Episode 16: Amy Berger- The Alzheimer’s Antidote

There is no FDA approved drug that will reduce the symptoms of Alzheimer’s disease. The most they promise is to slow its progression. Could there be an antidote to Alzheimer’s disease right in front of us that most people do not recognize?

Our guest is Amy Berger, MS, CNS. She is a Certified Nutrition Specialist who specializes in using low-carb and ketogenic nutrition to help people reclaim their vitality. 

Amy is an international speaker, has authored peer-reviewed journal articles, and serves on the review committee for the Certification Examination for Nutrition Specialists. She has published the book The Alzheimer’s Antidote: Using a Low-Carb, High-Fat Diet to Fight Alzheimer’s Disease, Memory Loss, and Cognitive Decline.

Amy has a bachelor’s degree from Carnegie Mellon University and a Master’s in human nutrition from the University of Bridgeport. She has been eating a low-carb diet and maintaining a 35-pound weight loss for over 15 years. Amy loves using both her writing and nutrition backgrounds to help other people learn about low-carb and keto nutrition.


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Robert Lufkin  0:00  

Welcome back to the health longevity secret show and I’m your host, Dr. Robert Lufkin. There is no FDA approved drug that will reduce the symptoms of Alzheimer’s disease. In fact, the most that they promise to do is to somehow slow its progression. Could there be an antidote to Alzheimer’s disease right in front of us that most people do not recognize. Our guest today is Amy Berger, and ask CNS who is a certified nutrition specialist who specializes in low carbohydrate and ketogenic nutrition to help people reclaim their vitality. She is an international speaker on low carb and ketogenic nutrition, has authored peer reviewed journal articles and serves on a review committee for the certification examination for nutrition specialists. She is author of the Alzheimer’s antidote using a low carb high fat diet to fight Alzheimer’s disease, memory loss and cognitive decline. She is also author of endure carb confusion with Eric Westman. Amy has a bachelor’s degree from Carnegie Mellon University and a master’s in human nutrition from the University of Bridgeport. And now, Amy Berger. Hi, Amy. Welcome to the show. Hey, how

Amy Berger  1:23  

are you doing happy to be here.

Robert Lufkin  1:25  

Oh, it’s it’s so great having you on the program. I want to say I’m a I’m a huge fan of yours. I just read your your new book, which, in your car confusion that you wrote with Eric Westman, I loved it. I’ve got stall Slayer ordered it, it hasn’t arrived yet. So that’s another book that you’ve written helping people on ketogenic diet and, and moving past the stalls in the diet. And then today, the Alzheimer’s antidote, this is one of my favorite books on Alzheimer’s disease for people to read about it. And I can’t wait to get into this and and talk about all the exciting things in it. But maybe before we do, since it’s the first time you’ve been on the program, maybe we could just take a moment and tell us a little bit how you came to be interested in such a fascinating area.

Amy Berger  2:26  

Yeah, sure. So I’m like so many other people, I got into the world of low carb and ketogenic diets because of my own personal issues. And I used to be a lot heavier than I am now. And I I learned about low carb dieting when I was young enough that I didn’t have any major health problems. But I do have a family history of type two diabetes, cancer and stroke. So we were, you know, fully stacked up in the family. But I really gravitated toward a low carb diet for the purpose of weight loss. And, of course, it worked in it, I worked while I got to eat delicious food, and I didn’t feel deprived, and I didn’t have to count calories and weigh my food and all that. And I just was so fascinated, I just started learning more and more about it. And I had been in and out of a lot of jobs that I didn’t like and didn’t find fulfilling. And it occurred to me, hey, nutritionist as a career, I could maybe I could do that. And I can help other people learn about this great low carb way of eating. And so I went back to school and got formal training in nutrition. And along the way I read about it was actually in Gary Taubes his book, good calories, bad calories that I first learned of a possible connection between glucose, insulin and Alzheimers. And it was it was kind of interesting, but I don’t have any family history. And I didn’t have a huge personal interest in that. But I kind of tucked it away for future reference someday. And a couple of years later, when I went to write my thesis in graduate school, I, I went back to that when I had to pick a topic I said, you know, let me see what is out there about, about that all timers thing. And lo and behold, when I started looking like even a very cursory search of the medical literature, it was everywhere. I mean, I was shocked. And I’m thinking, I’m honestly very passionate about low carb and keto and blood sugar. And how is this the first time ever hearing of this like this? This should be on the front page news. And so of course now I have written that book about Alzheimer’s. But apart from that, I’m so honored to see that you read the other book to my gosh, because over the years that I’ve been learning about low carb and ketogenic diets, even though I came into it personally for weight loss, I’ve since really come to believe in you, you probably agree, but that weight loss is like one of the least impressive things that this way of eating can do for you. I mean, you can literally Really reverse metabolic syndrome reverse type two diabetes and I’m not a physician but I’m not speaking out of turn that the medical literature supports that you know people getting off of insulin for type two diabetes no longer require medication it’s just fascinating what you can do by just changing the food you eat

