00:01 Dr Ede's personal health journey 

00:41 Discovering the connection between diet and mental health

04:26 Incorporating nutritional principles into psychiatric practice

07:36 Writing her book 

08:47 Importance of fats in brain health.

11:24 Harmful effects of modern diets

12:23 Refined carbs and vegetable oils

14:20 Limitations of psychiatric medications

16:29 Nutrition in mental health treatment

17:47 Psychiatric conditions responding to diet

19:10 How diet can improve brain health

20:00 3 steps to optimise brain health

22:43 Brain fuels: Glucose and ketones

26:37 Quiet paleo approach

30:00 Exploring alternative diets

30:51 Blood glucose affects brain health

33:32 Insulin resistance

34:13 Cholesterol myth debunked

40:00 Importance of nutrition in psychiatry

40:40 Overcoming scepticism 

41:40 Practical strategies

43:20 How to adopt healthier habits

45:20 Brain fog

47:00 Metformin and glucose regulation

50:03 Wheat and flour

50:43 Blood glucose and ketone testing

51:13 Rapid fire Q&A on so-called brain superfoods

53:16 Advice for improving mental health

57:23 Red meat

59:08 Conclusion

Dr Peter Brukner (00:00.664)
Hello everyone and welcome to the Defeat Diabetes webinar, the latest in our series of webinars. And I must admit today, I'm really excited because our guest is Dr. Georgia Ede, who is from the United States of America and is a nutritional psychiatrist who's just published this fabulous book, which is Change Your Diet, Change Your Mind. Welcome, George.

Dr Georgia Ede
Thank you very much, Peter, for having me.

Dr Peter Brukner
It's our pleasure. I was going to do a lengthy introduction, but I thought, no, no, why don't you just tell us your story about how you got to be, tell us your journey. Take us on your journey.

Dr Georgia Ede
Well, okay, so there was high school in college and medical school and residency and so four years of medical school and then decided to become a psychiatrist four years of psychiatry residency and then I practiced psychiatry conventional psychiatry can traditionally practice like about ten years medications and psychotherapy and Didn't have any idea that the brain cared at all about what we ate. I was never taught anything about that it

Honestly never crossed my mind. You know, the relationship between food and the brain, it just wasn't part of my training. But then in my early 40s, through my own health issues, I was coming down with some conditions that were pretty common among, especially my middle-aged and older patients, you things like chronic fatigue and fibromyalgia and migraines and IBS and that sort of thing that I had no idea how to help my patients with. And I had no idea how to help myself with either.

Dr Georgia Ede (01:40.536)
and I went to lots of smart and caring doctors. was working at Harvard at the time and all my tests were normal and everybody said everything was fine. And they sent me home with the same generic diet recommendations that they give to everybody. And I was already following them. I was already eating a high fiber, low fat, low cholesterol diet and exercising six to seven days a week, but I was not feeling well. And so I threw my own... dietary changes. I was kind of experimenting with my diet to try to help myself feel better. I kept a food and symptom journal and I was doing that. I was really quite motivated to do this because I'm very sensitive to medications and I'm not even sure what medications I would have taken, you know, to deal with these issues. But I was starting, it was starting to become difficult for me to work. And so in any case.

I kept a food and symptom journal. I made these changes to my diet, hoping to at least help with the IBS. And lo and behold, six months later or so, everything, all the symptoms I was dealing with were gone. And not just that, but my mental health was noticeably better. My mood, my concentration, my productivity, my mental stamina, my anxiety, like everything was better and I hadn't even been trying to help myself with any of those things. They were never really that much of a problem to begin with. And so I thought, well, this diet, which by the way, was completely almost completely upside down from what we're told to eat, it was high in animal foods, low in plant foods, low in fiber, high in cholesterol, high in saturated fat. This diet, I thought, well, this is really helpful for me and it seems to help my body as well as my brain, but given everything I thought I knew about nutrition, thought, well, this diet's dangerous. So in the long term, I mean, I can't recommend this diet to my patients. I need to learn about nutrition. I need to understand why this diet, you know, why this diet works. And so I studied nutrition independently for several years, really diving in to nutrition science articles, trying to understand, okay, why do we need fiber?

Dr Georgia Ede (03:59.886)
Why do we need whole grains? Do we need every fruit and vegetable or certain ones? Why is red meat more dangerous than other kinds of animal foods? I mean, there's all of these questions. My head was full of questions. And as you know, if you scratch the surface of this nutrition science, the nutrition science that supposedly is supporting our

dietary guidelines and mainstream nutrition advice, there's no science behind them at all. It's completely upside down and backwards. The truth about nutrition is completely upside down and backwards. And it really doesn't take that much time to figure that out. But in any case, that led me over the years to discover lots of fascinating things about food in the brain, what the brain is made of.

What the brain actually needs in order to function properly, how low carbohydrate diets and ketogenic diets fuel the brain differently, how low carbohydrate and ketogenic diets have been, especially ketogenic diets, have been used for decades, decades, over a hundred years now to stabilize brain chemistry in children with seizures. And that got me thinking about, well,

I'm a psychiatrist. prescribe seizure medications every day to people with bipolar disorder and people with anxiety and people with sleep problems to stabilize brain chemistry and thought, well, if the ketogenic diet stabilizes brain chemistry in people with seizures, could it also stabilize brain chemistry in people with mood disorders? so on and on and on, know, just curiosity, just curiosity led me down all these different paths.

