She Diagnosed Her Mother With Alzheimer's. Then Found Out She Carries the APOE4 Gene.

[0:02]I diagnosed my mother with [music] Alzheimer's. She's in term She has terminal Alzheimer's now. And then breast cancer is [music] quite a lot in my family. And so I was sniffing around trying to find if we had the breast cancer [music] gene and I found out that I had the APOE4 gene.

[0:19]>> Once you learn that you carry APOE4 and that you have this higher risk of Alzheimer's >> Life is finite no [music] matter which way you look at it and no point waiting. Do it now, you know, exercise now, [music] you know what I mean? Start do that keto or you know, investigate what's Do it Do it now.

[0:33]>> Once you start cleaning the diet and stopping alcohol and exercising, you feel like much more energetic [music] like on a very very short-term basis, right? The results are right there which I I really like. >> If you do this intervention, [music] you might get 6 to 8 years more, you know, brain healthy brain before [music] you get Alzheimer's. One in four people have APOE4 now. You know how you kind of go, "Oh, you know, it sucks having APOE4. We've got this crappy gene."

[0:59]>> Yeah, I I tend to say that learning that you carry APOE4, I mean for for me I believe it's the best thing that happened in my life. Not that I carry it, but the fact that I know it and that it really pushed me on the path of being extremely healthy and taking care of my health and not feeling invulnerable.

[1:22]Cool. Amazing. So I have with me Dr. Gertrude Behan. Okay, I'm pronouncing it like with a big smile. >> love the way you're saying it. It's great. >> Dr. Behan. I don't know if I should be saying it like that. Uh very excited to have you with us. I would love to start with an introduction. If you can tell us a little bit more about yourself. I know you live in Australia um and I know that you practice medicine. So what kind of medicine did you practice and tell us more about yourself?

[1:45]>> Yeah, well um yes, born in Australia and I did my medical degree in um Queensland and I did my residency in Queensland and I met my husband in medical school, and we set up and um um uh set up family a primary care family medicine. My husband working still. I retired well, I I got a skin cancer, which is no big deal in Australia, and I was in my 30s then, and I got a I had an interest in in skin cancer medicine, and as I said, my husband and I um set up a practice. We did family medicine primary care, and I had a leaning towards skin cancer um medicine. We got to the stage

[2:27]of having about 40 employees. >> Hm. Well. >> And yeah, and then in 2018, well, actually in 2016, um I diagnosed my mother with Alzheimer's, and then uh in 2018, was diagnosed with breast cancer. And uh as I said, had a very busy life with work, with looking after patients, and with the staff. Also had um three children, and so I uh I actually took that decision to step back then because um I'd never been sued. Everything had been really great, but I felt like I sort of all in or we think looking after patients or not, and I felt like I needed to step back and look after myself. And then breast cancer is quite a lot in my family, and

[3:23]so I was sniffing around trying to find the if breast cancer gene, and I found out that I had the APOE4 gene, and well, I sort of have answered the question now, haven't I? I'm sort of going too fast. That's it. That's me. >> No, it's it's a great. Thank you for the overall overview. I think there's a lot to unpack here, because I know a lot of our community members that also care givers, that also juggling between different things, and the fact that you are juggling between breast cancer and also APOE4, that makes your case really special, and I'm guessing there's a lot of overwhelm there. So, I'd love to cover that first. But, since we you said

[3:58]that chronologically, let's start with how you handle with your mother because you mentioned that you diagnosed her yourself. >> Yes. Yes. So, my mother lives in she does lives in she's in term she has terminal Alzheimer's now. So, she was in regional Australia and as as a primary care a physician, I had treated a lot of patients, well, not a lot, but a fair amount of patients with Alzheimer's. And so, um I'd seen the effect of the drug Aricept, I think is what we were using then. And it was really pretty useless, to be blunt. And the caregivers was you know, we're preaching to the you know, you know exactly what I'm talking about it. It was very sad the medications

[4:38]wasn't making much difference. Then, when I diagnosed my mother, my family were not were not prepared that they were more like put their head in the sand and and not >> Mhm. >> wanting to sort of try and, you know, really address the issue. And also, in regional Australia, there isn't much you can do, either. It's a big deal to to do anything. I wasn't mom's treating doctor, so I did tell mom to see the treating doctor, but really there wasn't it nature took its course. We'll put it that way.

[5:09]>> Mhm. >> But, because I diagnosed my mother and I was like even though I was going mom see see, you know, the the GP, I meanwhile was doing a lot of research on on the internet and trying to look it up as much as I could for my mother to to kind of tell what's on my father to tell my mother what, you know, she could do. So, I was looking around and a lot of the things that you bring up in your posts are so true. I think they're true everywhere, like um it's really a management issue.

[5:40]People uh there isn't really much therapy or really much interest in therapy. It's a lot more management. Why this is kind of important is that when I did a gene test and found out that I had I had APOE4, instead of being really like, "Oh my god, this is so terrible." which which which that did dawn on me. I did get that thought.

