0:00 Introduction

0:45 About Amy

3:15 About Alzheimers

6:25 Alzheimers is a metabolic issue

8:28 The glucose song

13:17 Exogenous ketones

15:13 Alzheimers genetics

20:34 High insulin levels

22:16 Cholesterol

24:54 Do we need cholesterol

25:48 Diet

28:33 Exercise and sleep

29:48 Is it too late

31:342 Tips for preventing Alzheimers

35:33 Diet and dementia

37:27 Low blood glucose

41:24 APOE4 Gene

42:31 Vitamin B12

44:28 How to damage the human brain

45:51 Omega3 fats

47:02 Wild vs farmed fish

47:57 Stress and Alzheimers

49:17 Sun and Vitamin D

51:02 Nitric Oxide

51:34 Summary

54:16 Conclusion

Dr Peter Brukner (00:01.614)
Hello everyone and welcome to this Defeat Diabetes webinar. We are very privileged today because we've gone international. Not enough of these Australians. We've gone to the US of A and we're very fortunate to have Amy Berger who is a, well, she'll tell you what she is. But I first came across Amy a few years ago. She'd been very prominent in the sort of nutrition world.

And I read her book, The Alzheimer's Antidote, some time ago. I've just actually reread it this week. It's a terrific book. And so we're to focus today mainly on Alzheimer's and diet and exercise and so on. But Amy, first of all, welcome. And why don't you start by just telling us a little bit about yourself and your journey, how you got to this stage.

Amy Berger
Yeah, yeah, thank you. And I just want to say it's an honor to be here. I've followed you, Dr. Brukner for a long time and admire. And I can't believe that I'm talking to people in Australia right now. I technology can be such a curse, but it's such a blessing at the same time. I mean, this is incredible. So hello to everyone on the other side of the world. I am a low-carb and keto nutritionist and writer and I always tell people that I got into this the way a lot of you do. I was overweight. I used to be much heavier than I am now. And I was heavier despite doing all the right things. was following what I thought was a good, healthy diet, doing lots of exercise, and I just could not lose weight. And finally, I discovered the Atkins diet. That was my entry into all this. And it worked. I lost the weight. For anyone out there who's struggling to stick to a low carb diet, I did not stick to it the first time. I started and stopped a few times before it stuck for the long term. And after being successful with it myself, and I was in and out of a lot of jobs that I was unfulfilled by, it occurred to me, hey, wait, nutrition is a career. Maybe I could do that and I could teach other people about this wonderful low carb way of eating.

Amy Berger (02:21.408)
I did, I went back to school and got formal education in nutrition. And I do work with private clients now and I write a lot in the keto and low carb space. But as we'll talk about tonight with the Alzheimer's, even though I personally got into low carb and ketogenic diets for weight loss, over the years that I've been learning about this and studying it, I'm so fascinated by all of the other things that this way of eating does besides weight loss. I weight loss is great, but you can literally reverse type two diabetes. You can be free of PCOS, fatty liver, all of these other things that have nothing to do really with necessarily your body weight. So I still to this day, I'm just fascinated by the science of this way of eating.

Dr Peter Brukner
Yeah, it's an amazing tool, isn't it really? Okay, well, that's great. Let's talk about Alzheimer's, because when you get to my age and you forget where your car keys are, you think, my God, I'm getting Alzheimer's. In all seriousness, I think it's something that's a concern to everyone once you get probably beyond 50. We see people, we read about it, and it just seems to creep up on people.

And quite honestly, I think it terrifies most people. I think it's more of a concern than even having a heart attack or something because losing your mind is the worst thing that could happen. So let's just go back to basics and tell us what your understanding of Alzheimer's and where does it fit into the dementia because there's Alzheimer's and dementia and are they the same thing? Alzheimer's is a form of dementia, probably the most common form of dementia.

Tell us a little bit about your understanding of Alzheimer's and maybe how your understanding has changed over time or improved over time.

Amy Berger (04:20.695)
Right, so you are absolutely correct. Alzheimer's is a subset of the larger category of dementia or cognitive decline. There's other things that can cause memory problems or these sort of cognitive changes, but Alzheimer's disease, as far as I understand it, is a metabolic disease. And when I use the word metabolic, I mean that it has to do with the way the brain uses energy. Metabolism is arnessing energy. And the brain of somebody with Alzheimer's disease is not taking up and using glucose the same way as a healthy person's brain does. So it's at its core, it's a fuel shortage or an energy deficit in the brain. And we don't know, we don't know for certain why that happens, but that is the problem, period. The brain is being starved of glucose. So it makes perfect sense that if the brain does not have enough energy, of course you have memory loss. Of course there are personality changes and behavioral changes. it's, of course the rates of Alzheimer's have skyrocketed over the last several years and decades. And it kind of parallels

the same increases that we see in things like type two diabetes, metabolic syndrome, and all these other metabolic diseases. And we take it for granted that diet and lifestyle play a role in things like type two diabetes or cardiovascular disease or obesity. Nobody, of course it does. We don't even pretend like it doesn't. And yet when it comes to the brain, we just think... well, the brain must be immune. Like we dismiss the possibility that the brain is every bit as susceptible to these diet and lifestyle insults, if you will, as the rest of the body.