I started a website as I was exploring these things to share what I was learning with the public and eventually started incorporating these principles into my practice. I felt absolutely confident that it was safe to recommend these different ways of eating to my patients to try to help them feel better. And that was, I mean, I don't know, maybe 12 years ago or so that I started mixing these principles into my work.

Dr Georgia Ede (06:21.986)
Gradually over time, more more use of the ketogenic diets in my practice and eventually left my beloved specialty of college mental health so that I could practice, really dedicate 100 % of my time to nutritional metabolic psychiatry because practicing this way, I mean using these tools, these are the most powerful tools I've ever had at my disposal as a psychiatrist to help patients. And that's why I wrote the book. I want people to know that

people who are worried about their mental health, which is now most of us. If you're not yourself worried about your mental health and someone very close to you is, that dietary changes can be powerful. They can help you in ways that no medicine can, but you have to know which dietary changes are the right ones to make.

Dr Peter Brukner
Great, fascinating story. There are so many things I want to explore in that journey. Let's go back a little bit and let's explore the brain. Let's try and give us your understanding of what the brain is made of and how it works and that will lead us to what foods are good and bad for the brain.

Dr Georgia Ede
Yeah, so if you took your brain out of your skull and rung all the water out of it, what you'd be left would be like this wad that was about 60 % fat. And that fat's divided into three types. So a third of the brain, the third of that fat is saturated fat. A third of that fat is a mono unsaturated fat called oleic acid, which is the same type of fat that you find in olive oil and pork. And then the and then another third, the remaining third of that fat is polyunsaturated fatty acids, omega-3 and omega-6 fatty acids like DHA, which is an omega-3 and arachidonic acid, which is an omega-6. And those two fatty acids come only from animal foods. The other the other two, the saturated fat and the oleic acid, the unsaturated, the monounsaturated fat, we can make those ourselves. We cannot make the DHA, the arachidonic acid ourselves.

Dr Georgia Ede (08:30.734)
So the brain is very heavily reliant on these very special animal fats to be fully operational, to develop properly and to function properly. And then of course there's lots and lots of cholesterol in the brain. It's the organ in the body that's richest in cholesterol. And every single molecule of that cholesterol is made on site from scratch by the brain. Because cholesterol is too big and bulky to make it from the diet into your bloodstream and across the blood brain barrier.

It can't get in, and the brain needs it so badly it makes it itself. And one of the things I like to say is, why would the brain go out of its way to make a molecule that's bad for you? It wouldn't. It's really smart. It's a brain. So lots of myths about nutrition that I came across that I found so fascinating, I put them all in the books of people who aren't familiar with these concepts, could hopefully enjoy them as much as I do.

And so if we have a poor diet, say, you know, you and I would regard as a poor diet, lots of processed food, processed carbohydrates, and the traditional low fat diet that we're all being told, mean, what does that do to the brain?

my goodness. if you're eating the way most people do now in the world, we used to call it the standard American diet, then we called it the standard Western diet, but now it's just with the standard global diet. And so we've exported it to all four corners of the planet. Unfortunately, I'm terribly sorry. we Americans, apologize. So thank you. So this diet that so

Dr Peter Brukner
Apology accepted.

Dr Georgia Ede (10:13.59)
A lot of, often will hear that this diet is dangerous for us because it's got too much red meat and too much saturated fat in it. But really that's not the issue. You we've been eating red meat and saturated fat since time immemorial. Those are not new ingredients. The signature new ingredients, the things that are so new to us as a species in the modern diet are the tremendous amount of refined carbohydrate.

just lots and lots of sugar and flour and cereals and fruit juices, all kinds of naked carbohydrates that turn instantly into glucose in the bloodstream and set you on a glucose and insulin roller coaster for hours and hours afterwards and all of your other hormones as well. And we find fats, the vegetable oils, the soybean oil and the sunflower oil and the safflower oil and the cottonseed oil and all of the corn oil and all of those. Those, I mean, the vegetable oils are very new to our diet. We've been eating refined carbohydrates for a long time, just not to this extent, but vegetable oils are 100 years or less, depending on where you've lived and how you've been eating, these are really new in our diet. Our diet prior to about 100 years ago was only about 2 % of the linoleic acid, which is the omega-6 in vegetable oil. The problem with refined carbohydrates in vegetable oils is that they promote

They're really powerful promoters of inflammation, oxidative stress, refined carbohydrates, inflammation, oxidative stress, and insulin resistance. And the oxidative stress, that's why we're told that we're supposed to eat foods full of antioxidants is because we're all suffering from tremendous oxidative stress. And insulin resistance or pre-diabetes, which all of your listeners will be very familiar with. And then vegetable oils are, we know, powerful promoters of oxidative stress and inflammation as well. So these are a deadly one-two punch for the brain. They are literally destroying the brain from the inside out.

Dr Peter Brukner (12:21.194)
So we think now, there's a theory that, I mean, that mental health disorders used to be regarded as basically chemical imbalances and not enough neurotransmitters and hence the medications and so on. I what was your experience with treating mental health disorders with depression, anxiety, bipolar, et cetera, with medications?

Dr Georgia Ede
Well, so many issues there. mean, medications do help some people, absolutely. And I still use them in my practice, in emergency situations, in people who don't respond to dietary changes, which are not, I mean, most people do better with dietary changes. And people who can't or won't change their diet, so they still, we still use them and we still need them.

