Diabetes of the Brain

Brian Mowll, MLDE, CDE, IFMCP

Thank you. Dr. Dave appreciate it, man. And this is a really, really important topic. It’s one that I don’t think people like to think about but it’s sort of no pun intended sort of in the back of the mind as just one of those things that no one ever wants to deal with. You know, like it’s probably if you can list out some of the worst things to suffer with in your old age, Alzheimer’s or dementia would be probably at the top of just about everybody’s list. So it’s an important thing. And one thing that, you know, I think we can help people to understand is that there’s a lot you can do to prevent it um if you focus and pay attention on keeping the brain healthy and I’m glad you mentioned insulin resistance because really Alzheimer’s disease and in fact, all forms of dementia including uh lewy and body dementia and vascular dementia, I have one thing in common and that is their connection to metabolic health or poor metabolic health, metabolic dysfunction as I like to call it. And it’s really more about insulin resistance than diabetes. You know, This is about type three diabetes. It has been uh coined as diabetes of the brain. Um, I don’t love the term because You really don’t need to have high blood sugar, which is the characteristic of diabetes to develop dementia. Um it’s it’s really it’s about insulin resistance which is the underlying cause of type two diabetes and prediabetes and um you know, many uh cases of obesity and overweight and PCOS and other things like that. But it is also the root of I would venture to say most cases of dementia of all kinds. 

David Jockers, DNM, DC, MS

Yeah. And that’s really interesting that you said that you don’t actually have to have high blood sugar because typically when people think about and this is really how diabetes is diagnosed as high blood sugar over 100 and 26 fasting blood sugar. But somebody could have a normal blood sugar on a on a lab test or you know, even if they’re checking their blood sugar on their own, but they’re, insulin may be through the roof

and most doctors are not actually testing your fasting insulin levels, which is a great test to look at your body, may be putting out so much insulin in an attempt to get the sugar out of the bloodstream and put it in the cells. And so let’s talk a little bit about the dynamics there. What is why is insulin so important and why is insulin sensitivity so important to keep blood sugar under control.

Brian Mowll, MLDE, CDE, IFMCP

Yeah, good question. So insulin is really, I mean, it’s hard to rank them, but one of the most important hormones in the body. We certainly could not live without it. Just ask anybody with type one diabetes who doesn’t make insulin how important insulin is for their life. Um, and you’ll quickly find out that this is a this is this is a life or death or so

David Jockers, DNM, DC, MS

We can get nutrients into a cell. I mean, you can’t get sugar, magnesium, you can’t get them into the cell without insulin. So, it’s literally like a key that opens the door, right?

Brian Mowll, MLDE, CDE, IFMCP

Yeah. So, you know, when diabetes was first described, um, you know, hundreds of years ago, it was described as basically, uh, you know, almost like we see in late stage cancer, the people were withering away because they couldn’t store anything. So they couldn’t store fat, they couldn’t store carbs, they couldn’t maintain muscle, they couldn’t even hold on to minerals. So everything was just liquefying in the body, coming out through the urine. So in the urine, you would see high sugar, you’d see high ketones, you’d see high sodium. You’d see all of this stuff just pouring out of the body because there’s no insulin to hold it in.  And so, yeah, that’s what insulin does. And so it’s so important. But you can imagine if you have too much insulin then too much gets held back. So you get uh too much fat in storage. 

You know, you get uh the kidneys hold onto too many of those um uh you know, important minerals which are electrolytes and important for fluid dynamics in the body. So our blood pressure goes up because we’re retaining those and that’s ultimately what leads to this metabolic dysfunction. So we get inflammation, high blood pressure, we get overweight and obese and all of that is sort of the other side of the coin from what I described of these people. Withering away, they’re sort of in this chronic state of storage and growth, you know, of fat tissue and so forth. So, uh so then you ask, well, what causes high insulin and high insulin can come both uh sort of acutely from certain dietary influences. Like if you had a high sugar, high carbohydrate diet, you’re going to get a huge insulin surge and it can come chronically and that usually is due to a poor metabolic health state, which largely comes from bad body composition. So, you know, we’ve got too much fat storage, not enough muscle mass. And so the body shifts and and the body becomes insulin resistant, which we mentioned earlier and then shifts into this high insulin state. And it’s that high insulin that ultimately leads to cardiovascular stress and epithelial dysfunction and things like Alzheimer’s disease and brain issues. In fact, even cognitive dysfunction. We’ll see that in people who are insulin resistant. 

David Jockers, DNM, DC, MS

Yeah. And now let’s talk about. So we’re talking about insulin being this key hormone that drives nutrients into cells. And so as the cells lose their sensitivity, right? So the we need more and more insulin, our body starts producing more and more insulin to try to get these nutrients like, like glucose or sodium or magnesium, whatever it is, into the cells. What is happening here with our brain and our neurons?