Dr Peter Brukner (06:26.808)
Yeah, absolutely. that's not the idea that Alzheimer's is a metabolic issue. is not the standard medical teaching. Most people talk about these beta amyloid plaques that you see in it and so on. So what makes you say that it's a metabolic issue rather than the more traditional idea of these accumulation of amyloid plaques?

Well, it's been proven that the brain of people with Alzheimer's disease, the brain does take up and use less glucose. That is absolutely for certain. The issue with the amyloid is very interesting because it's...

Some people with Alzheimer's have a large buildup of amyloid and some don't. And then there's people who do not have Alzheimer's disease who do have a significant buildup of amyloid. So if you can have a lot of amyloid and not have any cognitive problems, and you can also have Alzheimer's disease without a significant buildup of amyloid, then amyloid cannot be the cause of Alzheimer's.

And what it looks like more and more in the research is that amyloid may actually be not only a protective mechanism, but it may be an effect of the disease, not a cause. if I don't, I don't want to say, I don't want to get too far afield, but that people need to understand that you can have lots of amyloid and not have Alzheimer's. And you can have Alzheimer's and not have a lot of amyloid. So how can we say that this particular compound is the primary cause of the illness when you can have the illness without the amyloid buildup?

Dr Peter Brukner (08:28.558)
And I guess that explains why all the drug therapies have basically been focused on removing trying to remove or reduce the amount of amyloid. And as we know, they've been singularly unsuccessful really. It's been the magic thing that every drug company has wanted to get is a drug that improves Alzheimer's. And so far they've failed to do so because they're basically focused on these amyloid plaques. And I guess that your explanation probably explains why these drugs haven't worked. Let's get back to the glucose song. tell us, mean, why do you think then, you know, that the brain is not using glucose enough? And surely then, you know, the solution to that is to give the brain more glucose.

Amy Berger
Yeah, and I, before I answer that, I want to be clear that there's so much we don't know yet about Alzheimer's. There's a lot of unanswered questions, but that doesn't mean that we don't know anything or that we don't have enough information to take some potentially protective actions. So yeah, you would think that just, okay, if the problem is glucose, give more and more and more glucose, but

the problem in Alzheimer's disease, if you have type two diabetes, you're at increased risk for this condition. So it's not that there's not enough glucose, it's that the glucose for some reason is not getting into the brain. You can have hyperglycemia, you can have lots of glucose floating around your body, but it's not getting into the brain and fueling those neurons properly.

And I think I'm gonna anthropomorphize these cells for a little bit, give them kind of a human mind. If these neurons are already so highly damaged from a lifetime of metabolic insult and assault from chronic hyperglycemia, the brain might actually be trying to protect itself.

Amy Berger (10:46.05)
by down regulating the entry of glucose into the brain. It might be saying, no, no, I've had so much glucose, I don't want anymore. And so it deliberately kind of keeps it out. And this would not be a problem if there were some other alternative fuel source available. But in people eating a very high carbohydrate diet, there's nothing else.

So then the brain starves, or the brain is having a fuel shortage. But yeah, the answer is not to give more and more glucose because there's already plenty of glucose. It's just not getting where it needs to go.

Dr Peter Brukner
Right, now tell us about that alternative fuel source then.

Amy Berger
So. The brain, like much of the rest of the body, can run on several different types of fuel. Glucose is only one of them. We know that the body can, much of the body loves to run on fats, fatty acids. If you go on a very, very, if you go on a very low carbohydrate diet, there's not enough glucose to fuel all the needs. So the body must switch over to some other fuel, like, the body's not just going to collapse. It's going to say, I better find some other energy source. look at all this great fat I have stored all over my body. Or look at all this delicious fat that I'm eating. Why don't I just burn that? And when we break down the fat, we generate ketones and the brain will suck up ketones like a champion. And the beautiful thing.

In my opinion, the most encouraging promising thing about research in Alzheimer's disease is that even though the brain has lost the capacity to take up and use glucose properly, it still takes up and uses ketones. And this has been shown over and over in the research and the ketones can't 100 % close that fuel gap, but it can close it a little bit. And that is more than any Alzheimer's drug has ever done. Having ketones addresses the fundamental problem in this disease in a way that no drug ever has.

Dr Peter Brukner
And the best way to get ketones?