But it's a really frustrating and really disappointing experience to prescribe psychiatric medications. Most people do not get better. Most people do not respond fully or even partially to these medicines. Most people, the people who do experience some benefit from these medications pay a price, not just in terms of financially, but they pay a price in terms of their quality of life, their length of life, their metabolic health, side effects, sexual side effects, weight gain, apathy, of dulled emotions, type two diabetes. Some of these medications triple the risk of type two diabetes. And these are some of the most effective medications that we have as psychiatrists cause tremendous metabolic damage. And then the process of prescribing these medicines, we're really practicing in the dark.

I mean, there's no test I can give you if you come to me with depression to tell you which neurotransmitters are unbalanced in your brain and which medicines are the right ones to start with. It's still in 2024, a trial and error process that can take months or even sometimes years to find a medicine combination that will be worth taking. So it is really, really hard because most of our patients...  most of our practices are just filling up with people that aren't getting that much better.

Yeah, not very rewarding practice. I have a colleague who's a psychiatrist who's now 70 odd and semi-retired and has just discovered the role of nutrition and is so frustrated in that he spent 30 or 40 years of his psychiatric practice, as he says, wasting his time and his patient's time. And if only he'd known that 30 or 40 years ago, he's trying to make up for lost time now. I can imagine it must be a very frustrating profession.

Being a psychiatrist who's just trying to provide medications.

It is and you know, I I I loved I I loved my practice even back then, you know, I love working with people I I loved the psychotherapy element of practice. I love the the biochemistry element what I what I understood of it and know, I a really fascinating profession but also really really stressful and really heartbreaking sometimes and so Yeah, I mean this is a really exciting time to be a psychiatrist because we finally have really promising root cause strategies, empowering strategies that allow people with mental health problems, very serious, very chronic, long-standing serious mental health problems who haven't responded to traditional approaches. We're now able to empower these people to improve their own brain health, often reducing or even eliminating sometimes.

Dr Georgia Ede (16:15.938)
The need for psychiatric medications and able to sort of reframe their mental health issues as having a reversible and logical metabolic cause. And it's not that the other pieces don't matter. It's not that your childhood doesn't matter or trauma doesn't matter. It's not that the quality of your life as it is right now matters or your financial situation or your relationships. Those things all matter.

But even if all those things externally are going beautifully, if you're not feeding your brain properly, you will be unstable from within. And that's what so many patients would say to me, like, my life looks great on the outside. Why do I want to die? And I didn't have a good answer for those people.

So just take our listeners through some of the sort of common conditions that you see that you feel respond very well to the sort of metabolic nutritional approach.

Honestly, just about any psychiatric condition can respond to these interventions. And that's because these interventions improve total brain health. So anybody who comes to me with rare exception, I wouldn't use or recommend these strategies in people with underweight anorexia, for example. That's a very complicated condition that I don't work with my practice.

We don't know enough about in terms of how to safely use these strategies in those folks yet. But in just about every other case, there is the potential for these interventions to be useful. They make sense almost regardless of the diagnosis, regardless of how long someone's been ill, regardless of what medications they're taking or how long they've been taking or how many they've been taking. And that's what I teach clinicians in my training program is

Dr Georgia Ede (18:16.674)
These interventions make sense to consider for just about all of your patients, and because they improve total brain health.

Dr Peter Brukner
And how, what's your understanding of how they improve brain health? Is it reducing inflammation? Is it reducing oxidative stress? it, what are the main mechanisms in children's resistance? or all of the above? What are your, what's your sort of, how would you explain to a colleague or to a patient, you know, who asked you, well, okay, you know, you say this works well, but why, how, how does it work?

Dr Georgia Ede
So it works, so a brain healthy diet, so if we understand what a brain healthy diet needs to do, it needs to nourish the brain by providing all essential nutrients, that's step one. And the diets that we are taught to eat, even if you're following the guidelines to the letter, do not properly nourish the brain. They do not have enough nutrients in them, and in fact, they have too many anti-nutrients in them.

And this is why nutrient deficiencies are so common, even in people who eat animal foods and balanced diets and that sort of thing. It doesn't nourish the brain properly. Step two is you need to protect the brain. You protect the brain from damaging forces such as, just as you were saying, inflammation of the brain, which you can't feel or see, but it's often there, oxidative stress.

You know, this is the reason why we're told to eat antioxidants. This is too much oxy of stress, free radicals, running a muck in the brain like a bulls in a China shop, damaging everything they bump into. And you need to energize the brain safely and reliably in ways that, and cleanly, efficiently, with less inflammation and less oxy of stress, you need to energize the brain reliably in ways that protect your brain metabolism over your whole lifespan.

Dr Georgia Ede (20:14.348)
And what that essentially means is keeping your blood sugar and your insulin levels in a healthy range. And our modern diets don't do that either. So our modern diets, they don't nourish the brain properly. They don't protect the brain from damaging ingredients. They're loaded with damaging ingredients. And they don't energize the brain safely or reliably. When you're fueling your brain primarily with carbohydrates, particularly refined carbohydrates,

what you're doing is your brain's energy level is waxing and waning and every time you're getting these spikes in your brain glucose you're getting waves of inflammation and oxidative stress damaging the brain from the inside out. So everything about the modern diet is brain unhealthy and so if you simply restructure your diet from the ground up in these ways that make biological sense you're now nourishing protecting and energizing the brain and so how could you not feel better?

If you're finally after decades or maybe even generations of being fed the wrong nutrition information, if you feed the brain properly, it will serve you better. And it's just as if you've been bringing a really fancy, expensive car that's everything. It's a perfect car. But you've been feeding it, you've been putting sugar in its gas tank instead of gasoline. Of course, it's not going to work properly. When you give it the right fuel, suddenly it's going to, know, it's going to, it's going to, it's going to.