[6:03]Um but then my initial thought was, "Well, I think these people are onto something because, you know what? That's really quite believable because, you know, my mother has Alzheimer's. So, this this gene test isn't a lot of quackery. I think I think they're right, you know, because mom has Alzheimer's.

[6:18]But, as time went by, I was kind of got more of that oh dear oh dear because, you know, when you see someone deteriorating and my mother in her prime was very sharp person, you know, it was very You know, there's a silent screaming inside, isn't there? I mean, it's just I mean, like we I know that everyone that would be listening would know what I'm talking about of how how painful uh Anyway, so yes, so I just was sort of just started looking through the into the in and and and and in a way I'm lucky because with a medical degree, some influences you can see just selling their enthusiasm or their passion about

[6:55]something and it's not really evidenced at all. And so, in that way I was lucky in that I can kind of look at the evidence. And that's one thing I really like about the Phoenix community how we're so much looking at the evidence. That's really that's really great. But, I think I've gone off topic again. What was the question?

[7:14]>> It's it's that and and I'm I'm really sorry you had to go through that and you're still going through that with your mother and I I think for all of us carriers, at least that's how I feel, is kind of a view of hopefully not, but still kind of a view of what is awaiting us if we don't do anything, right? And that is really really scary.

[7:32]And handling that as being a caregiver on one hand and having the feeling that we're also sleeping towards that is something that I I like, it's not easy. How are you handling this? >> Well, that's kind of interesting. I'll tell you what. I mean, like, it's not good. We all can understand the not good bit. I not need to explain why it's not good. But, when you when when you kind of look at some of the research or some of the statements people make, like, if you do this intervention, you might get 6 to 8 years more, you know, brain healthy brain before you get Alzheimer's. And it kind of dawned on me when you read on that. Everybody walks

[8:11]around kind of going like, well, everyone else passes away, but I I'm not going to pass away. I mean, that's kind of just like how people think. And then when you kind of think, I get 6 to 8 years more, and you kind of go, well, what what what am I waiting for? If I'm going to do something, I should do it now. And so, that really made you galvanized me into being like, I've really got to start exercising more now. I've really got to, like, maybe look a bit of a fool, but connect with people now. You know what I mean? And in a way, it kind of forces you to be your best self as well as,

[8:46]now, trying to look after yourself. And in a lot of ways, looking after yourself is being your best self regarding to, you know, volunteering, connecting with other people, that kind of thing, you know, meditating, smelling the roses, all that kind of thing. And that's kind of one of the things it's done. It's kind of go, well, don't don't The realization that I have APOE4 is make me kind of go, well, life is finite no matter which way you look at it, and no waiting, do it now. You know, exercise now. You know what I mean? Start do that keto or, you know, investigate what's do it do it now. You know? And that's kind of a, you know, a glass half full way of

[9:22]looking at it, I think. >> Yeah, I I love that. I I think and that's the case for a lot of our community members, right? Like, you potentially have ways once you learn that you carry APOE4 and that you have this higher risk of getting Alzheimer's. Either you get into like putting your head in the sand and ignoring everything and trying to YOLO life and go through it or you use that as a catalyst to actually do some change that are not only good for the future and brain health but also has real positive impact on a day-to-day basis very very fast.

[9:55]Once you start cleaning the diet and stopping alcohol and exercising you feel like much more energetic like on a very very short-term basis right the results are right there which I already like that you're doing and both of the same time like improving long-term health but also like short-term quality of life improves significantly. So yeah I I tend to say that learning that you carry it with all I mean for me I believe it's the best thing that happened in my life not that I carry it but the fact that I know it and that it really pushed me on the path of being extremely healthy and taking care of my health and not feeling

[10:27]invulnerable. What you mentioned earlier that you know like it feels like it's only the other people who have like health issues or getting like she downs and everything you you feel like you're immortal but >> Yeah exactly. >> In the end yeah that's that's a electro shock that makes you feel like okay you're not and you have to do something and you still have the agency over your own life right so yeah a lot of that. I think we're very aligned on this.

[10:48]>> Yeah and also I got another idea I got another idea I want to I want to put this to you. Okay you know how you kind of go oh you know it sucks having APOE4 we've got this crappy gene that you know we're going to you know we we can't handle you know I don't know alcohol whatever you go like maybe we should sell it as like we're the wild variant we're we're the tough humans we're the people that you know had to like I don't know track a mammoth for like two weeks you know just using the ketones in our bodies you know what I mean rather than how we're not suited to modern day life

[11:21]you know maybe just sort of sell us as being like tough and wild you know but anyway that's just a thought. I see you're not on board like I I got another thought I got another thought. >> No no I am I am because if you look at research there's actually a lot of research that show that 8.4 carriers are overall smarter than other people. Now, their IQ levels, education levels, there's a lot of correlation there. So, it seems that for us, early lives is we benefit a lot. So, we got an upside at 94, which is where we get like stronger cognitive capabilities and so on. And it's mainly afterwards that it declines.