Amy Berger
Well, in my opinion and maybe yours or many people watching, it's a very, very low carbohydrate diet because your body will generate its own ketones, but there are what we call exogenous ketones, exogenous meaning from the outside, where it's typically a powder that you can mix in water and you drink it. And this will give somebody ketones and raise their ketone level. Eeven if they're not on a keto diet. And this is important because there may be people watching who have an elderly parent or maybe a spouse who's never going to do a low carb diet. They're just not ever going to do it. But is there some way that we can help these people? And I don't think that these ketones supplements or these exogenous ketones are a weight loss tool.

I don't think they're helpful for reversing diabetes or these other conditions, but they can be helpful in the case where to oversimplify it, maybe your brain is literally starving to death and we are desperate to give it some fuel. Well, let's give it some ketones. And I think that giving the ketones will fill that energy gap a little bit, but the ketogenic diet, if to the extent that Alzheimer's disease may actually be caused by chronically high blood sugar and insulin over a number of years, the ketogenic diet may actually go some way toward correcting that, where just giving the ketones is only really treating the symptom and it's not having a big effect on the disease process.

Dr Peter Brukner
Yeah, and obviously the ketogenic diet is going to help a lot of those other chronic conditions that you mentioned before. Now, some people would say that Alzheimer's is a genetic disease. You there's a particular gene that you could tell us about that makes people more susceptible to Alzheimer's. What's the role of genetics in Alzheimer's?

Amy Berger
There is a role, people are, I see some people have submitted questions about the APOE4 gene. That's the name of the gene that is most strongly associated with increased risk for Alzheimer's. But the thing that people really need to understand is that just like with the amyloid, if you have one copy of this APOE4 gene, you're at increased risk. If you have two copies, you're at very substantially increased risk. However, having this gene, even two copies, does not cause Alzheimer's because there's plenty of people that are homozygous, they have two copies of the gene, who never develop Alzheimer's. And the majority of people who have Alzheimer's don't have E4. They could have, there's APOE2, there's APOE3. So that gene does increase risk, absolutely. But it's so fascinating. The research that's been done on this gene seems to indicate that people with this gene are best suited for a lower carbohydrate diet. This is believed to be the oldest form of the gene in human evolution. And so it sort of came about in a time before agriculture, before we were eating lots of grains and lots of sugars. And so, yeah, the gene does increase risk, but it does not cause Alzheimer's. So if there's anybody watching who has this gene, please know this is not a death sentence. This is not your destiny to get Alzheimer's disease.

Guess if it was purely a genetic disease, then it wouldn't be increasing and the rate that it is at the moment because your genes don't increase. I mean, your genetic abnormalities, it's something else that in conjunction with that genetic disposition that is causing the rabbit increase in Alzheimer's. I mean, when I was a medical student, which admittedly was a long time ago, I don't think we even heard about Alzheimer's. We didn't even talk about it. It wasn't a big issue at all. It was so rare.

Dr Peter Brukner
And yet, like so many other chronic diseases, the rate seems to be increasing. I mean, it seems to be, I think if you're over 60, you're at about a one in 10. I if you're over 85, you're about a one in three chance of having Alzheimer's. So it can't be just the genetics, the gene that's causing this increase. So what do you put down this increase to?

Amy Berger (18:15.95)
I think you're exactly right. If this was a purely genetic disease, then the rate would stay the same. Or and or everyone with this gene would eventually develop Alzheimer's and they don't. But my I I think it is largely a diet and lifestyle condition, just like all of these other ones that have exploded in incidents over the last few decades.

And I do want to point out, I don't think we've used the phrase type three diabetes yet, but owing to the associations between diabetes and chronically high insulin and Alzheimer's, researchers now regularly refer to this as type three diabetes or diabetes of the brain. And I'm sure that like many of the people watching know, but just in case this is new to anyone. It's to this day. mean, my book came out, I think, five or six years ago. And this still blows my mind a little bit that the phrase type three diabetes is helpful. But we need to understand that it's not just about the blood sugar. It's about the insulin, because you can have chronically high. You can have totally normal blood sugar. So you're not diabetic, but you might have very, very high insulin. In fact,

That's why you have normal glucose because the insulin is sort of keeping that glucose in check. And it's the chronically high insulin that seems to be most strongly associated with risk for Alzheimer's. So this is not simply a matter of like, well, you my doctor says I'm not diabetic, therefore I'm safe. So I think that is largely probably the... the main driver, and then there are, if we have time, there are nutritional deficiencies, specifically something like B12 that can cause cognitive decline. But to me, that's not Alzheimer's, that's cognitive decline, secondary to B12 deficiency. And there are certain types of statin drugs that are known to cause memory problems.

Dr Peter Brukner (20:34.55)
Right, well, we'll come back to statins and cholesterol in a minute. I just want to just explore the insulin thing a little bit, just so that our listeners can understand. mean, you talked about high insulin levels, and we'll talk about why that might be the case, and the fact that the high insulin keeps the blood glucose down to normal levels until sort of breaking point, you where it can no longer do so, the body becomes so resistant to the insulin.