It's going to work beautifully. I think that those principles apply to all brains.

So if we accept that sugar and processed carbohydrates are damaging to the brain, I mean, so what are the alternatives? What's the right fuel for the brain? If that's the wrong fuel, what's the right fuel?

Dr Georgia Ede (22:03.566)
Well, brain does it. So the brain is designed to burn small molecules. And it's two favorite molecules to burn. Our glucose, glucose is one of its favorite fuels. And ketones. So glucose obviously comes from blood sugar. ketones, glucose is blood sugar. Blood sugar is glucose. That's the simple sugar that's traveling through your bloodstream. And ketones are a very small molecule that comes from breaking down and burning fat.

So Professor Stephen Cunane, who's one of the world's leading experts in brain metabolism and brain aging at the University of Sherbrooke in Canada, he describes the brain as a hybrid engine. And it really runs best when it's running on this mixture of glucose and ketones. So lot of people think of glucose as the ideal fuel for the brain.

And they think of ketones as an emergency backup fuel only to be used in the most dire of circumstances when all else fails. But that's not the case. And so what actually works best is if the brain has access to some glucose and some ketones at all times. And that's because, so we think of, well, why don't you want your brain to be running 100 % on glucose? Well, because glucose, it's a little bit, it's a faster fuel.

And you know, it's just faster energy but But it it in the process of burning glucose if you're burning a hundred percent glucose You're getting a lot more inflammation and oxidative stress when you're burning glucose So if you're if you're if you're running on a mixture of glucose and ketones ketones burn more efficiently more smoothly more cleanly less inflammation oxidative stress So you might think well why don't?

Why don't we run our brain entirely on ketones? Why do we need any glucose at all? And the brain does need some glucose at all times. It doesn't need much, but it does need some. And that's because glucose does burn faster and there are certain processes in the brain that need fast energy. And there's certain processes in the brain that can only use glucose. So there's a pathway in certain cells of the brain, a construction pathway that's used to build things like antioxidants.

Dr Georgia Ede (24:23.288)
We have our own antioxidants, no blueberries required. So antioxidants and DNA molecules, there's a pathway in brain cells that can only use glucose because ketones are too small. But most operations in the brain prefer to use ketones. And the more ketones you give the brain, the more the brain will absorb and the more the cells will take in, even if there's plenty of glucose around. So the brain chooses

Even if it could burn 100 % glucose, it chooses not to when it's given a choice. It chooses to burn a mixture of glucose and ketones. But even though the brain needs glucose, that doesn't mean you need to eat carbohydrate because we can make all of the glucose we need smoothly, reliably, 24-7 without any peaks or valleys or drama exactly the right amounts that we need at all times.

Through this process called gluconeogenesis, which is making glucose from scratch out of protein and fat. So dietary carbohydrate is optional. You can feed yourself that way, but it is safer metabolically to make your glucose from within.

So what diet then is going to give you the best fuel for your brain? mean, are we talking Mediterranean diet? Are we talking paleo? Are we talking ketogenic? Are we talking low carb? Give us your sort of, you I come to you as a patient with some mental health disorders. I have many. you know, you, you know, you, and I'm saying to you, well, what, know, what should I eat to, to, maximise my brain health? And what, what advice would you, would you be giving me?

So in the book I lay out three dietary strategies that people can explore and I ask them to start with what's called what I call a quiet paleo diet. And I ask them to, so paleo diet for folks who may not have heard of that, that's kind of a hunter gatherer pattern, what we would have evolved over a couple of million years eating whole fruits, whole plant and animal foods, but before agriculture. So no grains or legumes or dairy products.

Dr Georgia Ede (26:35.566)
And no sugars or flowers or cereals, none of these modern processed foods. So this paleo pattern, kind of a hunter gatherer pattern, but with a little bit of a ceiling on the carbohydrates. So the standard diet has at least 300 grams of carbohydrate in it. The diet that I recommend people start off with to explore whether changing their diet could change their mind.Is this quiet paleo pattern has about 90 grams of carbohydrate in it, so about two-thirds less than the standard diet. So that way people can still have some fruit and starchy vegetables, but they are not overwhelming their system with too much carbohydrate and they're not eating the most damaging foods.

Dr Peter Brukner
What do you mean by the use of the word quiet?

Dr Georgia Ede
Oh yeah. So I've made some adjustments, some unique modifications to a standard paleo diet to make it quieter on the gut, so easier to digest, quieter on the nervous system. I've taken out some of the foods that have some naturally occurring neurotoxins in them, like the nightshades. And I've modified it to be gentler on the thyroid, gentler on the immune system. So I've taken out a few of the plant food pulprits, know, plants defend themselves with toxins and some of those toxins are more aggressive than others. And so I haven't removed the plants from that diet, but I've just quieted it down so that it's easier to digest and gentler on these systems so that... And then people can expand it later. You know, if they feel better, they can then see if they can expand it more and find the broadest, most, you know, the most varied diet that they can...

Dr Georgia Ede (28:24.024)
kind of get away with and still feel well. But I've pared it down in the beginning so that people won't get frustrated and have to troubleshoot and know trial and error removals of various things. that's the first step. And then if that doesn't help enough, you can go to a ketogenic version of that diet, which is you know just lowering the carbohydrate to that ketogenic level. Usually about 20 grams of carbohydrate depends on who you are and it's customizable.