Robert Lufkin  5:21  

yeah that’s amazing i mean i i i want to emphasize that just for our audience which they probably know that Alzheimers disease right now there is no FDA approved drugs that indicated or claims to that will reduce the symptoms of the disease the most they promise is the slow the slow the progression and like you I mean, I’ve spent my entire career in the sort of traditional medical system at medical schools, teaching residents and students and when I found out about this I know about this effect of Alzheimer’s disease and its dependence on like we’re going to hear about insulin and glucose I can’t imagine why people aren’t shouting this from the tops of the rooftops and all nursing homes switch there types of mmediately but but anyway let’s do we’re getting ahead of things here maybe we could we can sort of set the stage and you could tell us a little bit about neuro degeneration and how how it how it responds to lifestyle and what the common themes are of Alzheimer’s disease and other neuro degenerative diseases that might allow them to respond to these kinds of tools we have Yeah, so

Amy Berger  6:50  

I think um you know, if if people are wondering what why would a low carb oriented nutritionist have anything to say about all disease they regularly refer to all timers disease now it’s type three diabetes or diabetes of the brain. And where this really comes from, is that the major malfunction in the brain of somebody with Alzheimer’s and and mild cognitive impairment that the precursor is that the brain is not receiving or not using enough glucose it’s based Think of it like the brain is starving, it’s an energy shortage or a fuel shortage in the brain. And and it’s actually they are finding the same thing in Parkinson’s disease and multiple sclerosis in some in several other neurodegenerative and neurological issues. So um, they’re, they’re starting to find that a lot of these diseases are metabolic in nature. And by metabolic I mean, they have to do with energy. You know, think about it, when you’re tired, when you when you don’t get enough sleep and you’re low on energy, we make mistakes, we get clumsy, we, we do dumb things we don’t normally do. So what would happen when the brain is the most, the most energy hungry organ in the body, it needs a constant supply of energy. So anything that’s going to disrupt the brain’s ability to to get or use energy, is going to have a major catastrophic effect on cognitive function. And that that’s exactly what all timers is, um, and I don’t I don’t want to get too far ahead of ourselves. But glucose is only one kind of fuel that you can give the brain but the problem in Alzheimer’s specifically is specific to glucose. For whatever reason, the brain is not metabolizing glucose. And this, this is something that starts when people are young, this isn’t something that happens overnight, you wake up when you’re 65, or 80 years old, and all of a sudden, you, you know, all of a sudden the cognition is massively declined this, they can measure the brain’s uptake of glucose. And they can see that even in people as young as their 30s and 40s. Sometimes the brain is already starting to use less glucose. But when you’re that young, and you’re still healthy, you have no signs and symptoms, because you’re still able to compensate, you’re able to meet that fuel deficit through whatever means. And it’s only after that little fuel shortage has gone on for so long as it becomes so severe that you can no longer keep up and compensate. That’s when you start showing the signs and symptoms. That’s when you start having the memory loss and the behavioral changes. But those are like late players to this game by the time you show those symptoms. This disease process has been in place for years and we just were not looking for it in people that young.

Robert Lufkin  9:57  

So let me let me summarize see if I understand This correctly, then there’s something that that happens in the brains of Alzheimer’s patients that affect their ability to utilize glucose. And we’ve heard in the past about the amyloid hypothesis for for Alzheimer’s, which has fallen out of favor now just because it It hasn’t yielded useful models for any sort of any sort of drug development or or it doesn’t explain a lot of things. And so what you’re saying is that with imaging studies like like PET scans that you can show actually decreased glucose utilization in the brain and this, this may be a better signature of Alzheimer’s disease, then then the bay there amyloid are certainly a more powerful one, because you can do it in living patients with a with a PET scan. But now you’re saying that this can occur, this decrease glucose utilization can occur in younger people before they get Alzheimer’s symptoms. What causes decreased glucose utilization? Is that just an aging thing? Or is it what what are the factors that drive that?