That's when the glucose levels rise and that's when you get the diabetes. But as you say, you don't develop diabetes overnight. It takes 10, 20 years probably of high insulin levels and so on. So what's the main cause then of high insulin levels?

Amy Berger
Well, there's a lot of debate about this. I think it's chronic overconsumption of carbohydrate.

Yeah, I think you're right. mean, it's clearly been shown that that's the case. So I guess the solution is to reduce that carbohydrate load. It's not rocket science, is it really?

That's the nice thing about it. Yeah. mean, you know, there may be other things. I do think that there is a role for getting proper sleep and staying active. But at the same time, we also know that, you know, shift workers and people that may be in wheelchairs can lose 50 pounds on a low carb diet. They can reverse diabetes. So

Amy Berger (22:05.652)
Exercise is not necessarily required to improve metabolic health in some ways. Regulating sleep is not necessarily required, although it can be helpful.

Sure, yeah. I just want to touch on cholesterol because it gets a bad rap for all cholesterol. yet, as far as the brain is concerned, mean, cholesterol is so important and such an important component of brain tissue. Why is it so demonized and why are we so obsessed with reducing cholesterol and what are the effects of reducing cholesterol?

It's a very unfortunate tale, I think. I think it's just been decades, over half a century now, of misguided medicine, misguided information. know, cholesterol, of course, has been demonized because we think it's the cause of cardiovascular disease or it causes heart attacks, even though about 50 % of people that experience a heart attack have normal or even low cholesterol. It's actually the parallels between demonizing cholesterol and demonizing amyloid are so, it's remarkable. We've identified this one compound that we think is the cause. Therefore, let's invent some drugs that prevent the synthesis or reduce the buildup of this compound. Problem solved disease cured. Well, then how come we still have so much cardio, you know, putting putting somebody on a statin doesn't necessarily prevent them from having a heart attack or stroke in the same way. Like you mentioned earlier, every single drug developed to target the amyloid has been a failure. In fact, some people taking these drugs actually get worse, which suggest again that this amyloid may be building up in the Alzheimer's brain as a protective mechanism. But anyway, the cholesterol, the human brain is literally built out of cholesterol, the myelin, all of those myelin sheaths, all of the neurons need cholesterol to function. And when we

Amy Berger (24:29.056)
It's, you know, I am not making this up. This is a very, very well known side effect of certain statins, memory loss, confusion, specifically the ones that they're lipophilic that cross into the brain more easily. There's some statins that don't, but I think they probably all run the risk of cognitive impairment. There's just some that are greater risk.

Dr Peter Brukner
Yeah and the role of cholesterol you say it's I mean do we need cholesterol in our diet or do we make our own cholesterol?

Amy Berger
Well, the human body definitely makes cholesterol. So even if you follow a vegan diet or you follow a diet that has no cholesterol is only in animal foods. Your liver will generate cholesterol, but I think most cells can generate cholesterol. But just like with any compound really that the body makes, you may not always be able to make enough for your needs. So you might as well get some from your diet just in case. But yeah, even if you ate none, you would still make some.

Dr Peter Brukner
Yeah. Okay. So I mean, I'm a patient, I bring my elderly parent in and say, look, they've got early stages of Alzheimer's, they come to see you for some dietary advice. So what are the basic things that you would be advising these people on?

Amy Berger (26:08.578)
Well, I am not a physician, but knowing what I know about what we just talked about statins, I'm going to look first to see is there potentially an obvious cause for the cognitive problems? Is somebody taking a statin drug? What was their B12 level? And for people listening, the reference ranges or the quote unquote normal ranges might not be appropriate.

You know, if you have somebody with a known cognitive or any neurological problem, in fact, and they're at the very low end of the B12 range, you consider them deficient. You want them to be at the midpoint at least of the vitamin B12 range. So other than that, I will absolutely recommend a very, very low carbohydrate or ketogenic diet. And if somebody's not willing to do that, or unable to do that, then I will recommend cutting carbs to whatever extent is possible and then maybe using those exogenous ketones, but also using coconut oil or MCT oil, which for sure, most of the viewers here know this, but those particular fats are more readily converted into ketones even when you're still eating carbs.

Dr Peter Brukner
So if you were to eat coconut oil or use MCT oil in some way, that person will still have slightly elevated ketones even if they're not on a low carb diet. But as you say, that's probably a poor substitute for going on a full ketogenic diet.