[11:54]And it declines because we are having a lifestyle that is very like a modern lifestyle sedentary and everything, right? And I mean, now the evidence is not there for the rest, but what I believe in is if we keep having a lifestyle that is as close as possible as the ancestral one, which means a lot of exercise, diet, and everything, then we can keep that advantage over like like 8.3s or other people, right? We've seen some studies showing that the impact of interventions, including like better sleep, exercising, better diet, is much stronger on us compared to other people. So, we're kind of playing the game higher stakes than everyone else, but it doesn't mean that we are hopeless

[12:34]and we can't do anything, that we can still thrive here. >> And there's another thing that I have a feeling, but I want to check what you think. And that is a different way of looking at diet in that when I was at medical school, because glucose is just so tightly kind of controlled, kind of feeling or the what we we learned was that humans run on glucose and we just have fat for a rainy day. You know, like if you know, that that's how it works. And and now I wonder whether we should be thinking we actually run on fat and we just keep glucose for like when we need to put our foot on the

[13:09]accelerator regarding like, you know, do a sprint or something like that, which is a completely different way of thinking. What do you think about that? >> Yeah, if you if you think about if you look at other animals, let's say like the top predators like lions and so on, you realize this they spend the So, the their time they're are laying down and and resting and then they have peak exercise that is like really when they need to hunt uh and that's when that happens. And for us, it's not really the case. We don't have a peak exercise and a lot of resting. So, it kind of goes there when we're talking about ancestral living

[13:40]where like if our genes are the same genes as we had 50,000 years ago and they didn't have time to uh like be selected for our modern lifestyle, then in the past like 50 years 50,000 years ago, we were living the same way that lions were like chilling, not doing much the majority of the time and then having peak exercise which burns all the glucose, all the glycogen in the muscle, and then the ketones as well at that point in time.

[14:08]And >> Yeah. Yeah, well, I think so. And then it just kind of switches to be thinking about what fat are you eating? I mean, like a lot of the nutrients are in are in your carbohydrate sources if you're having fruit and vegetables, but it's just a different it's just a different way I think of approaching your diet. I don't know if it's a lot for many APOE4s, but early on I read Bredesen about oh, you know, have the 12-hour overnight overnight fast. Well, I get nowhere near into ketosis after 12 hours.

[14:36]I need to be like 16 hours. And then to be 16 hours is like well, you know, I've got to become a hermit cuz I won't have any friends, you know what I mean? Cuz it's very hard to be social and fit that in and yada yada. So, um the way to be in ketosis then you can't I mean, you could do a bit of intermittent fasting, but you got you got to add ketones in or MCTs or something like that. You can't You can't I can't just do it from I can't be in ketosis nutritional ketosis with a 12-hour fast overnight, you know what I mean? Uh So, I wondered it'd be interesting with your Phoenix community

[15:16]whether that comes out that a lot of people with APOE4 need longer to you know, need a long time before they get into ketosis. I'm I'm not sure. And the other thing that I'm interested in is with the um facts that come up through your watch. And one of the things I'm interested in is people's antioxidant levels because this is, you know, n equals 1. My antioxidant levels are appalling. And I'm a naughty vegan, so you're going to go, "How does that work?" I'm a vegan that eats fish.

[15:44]And you go like if there's anything that I should be good at, it should be antioxidants. And you go, "Well, why is it so?" And then I just got back a bit. I know this is all very woolly thinking, but you kind of go, "People who've got, you know, the APOE4 gene, they're not really great with their metabolism. And they're having a lot of that, you know, energy being produced in the cytoplasm.

[16:03]And that's pretty, you know, dirty burning of the glucose. And maybe that needs to be mopped up with antioxidants a bit. And that's why my antioxidant levels are low." And a little bit to your post where you said, "Oh, plasma plasma um ketones might be low, but that's because your brain's sucking up the ketones." Do you remember when you said that? And I was sort of thinking of that something I don't know, n equals 1, but I was just like, "Oh, another strange thing, strange factoid. See if it comes up in the community." I really like that about your community that all these facts are getting amassed. And if there is a trend, we can see it. I think that's

[16:39]really great. >> Yeah, that's the goal. I mean, to to go a little bit on ketones and ketosis and everything, for sure, yeah, after 12 hours, if someone is eating tons of carbs, who knows if they'll get into ketosis at all. Yeah, there are a few things of going like very low-carb or no-carb at all and exercising in the morning like doing a like a zone 2 run and something to sink all the rest of the glucose out and then being able to go into ketosis, right?

[17:04]Otherwise, it's it's extremely difficult. Even if you're like a metabolically flexible and everything, it it becomes very very difficult. But yeah, like what you mentioned, right, the the ketone blood level is only a proxy. Like what matters is is your brain having enough ketones to function on on ketones or not. And in the end, if the brain sucks in all the ketones, then it's not in the blood anymore. That's all.

[17:25]>> Yeah. Yeah. >> But it's a constant like level of production versus consumption. And that's also like one metric. So, what I what I find very important is to be careful on blood biomarkers that are only a proxy, especially when you are looking at the brain. So, functionally how we feel, and that's why in the Phoenix we have this like daily check-in where we enter the brain fog level or the clarity and how we feel because I I feel like that's more important than than you know blood biomarkers.