Amy Berger  11:15  

That is a zillion dollar? Or on answered question, all I can really do is speculate, I can give my thoughts because we don’t know. We do know the problem is a lack of glucose, you know, fuel utilization. We don’t know why that’s happening. I think, you know, when, when we look at things like cardiovascular disease, or obesity, or type two diabetes, and nobody questions anymore, whether or not diet and lifestyle play a role, we know they do know we might debate about which dietary factors are at work, but nobody doubts that those are diet and lifestyle driven diseases. Nobody just spontaneously develops those things. And yet when it comes to neuro degeneration, we like dismiss even the mere possibility that these could be every bit diet and lifestyle diseases just like all of those other ones and because just like all of those other ones, you know, all fibers used to be a disease really exclusive to very elderly people. Oh, you know, grandma’s losing our mind grandpa’s getting senile. And now we’re seeing it in people in their 50s and 60s, ever, ever younger, just like we are seeing type two diabetes. In toddlers, now we’re seeing non alcoholic fatty liver in children, everything is skewing younger. In my opinion, it has a lot to do with our diet. It has a lot to do with perhaps like problems with sleep, disrupted sleep and circadian rhythm. I think diet explains a lot of it just like it explains a lot in all those other you know, non communicable diseases. And there are other things like, as much as we’re going to focus on the glucose and insulin angle here people people do need to be aware that a vitamin B 12 deficiency all by itself can cause cognitive problems of neurological problems. I don’t want to get too controversial here. But stat and drugs are known to induce memory loss and confusion in at least some patients, you know, the status, particularly the cross into the brain, they not all of them do. But that that’s like a warning label that has to be on those drugs now, because the FDA recognizes that that may be a side effect of those drugs. But I if I could go back to the amyloid just for a second. I wish that what you said was true that the amyloid hypothesis was falling out of favor. I don’t think it is yet. I think I’ve seen so many papers saying it should be scrapped. We should forget about it. But it that hasn’t trickled out yet like that that new drug that just got approved against the FDA, his own panels decision is an amyloid drug. And what I think what people need to know about this amyloid is that you you can have lots and lots of amyloid buildup in the brain and have no signs or symptoms of Alzheimer’s, no cognitive deficit at all. And you can have, you can have very severe dementia, very severe Alzheimer’s without a lot of plaque. So either like by itself, this plaque is not causing the disease because you can have lots of plaque and not have Alzheimer’s. And all of these anti amyloid drugs do work. They work in that they do reduce the formation of the amyloid, but reducing the formation of the amyloid has done nothing to to to prevent the disease progression. Like in fact, there were there was at least one drug where the clinical trial had to be stopped Early because the people on the drug were the disease was getting worse so much more quickly than the people on the placebo. They did unethical to continue the trial. So this amyloid stuff we’ve we’ve, it looked good on paper, it made a lot of sense. But the research for the last however many decades, has not supported it at all. And I wish it was falling out of favor.

Robert Lufkin  15:26  

Yeah, that’s a very good point that the the app is we’re not saying that amyloid doesn’t occur with Alzheimer’s disease beta amyloid, but it’s about causality and primary root cause. I think may have been Dale Bredesen used the analogy that amyloid may be like sandbags that occur around flooding and floods. If you go to flooded areas, you often see sandbags there. But to then make the assumption that the sandbags are causing the flooding, and if you remove the sandbags, the flooding will not happen, then that that may be what’s going on with amyloid there that it like you say in some patients, is there some patients it’s not, but the decreased glucose metabolism is, is fairly, fairly consistent. Again, with the one proviso that you said that, today we’re focusing on diet and Alzheimers risk, but as, as other speakers will be talking about, we should not exclude deficiencies, nutritional deficiencies or vitamin deficiencies, thyroid hormone, I mean, there’s still hormones, mold, toxicities, heavy metals, meal, Nathan, we’ll be talking about molds and Lyme disease and and those sorts of things. So we, we we need to have a multi pronged approach by Alzheimer’s disease, but certainly one of the major risk factors and one of the easiest things to address is to look at glucose and diet. So returning to that now, we talked about the brain is not able to metabolize glucose it as in these older patients, as we age, what what now could you review, what’s the alternative? Is there anything else the brain can metabolize to provide this energy instead of using glucose?