Brian Mowll, MLDE, CDE, IFMCP

Yeah, that’s a that’s a great question. And sometimes I’ve heard it described that, you know, if you’re insulin resistant, you can’t get glucose into the brain for fuel. So the brain doesn’t have uh that, you know, fuel to burn and and so forth. And that that’s what leads to the problem. That’s not that’s not exactly true. I think that there are cells. So, so first of all, we have to look at what which cells respond to insulin and what the response is. So, for example, the way you just described it is exactly right for certain cells. So, like muscle cells, for example, they need insulin to take up glucose in a resting state when you’re exercising a little bit different. But when you’re in a resting state, uh the what’s called the glute for glucose transporter is insulin dependent. So insulin, like you said, is the key that unlocks that allows the glucose to come in. Fat cells are the same. There also have insulin dependent, glucose transporters, liver cells do not. So they have something called GLUC2 which is not insulin dependent. So glucose can just flow right into the liver doesn’t need insulin to do that. But what insulin does in the liver is it basically stops you from breaking down glucose. So uh in the form of glycogen and then also something called leukemia genesis, which is the production of new glucose from other substrates. And insulin basically puts the break on those two processes. So you don’t release glucose into the bloodstream. This is important. 

We’ll get to the brain here in a second. But this is important because a lot of people say, you know, jeez I’m fasting and my blood sugar is still high. You know, how is that even possible? And you have to look at, okay, where is that glucose coming from? It’s not coming from your diet. It’s coming from your liver. Your liver is basically either releasing its stored glucose, the glycogen stores and sort of releasing them into the body. That’s for the first maybe 24 hours after that. It’s making glucose and exporting it. Um And you have to ask, well, why is it high? Why isn’t it keeping the blood sugar normal? And that’s because it’s insulin resistant. The insulin is not there to hold back that process. So it’s over over doing it? Um In the brain there are some cells that are insulin sensitive. But the majority of brain cells are not, the majority of brain cells can just read a  readably absorb glucose and use them for fuel. But insulin has other functions in the body than just um allowing certain cells to uptake glucose. Uh and it has uh it has functions in the brain that are important for uh for um function basically. And one of the things is there’s an enzyme which actually breaks down uh insulin which also breaks down uh plaques in the brain. 

And I know there’s some controversy around amyloid plaques and how you know whether that’s really the cause of Alzheimer’s disease, I don’t seems like it’s probably not the primal cause but definitely we see an association there and those plaques can certainly create some dysfunction and the body breaks those down. But the same enzyme that breaks those down breaks down insulin. So a lot of that gets used up uh breaking down all that excess insulin. And so it doesn’t break down the amyloid plaques. So that’s one of the connections. Yeah. And we also know that um inside the brain, insulin has some uh function for fuel metabolism and metabolic function. So um it’s not so much whether the brain absorbs glucose out of the bloodstream. That’s gonna happen for most brain cells. Um Although there are parts of the brain um that are insulin dependent and those parts do seem to be, you know a little bit more connected to Alzheimer’s disease. But um but but it’s more complicated than that. What we know though is that with insulin resistance typically comes high insulin that’s a contributed to Alzheimer’s disease. We know that it’s there’s dysfunctional glucose utilization that’s a connection to Alzheimer’s disease. And we know that that high insulin triggers chronic inflammation and there’s a strong connection there to Alzheimer’s disease. So if we can uh improve metabolic health, improve body composition, improve insulin sensitivity, lower blood insulin levels back to normal. I think that’s going to be very protective for long term brain health and allow people to prevent things like Alzheimer’s and other forms of dementia.

David Jockers, DNM, DC, MS

Yeah, it’s a really great explanation there Dr. Brian and and when people have blood sugar, this regulation some individuals get high insulin. Other individuals deal a lot with reactive hypoglycemia or hypoglycemic types of episodes, which can be really, really damaging to the brain, right? Because there’s not enough blood sugar. And this is why, you know, for for a lot of people and they have hypoglycemia, the main symptoms that they experience are associated with brain symptoms, anxiety, irritability, cravings, sometimes nausea, which, you know, in this case is actually brain related nausea, not stomach related nausea typically. Um you know, so they’re experiencing, you know, that the hungry kind of feeling that I’m sure, you know, most people that are listening here have experienced at some point in their life. So what is happening there when somebody has hypoglycemia or like a reactive hypoglycemia a few hours after a meal. 

Brian Mowll, MLDE, CDE, IFMCP

Yeah. So really good point. And you’re right, when you don’t have the blood sugar, you don’t have the glucose in your blood to for the brain to take up and use then the brain is going to suffer. And not only the brain, but all the other organs like your heart as well. Um You know, the heart can burn other fuels. It can burn fat and burn ketones. The muscles can burn fat, glucose ketones, but um but you know, they like to burn glucose in a in a short window. Um it’s readily absorbable. It’s usually readily available. It’s a quick burn um a little bit dirtier fuel perhaps, but it’s a quick burn. So the um so when that’s not available, uh certain organs, particularly the brain is going to suffer. So it’s important not to have high blood sugar because high blood and I’ll just define it real quick. If you if you do a fasting glucose test, either a finger prick on a glucometer, which is whole blood or or you go to a lab and have your blood drawn, which is a serum test. The number should be around 80. So we use a range of 76 to 92. There’s a little bit of variability there once it gets into the mid to high nineties, over 100 certainly.

