, much like how physical health was emphasized in the past. Why do you think this shift has occurred ?

 

I think there are macro trends toward people being more open about their personal health challenges, including mental health. Historically, and still in some cultures, it’s been seen as a weakness to talk about anything related to mental health. You were just supposed to internalize the stress, the low mood, the anxiety—because if you couldn’t, it meant you were weak.

You were perceived as lacking the willpower to push through. But for reasons that are more social and macro, that mindset has shifted, at least in the United States, toward greater openness about these realities. Part of this shift comes from celebrities discussing their mental health challenges, and part of it is a broader movement toward transparency about the complexities of being human.

That said, it’s important to note that despite this cultural shift and improved access to medical care and modern technology worldwide, mental health hasn’t significantly improved in recent years. In fact, in some cases, we’re seeing a decline—particularly with youth depression, especially among young women, and increasing levels of anxiety and stress among adults globally. I don’t think this is an artifact; I think it’s real.

What’s striking is that this is happening despite incredible medical advancements, including, in theory, better access to mental health services. This underscores the critical importance of mental health. Without it, none of the other aspects of health—like blood pressure, diabetes, or even cancer—carry the same weight. It’s not that they don’t matter, but mental health is foundational. Without it, we’re not enjoying life, we’re not present, and everything else becomes secondary.

This raises a key question: Have we misunderstood what’s driving mental health issues and what we can do about them? I’d argue that we absolutely have. During my training as an internal medicine doctor, I worked extensively in the VA, where depression, PTSD, anxiety, and stress were far more prevalent than in the general population. We primarily relied on psychotherapy and pharmaceuticals to manage these issues. But the deeper question is: What’s happening in the brain?

Mental health issues aren’t separate from brain issues. We know that changes in the brain affect how we think and feel. So, what’s driving these conditions, and what might we be missing—especially in terms of the underlying biology? Over the past couple of decades, and particularly in the last decade, we’ve gained a better understanding of how pathways within the body influence the brain and contribute to mental health conditions.

My area of expertise focuses on how inflammation in the body can lead to depression when it affects the brain. This shifts the conversation. It’s no longer just about acknowledging mental health struggles or being open about them. It’s about recognizing that what was once a “black box”—issues like depression, poor decision-making, and cognitive decline—might not simply be “mental” or “mind” issues. Instead, these could be biological processes, like neuroinflammation, neuroplasticity issues, or metabolic dysfunction.

This shift changes how we view mental health. Instead of blaming individuals for a perceived lack of willpower, we can examine the biological factors at play. Maybe depression isn’t a failure to cope with life’s challenges but rather the result of neurobiological factors we can address. When we understand that biology plays a role, it moves people from blame and stigma to curiosity and, hopefully, to better solutions.

Obviously, we blame society. The big theme is always social media, exposure to digital content, and stress. But my argument would also include looking back at the past—people also lived extremely stressful lives or endured hardship, like wars. Yet, we didn’t address mental health issues then.

 

There are a couple of considerations. One is, if you were to compare the mental health of people living during a major period of conflict—and we have many such situations in the world right now—to the mental health of people living in the United States, you could objectively say that a person in a conflict zone is experiencing far more extreme variables, particularly at the lower levels of Maslow’s hierarchy, like basic safety.

A person in a conflict zone is far more likely to develop PTSD than someone dealing with people yelling at them on social media. These are different degrees of intensity. However, what I think is relevant in the larger context of how most people in the United States, and in many other countries, operate is that their stressors are low-level but perpetual.

For example, if you go through a really stressful period in your life, such as the death of a loved one or losing your job, these are acute stressors that can significantly and negatively impact mental health. However, the stressor itself will eventually pass, leaving only its echoes to deal with. In contrast, when we talk about the most common diseases today, such as diabetes, heart disease, and even Alzheimer’s, the principal driver often seems to be the cumulative effect of long-term stress and inflammation. This leads to the dysregulation of pathways within the brain and body, resulting in these very slowly maturing diseases.

The important point here is not to equate the stress people experience today with the stress experienced in parts of the world facing conflict or historically during events like world wars. Instead, it’s to recognize that the sum of everyday, ongoing stress—bad news on the media, social media pressures, dissatisfaction with work, and so on—combined with factors like poor diet, lack of social connections, lack of exercise, and lack of connection to something greater than ourselves, creates a cumulative effect that is deeply detrimental to physical and mental health.

Historically, people have always been stressed, but the stressors were often more acute—they would either resolve or not. For instance, if you were faced with a cave bear, you either got up, fought it off, and survived, or the cave bear ate you, and in that case, you were no longer stressed. Today, however, stress looks different: watching the stock market every day, being overwhelmed by bad news, worrying about not getting enough likes on your photos, wanting a better job, or struggling in a relationship. These stressors, compounded over years and decades, are incredibly damaging to mental health.

Even if any single day doesn’t seem like the worst, the cumulative effect of these ongoing stressors adds up in a way that is profoundly harmful over time.