Amy Berger  17:27  

Yeah, and but before I do that, though, let me make sure that we touch on something because the I love the phrase type three diabetes, because it really kind of immediately suggests, Oh, is this is this a blood sugar thing? Is this a glucose thing? But and certainly people with type two diabetes have, you know, much increased risk for Alzheimer’s disease, but there’s been a couple of studies where, you know, people I think people really need to appreciate the fact that there’s millions of people and that’s not an exaggeration, millions of people were the blood sugar, the blood glucose is normal, so they don’t have died, they’re not diagnosed with diabetes, there’s no problem there. But the blood sugar is only normal because really, really high insulin is sort of keeping that blood sugar in check. And there’s been some prospective studies where regardless of the blood glucose level if you have chronically high insulin that massively increases risk for developing Alzheimer’s so it’s not we can’t just look at the glucose it’s um but but you know what, what causes high insulin in most people, we could debate but a very high carbohydrate intake or or, you know, metabolic problems that may come just from overconsumption of food in general, that makes it more difficult to metabolize everything but that’s um, you know, somebody might be thinking well, you know, my husband is showing signs and symptoms but he’s thin and he doesn’t have diabetes. looking healthy on the outside does not speak to anything that’s going on on the inside with regard to the blood sugar and insulin. Yeah. To me, underscore

Robert Lufkin  19:09  

me underscore that to about the insulin before we leave that the the fasting glucose, as we’ve we’ve talked about before on this program is is it can if it’s high, it’s it can indicate diabetes, but like you say, if it’s normal, it doesn’t rule it out. Even the H a one C, which is average of three months of blood glucose levels, it’s still averaging the blood glucose levels as you beautifully pointed out, the the insulin can be elevated abnormally elevated for a decade before the glucose goes up and before the pancreas starts to fail essentially, and that elevated insulin is is the problem. It is pre diabetes and it’s increasingly not recognized and you can do a fasting insulin, which is You know a $10 test if most doctors don’t order it but more and more getting it get your fasting insulin but even that can be normal. And the insulin response as you mentioned in your book referencing Joseph crafts work and and really the gold standard is the oral glucose tolerance test with insulin levels but that’s fairly involved in all but but certainly a fasting insulin wouldn’t you recommend that now for most people to get their aspiration said have a glucose?

Amy Berger  20:36  

Yeah, and like you said it does have shortcomings just like it can be, you know, a little elevated for many different reasons that are not necessarily a problem. And like you said, it’s more, I think it’s more important what’s happening to blood sugar and insulin after meals. And that’s, that’s harder to test. It’s possible, but it’s difficult and, you know, looking at someone’s blood work, you you can get indicators of that problem without even measuring the insulin, you can kind of have these indirect things that really shine a light on that, I think.

Robert Lufkin  21:08  

Yeah, that so. So the alternative fuel for for glucose, then that the brain can use what can you tell us about that?

Amy Berger  21:21  

Yeah, so the, to me, in my opinion, the most encouraging most heartening thing about the Alzheimer’s research now is that they are finding that even though the the Alzheimer’s riddle brain cannot really properly metabolize glucose, it can still take up and use ketones. So we sort of have this like alternative, like if we think of the brain as a hybrid car, okay, we’re not really so good with the glucose. Let’s give it some ketones. And I don’t know if you’re Dr. Stephen crenate on here, or any of his colleagues, they do the most fascinating research showing that this this fuel shortage we’ve been talking about can be made up at least a little bit by ketones and not you know, not 100%. But it’s so it’s the single most promising thing that I’m aware of it, because if the problem is that the brain is starving for energy, what can we possibly do to give it some energy. And I personally think, you know, if anyone watching this has affected family members, or knows really about this, they report that so many people with Alzheimer’s, especially in the late stages, absolutely crave sugar, even if they weren’t sugar junkies earlier in life. And I think that may be the brains way of asking for fuel, even though the brain can’t really metabolize. It knows something’s wrong, and it’s trying to get that energy. But we can’t keep giving it the same fuel that it already has a problem using, we’ve got to give it something else. And the you know, the problem is that most people don’t generally have a lot of ketones circulating, because ketones are, there’s a lot of different ways to get ketones into the body. But one of the very, very normal, natural biological way to do it, is to you could keep your carbohydrate intake very low, because what insulin will prevent the formation of a significant amount of ketones. So we’ve got to get the insulin level lower, you can do that on a very low carb diet. You can also do it on a very, very low calorie diet or with fasting, but at least with a low carb or ketogenic diet, you don’t necessarily have to fast or restrict calories as long as you keep the carbs very, very low.