That’s starting to become elevated in a fasted state. And uh the chief reason for that is insulin resistance. So again, your uh the insulin isn’t um your liver isn’t responding to the insulin well enough to hold back the glucose release. So um so you don’t want high blood sugar. Certainly you don’t want blood sugar. That’s, you know, in 100 and 5200 range. And above that’s very, very toxic to pretty much every cell in the body. The but you don’t want low blood sugar either. So, if the blood sugar starts getting into the sixties and fifties, or even low seventies for some people, um that’s not healthy because you don’t have that fuel available to the brain. So what causes that? Um it’s basically, you know, we can think of this as just dis regulated blood sugar and uh you know, the body has a regulation system for keeping your blood sugar in a pretty tight range. Just like it does body temperature and blood pressure and other things. You know, it can go up a little bit after you eat, but it should come back down and it should come back down into a healthy range. So if it’s dropping too low either after exercise or after a meal. Typically a higher carb meal. Usually what’s happening there is you’re having an over release of insulin. So we talked about uh insulin and how it’s uh well, I don’t know if we talked about this, but it’s released in a in a fasting state to hold back glucose it’s released after a meal to allow those muscles and fat cells to absorb glucose. 

And uh if you over release insulin, you’re gonna get too much of that effect. And your blood sugar can actually drop too low. Now, the other uh side of that coin is adrenal function because your adrenals make hormones like cortisol and adrenaline, which have the opposite effect. They actually tell your liver to make and or release more glucose. So there’s sort of a um like, I like to think of those old radio dials where you sort of turn the knobs a little bit and if you if you turn it too much to one side of staticky too much the other side static you so you gotta get it right there in the right spot for anybody who’s over, like maybe 35 or 40 understands what I’m talking about. So the the the idea there is you have to get those hormones dialed in properly. And of course, the body has an innate intelligence and inborn intelligence that does that for us, but that can become altered when our metabolic health or our adrenal health is uh this is dysfunctional. So it’s an over release of insulin usually from uh, you know, an existing state of insulin resistance or high carbohydrate diet, especially simple, you know, refined carbohydrates. And then we usually on the other side of that, we don’t have the adrenal health to balance that, so we’ll see the blood sugar drops too low. 

And then, you know, people can get, like you said hungry, they can get dizzy or lightheaded uh you know, they can become even delusion, you know, sort of have delusions if it gets too low um pass out. Yeah, so it can become very very dangerous. I mean I’ve you know, these are people who usually are on insulin, but I’ve I’ve had patients who uh you know, their family had to break the window of their car because they were in their car with it running and uh you know in sort of some some sort of altered state about to go drive somewhere in a hypoglycemic state. So uh it can be super dangerous um you know, most people don’t experience that unless they’re unless it’s some, you know, drug induced basically. But um but it can get low enough to be really uncomfortable or cause a lot of sugar, carbohydrate cravings for people make them, you know, affect their mood certainly. And it’s not really a great way to live, you know, having to sort of manage your diet all day long, so you don’t drop into a low blood sugar episode. So that you know, the solution there is a combination of uh good insulin sensitivity, a good healthy real food, lower carb diet and um and adrenal health, making sure your adrenals are healthy so they can help regulate your blood sugar.

David Jockers, DNM, DC, MS

Yeah, that’s key. And and you know, a lot of people with insulin resistance are overweight. Obviously not all of them. A lot of the people that I see that deal with these hypoglycemic episodes, people that I can think of that passed out. I mean, just even at my church in the last year, I think two or three people have passed out just during worship all every time it was due to a hypoglycemic episode. And these were people that were these were typically young women, teenagers or maybe in early twenties, right, who are pretty lean, right? So you would look at them and you think, well, they’re probably pretty metabolically healthy from the outside, they look that way, but they’re having this blood sugar dis regulation and hypoglycemia.

Brian Mowll, MLDE, CDE, IFMCP

Exactly. And you know, probably had a donut or bagel and some orange juice for breakfast and had an insulin spike, and then they’re you know, sitting in church um sort of relaxed and calm and the blood sugar just starts dropping, you know, um and you know, maybe they don’t have that cortisol release from the adrenals and boom, yeah, that’s Yeah, I see that a lot. And young women, 

David Jockers, DNM, DC, MS

Those neurons, what is happening actually happening to the neurons that ends up causing those um neurological symptoms are the neurons actually dying because they’re not getting the glucose and therefore you’re kind of getting this excited toxicity because when one neuron dies it spills out its contents to other neurons and causing kind of like a cascade of death, is that actually what’s happening?