And then for people who want to go even deeper, if they're still struggling, they have a lot of autoimmune issues or food sensitivities, gut issues, et cetera. They could experiment with a carnivore diet, a plant-free diet, still ketogenic, but plant-free. And all of these are discovery strategies, like curiosity strategies and discovery strategies that people can then personalize as they go along. But I've found in my practice that these are the most efficient ways to help people feel better quickly.

If their mental health condition is largely rooted in dietary issues, which for a lot of us, they are to a significant extent.

Dr Peter Brukner
Yeah, obviously our Defeat Diabetes community that the listeners today suffer either from type 2 diabetes or pre-diabetes metabolic syndrome and so on. What can you tell us about the relationship between those conditions and mental health issues and then on to dietary solutions?

Dr Georgia Ede
I love this question because I like to tell my patients, if you have pre-diabetes or diabetes, you don't just have a blood sugar problem, you have a brain sugar problem. And the reason for that is that when your blood glucose levels are going too high after meals, which they will for people with pre-diabetes and diabetes and people who are eating too many of the wrong carbohydrates too often, you're gonna get these spikes in your blood glucose.

Dr Georgia Ede (30:23.31)
And every time your blood glucose spikes, you get a brain glucose spike as well, because the brain glucose is always directly proportional to, they rise and fall together. And it's the same, but they rise and fall together. So the higher the blood sugar, the higher the brain sugar. And so you don't want, you don't want ex-glucose in your brain. If the brain sugar spikes, that can be quite dangerous because every time it spikes, you get a wave of inflammation and oxidative stress that's very damaging. And that can cause your neurotransmitters to become very imbalanced. You can get lots of physical damage to membranes and the blood brain barrier and mitochondria and all kinds of important structures inside the brain can be physically damaged by that inflammation and oxidative stress. And so that's one issue is there's too much glucose in the brain, which is quite toxic and damaging.

The other issue with pre-diabetes and type 2 diabetes is the insulin. So the high glucose will give you the, you know, those waves of glucose will give you brain sugar spikes that are damaging. But the fact that your insulin level is climbing and climbing and climbing as the pre-diabetes progresses slowly towards type 2 diabetes over many years, your fasting blood glucose is going to stay normal. Often fasting blood glucose is the last domino to fall.

On the road to type 2 diabetes, as you know very, very well. So most practitioners, when you go to your doctor or nurse practitioner for your annual checkup, the way they're going to look at your metabolic health is they're going to check your fasting blood glucose and your hemoglobin A1c to see if you already have type 2 diabetes. But that's not really what you want to know. What you want to know is

Are you already on the 10 to 20 year road to type 2 diabetes? And how do you get off of that road and turn things around, which is actually very easy to do. And so what's keeping your blood sugar normal for all those years until it can't do it anymore is rising insulin. And so that rock that climbing insulin over the years is keeping that blood sugar normal till it can't do it anymore. That's what you want to know. How high is your insulin level? How much insulin, how much insulin does your pancreas have to pump out to manage and cope with all of that carbohydrate that's coming in? And that climbing insulin naturally causes insulin resistance throughout the body and brain. The brain becomes insulin resistant the more you bombard it with insulin, the harder it becomes for insulin to cross into the brain, the surface of the brain, the blood brain barrier becomes insulin resistant.

Now you've got a brain swimming in a sea of glucose, glucose still waltzes in, no questions asked. Now you've got a brain swimming in a sea of glucose, too much glucose, but it's still slowly starving to death because the insulin can't, not enough insulin can get through. And the more insulin resistant you are, the more years you've had this issue, the lower your brain insulin becomes and the more sluggish your brain glucose processing becomes as a result. The brain can't

process glucose and turn it into energy or anything else efficiently or to full capacity without adequate insulin. So the brain is slowly losing its ability to use glucose for energy. So by the time you have any noticeable signs of memory problems, your brain glucose processing capacity can already be down by 25%.

So this is the path to Alzheimer's disease and then all kinds of other mental health conditions as well.

Dr Peter Brukner (34:45.806)
Fascinating. We've spoken about Alzheimer's disease previously in these webinars and it's a huge fascinating relationship between sugar and diabetes and Alzheimer's. But yeah, look, there's so much to explore. I just want to touch briefly on cholesterol because everyone's obsessed about cholesterol and you alluded to it earlier on in your own journey that you were concerned about the fact that you had a high cholesterol or semi a high saturated fat diet effect on your cholesterol. So what do you say to patients who express concern? but my doctors are worried about my cholesterol.

Dr Georgia Ede
My goodness, this is a major roadblock to recommending healthy, nutritious, whole foods, low carbohydrate and ketogenic diets and of course, carnivore diets as well to patients. Healing, therapeutic diets. This roadblock is important. So what happens is people say to me, well, I can't go on this diet because my LDL cholesterol is too high or

My doctor won't let me go on this diet because my LDL cholesterol is too high or even worse. I just started this ketogenic diet a few months ago. I feel amazing. I'm not depressed anymore. My anxiety is gone. I've lost 15 pounds. But my LDL cholesterol is going up and my doctor feels it's dangerous, wants to give me a statin medication to lower the cholesterol. So this is a tremendous misunderstanding of the cholesterol.

The purpose of cholesterol in the body and metabolic health in general. But what I would say to people who are concerned about this, you're viewers out there, when you look at that cholesterol panel, there are several different numbers on it. One of them, yes, is the LDL cholesterol. And the LDL cholesterol is what most practitioners are going to be focused on like a laser beam because that's the number.