Robert Lufkin  23:51  

So so to get into ketosis, we can either restrict carbohydrates and that will that will men produce these ketones which our brain can use and it’s not limited like glucose is as we age or in Alzheimer’s disease. So we can either do it through a low carb diet or with fasting when we burn up our glycogen stores our glucose stores after about 12 hours of fasting then which which is really overnight for you know people and if you skip breakfast, then you’ll probably be in ketosis. And then and then what about exogenous ketones? Very Newport you know famously used MCT oils for her husband and had you know dramatic results and everything. What about

Amy Berger  24:35  

those Yeah, good question. I just before we get to that I just want to say about the fasting I don’t recommend it you probably don’t either. I don’t know I don’t recommend fasting for somebody that is frail or underweight. You know, a lot of these elderly people are already malnourished. The last thing I want them to do is stop eating. You know, for somebody that’s younger, you know, 12 hours is fine, but like in the keto World Anyway, there’s all this hullabaloo about multi day fasting. I don’t recommend that for someone who is frail and underweight and elderly. But yeah, so the another really, really promising development in all this is, ideally, you would go on a very low carb or ketogenic diet and have your own body, we just naturally produce ketones, but there’s always going to be people who are unable or unwilling to adhere to a ketogenic diet. And what you know, let’s still help them like, Can we offer them anything, and there are these, they’re called exogenous ketones, and people can think of them as a ketone kind of supplement, they come either as a powder that you can put in water and drink, or there’s a different form called an ester that is much more potent, much more powerful, much more expensive, much harder to get. But these ads MCT oil or coconut oil, which which is rich in these special MCT is the medium chain fats. The way the body metabolizes those special fats and oils is a little different than the way it processes like butter, and tallow and olive oil. And it’s a different process. And the body more readily converts those fats into ketones, even when somebody is still eating a higher carbohydrate diet. So even when somebody is not able or not, you know, doesn’t desire to do a low carb diet, we can still get ketones into the body and into the brain. And I wholeheartedly support that. But I think, because if if, again, if the problem is this fuel shortage, the ketones will help close that gap a little bit. But if the reason for the fuel shortage is a long term, sort of metabolic dysregulation, a diet and lifestyle thing, then just taking the ketones isn’t doing anything to address the underlying cause the underlying dysfunction, and it may be that somebody who’s afflicted with this is in such a severe state, that the, you know, there may be a point of no return where even a ketogenic diet isn’t going to help them they need the exogenous ketones. Ideally, I think somebody should do both go on the you know, if you already are in the throes of cognitive impairment, do both do the diet and take the ketones but I compare it in my book, that if you are taking the exogenous ketones without addressing your diet and lifestyle, you are bailing water out of a leaky rowboat without stopping to patch the hole you’re kind of managing the crisis you’re managing the symptoms, but you haven’t actually fixed the problem. That’s

Robert Lufkin  27:51  

so it seems like Yeah, so the fasting obviously, we want to be careful about with elderly people so it might not be might not be good for this population, at least the elderly ones and and the exogenous ketones have have limitations so really the value that the optimum approach seems to be the ketogenic diet which is low in in carbohydrates and and if it makes me wonder if refined carbohydrates they’re you know, now associated with with Alzheimer’s disease they’re associated with heart disease, obesity, diabetes, hypertension, dyslipidemia, some cancers and stroke. Why? Why does anybody take carbohydrates trizol they’re not an essential nutrient we don’t need them for our bodies is our carbohydrates the tobacco of the 20th 21st century to people just take them because they’re pleasurable it’s a habit but it’s a habit we should all be dropping

