Reporting Aboard

Newcomer introductions, personal anecdotes, caregiver issues, lab results, and n=1 experimentation.
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cdamaden
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Reporting Aboard

Postby cdamaden » Sun Apr 03, 2016 1:40 pm

Hi All,
Here’s my story of how I came here and what I’ve been working on healthwise. I would really appreciate any feedback. :D
I’m a 48 years-old man with E4/E4. I have a BMI of 22.5, body fat around 13%. I’m married with two kids. I have a desk job but get up every 30 minutes or so to walk about. I do strength training twice a week, bicycle with my dog every morning and have added 30-minute walks into my program (I was an avid runner but kept getting sidelined with injuries so pursued strength training 2 years ago). I also have a good amount of education and continue my education when I can.
I took meds for Benign Prostate Hyperplasia (BPH) from 2006, adding finasteride in 2010. I went through a stressful work situation in 2010-13 and went through a series of antibiotics in 2011-12 for sinus and prostate infections, which I think caused some gut damage. In 2012, I got GERD and took Omeprazole. In early 2013, I was trying to resolve some nerve pain on my foot and the doc tried Gabapentin. That threw me into a complete brain fog and caused anxiety. Even when I ended that experiment (3 weeks), the brain fog continued at a lower level. I also had mild depression and afternoon fatigue.
By December 2013 I couldn’t stand the brain fog any longer and pursued dietary changes (my doc was not convinced I had a problem). I got rid of gluten and stopped taking finasteride. This improved my brain fog. I removed the other BPH drug in February 2014. I researched a paleo diet and by April I was grain free, alcohol free, and coffee free (one cup of tea per day). I continued to feel better. I titrated off Omeprazole (not fun) using Rantitidine. By August I was reflux free and drug free. The reflux comes and goes and I’ve identified some trigger foods (excess fruit, excess fodmad, alcohol, large meals). I’ve added back wine and then mostly took it out. I’ve added back coffee but keep it low because I now seem to be very sensitive to caffeine.
I did try a low carb diet but felt like crap. I added back in one sweet potato a day and that cleared it up.
By December 2014, I was finally tested and learned that I had low Testosterone. Going on Testosterone Replacement Therapy (TRT) pretty much cleared up my remaining brain fog. I also have learned that I’m very sensitive to inadequate sleep.
I started seeing a functional medicine doctor in February 2015. He diagnosed me with methane SIBO. I’ve gone through the gamut of natural antibiotics, pharmaceutical antibiotics, and now a high prebiotic and probiotic protocol. We’ll see if this ever gets resolved. I think a healthy gut is foundational to healing so I’m giving it the college try.
I learned through my various food additions/subtractions that I have a problem with eggs (itchy skin - maybe just the whites?) and garlic (tingling sensations in my feet).
I started to see another functional medicine doctor to see if I could transition off TRT. He did a full lab panel, which included the APOE test. When I learned of my 4/4 status, I shifted my diet away from red meat and dairy products toward lower protein overall keeping a good amount of fish and some chicken in the diet and added in the 30 minutes walks.
I went back and recorded all my blood work over the years. Here are some results:
06’ 11’ 12’ 13’ 14’ 15’ 16’
Glucose: 96 // 96, 109 // 104, 76 // 109, 99 // 103, 87 // 102, 97, 105, 99, 95 // 111, 98
HbA1c: 5.6, 5.7, 5.3 // 5.7 (2015-16 only)
Avg Glucose: 114 // 116.9 (2015-16 only)
Vitamin D: 23.9 // 29.8 // 38.7 // 32.9, 28.6 // 29.3, 33 (2011, 12, 14-16)
Insulin: 4 (2016 only)

Before Paleo, my lipids were so-so. Here are my two 2013 results:
TC: 185, 161
LDL: 118, 96
HDL: 50, 47
Tri: 95, 92

After Paleo, my lipids shift a good bit. 2015-16 results:
TC: 247, 220, 227, 191, 259
LDL: 166, 135, 148, 129, 187
HDL: 68, 73, 62, 48, 67
Tri: 68, 60, 82, 72, 79

My latest test earlier this year had the advanced markers:
Apo B: 126
LDL-P (NMR): 1905
Small LDL-p (NMR): 641
sdLDL-C: 44
Apo A-1: 168
HDL-P: 40.3
HDL2-C: 17
Lp(a)-P: <50

Clearly all those results were before my recent dietary change. I will try to retest in another month.
Here are my current supplements:
Pregnenolone and DHEA
Pre/pro biotics: ProFiber select, Biotagen, Primal Defense, Ther-biotic
GI-Revive
O.N.E multivitamin (includes methylated Vit B*, D3, alpha lipoic acid, coQ10, zinc)
Vitamin C, 1000 mg
Magnesium 200 mg
Vitamin D3 2000 IU (thinking of increasing)
Experimenting with Active B12* and Super Bio-Curcumin