That we were all trained to bludgeon into submission with medication if it went above a certain number, right? We were never taught what cholesterol did in the body. We weren't taught, you know, why is it high? Why is it low? What does it even mean? So we were just taught to prescribe medications if it was too high. So when you look at that panel, I do not seem to ignore the LDL. The LDL is not a completely useless number.

Dr Georgia Ede (36:47.52)
It's just that it gives it's the least useful number on the panel because it can be high for good reasons. It can be high for bad reasons. It can be low for good reasons. It can be low for bad. It doesn't tell you much of anything at all. In fact, your chance of having a heart attack when your LDL is high is exactly the same as the chance of a heart attack if your LDL is low. So it's like a coin toss. And so what you want to know, you want to pay attention to the numbers that matter, the triglycerides are really, really valuable piece of information. And the HDL cholesterol. So if your triglycerides are above 100 milligrams per deciliter, and I can't remember what the international unit is, 1.1 maybe? Yeah. Don't quote me 1.5, yeah. 1.5, thank you. So if your triglycerides are too high, all that's telling you, it's valuable. You're eating too much more carbohydrate than your body can handle. And your liver's turning it into fat.

And you don't have to eat a gram. You don't have to eat a gram of fat. You could have a fat-free diet and your bloodstream could still be loaded with fat because we turn every excess gram of carbohydrate we eat. we more than we need, the body turns it into saturated fat on purpose and stores it in your body fat. That's how it works. That's where the come from. So if it's too high, you're eating too much carbohydrate metabolism. And so...

There's lots you can do with that cholesterol panel. What I hope you won't do is automatically just look at the LDL and stop thinking there. There's more you do. can get a coronary artery calcium scan. You can get a fractionated LDL. You can look at what kind of LDL it is, healthy, unhealthy, but please don't just look at the LDL and stop there and think that the diet that is so healthy for you is automatically bad for you.

Absolutely. And as you mentioned before, cholesterol is an essential part of the brain. mean, we make cholesterol to fuel our brain because the brain needs it. this demonization of cholesterol is sort of the most evil thing around. mean, it's essential to life. vitamin D comes from that. mean, it's so much important. OK, just final question from me, George, before we turn it over to our listeners.

Dr Peter Brukner (39:13.58)
Obviously, you've been enlightened as to the importance of nutrition in psychiatry. But I think it's probably fair to say that you're in a minority in your profession in psychiatry. How do you think you can win over the rest of your profession, if you like? What's going to happen in the future? you see, but obviously we'd like to see this adopted more broadly, but and what are the barriers to that, do think?

Dr Georgia Ede
Well, I could bribe them all with refined carbohydrates, maybe chocolate or ice cream care packages or something. I'm sure that'll go over well. Actually, I'm very, very hopeful about this because mental health practitioners, we are hungry for new solutions. Most of our treatments don't work very well. And I teach clinician trainings in this topic, and it's wonderful.

You know, meet clinicians of all backgrounds from all around the world who are so excited about these interventions because they need new tools. You know, we need we finally have strategies that make sense, that help us understand what's going on in the brain and the body, how the two are connected and they're really empowering strategy, powerful strategies, effective strategies. It's really an exciting time to be in the mental health field, especially if you know, if you're, if you're interested in using these these interventions. So now there's certainly still lots of skepticism in my field and and lots of just you lack of information. Lots of practitioners in the field don't know yet about these strategies but word is getting out. I one of the reasons I wrote the book was to I'm really frustrated with patients and clinicians but mostly patients having to accidentally stumble into these interventions.

Dr Georgia Ede (41:13.112)
By, my gosh, know, I mean, how many times do I hear this? And I'm sure you hear this too. you know, I started a low carb diet for weight loss and my gosh, my depression got better. Huh? I wonder, I wonder. Funny about that. No, that's what happened. Right? So, so what if all mental health practitioners, you know, if this is my dream, my step number one dream, number one is that every patient with a mental health concern, goes into their practitioner and gets in their very first appointment as part of their intake, a metabolic evaluation as part of that intake. There are lots of things you can do with that information, but that should be step one. Have that discussion about profound impact of your metabolic health and your diet and your metabolic health on your brain health. I think that would be fantastic. And I do think

I do think that that's not too difficult to achieve.

As you said, that metabolic assessment has got to include a serum insulin level because that's not generally done, certainly not in this country and I suspect not in your country. some reason, I don't really understand. Doctors are reluctant to measure serum insulin. It's probably the single most valuable measurement, I believe, as you pointed out before, because it tells you well before your blood glucose goes haywire or your HbA1c, it tells you you're developing. Insulin resistance and type 2 diabetes. And yet, most doctors don't actually measure serum insulin.

Dr Georgia Ede (42:50.062)
No, they don't. And it's an inexpensive test. Here in the United States, even without insurance, it might cost you $10, $12, $15 at the most. And so what I tell people is if your doctor or nurse practitioner won't order it for you, go to an online direct-to-consumer lab and order it for yourself. Order it for yourself. most people will be able to, mean, unfortunately, when you order your own labs, they're not covered by insurance here in the US.

But it's a cheap test. And if you can't get that test for whatever reason, there are these other simple tests like your triglyceride levels, your waist to height circumference. If you measure yourself around the belly and that's more than half your height, that's a big clue to insulin resistance. If your triglycerides are too high, that's a clue to insulin resistance. If your HDL is too low, that's another clue to insulin resistance.

You could get a glucose monitor or check your finger stick glucose an hour 90 minutes after you eat and your glucose is going too high That's another sign of insulin resistance. So lots of ways to skin the cat But I agree with you. The fasting insulin level is really really it's it's so valuable and so easy to add on to that to your standard tests

Dr Peter Brukner
Great. Right. Enough of me. Everyone's sick of my questions. What about some of their readers questions? How someone asks, how do I convince my family members to read your book when I might disagree with what their government assigned doctor says?