Amy Berger  28:58  

that’s that’s a good question you know, I I even though I specialize in lower carbohydrate and ketogenic diet I do not demonize carbohydrate as a whole across the board I mean look at healthy human beings all over the world and especially up and you know, this this all timers epidemic really only exploded the last few decades people have been eat healthy long lived people that age gracefully with all their faculties and tack have been eating fruit and beans and potatoes and even you know, um, bread and rice like, but um, it wasn’t i don’t i don’t know that we would say it was the preponderance of their diet. I guess the point i’m saying is it’s carbohydrate per se by itself is not causing this problem. With regard to the refined carbs. I think we eat them because they’re delicious. I mean, let’s face it, like they are delicious. There’s a reason we all love And I, I do think to some extent, we are probably evolutionarily hardwired to seek out that like sugary, very high energy, high calorie foods. We are just, you know, it’s a blessing and a curse to be alive at a time when we are surrounded by food. We are surrounded by by cheap, easily accessible, very high calorie food. This is not the evolutionary norm where you you had to walk maybe three miles to go pick some berries or something like, and so, you know, people People often ask me, do I have to do a ketogenic diet to prevent this? Or do I have to do it or like I’m, you know, I’m 75 years old, I’ve been eating the standard American diet my whole life, is it too late. And I don’t think it’s ever too late for someone to improve their health. But I also don’t think we need a ketogenic diet to an I have to say to potentially prevent this, because we don’t know that we can prevent Alzheimer’s, I believe we can, but we don’t know for sure. But to the extent that this might be the result of long term dysregulation in blood glucose and insulin from this very, very high carb, high refined junk diet, then I think, we don’t necessarily need a strict ketogenic diet all the time. But what we do have to do, I think, is eat and live in such a way that keep those blood sugar and insulin levels within a normal range. And the amount of carbohydrate that any individual can eat and still accomplish that is going to be different. Some of us, you know, Dr. Westman, and I wrote about this in endocarp confusion, some people are just going to have to keep things really low most of the time, other people have more flexibility for higher starch, higher carb diets. And, you know, I like to say that the interview that the strategy you need to fix a problem is not the same strategy, you might need to prevent the problem from happening in the first place. So if you if you have an insect infestation in your home, you could call an exterminator. And they come and they spray and they set off the bug bombs and Okay, great, that solves the problem. But what could you have done to prevent the problem? So you didn’t need to resort to this toxic, you know, poisonous solution? Maybe, you know, keep food sealed, don’t keep the windows open, and don’t keep food out on counter like, but I think once so do you need a strict keto diet to potentially prevent this? No, but once you have it once you are already affected. We need to like hit this hard to get you out. And and you know what I mean that the repair process is not necessarily the same as the prevention?

Robert Lufkin  32:57  

Sure, yeah, I guess with by the time you hit mild cognitive impairment or subjective cognitive impairment, there’s there’s been the damage in the brain. And it’s very serious, you potentially have a terminal untreatable disease by conventional medicine, which is all simers and

Amy Berger  33:16  

and the thing is, I don’t, I don’t think there’s anything mild about it at all, like mild cognitive impairment. That’s what it’s called. But like I was saying, this disease process is ruing for decades, sometimes before like that memory loss is a late by the time you start showing those symptoms. You’re pretty far advanced. So like, I don’t think there’s anything mild about it. But um, I also, I also know that people, mild stage have had remarkable transformations in regaining the cognitive function. So I don’t want anyone to think that like they’re all it’s already too late. Not Absolutely not. But I think I think maybe just realize that like, Oh, it’s just like mild cognitive impairment is like pre diabetes. You are already in serious trouble. You can fix it. But like, take it serious. There’s, you’re not in like an early mild stage at all, in my opinion.

Robert Lufkin  34:19  

Yeah. So So what about people before they don’t have mild cognitive impairment? who’s at risk for Alzheimer’s disease? Who would you recommend starting this diet? Or this this, these lifestyle choices earlier? who’s at risk for Alzheimer’s disease? And how, how do you how do you quantify that and which, which people should should do that? Because like, you say, if I wait till I get mild cognitive impairment, I can’t remember where my keys are. I’ve probably had this for 10 years. So what what can help me decide to start this 10 years earlier? What should I look for To do that in my my family history or whatever

Amy Berger  35:05  

I do think I mean obviously if you have a family history you know you need to be a little more concerned I mean everybody should be concerned but if you know that you may be you know prone to this or something and there there is the the genetic factor we’ll maybe talk about that in a minute but definitely if you have pre diabetes or type two diabetes you are at higher risk if you have metabolic syndrome which is basically a fancy name for high insulin all the time then you are also at risk so you definitely want to look at that and you know, they’re you most of the tests that would identify this are done at a routine checkup right? Oh glucose, you know, your triglycerides triglyceride to HDL ratio is very critical. If you have hypertension that’s unexplained that’s usually a metabolic syndrome insulin thing. And then you know, there there are like, like you we were talking offline earlier. There are imaging scans you can have done but they’re not really standard things that have gone at your you know, your annual checkup, but if like someone’s really concerned, they can maybe look into some of that stuff. But the the single strongest genetic risk factor is what they call the APL e4 gene. And, you know, we have two copies of every gene one from the mother one from the Father, and people with one copy of Eva we for our increased risk for Alzheimer’s people with two copies have a massively increased risk, but it’s kind of the same story with the amyloid you can have two copies of a bowi four and never develop any cognitive issues at all. And millions upon millions of people who do have Alzheimer’s don’t carry the e4 gene at all. So I would the the e4 gene definitely makes you more susceptible but it doesn’t cause Alzheimer’s in and of itself.