*I am homozygous for MTHFR (A1298C) C/C
OK, huge data dump. I’m very interested in your thoughts and suggestions.
Thanks,
Chris
E4/E4
Alameda, CA, USA

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Re: Reporting Aboard

Postby hill dweller » Sun Apr 03, 2016 2:38 pm

Coincidentally, I just finished reading a transcript of 2015 08 Rhonda Patrick interview with Tim Ferris. (I don't think Ferris would be insulted to be described as a showman, and he certainly isn't a scientist. Patrick is credentialed and credible.) At pages 16 - 18, they discuss personal experiences with long courses of antibiotics and resulting gut damage.
tim_ferriss rhonda patrick 2015 _08 11.pdf
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KatieS
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Re: Reporting Aboard

Postby KatieS » Sun Apr 03, 2016 3:52 pm

Welcome another Northern Californian! It sounds like you're doing the correct steps, mostly off drugs (esp Gabapentin), exercising more, average BMI (with the increased exercise & decreased carbs will come down more) and gut restoration. I would analyze your dietary saturated fats, carbs (do you need a sweet potato every day?) and protein (likely to be higher than you need) with the CRON-O-Meter to aim for lower A1c and LDL-P. Being a 4/4 male, cardiovascular disease should be actively monitored with a home blood pressure measurements and in your 50s, a calcium heartscan.Testosterone supplemental might increase these risks as it does for sleep apnea (note to wife for snore checks). You are certainly an example of why we need to know our E4 as this knowledge prompted more changes.

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Stavia
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Re: Reporting Aboard

Postby Stavia » Sun Apr 03, 2016 7:04 pm

Thanks for the comprehensive data.
I always look at glycaemic control first, and your HbA1c and blood glucose readings are not concordent with your fasting insulin. I'd like to see a lower HbA1c.
Then I look at lipids and I'd personally like a lower apob/LDL particle count. Perhaps reducing saturated fat will help here.
Also, you could consider running your D3 a bit higher.

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cdamaden
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Re: Reporting Aboard

Postby cdamaden » Sun Apr 03, 2016 9:45 pm

Hill - good read. Kinda scary about the IRS-1 marker.

Katie - ah yes, the Californian good life (some charges apply). I will never take Gabapentin again. I have no idea why it threw me for a loop - maybe somewhere in the methylation cycle ?!? For the moment I'm focusing in on dropping out the Saturated Fats. Once I get a handle on that, I will revisit my carb loading. Last February I tracked all my food via cron-o-meter. With a 2300 kcal diet, I was only eating 110 grams of carbs (including my sweet potato). My protein intake has dropped significantly, so I'm really looking forward to my next set of labs to see the results. My blood pressure has been picture perfect for years, but I will keep an eye on it. I will look into the heart scan - good info. I started to reduce my Testosterone and hit a rough patch. I will also revisit that one as soon as I can. Thanks for the solid advice!

Stavia - yes, I don't understand why my fasting insulin is normal based on the other markers. Since I only have one data point compared to several for the glucose, I'll assume it isn't reliable. With more cardio in my program and less protein, I hope that makes some good changes to those markers. Concur on the lipids. I do have one question though. When I looked up best markers for Insulin Resistance, it pointed me to lipid ratios: Trig/HDL and HDL/TC. They are supposed to be the best markers for predicting IR and for estimating particle sizes. My ratios are very good. So, it clearly doesn't align with my high LDL-P and Apo-B. Is that an E4 effect, or am I just a special snowflake? :D

Regards,
Chris
E4/E4
Alameda, CA, USA

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Stavia
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Re: Reporting Aboard

Postby Stavia » Sun Apr 03, 2016 11:39 pm

I don't know if the tg/hdl is the best for predicting IR. I thought it was good for predicting CVD risk by correlating somewhat with particle size.
As far as I know the 3 most accurate ways of predicting CVD risk are the Framingham tables, apoB/LDL particle number and coronary calcium scan - all flawed.
IMO the best predictors of IR are the glycaemic control markers of glucose HbA1c and insulin, not the lipid surrogates.

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Julie G
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Re: Reporting Aboard

Postby Julie G » Mon Apr 04, 2016 11:09 am

Chris, kudos on all of the health improvements you’ve made so far! Your BMI and body fat are excellent for a male. Also, great job of quantifying your numbers. It’s so helpful to be able to see how diet/lifestye are impacting biomarkers.