[17:50]>> So, how many people are doing that? Are you getting a big uptake on that with the daily check-ins? >> Yeah, so we have around I think like 70% of our members on it. I know a lot of people are still not aware the app exists. I know it's a bit confusing for everyone because we have like this community app and then the Phoenix app and they're not really interconnected yet. But yeah, it's it's getting there.

[18:13]So, I'm I'm sending tons of emails to explain how to go on it. So, if like if you're a Phoenix member that is listening to this, we have a mobile app now and a web app. So, mobile app on both Android and Apple where you can do those daily check-ins on your phone. And you get insights, for example, in the morning you'll get insights like oh, we noticed that your sleep because the the app connects to your wearables, your watch and everything.

[18:35]>> It's brilliant. >> So, we noticed that your sleep increased by was better by 20% and this is what changed yesterday. So, yes, like basically we tag things in our daily check-in saying say um I don't know, exercising or like having under the sunlight in the morning or I've taken that supplement or that supplement and then the app is able to detect the AI is able to detect if there is a change, let's say better sleep, what changed before or in the days before to be able to correlate that. And not only we do that on the individual level, we do that at the community level as well to be able to derive insights not on n equal one but n equal many. And

[19:11]that's really kind of the goal, but we need like way more members to to do it. So, if you're a Phoenix member and listening to this, like use use the app. It helps all of us. >> I I I can I want to ask you about the age group. What what what's the most common age group that are in the Phoenix community? Are they pointy-end like me, or are they more like babies like you?

[19:30]>> Uh I think I'm one of the youngest. So, 80% are between 50 and 70 years old. So, you're right there. And we have also 80% of women, surprisingly. Yeah, because I'm not marketing specifically to women, but somehow I think like women care more about their health than men overall. So, you have these different type of persona, right? You have the persona of the caregiver who have seen that their parents have had Alzheimer's, and then they decided to test because their parents got tested, so they detected it.

[19:56]And you also have the younger biohacker, like more fitness-oriented like people like me. Then you have the middle-aged, usually women who still is working, has a career, and also has detected that. So, these are typically the three three main personas I see inside of the community. Now, if you if you go back to Yeah.

[20:14]>> Oh, yeah. Sorry. Sorry. You were supposed to be doing the You were supposed to be asking the questions. Sorry. Sorry. Okay. >> I'm glad to answer the questions, too, but I think if we go back to to you. We can talk a little bit about that, but it's great to to talk a lot about that.

[20:25]But what I want to focus on is the second element. Right, we talked a little bit about your mother, but now about you. So, you detected that you carry APOE4 at the same moment when you looked at cancer genes and that you got breast cancer. So, a lot of our members already struggling with APOE4 alone, you are managing both at the same time. How do you handle this overwhelm of information? Sometimes I'm I'm guessing that interventions that are not completely aligned, things that are good to avoid cancer are not necessarily good for APOE4 and vice versa. So, how do you handle all of that and the amount of information that is out there?

[20:59]>> That's a really good question, cuz you're right. I do find it um a bit overwhelming. And um often I want to like uh talk through what I think I should do, um, and the community is good in that way that I don't kind of wear out all my friends and bug my husband too much, um, about you know, talking about me. But, actually, in disagreement with what you said, a lot of the things to be, uh, decrease the risk of breast cancer recurrence are the same as the healthy lifestyle things you should do >> for Alzheimer's. There is a little bit of a, you know, um, team breakfast and team no breakfast. There is that that

[21:40]little bit of a divide, but there is a lot of overlap in what you should do. And I also think back to that previous point, it's a little bit, you know, was it Socra- Socrates said, you know, a life not examined is a life not worth living. So, >> Yeah.

[21:56]>> uh, you know, push your forward, be your best self, do as best as you can, and then it what will be will be, kind of thing. Yeah, that's my answer to that one. >> How do you decide on what protocol or which intervention to follow among everything that is out there?

[22:13]>> It's got to be able to do it, hasn't haven't you? There's some things that you just can't do. So, if you're going to be able to do it, and then it's a little bit like, it's really good to be able to have some parameter that you can check what you were at the beginning and then have a little look after you've done the intervention to to to see if there has been a change. And then, I think, you know, do all that, and then you've got to kind of not get consumed by it a little bit, too. You got to, you know, have a little maybe a holiday from being healthy sometimes. Just, you know,

[22:44]but but that's not not a lot. But, I mean, like, don't don't get overwhelmed. I mean, you can't you can't help being overwhelmed, but, you know, have a break. >> I I agree. I totally agree. So, on the the two different things, right? The the first thing that you mentioned, which was being able to validate it in an objective manner, whether it's a and all we mentioned that blood biomarkers only proxies, but it's it's still better than nothing.

[23:06]>> Yes. >> To be able to do a before baseline, changing hopefully only one parameter, not too many correlated parameters, and evaluating after if it changed. So, there are a lot of things that are very easy, let's say reducing cholesterol levels and so on. That's a very objective metric that you have. Things that are that are a little bit trickier, let's say omega-3 levels in the brain, that's a little bit trickier to measure.