Amy Berger (27:49.878)
Yeah, that's really, mean, if we are talking about a brain that is starving for fuel, what is the best way that we can get this brain fueled again? And like you said earlier, the low-carb or keto diet isn't just going to fuel the brain, it's going to potentially improve all the other metabolic problems. Because if somebody has Alzheimer's,

They very likely have some other metabolic problem too. They might have hypertension or type two diabetes or gout or skin tags or obesity or any of these other things that we know are primarily driven by high insulin.

Sure, yeah. Now you talked, you mentioned briefly before the other lifestyle factors and in particular the two that I'm interested in are exercise and sleep. So tell us a little bit about the role of exercise for Stata in Alzheimer's, both in the prevention and the management of Alzheimer's disease.

Well, correct me if I'm wrong, but in my opinion, mean, apart from all the wonderful mental health benefits of exercise, which is the main reason I do it personally, but exercise helps improve or maintain insulin sensitivity. you know, building muscle mass and using those muscles is one of the best ways to prevent or improve something like type two diabetes or insulin resistance.

So I think it's all, it's not that exercise is doing something magical, completely unrelated to this metabolic piece. I think it's all together. And I think sleep, sleep does the same thing. When you do not, when you have broken sleep or short sleep or sleep apnea, you have increased risk for things like type two diabetes and metabolic syndrome.

Dr Peter Brukner (29:49.334)
Yeah, absolutely. Okay, so what about someone who's already got significant Alzheimer's? mean, you know, is it too late then? Or is it worth trying to do something in the way of diet?

Amy Berger
That is a really good question. And I don't think it's ever too late. might not be able to, depending on the person's age and depending on the severity of the disease, you might not be able to turn the clock back, but you might be able to improve that person's cognition and quality of life in the time they have left and improve the quality of life of their caregivers and loved ones.

We often forget that that is one of the most difficult roles in this whole situation is the child who's caring for this person or the spouse or whoever it is that's the caregiver. We're talking about changing the person's food. That's the beauty of the, we're not talking about some crazy, dangerous, wacko intervention. We're talking about a diet. We're talking about food.

So you might as well change it and see what happens. If nothing happens, you're not gonna, what's going to happen is the person's eyes are going to get noticeably better. They're gonna get a little better or they're not gonna get better. You may have seen this more in your experience, but I've never seen anybody get worse on a ketogenic diet when done properly. I've never seen many health problems get worse.

Dr Peter Brukner
Yeah, fair comment. Okay, so most of most of our listeners don't have Alzheimer's. But as I said at the start, you know, we're all in the back of our mind, you know, we're all a bit scared. So tips for preventing Alzheimer's, because, as we said, this doesn't develop overnight, you know, you don't get wake up one morning and suddenly got Alzheimer's. This happens over 1020 30 years, maybe who knows. So if I came to you as a 40 year old and said, look, know, my parents have got Alzheimer's, I'm terrified that I'm going to go down the same track. What advice would you give me for the next 20 years or so to not, you know, obviously to completely eliminate my prospects, but to reduce the odds of me getting Alzheimer's? What advice would you be giving someone?

Amy Berger
Yeah, and thank you for, so I'm like a writer first and foremost. I appreciate you using the phrasing that you used because I don't wanna over promise. We don't know for certain that we can prevent this. I think we can, but I do think that what we can do absolutely is reduce risk. So how can we do that? If you're already following a low carb diet, keep doing that. Stay on your low carb diet.

I mean, I shouldn't say that. What I think can help reduce risk is keeping blood sugar and insulin within a healthy range. And the amount of carbohydrate that any one of us can eat and still accomplish that is different. Some people have to stay ultra ultra strict keto all the time. Some people can have a bit more carbohydrate. So it's really individual, but that's you want to at least control your carbohydrate intake to the extent that you maintain healthy blood sugar and insulin. And personally, I think fasting insulin should be a routine part of blood work. And I cannot fathom why it's not, except that medicine just hasn't caught up to what we all know. And then of course, getting the nutrients that we need. Like I had mentioned B12, we need... we need the full complement of actual vitamins and minerals for healthy brain function. So you just wanna make sure that you're eating good quality food. Like you said, stay active, keep those muscles insulin sensitive. Something I forgot to mention about sleep earlier was that not only does it help maintain normal insulin sensitivity, the brain, while we sleep, think of it like cleaning house. That's when the cleaning crew comes into the brain and sweeps out the, know, very scientific terminology here, when it sweeps out the junk, it's called the glymphatic system for anyone that wants to look it up. G-L-Y-M-P-H-A-T-I-C, glymphatic system is when the, during sleep is when that happens in the brain. You know, and we know.

Not only that, but when you don't get when you don't sleep well, what happens the next day? You're more hungry, you're more irritable, and you want carbs. You I know I do if I haven't slept well. Sugar is a lot more tempting than it normally is. But these accounts here to your question, what would I tell somebody younger who's looking to reduce risk? Do all of these things to stay metabolically healthy. But the good news is, it's not

There's not that many moving parts. Eat a low carb or low-ish to ketogenic diet, whatever you need to do. Stay active, get good sleep. And that's the majority of what I think is important.