Dr Georgia Ede
Well, oh my gosh, well, you can lead a horse to water, but that's really all you can do, right? so the way I think about it is A, be a good role model, like a quiet role model. Sometimes people will get curious and ask you, my gosh, you look so great. You sound so great. Things seem to be going so well. What are you doing? What's your secret? And sometimes, kind of like a cat, you let them come to you.

Dr Georgia Ede (44:55.554)
There's that piece of it. But then there's also, you know, we can't control what other people do. But there are lots and lots of people out there who are looking for these answers and want to talk about it and want you to, want to engage with you about it. Focus on those people, the people who want the help and want to change. And other people will either come around or not, depending on where they are in their own journey. They may not be interested right now, but they may

Something may come along later on in their life that might, maybe they have a child or maybe they go through a bunch of medicines that don't work. Maybe someone else does a better job of convincing them than you were able to do. There may be another opportunity, but as I teach in my training program, no means no. And if somebody is not wanting to talk about it, you do have to respect that. But I think most people are at least a little bit curious, especially when they see really dramatic.

Positive changes in somebody that they know well, that they've seen struggle for a long time.

Yeah, I always sort of just say to people, well, just give it a go. Just try it for three weeks. See, that's not too hard. And if nothing happens, fine. But you'll be amazed in three weeks what a difference it can make to your life. Because I think people are worried about this lifelong commitment. But once you are on it and you feel so good, then the lifelong commitment becomes quite easy.

That's right. Just like, they say never say never say never say always never say forever. Right. Just let's just just try it out and see how it goes for a while. Just so anybody can do something for three to six weeks. Right. How most people can can manage that.

Dr Peter Brukner (46:38.542)
And Georgia, even those without, you know, sort of diagnosed mental health issues, you know, because we, lot of people suffer from brain fog, you know, I not sure what the medical definition of brain fog is, but I think we all know what we're talking about, you know, and, I mean, what's your, you know, what, what do you think of brain? What is brain fog? What do you think of it? And how do we fix that?

Dr Georgia Ede
Yeah, you know, that's not something that's been formally studied much. But you know, the way I think about it, as I think of it as a sluggish brain, sluggish brain glucose processing, it could also be reflecting in it could be that the brain isn't getting enough energy. It could be because of, you know, inability to extract all the energy from glucose possible. It could also be inflammation. It could also be oxidative stress. I mean, all of these things can cause the brain to to function below its full capacity. So if you want your brain to really firing on all cylinders, all of those systems have to be working properly. has to have all the nutrients it needs. It has to be protected from damage. It has to be not inflamed. can't be under too much oxidative stress. And it has to be getting energy. And so all of those things have to be in place for the fog to clear. It could be any number of those things.

Dr Peter Brukner
Yeah. Okay, back to next question. This is a question about metformin, which is obviously one of the most common medications used in diabetes. What if you're taking metformin that inhibits gluconeogenesis? How does your brain get glucose?

Dr Georgia Ede
Oh, what an interesting question. So lots and lots of people take metformin. Lots of people take metformin in combination with a low carb diet. Lots of my patients come to me already taking metformin. I don't believe, and you may be a better person to answer this question than I am. So I'm gonna shoot it over to you in just a second. But I don't think it turns gluconeogenesis off. I think it just turns it down. Is that correct?

Dr Peter Brukner (48:38.186)
That's my understanding. Yes, not completely. yeah, I think and as you say, there are many, many people benefiting from the combination of metformin and ketogenic diet or low carbohydrate diet. And some who choose to stay on metformin, even though they probably don't need it anymore for their blood glucose. They're all convinced that it's a secret to longevity or something like that. all right. Next question. I've always theorized that wheat is the evil to the human species. We've only started eating it because it was easy to grow and cultivate and grows fast. What's your feeling about wheat flour and so?

Dr Georgia Ede
I couldn't agree more. So I cannot think of a single reason to include wheat in the human diet. So any way you look at it, from a nutritional perspective, from a safety perspective, from a taste perspective, from just any perspective, there's just no earthly reason to eat it unless you have no other choice.

Dr Peter Brukner
Yeah, fair enough. Okay, another question from Plum who's read your book and loved it. What numbers should she be aiming for when she tests her blood glucose and ketones? And should we be testing ketones?

Dr Georgia Ede
Sure, glucose and ketones. Yeah, so chapter seven of the book explains all the sort of different ranges you want to you know, the ideal ranges and the less than ideal ranges and the danger zones for your glucose levels, but essentially, you know, I like I really like to see the the the glucose level not go above 110 even after meals. I mean some people maybe 120 at the most I like to ideally you want to keep it under under a hundred and

Dr Georgia Ede (50:27.63)
110 milligrams per deciliter or below at all times. then the, you know, so in your ketone levels, this really depends on your goals. For some people, a particular ketone range is going to be absolutely critical for them to keep their mental health optimal.