Brian Mowll, MLDE, CDE, IFMCP

Yeah that’s a good question. I haven’t seen that data and I I would think that the neurons probably aren’t dying, but they definitely go into a dysfunctional state clearly, you know, they’re they’re being starved. So you know, they’re definitely not able to, you know, carry out their function essentially. So I think um you know, I’d have to probably look into that and it’s a really good question. In fact, I’ll probably go see if I can learn a little bit more about what’s actually happening there. But um but yeah, I would definitely say, you know, and this is true for any cell. I mean if you don’t give obviously they need oxygen and other nutrients but if you don’t give them uh some sort of fuel, glucose or fat to burn for energy. And um and and you know, the brains a little bit unique because it’s hard to get fat to the brain for fuel because it doesn’t that doesn’t cross the blood brain barrier. So you know, the brain likes glucose and ketones basically for fuel. And uh if you don’t you know, if you’re not in a ketogenic state and you’re depending on glucose and you don’t get the brain the glucose it needs, it’s not gonna work.  

David Jockers, DNM, DC, MS

Yeah. Yeah. And that’s my understanding is that those neurons they need a continual supply of glucose

or ketones and of course if you’ve got, you know high insulin at times and if you’ve got blood sugar this regulation your body is not producing these ketones at least not a sufficient quantities to be able to support the metabolic needs of the brain. And if your blood sugar is dropping those neurons are not getting supply that they need and a certain percentage of them start to die off and kind of spill their contents and cause this sort of neurotic psycho toxicity. So it’s actually very, very dangerous having these hypoglycemic episodes. And a lot of people with Type one diabetes for example, obviously they’re more prone to having it because they’re not producing insulin. They need supplemental insulin basically through injections and a lot of them end up with retinopathy these right and so you know, which is kind of part of the brain. So the retina is like a you know, it’s part of your eye but it’s also you know i is basically like an attachment of the brain. A lot of these cells start to die. They end up with you know, a lot of vision issues and um you know, other

neurological issues as well. And there’s also a strong link between somebody who has a lot of hypoglycemic um episodes throughout their life and their risk for dementia for you know developing Alzheimer’s and things like that as well.

Brian Mowll, MLDE, CDE, IFMCP

Oh yeah, definitely and and type two diabetes we see that um you know, I do a lot of consultations and I would say, you know, probably 30 to 40% of the people who have Type two diabetes at one point had pretty bad reactive hypoglycemia, 

David Jockers, DNM, DC, MS

interesting. Yeah. And so, you know, we’re talking about there’s different ways that people will express their blood sugar dis regulations, you have some individuals that they just have this, you know, they have this reactive hypoglycemia. Like we talked about other individuals that it seems like their blood sugar is good, their hemoglobin A1C may even look good, but they’ve got very high fasting insulin. Then you’ve got other individuals that, you know, insulin doesn’t seem to be terrible, but their sugar is high, Right? And then you’ve got other individuals that have both high insulin and high blood sugar. So what is happening when you have high for somebody that is diabetic, let’s say they’ve got high blood sugar. You talked about how that’s toxic for the neurons, what is actually happening? Like what are those sugar molecules actually doing?

Brian Mowll, MLDE, CDE, IFMCP

Yeah. Yeah, that’s a good question. And so those are you just describe three patterns there and and I think, you know, maybe just talk about that for a couple of minutes because I think it’s important to look at that. People get confused even um, you know, even functional medicine practitioners and so forth sometimes get confused because, you know insulin in conventional medicine, it’s just not looked at at all, um, you know, rarely ever tested maybe in cases of, you know, like insulin or type one diabetes. Yeah, but even that that really look at insulin maybe c peptide but so it’s it’s largely ignored in in conventional medicine and functional medicine and sort of, you know, nutritional medicine, you’ll hear it talked about or do a fasting insulin. And the normal is, you know, in the ranges somewhere usually 2 to 6, something like that, which which I totally agree with. Um but that is assuming blood sugar is normal. So Um if you have an insulin of five and your blood sugar is 300, that’s not good. Right? 

So, you know, you’re supposed to be making insulin to bring down your blood sugar. So in that case, you know, we wouldn’t say, Oh wow, well your blood sugar is high but your insulin is totally normal. Now, we would say, okay, your blood sugar is high and you’re you know, you’re not making nearly enough insulin to be able to bring your blood sugar down there. So there’s a couple problems, probably insulin resistant, but also um something is starting to happen with the pancreas and the beta cells which make the insulin not being able to produce enough. But that’s usually late stage. So by the time somebody gets their they’ve usually been dealing with this for decades. So what we see are in the early stages is, as you said, more normal blood sugar or slightly elevated. So maybe it’s in the low hundreds. And then you check that fasting insulin and instead of it being five, it’s 15 or 30 or 50. 