Dr Peter Brukner
Right. Okay. I've got a question in relation to diet to the specific to the diet from Jennifer, who says that she's heard that high meat and salt diet can contribute to the effects of the brain and risk of dementia and Alzheimer's. She thinks it might have something to do with acid production. Tell us what your thoughts are on on meat. Parole meat gets a bad rap these days. It's sort of demonized and it always sort of amuses me that, you know, we've been eating meat for... for hundreds of years and in fact we're eating less meat than we ever ate. And yet all these chronic diseases are getting worse and more common and more common and people are blaming meat. That's quite bizarre really.

Amy Berger (36:17.218)
Yeah, I don't really know what the mechanism for that would be behind meat and salt increasing risk, except you mentioned acid. I know there's a lot of focus on uric acid these days, but the biggest contributor to elevated uric acid is elevated insulin, because insulin causes the body to retain uric acid. So it's not even so much the pure...

We eat, there's nitrogen containing, or maybe it's the base, whatever, the purines in food that get broken down into uric acid. And purines are high in a number of foods, but including red meat and shellfish and organ meat specifically. But what caused, it's not so much that we're ingesting these foods, but why is our body holding on to too much of this uric acid? And in most people, it's the insulin. And there are some people who think that elevated uric acid should actually be added to the diagnostic criteria for metabolic syndrome. So I don't think it's the meat, I think it's the insulin, which is not coming from the meat.

Dr Peter Brukner
Yeah, I think you're absolutely right. So David's concerned about having too low blood glucose when you're on a, is there a sort of a, know, can you be, can your blood glucose get too low? He was talking about, you know, less than three millimoles, which is what 120 odd in your language and so on. But yeah, can you can you be too low in your blood glucose when you're on a ketogenic diet and therefore I guess have symptoms, you know, like activeness and so on.

Amy Berger (37:59.22)
That's a really good question. somebody, so I honestly can't say for certain what the long-term ramifications of that would be, but in the acute sense, if your blood glucose is that low and you are symptomatic, then eat a small amount of carbohydrate to raise it. If you're symptomatic, it would be my guess that your ketones are not high enough to compensate.

They did some fascinating studies decades ago that would never get approved today by a review board where they would fast people and then inject them with insulin. So their blood glucose is basically in the floor and they were fine. And it's because their ketones were so high that their brain was totally fine. But so yeah, if somebody has especially low glucose and they're having problems, I would eat a little bit of carbohydrate. You know, we've gone a little too far in demonizing carbohydrate in the keto world. Like I said earlier, not everybody needs an ultra ultra strict ketogenic diet to be healthy. Some people have a little more flexibility for certain carbs.

Dr Peter Brukner
Yeah, yeah, I think everyone has the right amount of carbs and it varies, you know, and I think if you're, you know, if you're morbidly obese and got chronic disease and type 2 diabetes, well, it's probably pretty low. But, you know, if you're young and fit and healthy and insulin sensitive, you can, you can probably have, you know, 100 grams of carbs a day and be quite, be quite healthy and, you know, eat some fruit and things. So yeah, there's a right amount for everyone. And that can change also as you as you become healthier and your insulin resistance improves, you become more insulin sensitive, you can actually transition to having more carbs.

Amy Berger (39:48.92)
Totally agree.

Dr Peter Brukner
Yeah, good. Okay, some more questions. Are there any tests that can be taken to see if you're at increased risk of developing Alzheimer's? Well, we talked about the gene, the APOE4 gene, but other than that,

Amy Berger
You could have your routine and maybe some advanced blood work done like a fasting insulin test. Although just like fasting glucose, there are shortcomings of fasting insulin where it can be slightly elevated and it's not automatically a problem. We never want to become alarmed over one number all by itself. We always want to look at the total picture. There is... so the reason that they know that glucose uptake in the brain is compromised is because they can do PET scans where they inject you with glucose and they can see how much is getting into or is not getting into the brain. But that's not a test you would routinely have done at the doctor's office. They really only do that in scientific studies. I mean, other than that, I mean, there are some... assessments that are not blood tests, like the it's called the Mocha, the Montreal cognitive assessment, there are, you know, tests where they get Donald Trump was famous for taking one of these assessments. these these types of assessments where they give you a cognitive performance test rather than actually assessing biomarkers.

Dr Peter Brukner (41:14.446)
Let's not go there.

Dr Peter Brukner (41:24.396)
Yeah, sure. Okay. Question from David, my PET scan or yes, had a PET scan shown I have 50 to 70 cl of beta amyloid in my brain. I have no outward signs of dementia. Should I also check to see whether I have the APOE4 gene? That's a complicated one for you.