From your research, what are some of the most effective science-backed practices people can incorporate into their daily routines to promote brain health and prevent cognitive decline?

 

The most evidence-based strategies for promoting brain health and preventing cognitive decline include:

  • Regular aerobic exercise.
  • Regular resistance training.
  • Eating a Mediterranean-style diet rich in whole, minimally processed foods.
  • Spending time in meaningful relationships.
  • Prioritizing and optimizing sleep.
  • Reducing unnecessary exposure to environmental toxins.
  • Practicing stress mitigation.
  • Spending time in nature.
  • Committing to lifelong learning.

You advocate for nature exposure as both a personal practice and a medical intervention. What does the science say about the impact of nature on mental and brain health, and what are some simple ways people can benefit from it?

 

Nature exposure offers several benefits for brain function, including improved focus, attention, mental health, and reduced stress. For most people, the key is simply finding ways to spend time in nature, even in urban areas.

Starting with just 20 minutes a week of nature exposure is a great first step. Simple activities like walking outdoors with coffee, meeting friends in green spaces, or reading in a park are accessible ways to incorporate nature into daily life. For those ready to commit further, more immersive experiences in nature can offer even greater benefits.

In your opinion, what role does sleep play in maintaining brain health? Are there specific habits or strategies you recommend for improving sleep quality as a preventative measure?

 

Better sleep is perhaps the most important, rapid, and effective way to improve brain health. Key steps for improving sleep quality include:

  • Reducing blue light exposure before bed.
  • Avoiding caffeine in the afternoon.
  • Not consuming alcohol before bed.
  • Creating a “sleep sanctuary” in the bedroom.

What role does neuroplasticity play in mental health, and what practical steps can people take to “rewire” their brains toward healthier habits and thought patterns?

 

Neuroplasticity is a fundamental feature of the brain—it’s constantly rewiring in response to daily experiences. This process is thought to underpin mental health conditions and cognitive dysfunction.

To enhance neuroplasticity in a positive direction, people can:

  • Engage in regular exercise, which promotes higher levels of BDNF, a neuroplasticity-boosting molecule.
  • Establish small, sustainable healthy habits that occur in the same place and the same way each day. This repetition increases the likelihood that these behaviors become ingrained as part of new, healthier patterns through neuroplasticity.

What do you think about the growing interest in alternative wellness practices when it comes to mental health, such as meditation, breathwork, or plant medicine? Do they complement conventional medicine?

 

I think “alternative medicine” is a somewhat fraught term because it usually implies an alternative to “real” medicine. You have conventional medicine, and then you have alternative medicine. There are other terms like complementary medicine, integrative medicine, functional medicine, and regenerative medicine.

The point I would make is that, in a perfect world, we would evaluate any opportunity for healing through a few key lenses: Has it been shown to help people? Does it have a high cost? Does it carry a high risk of side effects? Is there a significant downside? From that perspective, you can stratify different interventions in terms of their risk-reward balance.

For example, if someone is in the hospital with a blood pressure of 200 and experiencing changes in their mental or brain state—a hypertensive emergency—we would prioritize a medication that may have a significant side effect profile because the benefit is critical, and it’s the right intervention for that situation. 

On the other end of the spectrum, you have something like mindfulness meditation.There’s strong research showing that meditation is beneficial for many people. But if you were to dedicate 10 minutes of your day to mindfulness, do we know for certain, without a doubt, that it will work for you specifically? Maybe not—it’s not always consistent for every individual. However, what’s the downside? Almost zero. 

Maybe mindfulness and meditation aren’t the best examples, given that we have plenty of science-backed evidence suggesting they are beneficial for the brain. But the larger question is always about the risk-benefit profile and how we should approach these things.

Psychedelics and plant medicine are particularly interesting because, while they have a notable side effect profile, their benefit profile also seems significant. Relative to most conventionally prescribed antidepressants and mental health medications, the side effect profile of psychedelics appears quite reasonable, and the benefits seem equally compelling.

I’m a huge proponent of at least continuing to research these molecules. I do think we’ve been overly restrictive in the United States when it comes to providing access to them.

Why do you think that is? Other cultures have worked with mind-altering substances for thousands of years.

 

Well, let’s be clear: the vast majority of Americans consume mind-altering substances every day. The best example is caffeine, right? Most people drink caffeine daily—that’s a psychoactive molecule. An even better example might be alcohol. Most people will consume it at some point in their lives, and many consume it daily.

Alcohol has a well-known toxic effect on the body when consumed at high levels, leading to hundreds of thousands, if not millions, of deaths each year. Yet, we’re okay with it, right? Because we’d say we know it—we understand its side effect profile and risk-benefit ratio.

I think there are a number of reasons why the United States has historically been resistant to making psychedelics more accessible. Some of these reasons verge into what might be considered conspiracy theories, while others are argued from a pure safety perspective. However, I think the general concern—perhaps more on the part of the United States government—has been around mind-altering substances, particularly those that might lead people to question certain aspects of what supports a capitalist society.