And so those people are highly um insulin resistant. And so they’re having to make huge amounts of insulin to keep their blood sugar down. Now, fortunately they’re able to do that. So their pancreas is working, but uh but it’s it’s going to take a huge toll on the pancreas over time. And then you’ll see blood sugar will start to climb, uh insulin will start to fall. So a lot of times we’ll see somebody with a blood sugar of say like 130,140,150 which is diabetic and then they’re fasting insulin will be like 10 or 15. And so those are people who are sort of in between those two, you know, they’re starting to lose control of their blood sugar, they’re still making insulin. Um which by the way, I just want to say, I know the this is supposed to be about the brain, but this is a um this is a common misconception and conventional medicine, you know, once you’re diagnosed with diabetes, most doctors just believe your pancreas at that point is sort of not making insulin or not making enough insulin. And um and and for most people, I mean, probably 80% of people with type two diabetes, the pancreas is making plenty of insulin, it’s just uh they’re highly insulin resistant. And so all of this of course is related to the brain. Because the more insulin resistant you are, the higher your blood sugar is and the higher your insulin levels are for you know, a period of time the more damage is being done to those to those brain cells. I sort of went off on a tan. You would ask me a question there at the end.

David Jockers, DNM, DC, MS

Yeah. So following up so the high blood sugar when sugar is high, what are the sugar molecules?

Brian Mowll, MLDE, CDE, IFMCP

Oh yeah. Yeah. Yeah. So so yeah once the once the blood sugar gets high that’s you know, I talked about how high insulin can cause damage inflammation and endothelial dysfunction and can affect kidney health, eye health and other things. Uh well, high glucose that’s like a double whammy. So that that causes something called publication to the form of sort of what we term oxidative stress. It’s a it’s basically damage to the delicate proteins in our cells tissues and organs that um that leads to you know dysfunction. So uh we call these A. G. E. S. Advanced location and products. And so if you’ve ever seen like uh as people age they get like dark spots on their skin or skin tags and things like that. Those are examples of visible A. G. E. S. Advanced location and products they’re basically uh you know mutated cells damaged cells from oxidative stress in this case it would be from high glucose. So glucose just like we talked about insulin very important for the body. But when it gets elevated glucose becomes very toxic.

David Jockers, DNM, DC, MS

You can measure publication with the hemoglobin A1C Which is a form of glycation of the human blood cells

Brian Mowll, MLDE, CDE, IFMCP

Yeah. And so that’s a great test for that very reason. If you want to know how much damage is happening to your brain and your blood vessels and the and your organs like your kidneys or your eyes. Uh The A1C is a good surrogate for that because we’re measuring basically damage done to the red blood cell and the red blood cell also carries oxygen. The hemoglobin on the red blood cell carries oxygen. And when you when it’s sort of sugar coated or loaded down with glucose it’s not able to do that very well. So you get poor wound healing poor circulation. You get uh clotting you get all kinds of problems from having a high A1C. And dysfunctional red blood cells. But yeah mostly it’s a window into the damage being done to your body. So normal A1C is around 4.5 to 5.5%. It’s a percentage of uh like a shin or you think about it like sugar stuck to the to the hemoglobin in the red blood cell. So normal is around 4.5 to 5.5%. If it gets over that uh then you know it starts impairing the function of the red blood cell. So if it gets up to 6,7,8 you know 10 I’ve seen people at 14. So these are you know obviously you know causing massive damage. And there’s been studies that show for every 1% that the A1C Goes up up. So like from 6 to 77 to eight it’s about 18 to 20% greater likelihood of any complication. That could be a heart attack stroke, dementia, kidney failure. You know blindness amputation. All of those things that are associated with high blood sugar 

David Jockers, DNM, DC, MS

For every 1% rise in hemoglobin. A1C there’s an 18 to 20% rise in some sort of major health complication.

Brian Mowll, MLDE, CDE, IFMCP

Risk of health complication. Yeah. Yeah. So you know it’s it becomes almost logarithmic when you see it go from uh you know your a one c go from 6 to 7 which by the way 7% is considered acceptable to most uh general practitioners at least in the diabetic community. So they would say well we don’t want you to go too low for all the reasons we talked about earlier. So just keep it around seven and you know they figure they’re going to develop complications anyway so you know we don’t want to rush to the hospital and in the middle of the night where I’m gonna go into the hospital and see them. So you know, let’s uh let’s keep their blood sugar a little high, you know, that’s safer. They can see. But you know, I think that’s probably um you know, not great medicine, I think, I think it’s, you know, we should always shoot for normal blood sugar. Uh The the great dr richard Bernstein, who’s a diabetic advocate, an endocrinologist has Type one himself says, you know, everyone deserves normal blood sugar, especially diabetics. So Anyway, the uh but yeah, 6-7%, you’re just increasing your likelihood of any of these problems by 18-20%. And as it gets higher than that, it gets really scary territory.