Amy Berger
It's interesting. The question would be, what would you do differently if you knew you had that gene from what you're doing now? Would knowing you have that gene change your behavior in some way? That's the only reason that I would maybe recommend having that test. But again, like we said earlier, that gene does not program you to get Alzheimer's. If anything, if you have the ApoE4, that would just maybe give you more of a reason to be diligent about the diet if you happen to be someone who has difficulty sticking with it. That knowing that you have that gene might give you more motivation to get really serious about it.

Dr Peter Brukner
Right. Okay, question from Shelley about B12. You mentioned vitamin B12. Maybe tell us a little bit more about the role of B12. And then specifically, Shelley says that I've learned that there are two forms of vitamin B12 as a supplement, which is the better one and why. just explain why you're concerned about B12 and where we get B12 from.

Amy Berger
So B12 is found only in animal foods. There is no B12 in plant foods, although supposedly there are B12-like compounds in plant foods, but really you cannot get B12 on a strictly vegan diet. So it's only in animal foods and it is absolutely critical for neurological function. So there have actually been cases of vitamin B12 deficiency that have been misdiagnosed as multiple sclerosis or Parkinson's disease. So I wonder how many people out there are actually experiencing these types of issues that what they really have is B12 deficiency. So there are different forms of B12 available as supplements. You may hear that, so,

B12 is also called cobalamin because it has cobalt at the center of the molecule. So cobalamin, the mineral cobalt. You may hear that methyl cobalamin is the best or the most effective. I'm not convinced by the research. I think probably supplementing with any form of B12 is better than not supplementing if you need it. I'm not saying here that everybody should go buy B12. Get checked if you're concerned about it.

If you want to get methyl B12, that's fine, but I don't know for certain that that's the most effective compared to the other forms.

Dr Peter Brukner
Okay, fine. Now I want to go to your book and I love that you've got a great section in the book. It's a conclusion and that the heading of the chapter is why Alzheimer's is on the rise and how to repair a broken brain. And you asked the question, if someone were to ask me how to damage the human brain, who is what I would say about attacking on the dietary front? Want to take us through some of the things that you think are the worst advice you could possibly give someone if you want to damage their brain.

Amy Berger (45:07.618)
Well, I haven't even read that. You've read it sooner than I have. I probably said something to the effect of eat a lot of sugar, eat a lot of refined carbohydrates multiple times a day, every day for years. Deprive yourself of proper sleep. Don't move enough. And I don't mean that you have to go to the gym and really work super hard, but just your everyday life is full of convenience. Take the closest parking spot, you take the elevator or escalator, even though maybe a staircase is available, these little things. Probably taking a statin drug was on that list.

Dr Peter Brukner
Yeah, I'll tell you what else was I'll tell you what else was on it. You said, if I wanted to damage human brain, I would deprive it of cholesterol. I would deprive it of omega three fats. Now maybe you could just tell us a little bit about omega three fats and their role.

Amy Berger
Right, right. So omega-3s are just a kind of fat that is also critical to the brain, critical to neuronal health. And we often hear, so this, if people know fish oil, this is why people take fish oil supplements to get these omega-3s. But you don't have to take fish oil. You can eat fatty seafood, but you will also get omega-3s in land animals like beef, like chicken, aspen.

Not everybody can afford the free, know, free ranging grass finished. Although in Australia, you have much better food quality than we have here. So you are, you are blessed over there in that sense. But even regular conventional meat still has some. So, you know, if somebody's allergic to fish or can't, can't eat seafood, you, can still get those Omega threes other ways.

Dr Peter Brukner (47:02.422)
What sort of features are the best for for Omega 3s?

Amy Berger
They say fatty fish, beyond that, can't specify, salmon and mackerel, sardines. But I think there probably is a difference between the wild caught versus the farm raised just because where the fish itself gets the omega-3s from is in what they eat. And so farmed fish may be eating these manufactured pellets or whatever that don't necessarily have the omega threes that the fish would get in the wild. So, you know, if you're going to spend your food dollars, allocate them in a certain way, and you only have a certain amount, if you eat fish, I would maybe prioritize the wild caught fish and you can get some other meats in a cheaper way.

Peter Brukner
Sounds good. A couple of other things that are two things we haven't talked about that are probably important. One is stress and one is sun. So tell us a little bit about the role, you think the role of stress in the development of chronic disease, in particular Alzheimer's disease.

Amy Berger
Well, in my thinking, it goes hand in hand with the whole glucose insulin system because chronic stress keeps blood sugar higher than it would otherwise be. It's, you know, people, if anyone watching has ever used a CGM, a continuous glucose monitor, or even just a regular finger stick glucose meter, you may have noticed that after an aggravating commute or after an argument with someone, your blood sugar is higher. It's because of that sort of fight or flight state, those hormones liberate glucose. So if you're kind of in that state all the time, well then we're not gonna have the proper metabolism. there's probably other biochemical mechanisms that I'm not familiar with, but that's the biggest one in my mind is that it just still interferes with that whole regulatory system.