Robert Lufkin  36:59  

So so if I had a talking about the you mentioned the family history so if I have like a first degree relative with the had Alzheimer’s disease, or it may have just been dementia or memory problems as they got older, then I should backdate that 1010 years at least and start thinking I mean backdated I mean if they had problems at 60 at 50 I should seriously started thinking about my diet and these things are even earlier if things start even before and then you mentioned the a PO E for a Leal that that if that’s something else that that if you have one of those copies or or both then you need you’re at higher risk you need to think about it I love the part in your book where you describe the AP for a Lille as as the four version of it is sort of the ancient version that we had and at some point in our history it it allowed advantages I guess and then certain populations now it’s decreased and based on the the agriculture those populations It was fascinating to hear that

Amy Berger  38:16  

yes some of the I mean I can’t take credit for it all I do is write about other people’s fascinating research like Dale Bredesen and Steven cunanan all them but yeah it’s it’s really interesting it’s it’s believed that the so there’s um, April II two three and four within the human family, I think that there is a one but it’s maybe in other primates or something. And it’s it’s believed that the e4 is the oldest version of this gene. So it was forged in a time when the the dietary landscape was very different than it is now. And it appears to have been like, weeded out or selected against in populations with longer histories of grain agriculture. So like in in the Far East, where they eat a lot of rice, the Middle East with a lot of wheat, or even Central America with corn, where they’ve been cultivating grains for longer, they have a lower prevalence of this e4 gene. And that suggests that if you do have the e4 gene in the modern world, you are not very well suited for a higher carbohydrate diet. It’s more of like a hunter gatherer gene. So you may be and the thing is, though, like I, to the extent that all timers might be this blood sugar and insulin metabolic problem, I, I tell people not to worry too much about the form, you can get tested. It’s just a blood test. You can identify if you have this gene or not. But my advice to most of my clients that are concerned about this, my dietary advice wouldn’t be that different because we regardless of whether or not you have this gene, we need to control the blood sugar and insulin. And I would I would just say Say that maybe people with e4 need to be especially careful, like they need to kind of pay even more attention to that than somebody with a two or a three. But I wouldn’t I mean, I wouldn’t tell anyone to go out and eat, you know, 70% 60% carb diet like regardless of the genes.

Robert Lufkin  40:18  

Yeah, yeah, it’s interesting, our whole conversation where we’re focusing obviously, on Alzheimer’s disease, but it’s fascinating that the dietary recommendations you’re you’re you’re making about controlling glucose spikes and keeping insulin levels low, we’re now finding out that that’s those same, that same advice helps minimize heart disease risk helps minimize certain types of cancer risk, as we said, certain types of stroke. I know of course, you know, diabetes, obesity, hypertension, dyslipidemia, all these things. So there’s so many reasons to, to think about controlling glucose spikes and managing it that there’s that above and beyond, above and beyond the Alzheimer’s risk. So it’s, it’s it is basically there’s, there’s very little downside to it health wise I, that I’m not aware of.

Amy Berger  41:12  

Yeah, I mean, like I was talking earlier about how I got into low carb at all, and it was, it was through weight loss. And I’m grateful that I learned about it, because now I feel more empowered, you know, I do have that family history of type two diabetes and all that, and I don’t know for sure that I will prevent all of that happening by following a low carb diet, but I’m, I’m betting a lot on it. You know, I mean, it’s not the only thing I exercise, I do these other things, but um, it’s it’s like I said, you know, we we know, the cardiovascular disease, and diabetes and gout, and all this stuff is is largely dietary dietarily driven? Why do we not even entertain the possibility that the same is true of Alzheimer’s or Parkinson’s or ms, or any of the other? I’m not? we don’t we don’t know for sure that that’s the case. But let’s look into it, at least I mean, that’s when I first started just looking at the research and just, I, I’m still I still find it hard to believe sometimes that this isn’t more widely known, you know, among even even among neurologists, it’s not really it hasn’t kind of gotten down yet to all those all those practitioners.