And for some people, it's less important. And for some people, don't even need to be in ketosis. They just need to eat a low carb diet and keep their glucose levels and insulin levels under good control. So there's a difference between a low carbohydrate and a ketogenic diet. So low carb diet may or may not put you into ketosis. It may just keep your glucose and insulin levels in a healthy range. And that's huge. You want that. But there are some people, especially a of people with mental health issues, who

In addition to needing this nice, low stable glucose and insulin pattern, also need to lower that insulin down to the point that fat burning, vigorous fat burning turns on. And when you're vigorously burning fat, you're making ketones which can cross into the brain and bridge that energy gap. If you've got significant degree of insulin resistance or difficulty, if your brain is in trouble using glucose for energy,

You're gonna need that supplemental fuel source and you might need a significant degree of ketones to get it there. So for a lot of my patients, I find that somewhere between one and three millimole beta hydroxybutyrate on the ketone meter, that seems to be the sweet spot for a lot of people. There are exceptions, but that's what I ask people in the book to aim for to begin with.

Dr Peter Brukner
Yep. Okay. So tell me what, I'm going to mention some foods and you tell me, tell me what your response to these foods are. Blueberries.

Dr Georgia Ede (52:26.818)
Delicious, but they have no special superpowers. Right. Quite high in carbohydrates. They're very high in carbohydrates. If you're going to eat fruit, strawberries, raspberries are a better choice. And still, you got to be careful with those two, not too many of those, please.

Do like blueberries. okay. Red wine. Toxic.

Dr Peter Brukner (52:50.158)
Okay, right. I'll throw that one out. Destroying my diet. Dark chocolate.

Dr Georgia Ede
Hmm. Contains sugar. Also has no special brain superpowers.

Okay. 33 salmon.

Very good for you.

Okay, coffee.

Dr Georgia Ede (53:18.754)
How unpopular do you want me to become?

I have to warn you that I live in Melbourne, which is the coffee capital of the world, and we are all addicted to coffee here. Real coffee, not that dish water you serve up in America, but real espresso coffee is part of our Italian cultural background. So you take your life in your hands if you come to Melbourne and say coffee is bad, but far away.

Here's what I'll say, and I say this in the book, is so when people first come to me, I do not open the conversation by saying, let's take your coffee away, because I've never seen them again. So I use it as a troubleshooting strategy, because some people are very sensitive to coffee and can only get good results when they cut it back or remove it. And other people, it really is not important in terms of getting where they're trying to go with their meeting and mental health goals.

So I use it as a, a, you further down the line as a troubleshooting step, not as a step one.

Dr Peter Brukner
Okay. All right, look, we're really nearly up to the end of the webinar. So I just wanted to finish, I guess, with just simple pieces of advice that you would give someone who has some mental health issues or wants to improve their brain health, if you like. Just some real basic sort of starting points as to what you be advising these people.

Dr Georgia Ede (54:40.974)
Practice whole food strategies meaning getting all the junk in the process stuff out of your diet boxes and cans and bags and jars and all those things Whole foods meaning a peach a fish and egg a nut Really single ingredient whole foods that you might expect to find in nature if you were wandering around, you know a hundred thousand years ago That's a huge change but and so practicing that is really the most important thing you can do

And then you may need to go further than that, but start there. And this would include fruits and vegetables and carbohydrates as your first step. foods is really, really important. No sugars, no flowers, no cereals, no vegetable oils, no alcohol. And if you're trying to improve your mental health, no alcohol. And of course, no sugary drinks, things like that. So whole foods principles.

If you want to go further than that to a low-carb or ketogenic diet, please learn more about them and consult with somebody first because those are very powerful interventions that can change your medication levels. If you're taking medications, can quickly drop your blood sugar, your blood pressure, change your fluid and electrolyte balance very quickly if you're not safely guided through that keto adaptation process, especially if you're taking certain medicines or have certain health conditions. Make sure you're working with a practitioner, clinician director... my website completely free to search international and you know don't change your medications without you know working closely with somebody who can guide you through that process. Change your diet first and look at the medicines along the way and because that can be quite quite dangerous if you don't have a good support and guidance around tapering very very slowly those medications one at a time. So but but Whole Foods first and include... you can at the core of your diet at least some animal foods. That's the best way to get all your nutrient needs met, not just your protein needs but your your all of your micronutrient needs met as well than your brain really needs. Some of those nutrients are irreplaceable, extremely difficult or or even impossible in some cases to obtain from plant foods. So

Dr Peter Brukner (57:11.246)
No, we've just lost lost Georgia for the moment. You're frozen. Oh, she's back.

Dr Georgia Ede
Sorry. We're back. Hope is on the menu.

Okay, hope is on the menu. Hope is a very important thing. Just lastly, mean, red meat gets a bad rap these days everywhere, you know, for all sorts of reasons. I mean, what's your response to that?

Red meat is good for you. And it's as simple as that. There is absolutely no science behind any of the claims, any of the scary claims against red meat. I don't care if it's colon cancer or diabetes or obesity, inflammation. There is just no evidence. And there's a whole chapter in the book about this, if you don't believe me. It's quite clear that this is one of the most one of the safest and most nutritious foods that you can eat.

Dr Peter Brukner (58:06.314)
Absolutely. Well, Georgia, this is the book. It's a fabulous book. think Georgia's great, I mean, obviously she's incredibly knowledgeable, but her great skill really is to put very complex issues into very understandable, readable terms. And I think, you know, even though this is a complex topic, anyone could benefit from reading, Change Your Diet, Change Your Mind. It's excellent... book. I'm sure you're all looking for something to do over Easter. can't recommend anything better. Just throw away the Easter eggs and get this book instead. It would be much better. Thank you very much for joining us. We really appreciate your time. You've written a fabulous book and we really congratulate you on that. Thank you very much for your contribution to the defeat diabetes webinar. We'll see you next time. Thanks, everyone.

Dr Georgia Ede
Thank very much.