[23:29]That's why you have like all the subjective measures of like how's the brain fog, how's your energy level. But, I really like that so we able to validate it. Because what what we see in terms of being able to consistently follow a routine, you need generally need to see results. The typical thing when you you use that fitness as an example is when people realize that they look better in the mirror, right? Then they saw they see the result, then they are motivated. So, for us when you have interventions where you don't visibly see any changes, being able to track it especially over time is very important because the memory, so I try to remember

[24:04]the last few months how you were cognitively versus now, it's very very difficult to have a very objective view on how each day were, but tracking every day is whether it's through a journal or something, then you see the pattern like the the curve going back up. Um I feel like that's super important.

[24:20]>> Like I got two questions about that memory thing I wanted to ask you about. One was in a post that you said it wasn't really how well you did on a cognitive test. You said that really it was the kind of variability or the static around it that you thought was um more telling. I thought that was interesting and I actually do the um you know that that connections thing from the New I think it's the New York Times has that connections little quiz thing.

[24:47]Do you know what I'm talking about? >> know. So, well basically you get like 16 words and you got to put them in rows of four and each row has got to be in some way connected. And so, what I because of that post you said, I see like how long the difference is like what if if if I'm getting them quickly or not not more than if you're getting them or not, if you get what I mean. More the static around it to sort of I'm using that as a proxy for how clear I'm thinking. And then I also notice that you have in development on your Phoenix site about cognitive testing. You know how you And

[25:18]I was wondering that's a minefield, I think, because I think if somebody's got APOE4 and they're told that I don't know the homocysteine's, you know, a bit naughty. Well, what you know, it doesn't upset them as much as if they did a cognitive test and they can see that their brain brains oozing out of their ears. You know, you you um I wonder how you're approaching that because that is such a Ooh, that is this that that topic is very sensitive. You know, people are very care a lot about that if they've if they're got APOE4. So, how are you approaching the cognitive testing part?

[25:55]>> It's it's a good question because what you mentioned, right? If someone sees a bad score, if they get discouraged and it's overwhelming, that's terrible. And and we also know that sometimes the mind and the body plays trick on it, like the reverse of the placebo effect or the nocebo effect that happens when you feel like you have a bad score then everything goes to hell. I know it happened to me when when I discovered that I carry APOE4, like I started having like random very weird things happening to me, like leaving my clothes in the washing machine, like missing out on steps and so on that I never expected. I never expected to have

[26:30]any random symptoms appearing at my age. It's not possible, right? But still, it happened. So, you have these type of things that you really want to avoid. So, getting a bad score is is yeah, that that can be a very challenging. I I tend to think very rationally that what matters is not where you are, but the delta. If you manage to increase that score and you see progression, it's better and better. The second point is Uh you do tests are just like one way one window into something that is so complex that there's no way to really measure everything. It's only one measure and to not take it too seriously or at least only one small element.

[27:06]>> How do you think we should approach that? >> I think you should approach it like are you going to do anything? Actually, I'm just making this up as I'm going along, so I haven't thought about it. But are you going to do anything with the result of this test? If you know what I mean.

[27:19]Because that was one thing working as a doctor is like don't do a test unless the result is going to make you, you know, change your behavior kind of thing. And I think maybe if you go like then if somebody has a bad score, it's not like see are you, you know, you got you got Alzheimer's. It's like, okay, you've got a bad score and this we we we've got something for you. You know what I mean? That's what I would think cuz I agree with you 100%. You you don't This whole trying yourself with APOE4 is not going to work if people get very discouraged.

[27:55]>> Yeah. Yeah, I agree. So the way we approaching it and and this module has been taking like forever to build because it's a very tricky one. That's why you you see it in the long run all the time. Is that we're also using these games not only as diagnostics but also as an exercise to improve like cognition. Now the problem of doing that is you get a huge practice effect after playing a lot of these games. For example, the connection in your times and everything. And you just become better at that game specifically. And then it throws everything off. But but I have like it kind of defeats the purpose if we talk about it, but technically if

[28:27]you feel like you're getting better, you'll get the placebo effect and it's a real thing, right? Placebo effect. We know it even worked on cancer. For example, for people who are really like it works. Placebo effect works. So if someone feels like they're actually getting better just because of placebo effect, in reality they still get better. So >> Exactly.

[28:46]>> kind of compensating. but yeah, so that's fine. Yeah, I'll take it, you know, if you still feel better and you your biomarkers are better because of placebo effect, it it's great, you know. >> Yeah, yeah, yeah, yeah. >> I'm kind of juggling between the two. I don't know if someone if someone is aware of the placebo effect and it's because of that, does the placebo effect still apply or does that disappear? And I just like spoiled it for a lot of people. At least I don't know.