In a society where we’re supposed to focus on GDP and put in a daily output of work that aligns with the expectations of an American citizen, many psychedelic molecules fundamentally shift how we see the world. Often, they provide a lens that isn’t necessarily in alignment with historically accepted American work ideals.

I can’t explicitly say these are the reasons why the U.S. government suppressed psychedelic research, but the traditionally held narrative suggests that during periods when people were defecting from participating in foreign conflicts and questioning the status quo of what defines a “good American,” the government was not in favor and therefore pulled the plug on research.

From a scientific perspective, it seems like more studies are being conducted in this area?

 

It’s true that psychedelics have been studied in hundreds, if not thousands, of trials. It’s also true that these are not large-scale trials conducted over many years, like, for example, beta blocker trials in heart failure. We just don’t have that type of large-scale data. From the aggregate of what I’ve seen—both in terms of examining a lot of studies and looking at well-done studies published in top-tier journals—the benefit profile of psychedelics in conditions like PTSD and depression, especially refractory depression, is quite impressive.

There’s nothing else I’ve seen that demonstrates as large and consistent an effect as psychedelics have been shown to provide. Now, the questions and concerns people have about legalizing or making them more widely available center on whether they have significant side effect profiles and how to ensure the same quality of care outside controlled trials.

For example, in trials like the Johns Hopkins protocol, participants are placed in a very specific scenario: they work with multiple therapists, listen to curated music, and engage in pre- and post-session integration. The question becomes: how do we ensure that the quality of care in real-world applications matches what’s done in these controlled environments? I think these are reasonable questions, but the approach in the United States has been overly conservative regarding what we allow.

I’ll make a couple of points here. Look, people in the United States—and increasingly around the world—are dying earlier. In the U.S., life expectancy has, at best, plateaued, and if you’re more pessimistic, it’s declined over the last five or so years. People are not only dying earlier but also living with chronic, preventable diseases, including mental health conditions.

We can either accept this as the best it’s going to get and continue slowly refining the tools we already have, or we can recognize the need to explore different solutions. There’s resistance to this because significant change often threatens the people and companies currently in power.

I also think there’s something intrinsically unsettling to those in power about making available substances that cause people to question the things they’ve historically believed were rock solid—whether that’s religion, political structures, or societal norms. For instance, one fascinating effect of psilocybin is the immediate and significant increase in people’s sense of connectedness to nature. That doesn’t benefit any company, government, or organization, but it benefits humans by prompting them to reevaluate whether the things we spend most of our time doing each day actually make sense for our mental health.

This is just some general philosophy around the subject, but I think it’s an important perspective.

You say you don’t have all the answers and that your goal is to keep learning. What is a question you’re currently exploring that excites you?

 

The main thing I’m educating people on at scale right now is the understanding of how a few core systems within our brains govern our thoughts, actions, and feelings. These core systems include the immune system—brain immunity, neuroinflammation, neuroimmunity—brain metabolism or neurometabolism, and neuroplasticity.

Starting from that framework, there’s the question of what we can do to understand whether those systems are functioning in the right way or going off track. I’m involved with a couple of different groups studying this. The study I’m most interested in right now involves researchers at NUNM (the National University of Natural Medicine in Portland, Oregon)  and is spearheaded by an amazing medical student named Payton Follestad. We’re exploring how ayahuasca influences these pathways by examining epigenetic analysis and the microbiome.

What makes this so fascinating to me is that we’re starting to get to the core science of how environmental factors, in general, influence our health. Specifically, we’re looking at how certain dietary components, as in the case of ayahuasca, can reshape who we are by changing how our DNA is expressed, altering our immune system, and modifying our metabolic state. This is a complete game changer in terms of advancing the conversation.

Returning to the topic of psychedelics, it’s important to note that the benefits aren’t just about having a meaningful or transformative trip—though that’s valuable and I wouldn’t diminish its importance. I don’t think it’s a good direction to focus solely on synthesized chemicals stripped of the ritual and history that come with psychedelics. But from a research perspective, it’s critical to ask deeper questions.

For example, while it’s amazing to have a profound experience with a psychedelic molecule, what’s driving the biological change beyond just alterations in serotonin? If we can understand those changes, it elevates psychedelics from being perceived as merely recreational drugs to something much more significant. We’re talking about pathways within the body and brain that help us understand how the environment acts on brain function—not just in a simplistic sense, like “stress increases inflammation and that’s bad,” but through the specific pathways that influence the brain.

This opens up a bigger picture. We’re starting to trace the data flow—how plants, fungi, and our gut microbiome interact with our bodies to change our brains. We’re filling in gaps in the continuum of data, which I think will excite people and make them more curious about how interconnected everything is. It’s not just, “I’m here, my mental state is over there, and this is a food, a plant, or a fungus.” Instead, it’s all interconnected, and here’s the science and the web behind it all.

Thank you, Austin, for your time—it was a pleasure talking to you.