Like Stavia, I was struck by the discordance of your insulin with A1C and FBG numbers. Your insulin is decent, but the other numbers indicate you may be pre-diabetic. Given your high small LDL-P (that tends to confirm the pre-diabetes,) I would turn my focus on glycemic control. Are you testing your glucose after meals to find foods that have a big impact on your post-prandial numbers? You might find some (like sweet potatoes) are having a big impact. I’m also a huge fan, but limit the amount I eat because of the effect it has on my BG.

If you can greatly reduce your small LDL-P, that will have a big effect on your overall LDL-P and ApoB. FWIW, Dr. Gundry has found that ANY animal fat has a strong impact on small dense LDL particles in E4 carriers. That might be an area where you can cut back. I also completely agree with everyone that cutting back on SFAs is a great idea. It gets tricky for us as dietary fat is what generally increases particle size. Lots of us hack this paradox by using generous amounts of MUFAs and PUFAs (olives, avocados, nuts, EVOO) to yield larger particle sizes and hence lower LDL-P. You’ve probably noticed that many here try to keep their SFA intake between 7-10% of total calories.

Like me, you’re also clearly a hyper-absorber of dietary fat given your higher cholesterol when you switched to a Paleo Diet. Eating lots of non-starchy vegs, nuts & seeds (all high in fiber) should help absorb some of that out of the gut and provide lots of small chain fatty acids for a healthy gut biome. I can eat 10+ cups of veg a day and still stay within 75-80 grams of carbs and stay mildly ketogenic. I recently ran an experiment where I increased my dietary fiber to between 40-50 grams a day and yielded my lowest LDL-P, 881.

You are young and perfectly poised to avoid the pathologies associated with the APOE-ε4 allele. Keep up the great work and let us follow your progress. We learn so much from generous sharing like yours. Thank you.

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cdamaden
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Re: Reporting Aboard

Postby cdamaden » Wed Apr 06, 2016 12:54 pm

Julie, you said any animal fat will affect small dense LDL particles in E4. That includes fish and eggs?
Chris
E4/E4
Alameda, CA, USA

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Stavia
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Re: Reporting Aboard

Postby Stavia » Wed Apr 06, 2016 1:40 pm

Chris this is a good question and there is no solid evidence yet. Some of the members follow Gundry's opinion (it is an opinion as there is no published data and he prescribes many interventions at the same time as limiting animal protein) that yes it might and they limit their animal protein to 20 grams a day. Other members are not convinced and do not overly limit animal protein as they feel its not that black and white and follow the mainstream paleo opinion (again no convincing proof) that a high LDL in the absence of inflammation is irrelevant. Another group of members do not have any animal protein at all because they are worried about methionine activating mTor amongst many other reasons. Another group tries to limit saturated fat from whatever source.
It's complicated. There are many camps, some of which are diametrically opposed. There appears to be no one overwhelmingly convincing truth IMO but at this stage my personal feeling is we have suggestions that high animal fat and high animal protein might not be the best thing for e4s for many complicated reasons, sdLDL being only one of them.
I have taken the position of trying to limit my saturated fat as much as possible while keeping total fat around 50%. And try to keep to 1mg/kg protein a day.

Specifically - the protein in eggs is simple albumin. Not seen any issues raised with it as such.
Fish - well....studies consistently show people who eat fish are healthier and live longer. Fish is a whole complex food with omegas and other great stuff and low in sat fat and we can't just look at its protein in a reductionist way. I say yes to fish. There is consistent evidence it's good.

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cdamaden
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Re: Reporting Aboard

Postby cdamaden » Wed Apr 06, 2016 3:06 pm

Great, Stavia. I'm following your lead. I was intrigued when I found this study though:
http://www.lmreview.com/articles/view/o ... e-decline/

"Despite the disproportionately high prevalence of ApoE ε4, cardiovascular disease and diabetes among Native Americans, and the Pima Indians, specifically, research examining a Native American rural population in nearby New Mexico clearly shows that carrying the ApoE ε4 allele does not increase the risk for any of these conditions in people eating a low fat diet and following an active lifestyle."

Then I found this one about what their macronutrient profile was:
http://care.diabetesjournals.org/content/16/1/369
"We estimated that the traditional Pima diet, although seasonably variable, was ∼ 70–80% carbohydrate, 8–12% fat, and 12–18% protein. A diet analogous to the traditional Pima diet is largely reproducible with the foods available today. Many native foods are available locally and many commercial products can be substituted when native foods are unavailable. "

Another website claimed: "Things were very different for them before 1539, when the Spanish first made contact. They lived on an agricultural diet of beans, corn and squash, with wild fish, game meat and plants."

Has anyone pulled this string of a native people who appear to have had a High Carb / Low Fat diet with an apparent animal source of protein and fat yielding seemingly good results for APO E4s?

Regards,
Chris
E4/E4
Alameda, CA, USA


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