[29:09]Uh but yeah, that that's interesting. I I want to go back to what you mentioned earlier about how to not get overwhelmed about taking a break. Also totally agree. For example, me, I realized um that I lost a lot of life pleasure. So, for a long time, I mean, for my entire life, I always loved eating um and usually the good food that I love eating is not good for health at all. So, it's very uh correlated. If I love it, it's bad for your health. And and then I realized that if I always care about, you know, eating salmon and vegetables, no carbs and everything, um I kind of lost a sense of joy in in life. And then

[29:46]even when I allow myself to eat it, I feel guilty. So, in the end, I felt guilty all the time when I was like indulging and then it destroyed an entire pillar of happiness in my life, which I felt like sucked. The solution that I have, like you, is to decide when I allow myself to not be perfect. And for me, that's when I'm traveling. When I'm not in a routine place, I can allow myself to either drink a few cocktails, drink wine, eat pastries, eat sugar. But when I'm back into my home, whatever that is, I am back into this very, very strict routine, which means that 95% or 90% of the time, I have a baseline that

[30:24]is very healthy. And then I have this 10% where I allow myself to do it. And it's it's about being kind to yourself and >> Yes. >> um you know, like having some pleasure in life, otherwise what's the point? It's like a >> Exactly. It it gets to >> How how do you handle that? Yeah.

[30:39]How do you handle allowing yourself these breaks? >> Well, my kids have all grown up and left home now. And so, uh um I love it when we get together. And so, um I try and see them pretty regularly. And for me, that that's a time where I'll enjoy having a wine, and we'll go to a restaurant, and I'm having I set out to have a good time. I'm with the people I love the most, and that's when I go, "Okay, yeah, this is time out." A bit like you, and it's a different environment, that kind of thing.

[31:06]>> Yeah. >> So, yeah, that that's sort of my time out. >> Uh that's good. I think that's that's really key, having like clearly delimited like time out, like breaks, and still enjoying life, right? In terms of interventions that you decide to follow, let's say specific interventions, you can pick any examples of things that you decide to stop, or that you decided to start. How do you look at it, especially like coming from someone who is like medically trained, right? So, you understand the clinical trials, you understand the studies, you understand the limit of them, especially when it's like mouse model versus like human, um and etc. How how do you look for information? How do you decide,

[31:39]all right, this is worth trying, or this worth trying? >> Well, I don't I don't rush into things quickly because you just need to think think them over. And particularly with supplements that, you know, you buy in a bottle, you go like the person who's making this supplement is doing it to make money when push comes to shove, you know what I mean? And so, they're not really trying to look after me. And so, like, you know, there's might be contaminants in them, or they mightn't have the amount of what the supplement is that you think, you know, that says on the bottle, you know, that kind of thing. And you go, "Oh, yeah, but they

[32:13]have third party checking." And you go, "Yeah, but how often do they have third party?" You know, that the company might change hands in the meantime, that kind of thing. So, I'm much more wary about supplements in a bottle compared to a lifestyle change of like exercise, or, you know, diet, or or or or something like that.

[32:35]And the other thing is, um the safety, which is I suppose the supplements in a bottle is a safety concern. But the other thing is I've seen with the research you've got there with the What is it? Xenowell the vagus one of some of those things and you kind of go well when x-rays first came out they were in shoe shops for kids to you know put their feet into the shoes and they put a x-ray on feet. Yeah, to see if they you go like you know this was not safe practice people didn't know. And so you kind of go oh just be careful like you know just be careful of these that's what kind of moves makes me think twice

[33:12]you know about but will approach cautiously anyway these interventions or but after saying that I I certainly do take supplements from a bottle. I guess that you need to continually check the the credentials of the the company that is making something you're taking every day, you know, every day that that you know, that's a lot.

[33:38]Yeah, so yeah, does that answer the question? >> It does partially. I'll go back to a few other things but I want to bounce on on a few things that you mentioned, right? The one is where I don't necessarily agree. I I appreciate your point on that there is I feel like you mentioned that there's kind of a conflict of interest where they're there like the supplements company there to make money. They're not as regulated as farmers which means you have impurities that can be inside. You can have contaminants and the dosage can sometimes be off by a lot.

[34:05]>> That sounds like you agree with me. >> Yeah, I agree with you on that part. >> Okay. >> The part where I don't necessarily agree is maybe it's an optimist in me is if a company does that in the short term maybe they can make more profit by cutting corners and everything but in the long run once their reputation is destroyed it's very hard to go back. So if they're thinking long term I tend to hope that they are aligning their value to the value they bring to the customer because that's an exchange, right? The customer bring pays money and then they bring value to them. If they no value brought to the customer, then they don't

[34:39]pay anymore. So, I tend to trust >> Oh, yeah, yeah. No, no, I'd I'd agree with that. But, they might I agree with that, but there might be contaminants in there which are not good to have and and they're unaware of it all. But, I don't know. It's it's it's a lot of trust buying a supplement that you take every day. That's why I kind of go I approach that with a lot of caution. But, as I said, I'm I'm taking them, so you know.

[35:02]>> Yeah. And actually one of the things that you mentioned is is the risk benefit balance, right? Like, taking something that potentially has side effects and everything requires a much more thorough thinking than something that worst case it doesn't do anything, it ends up in your urine and you could pee it out. Definitely agree with that.