David Jockers, DNM, DC, MS

Yeah, absolutely. And from from a functional health perspective, I mean, I like to see it under 5.25, you know, and we know that hey, there’s less oxidative stress, less inflammation, less kind of browning. You know, I think about the location almost like browning inside of our body. Rusting. Um And so there’s less of that going on. It’s going to slow down the aging process. You’re gonna feel better, you’re gonna get more oxygen delivery to all the different tissues of your body, so your heart’s gonna function better. We’re talking about brain here, so your brain is gonna function significantly better. So yeah, keeping that hemoglobin a one c under control is really important and I’ll see a lot of people when I look at labs where they’re fasting blood sugar looks okay. Their insulin looks good, it’s in the right range but their hemoglobin A1C will be 5.75 point eight. You know are you seeing things like that as well? 

Brian Mowll, MLDE, CDE, IFMCP

Yeah. Yeah. And so that that usually means that there’s like wide blood sugar fluctuations and so the A1C Is sort of you know, it’s picking up your blood sugar all the time. So you can those red blood cells can get complicated um You know when you’re eating or not eating or whenever the blood sugar is high. So you know if your fasting blood sugar is perfect but when you eat it goes up to 1 80. And especially if it stays up for longer than you know, than it should then yeah you’re gonna be you’re gonna have high blood sugar for too long, you’re gonna be experiencing location and that’s you know, that’s going to affect your health. So uh and then you know, you’ll see it reflected in the A1C So that’s why I think we have to look at all of these like you can’t just do an A1C So everything’s great. 

You know if your blood, if your fasting blood sugar is like 1 10 you could potentially have an A1C Of 5.5 if like that’s the highest it ever gets, that’s still a problem. There’s still something going on there with your with your insulin sensitivity. So I think it’s good to look at and um you know one thing you can do is wear a C. G. M. Continuous glucose monitor which will help you see those fluctuations throughout the day. They’re not perfectly accurate when it comes to sort of um monitoring your baseline blood sugar. So they can be off a little bit compared to what you get in the lab with the glucometer. But they’re really good for tracking changes and fluctuations. So you know you can see okay you know after I eat this particular meal house, you know what happens to my blood sugar after I do this particular type of exercise. What happens if I you know have a good night’s sleep versus a bad night’s sleep? What happens to my blood sugar in the morning? So or even overnight? So the C. G. M. Is really good for that. And it can help you to sort of um get a little bit more data on perhaps why you’re him a globe and A1C Is a little higher than you’d expect it to be.

David Jockers, DNM, DC, MS

Yeah that’s really good. The C. G. M. Can really help identify certain foods that you know you think are healthy and um perhaps your spouse responds really well to right They may be wearing a C. G. M. And then you’re not responding well to it for whatever reason your blood sugar is going way up when you consume that food. You may have a sensitivity and tolerance to it. You know even things like coffee. You know in a family one spouse may be a normal caffeine metabolizer. Another spouse may be a very slow caffeine metabolizer they drink the same cup of coffee. One of them their blood sugar goes way up stays up. They feel fatigued. You know or or they feel overly anxious, the other individual feels great and they’re able to perform at a really high level. So sometimes we don’t even you know sometimes there’s factors like that play a role. Yeah. Now let’s talk about best strategies to get blood sugar insulin back under control and support metabolic health.

Brian Mowll, MLDE, CDE, IFMCP

Yeah so I think um sometimes we have to look at big picture. I mean there’s a lot of things and you you do a great job of this. There’s there’s a lot of supplements and tools and things that can help protect the brain can help with blood sugar. Um But if we just take a step back and look at you know people who develop alzheimer’s or other forms of dementia or have poor brain health usually it’s in people who are not metabolically healthy. So I think that’s the first thing we have to look at is how do we produce good metabolic health and a lot of that comes back to body composition. Um So we wanna make sure that we’re insulin sensitive and we can, you know, we’ve talked a lot about that. We can talk more about it as far as maybe measuring that if if we want to. But I want to make sure we’re insulin sensitive. I want to make sure that we have muscle, you know, as we age, especially we lose a lot of muscle. And particularly people who are uh maybe have struggled with their weight over their lifetime. They’ve done a lot of dieting and things and they’ve lost a lot of their muscle mass. And if you’re not actively working on building muscle, um then you can end up with two little muscle mass on your frame and muscle is, you know, really your best protector when it comes to uh glucose, it gives you a lot of metabolic flexibility.

You have more insulin receptors, you have more room to store glucose as glycogen. If you have more muscle, you’re gonna just use more glucose and and all fuel over the course of the day, your metabolic rate is going to increase if you have more muscles. So all of those those things, all of those things are reasons to want to build more muscle. And so so that’s really key. And then on the other side, we wanna, you know, reduce excess fat and it’s not just subcutaneous fat. I mean uh you know, there is a there’s genetic patterns for how we store fat. So some people uh store a lot of subcutaneous fat, the fat under their skin, that sort of, you know leaves the sort of rolls and bulges and things. Um other people store very little subcutaneous fat and uh they can actually be in a more precarious situation because they may store, you know, they may only be say £15 overweight, but most of that fat is stored around their organs or in their organs or their muscles. 