Robert Lufkin  42:32  

Yeah, it’s amazing. We’re going to hear on the on the summit from Matt Phillips, who is a neurologist who just who credits your work and putting these ideas together and others in the field. And he has just completed a first randomized pilot controlled clinical trial for a ketogenic diet for Alzheimer’s disease. And they saw statistically significant improvements. It was a crossover diet. So they went back and forth. Interestingly, he saw, he also ran a study with Parkinson’s disease, going back to what you said about neuro degeneration. And the ketogenic diet had benefits for them too, as well. So but these are this is those are both literally the first studies that have ever been done in the last few. And they were done in the last few months. So this is, this news has not reached the majority of the medical profession or neurologist. So we have a long, long way to go. You mentioned Yeah, it’s really

Amy Berger  43:27  

nice, though, to see studies finally being done with a diet because we do have some studies on all timers patients with MCT oil or with the exogenous ketones. And you know, the findings are mixed. And I you know, I think there’s reasons for that just study design or the patient populate, there’s reasons, but it’s really nice to see researchers finally looking into the diet. And I know that the it’s just so much harder to do a study with diet because there’s so many variables as opposed to taking an exogenous ketone where that’s the only thing you change. But it’s really it’s just it’s nice to see this happening more for sure.

Robert Lufkin  44:08  

Yeah, yeah. It you mentioned some things that you do yourself. Would you mind as an expert in the area tell us what personal choices you make for yourself for your for your diet or lifestyle?

Amy Berger  44:20  

Yeah, I do follow a low carb diet. I’m not ultra strict keto all the time. that they’ll kick me out of the club. I didn’t say that. I am. I’m in and out of ketosis here and there just based on what I’m eating or not eating, but I’m always low carb, always low carb. I do exercise regularly. I don’t like lifting but I forced myself to do it a lot. So I will admit because people need to know we’re not all perfect here. My sleep is a really, really weak area. I like to stay up very late for no reason. And you know, don’t It’s not like I’m up late at night writing papers or no I’m just up doing nothing and so but I know that it’s a weak area I don’t know if you’re having Matthew Walker on or not but um I I’ve definitely gained an appreciation for the importance of sleep and that’s, that’s my weakest area. But I think when when you know, because there was something there shift workers or if you’re caring for a sick loved one, you may have obligations that you’re never going to get good sleep, maybe you’re going to have two or three years where your sleep is just not going to work so well. Then you have to, you have control the things you can control as best you can, because there’s always going to be factors that you either can’t control or can’t manage as much as you would like to. So like there’s so many different levers we can pull. Let’s pull really hard on the ones that we have the most influence over and diet is one of those. But yeah,

Robert Lufkin  45:55  

by by far and and now you have you have programs if people want to want to access you and get help with a ketogenic diet or some of these things that we’ve been talking about. I understand you have a program that that you run through, it’s available on Eric Weston’s website and maybe you could tell us the tell us your website now for the listeners if you don’t mind we’ll put it in the show notes also but you can say it online also.

Amy Berger  46:24  

Yeah, thank you so my website needs a bit of overhaul but it’s to@nutrition.com t u i t nutrition calm but I’m much more active on on Twitter I that’s my handle to it nutrition. That’s also the name of my YouTube channel to intuition. And yeah, I have collaborated with Dr. Westman from Duke University. We wrote the book together and your carb confusion and we are leapfrogged provide an online course about ketogenic diet and the website name is kind of long, but it’s adapt your life Academy calm, adapt your life academy.com we have three courses one one is like a basic intro to keto, how to do it safely, effectively. And simply. We have one based on my book assaults later but the big news is we have well I’m not sure this summit this might be after it’s out but people can sign up for next round. We have a new course coming out about cholesterol. Cholesterol is a very controversial topic and the low carb world and so Dr. Westman is going to try to provide some down to earth plain English education. But if you’re, you know if anyone out there is either brand new to low carb or keto or you’ve been doing it for a while you feel really confused and overwhelmed because there’s so much out there definitely check out the keto Made Simple master class that that will say.

Robert Lufkin  47:48  

Right, well, thank you so much, Amy for for spending time with us today. It was great to take an hour and talk to you and hear about the great work you’re doing and get to know you a little better. Thanks again so much.

Amy Berger  48:02  

Thank you so much. I hope people find it helpful.

Unknown Speaker  48:05  

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