Okay. And then sun and the role of vitamin D and we're just coming into spring and summer here in the Southern Hemisphere and it's time to get out in the sun.

So I will be completely honest, I know a lot less about this than I'd like to. If I had to speculate, I would say maybe more having to do with the circadian rhythm and allowing that proper sleep, of getting that sunlight at the proper times of day. But this doesn't mean that somebody who is a shift worker or who works the night shift, like you're not doomed.

I always say that, let's say in an ideal world, we control our diet and exercise and sleep and stress and okay, great. But if you can only control one or two or three of those things, do your best. If you can't control everything, do your best to control the ones you can and don't stress out too much about the rest because you, you... you will work against yourself, making yourself crazy, trying to manage everything and feeling guilty and feeling scared versus feeling empowered to, you know, optimize the things that you can. But the vitamin D, I know what what do you know about it? I'm I, I think we know a lot less about vitamin D than we like to believe. don't know what the optimal, should somebody living at the equator have the same vitamin D level as an Inuit living in the Arctic Circle?

Yeah, I think it's probably more important than we think it is vitamin D, but I certainly try and get out in the sun whenever there is some sun around. I'll try and get out. Obviously, you know, not at the peak times when you're going to get burnt, but I think it's really important to get exposed to because it's not just vitamin D, it's nitric oxide that gets produced and so on. I think all those things are important.

Do I do feel safe saying I don't think we evolve to be indoors 24 seven that that I can say I don't think we evolved to be in offices all day long.

And I always say, I think there's a reason that spring comes before summer. again, it allows your body to become used to gradually increasing temperatures and heat and you're not gonna get burnt and so on. So look, we're nearly running out of time. So I just maybe just wanna go back and summarize things a little bit if we can, And in particular, just go back to this idea of what we can do about either preventing or treating because

Dr Peter Brukner (52:03.214)
For a lot of people, once they have that diagnosis of Alzheimer's, they feel as though there's no hope. There's nothing they can do. It's a of a lifelong sentence. Things are only going to get worse. I've lost my spouse. I've lost my parents. They're not the person they used to be. don't recognize me. We can't talk about things that happened in our childhood and so on. And as you said, it's incredibly distressing for people who are carers of people with Alzheimer's.

So what would you say to these carers and is there hope and if there is hope, how can they best help their spouse, parent or whatever to reduce the impact of this horrible disease?

Amy Berger
I love ending on this type of theme because I really, really want people to know that there is hope. This is not a hopeless situation. Like I said kind of earlier, there are a lot of unanswered questions. There's a lot we don't know, but that doesn't mean we don't know anything. It doesn't mean we are powerless. And to the extent that it certainly looks like Alzheimer's is a metabolic problem and it's a fuel shortage in the brain and it's secondary to chronically high blood sugar and or insulin, just like all of these other chronic non-communicable metabolic diseases that have exploded in incidence, then it stands to reason that the same thing that helps those might help the brain or might protect the brain over the long term. And that's gonna be a low carb or ketogenic diet or even a paleo diet, eating in such a way that gives you the nutrients you need, that keeps the blood sugar and insulin within a good range and healthy lifestyle practices, staying active, getting sun, getting good sleep. Even if your parent has this and their parent had it, that doesn't mean that you're automatically going to have it.

Amy Berger (54:09.836)
You just need to maybe not do the same things they did.

Excellent. Yeah, that's great advice. And yeah, there is hope. And that's important, I think, to give people hope. And basically, that's why we developed our program, our Defeat Diabetes program, to facilitate that. So to give people the knowledge and the practical means of going on a low-carb ketogenic diet for conditions such as Alzheimer's, not just for diabetes, but as you said, there's a lot of overlap between diabetes and Alzheimer's was just going to say, let's just remember that there's a little bit of a delay. Let's just remember that the brain is not immune to the damage that the rest of the body suffers in the modern diet. So that's...

Dr Peter Brukner (55:05.55)
I mean, it's been terrific. I really enjoyed it. I'm sure our listeners have got a lot out of your wisdom and your experience. If they want to check out your website, it's Tuit Nutrition, isn't it? T-U-I-T.

Amy Berger
They can contact me there. That is in desperate need of overhaul and updates. So it's better to go to stallslayer.com, stall like a weight loss stall, stallslayer.com. But I'm on YouTube. People can find me.


Dr Peter Brukner
Absolutely. And you're doing a fantastic job. Keep up the good work. And we really appreciate you coming to talk to us all the way down under. Yeah, it's been fantastic and we appreciate it. And I'm sure our listeners are really grateful. So thank you. until next time, see you later.

Amy Berger
All right, thank you.