And so I think we’ve got to be a little bit careful with that. And we want to look at body shape. We want to look at numbers like our triglyceride levels on a blood test. We want to look at our fasting blood sugar on a blood test because those are going to give you signs about, you know our is your body composition optimal or are you starting to develop some problems? And I mean there are lots of again uh sort of bio hacks and and things that you can do to improve or protect your brain health. But I think the biggest thing is you just really, you know, don’t lose the forest for the trees, make sure you’re doing everything you can to become as metabolically healthy as possible. 

David Jockers, DNM, DC, MS

Yeah. So building muscle burning fat and we know muscle also has unique hormones like mile kinds that actually help increase the the trophic or the growth factors in the brain like BDNF neurotrophic uh nerve growth factor, things like that was interesting. So not only do you get the metabolic benefits where you kind of have the glucose sponge effects of the muscle, but muscles actually releasing compounds that stimulate greater connectivity and neural plasticity, positive neural plasticity in the brain, which will help prevent against dementia, age related memory loss, different things like that. So yeah, super powerful there. So I’m huge on that good exercise. How about nutrition? What are some of the key nutrition principles?

Brian Mowll, MLDE, CDE, IFMCP

Yeah. So I think um you know, everything we talked about goes back to, you know, good blood sugar management and good, you know, good blood sugar control. And I think that’s really important for brain health. Again, that is unless you’re, you know, fasting or purposefully heavily carved restricted and ketogenic, your brain is going to be largely burning glucose. So we want to have a good steady state of glucose in the bloodstream. You don’t want it to be all over the place. And I think what we found is the diets that do that best are gonna be protein centric. So you’re going to be focusing on protein. You are going to be restricting carbs to some degree. Um you know, compared to the standard American diet of 3 to 400 g a day, you’ll probably be somewhere in the, you know, I don’t know, 75 to maybe 100 g of carbs if you’re if you’re, you know, highly active and you are metabolically healthy. Um I think a lot of people can tolerate that um coming from healthy carb sources and again, that’s optional. You don’t have to eat that many carbs, but you probably could tolerate that many. And then um and then the rest is, you know, healthy fat sources. 

So you know, you are uh you’re probably gonna wake up in the morning in, you know, some sort of mild nutritional ketosis. And then whenever you break your fast, you’ll, you know, you’ll shift into a fed state, you’ll start burning the fuel that you’re eating. You’ll have normal insulin sensitivity, your body will will process and store the fuel that it doesn’t burn right away. And uh you know, you’ll get back into a good fasted state until it’s time to eat again. And and your body just maintains uh you know, a good, healthy steady state blood sugar lipid level. And um uh you know, and functions well, I think that’s the best thing for the brain. So, you know, as far as diet goes, it’s gonna be a, you know, it’s gonna be protein centric because that protein is going to stimulate muscle growth, it’s going to be there to provide all those amino acids for the myriad functions in the body that amino acids are important for. And it’s gonna keep you satiated and full and you know, you’re gonna fulfill that protein hunger that we all have and then uh you know, nutrient, dense carb. So you know what, take your pick. 

You can eat a little or or more, but uh, you know, the leafy greens and maybe some low glycemic fruits and uh, you know, healthy, non starchy vegetables if you’re an athlete and you’re burning tons of calories and running and doing that kind of stuff, there’s probably some room for some more starch in your diet. So that’s, you know, that’s a choice you can make, you know, or you can try to become like a keto athlete and, and uh, and and get your body super fat adapted. That’s okay too. And then the healthy fats. So, you know, healthy fats are gonna come from animal products, I think largely and um, and then some plant sources avocado and you know, maybe some olives and a little bit of olive oil. That’s everything I do try to recommend avoiding any type of refined packaged food. So even from an oil perspective, um, you know, we’ll use a little olive oil here and there of course, but and maybe some coconut oil and so forth. But you know, these are still refined oils, really potent. Um, high energy sources. So I think it’s best to get our, you know, our fat from food, you know, from the food itself whenever possible. So, you know, uh, you know that those are, I think the areas to emphasize on the fats and certainly avoiding the, this is not new news to the listeners here, but avoiding the you know, the industrial seed oils which are the highly processed uh sort of quote unquote vegetable oils which are mostly linoleic acid, become oxidized and rancid and drive inflammation. And uh they actually lead to insulin resistance. Have a lot of metabolic by products like four H and E. And others that that drive inflammation. So we want to avoid those. 

David Jockers, DNM, DC, MS

Yeah. And I’ll and I’ll add in intermittent fasting as well with you know when you’re eating like this high protein, like you talked about healthy fats, lower carb, you’ll end up having more satiety and the need to eat or the need to snack. The drive to eat throughout the day goes down. And that’s a really good thing. And fasting helps stimulate autopsy and this is key. Especially when we start talking about neurodegenerative conditions or really all brain related conditions because we even know like for example, depression is related to brain inflammation. And so as we start to go into a fasted state for periods of time, like let’s say 12, 14, 16, 18 hours overnight, we start to bring down that inflammation, improve our insulin sensitivity. And then also um when people start developing the like we talked about beta amyloid, these plaques in the brain. This is a sign of proteome toxicity or protein toxicity. 