[35:19]Yeah. Yeah. One of the things that we're building in in in Phoenix is is that supplements module where all the members they can add in the brand they're taking and the dosage. Yeah. >> Yeah, yeah, yeah. Yeah, yeah, I saw that. >> Hopefully it helps. It's it's difficult to have something that is like really objective and but hopefully that that helps a little bit. If you go past the decision of I mean, if you focus on the decision of taking a specific supplement, how do you decide if you want to take it or not? A specific molecule or a specific diet ingredient.

[35:51]>> I think I think the thing answers it what why are you taking it? Like, how woolly is your thinking about taking it? >> Yeah. >> And so, with the whole odyssey of looking into my genes, I found out that actually that methyltetrahydrofolate reductase gene I've got is only working half speed. So, that means that it's a good idea for me to take activated folate and activated vitamin B12. And when I did that, my homocysteine level came down. So, you go like, "Well, that's good. I'm taking these supplements and I can see that my homocysteine level came down." Vitamin D, everyone goes like great it is. And you know it's just full of it it's full

[36:28]of it but a lot of people avoid the sun because of skin cancers and so it's really quite a joke how many people here have low vitamin D levels. I'm one of them and so I take the vitamin D so there's a reason why I'm taking the vitamin D. There's a reason why I'm taking the the B groups but the other thing that I took there was a study done years ago about nicotinamide being helpful in protecting against skin cancer and then after that somebody did where they I think it was maybe David Sinclair went on about nicotinamide wasn't very good because it kind of made all I don't know all the reactions go to the left and so I

[37:06]stopped taking it and just recently I have been convinced about NR so I think that NR will give me the benefits of the nicotinamide and so I'm taking that for a little I guess my is a little bit more woolly so the NR is going to help with I'm hoping with reducing my skin cancer risk but I think also helps with you know the antioxidant and the energy in the actual >> energy >> Yeah near brain energy with the neuron so that's that's the reason why I'm on that and and that's that's my lot at the moment.

[37:41]I heard Grant Fraser saying that people with my I should if he was my doctor he would have me on um I was just trying to think of the what's the name of that drug that I think it's definitely off label. I've been to to rapamycin. Yeah so yeah so I don't know where you get it from here. I suppose you could inquire but that's the next one that's sort of on my think about list.

[38:07]Yeah anyway. Yeah so so I think if things were going south if I had a a scan and it showed plaques and things maybe I'd I'd move to do something but you'd really like to know why you're taking something not just take it cuz there's a bit of a hubbub about it. What do you think?

[38:26]>> Yeah, makes sense. I mean, starting from from there, right? Do you look at the answer from your genes, you see because genetically we're able to see our absorption levels as well, right? Um it can be on a lot of different like nutrients, it can be on a lot of things we're able to detect if you're within our genes we need to supplement or not specific elements. So, starting from there is good and I think a lot of our community members they either did a snip as gene sequencing or they did the other the whole genome and then we're able to get insights out of that. Starting from there. Then you have the more experimental stuff where you have to

[38:59]look at studies which is like very recently we had lithium, we had energy >> microdosing lithium. >> Yeah. >> I thought that was interesting. >> you go towards that? How would you go towards that? I want to know your thinking about lithium. So, you've seen the study that was published in Nature.

[39:14]>> I'm very tempted actually for you. I know, do you know how they had that lemonade called 7-Up because they put lithium in it? And they kind of go, "Do people actually happier on it?" I mean like why would you put lithium into a soft drink unless it worked? I mean, I don't know. And so maybe lithium is, I don't know, the microdosing and the way they said that, you know, places that had lithium in the water had less rates of dementia. I mean, it's all very um it's all very tempting, isn't it?

[39:41]Putting a bit of lithium in the water, being really happy and I don't know. I'm tempted on that, but that goes completely against what I just said before about, you know, being very needing to see move the needle. I mean, I putting it it just tempts me. The whole thing tempts me, but where's the needle being moved? I don't know.

[39:56]>> Exactly. So, you wouldn't know. That that would be like pure trust on the studies, right? But then it goes on to your point where you're looking at the side effects and microdosing lithium is not like at the dosage like people that are bipolar are taking which is I think thousand times higher. So, there's not not so much strain on the body, right?

[40:12]>> Actually, I tell you what I did. I I try and grow my own uh vegetables and stuff, but look I don't get much, but you know, I had fun in the garden. And I was like, "You know what? I'm going to go and find a fertilizer with lithium in it because that that way I thought I had a look there. I think I just have to throw around some lithium batteries or something because there's no there's no fertilizer I can find with lithium in it, but I was very tempted by the whole lithium story.

[40:36]>> That's interesting because I I feel like that this would be super dangerous because you would have no like no control over the dosage of the lithium you'd have through your vegetables. It's like you have a solution that would be That would be so uncontrolled. You wouldn't even know, right?