And that’s not related to protein in our diet, but it’s actually related to an inability to break down and repair damaged proteins in different regions of the body, like in this case the brain. And so when we fast like that we undergo autopsy gee and our body actually starts to break down these damaged proteins and starts to regulate them and eliminate the bad stuff. And we combine that with good sleep which helps activate our lymphatic system. We already mentioned exercise really important for the lymphatic system. We drain the damaged proteins, the protein waste out of our brain through the lymphatic system and out through our, you know, all of our detoxification systems are feces or or you’re absolutely that we get rid of all this bad protein in the brain and this is something we need to be doing regularly. So critical there.

Brian Mowll, MLDE, CDE, IFMCP

And you know, and I think I mentioned something about this earlier but I think this is probably can be the biggest takeaway from this talk today is that I do believe that dimension Alzheimer’s is an accumulation problem and uh it really happens because we’re not breaking down those damaged proteins in the brain and you know, insulin is a potent stimulator of M. Tour and it stimulates M tour uh in all the wrong places. So when you uh protein sometimes gets a bad rap because it stimulates M tour but it stimulates M tour in the muscles. It’s pretty specific to the muscles because it’s stimulating muscle protein synthesis. Uh insulin stimulates enter in the liver, the brain and other places. So the problem with that is if you’re walking around with high insulin 24 hours a day, which I mean I would say 90% of the people I test are there never really in that accelerated autopsy gee state. And even if they’re fasting so you know, they may fast for say they might be doing like some time restricted feeding. And so you know, they say, well I don’t eat until noon every day. But we test their insulin at noon right before they eat and it’s still like 15. Well guess what? You’re not getting those benefits of all top Aji because you’re still high insulin, you’re still anemic. You’re still turning on em tour uh and you’re kind of blocking that pathway. So um So yes, fasting is incredible. Uh Sometimes people who are you know insulin resistant do have to fast longer to start to see those benefits. Um and just as a side, I’m not a big fan of of sort of multiple day fast for most people. At least not on a regular basis but but certainly, you know anything up to a 24 hour fast. You’ve got plenty of stored glycogen onboard. You’re not really going to have to break down muscle tissue for glucose at that point. So. So yeah, I I love like alternate day fasting for example, for people are insulin resistant.

David Jockers, DNM, DC, MS

Yeah. And he starts stacking in exercise resistance training with that. uh super key. What are your top let’s say two or three supplements that you like for helping support insulin resistance. 

Brian Mowll, MLDE, CDE, IFMCP

Uh no Seattle is great um really important compound um berberine can be helpful. It’s a basically um has a kind of a plea a tropic effect on the body so it acts on the liver to suppress the release of glucose um Similar to what Metformin does which is a diabetes drug um It uh activates A. M. P. K. Which is a nutrient sensor that basically is you know one of the things that’s turned on with fasting and it um you know helps our body to burn energy and um uh so berberine can kind of accelerate that process which is good. And uh let’s see for insulin sensitivity. Those are probably the top two. I also like um chromium and buy it and combined. They’re really good for. Yeah for glucose tolerance and zinc. So zinc is something that is important. You know we think about it with immune health which it it does have some functions there certainly prostate health but has um has a lot of a lot to do with insulin uh production release and uh insulin sensitivity. So zinc is um yeah zinc is is involved in the um you know production and release of insulin which is basically insulin is a protein. It’s a 51 amino acid protein made in the pancreas. Um And zinc is sort of important in constructing that and then and then its release and and in the uh response at the cell. Um and then one last thing I’ll say this is sort of a secondary effect, but anything that reduces inflammation, chronic systemic inflammation, um I prefer to do that, you know from the root cause perspective. But um if you’re looking for short term inflammation relief, like curcumin or other anti inflammatory herbs can be helpful. Mega three is absolutely 

David Jockers, DNM, DC, MS

yeah, really good stuff. Dr. Brian, this has been a great interview, went through a lot of really good topics. Really appreciate that. And where can people find out more about you?

Brian Mowll, MLDE, CDE, IFMCP

Yeah, thank you for that. You know, website is  drmowll.com That’s D R M O W L L .com Uh there’s uh something on there called blood sugar manifesto, which is just a uh you know, sort of a 45 page guide on how to improve blood sugar and metabolic health that you can get for free um podcast is mastering blood sugar. So check that out. And um that’s probably the best way to get on the mailing list. And then, you know, 

David Jockers, DNM, DC, MS

you’ve got a great book to the pro fast diet guys, gonna check that one

out as well.

Brian Mowll, MLDE, CDE, IFMCP

I appreciate that, 

David Jockers, DNM, DC, MS

Awesome. Absolutely. Thanks so much. Dr. Mowll