[40:50]>> Well, no. I don't know even goodness what else would be in those batteries too. I don't know, but I was I was pretty tempted by the microdosing of the lithium. Yeah, yeah. >> Yeah. Mhm. Yeah, if I summarize uh yeah. >> But I think the thing is like it's good to know about the rapamycin. It's good to know about the lithium because I think it's good to be in reserve cuz you kind of go, "Okay, I'm I haven't got my amyloid or PET scan levels yet." It's not that easy to find here that will do that.

[41:19]>> Okay. Mhm. >> Sort of going on a journey trying to find somebody. Also go along and have a scan. I think I'm moving towards doing that. And I think if I have a bad result or a result I'm not happy about, at least I've got something up my sleeve that I can try rather than >> [clears throat] >> you know, having nowhere to go. So, that's a good thing.

[41:39]>> Yeah, so you have like arrows in your quiver basically that you can shoot with. >> Exactly. >> All right, cuz there's something there. Yeah, I like that. I like that. Okay, very very good. I think I'm I've like almost everything. If you had a message to say to people who just discovered the carrier APOE4, like what would you tell them?

[41:58]>> Oh my goodness. I'd tell them, you know, they're not alone. Isn't it one in four people have APOE4 now? Isn't that right? >> Yeah. Yeah, yeah. 25% yeah. >> So, you go like we all there's quite a few of us. And I'd say Kevin Trans is what we're cleverer than most other people. So, that might [clears throat] they can feel better.

[42:16]And I think actually it's an exciting time to know about this gene and its association with this disease because there are just is just a hotbed of research at the moment and there are so many trials and there are so many people interested in and there are so many people looking at it from therapies, from mechanisms of action. So, you know, we got a lot of reasons to be optimistic and until we get if there is a silver bullet, until we get that we have got all these other like lifestyle interventions that we can do that we have that have been shown to definitely improve the situation. So, no room for optimism. That's what I think. Actually,

[42:56]there's another thing I'd say too because for people at the pointy end like, you know, my age, I think that a lot of people can get a little bit disheartened if you go, "Oh, you need to do 150 minutes in zone two." You know, and you go like and they might go, "Well, no, you know, I can't. I've got a you know, I've got a bad knee." Or I think that the truth is that you you can't have got to the age where you're at risk of developing Alzheimer's without having got some medical or orthopedic things and you know, just do what you can and it's great rather than thinking, "Oh boy, I'm going you know, I'm for it now. I

[43:33]couldn't do my 150 you know, minutes of zone two." So, that's one thing. And then another thing, and this is my last thing cuz you probably got things to do is that I think I think if one in four people have this gene, I think that it should be a community health thing that everyone at the age of, I don't know, pick a number, 30, at that age has the test done to see the genetic to see if they have it and then if they don't have it, see you. But if they do have it to like periodically be checking their blood pressure or their LDLs or things like this as a population health measure cuz I think

[44:11]that will improve the health of society. Full stop. You know, if you act on those results. >> Yeah, I totally agree on that one. I think that it's it's a big debate right on. You should be looking at for example I'm not exactly sure how it is in in Australia. Is it one payer? The government is the payer or do you have multiple payers and our insurance?

[44:30]>> Oh, we have Medicare so that's just so you're covered by Medicare. >> One payer. >> One payer. >> Okay. >> Yes, and it's very generous and so it's very there's always a little bit of a tug-of-war between the patient having to pay a little bit of money towards the general the primary care visit but a lot of primary care is not charged to the patient at all and the hospitals are free. So and you can go.

[44:54]>> That's good. >> So it's very generous. It's very good. >> Yeah, so to that point right when I think when there's one payer let's say in Europe or even like in Singapore like in Australia then it makes sense to like focus on prevention and because in the end you're saving money to society right? So but in it's all the countries where you have multiple payers when the payer can change over time let's say it's an insurance that is tied to your job like in the US and they know that they are not covering you for the rest of your life so they don't really care.

[45:20]They just want to reduce the cost on a uh short term. >> Mhm. >> Uh then it it matters a lot. Um we we have seen a lot of advancement there on genetic screening for example in Singapore they started to aggressively screen for familial hypercholesterolemia. When someone has very high level of cholesterol they highly highly recommend people to get tested genetically because if you have that then they can take measures and they can take you in charge and and help you as a prevention measure. I am talking to a few people in Singapore to try to bring a bill forward there as well as a test that is recommended.

[45:54]Hopefully that happens but I I totally agree that when someone knows then you know that you have to take care of your heart health and metabolic health to really combat diabetes and and so on, right? And and it makes sense because then down the line, even for society and societal cost, preventing an Alzheimer's case is is huge, right? Not only in cost for the patient, the cost for the caregiver, and everything that issue we think like very objectively, the cost of preventing one case is huge.

[46:20]>> Yes. Yes. Okay. Well, I feel we're going to wrap up now, Kevin. And before we do, I just like to say thank you so much for everything you do. And I think you're very innovative and I think that there are so many people with APOE4 that are very grateful for everything you're doing and it makes us all feel more optimistic facing the future.

[46:40]>> Well, thank you so much, Shae Zoutis. I love that. Thank you for for your time today and thank you for like sharing all your wisdom and your story.