my ApoE4 story so far

[slacker]

To my ApoE4 tribe;

I learned of my homozygous ApoE4 status in 2011 from a “functional medicine” test described to me as informative about my ability to benefit from statins. Since I had been on almost all prescription statins for high LDL cholesterol for years with great results and without problems, I thought “so what?” On review of labs, I was told this gene also increased my risk for Alzheimers. Since I had no family history of Alzheimers, I though “so what?” Genes are only part of the picture.

Just so you know, I have a degree in electrical engineering (worked for IBM for 12 years), and have worked as a physician assistant in adult primary care for 18 years. I have completed a 2 year Integrative Medicine Fellowship with the University of Arizona in Tucson, a program started by Dr Andrew Weil. So there is really no excuse…

Fast forward to 2015 when my brother who is 2 years older than me is diagnosed with Alzheimers at age 57. I suddenly recall my ApoE4 status…a heightened awareness begins to develop…

I receive an email from the Institute of Functional Medicine in early 2016 announcing the first Functional Medicine Ground Rounds from Cleveland Clinic’s new Functional Medicine Department - topic Alzheimers, speaker Dr Dale Bredesen. For the first time, something to grab onto, a possibility to prevent or reverse the disease. I immediately signed up for notification of provider training through MCI Cognition and Buck Institute.

Arrived at Buck Institute in July 2016 to learn about Dr Bredesen’s protocol. In over my head with information. Met the astounding Julie Gee and invited to join this fierce ApoE4 tribe. So I become my first case study of how to go through the Bredesen protocol. Playing with Brain HQ, disturbed by cognitive message from it and MoCA screen. Working on changing my almost vegan diet to include more plant fat, eggs, and fish; so hard to cut back on legumes and whole grains which was over 50% of my diet. Breakfast is the worst. Trying to hit 12 hour fast overnight. Increasing exercise, working on stress management (aka accepting what is and letting go, oh and stopping Brain HQ for now). Adding supplements. Subset of recommended labs pending (15 vials of blood!). Trying to find competent bioidentical hormone replacement provider who is in line with cognitive target, not hormone levels of 30 year old female.

How fortunate to be on this roller coaster journey into the unclear with all of you! Your stories and persistence in the face of the nebulous is inspirational and awe inspiring. I am honored to be with you along the way.

PS. Off statin since 2011 through lifestyle changes Not completely a slacker…

[Julie G]

Welcome Slacker!!! So nice to have you join us. I'd recognize you anywhere from your sweet pic. You haven't aged at all . Wow- nothing like your brother's Dx to shake you up. So sorry. Congrats on all of your positive changes. Most importantly, are you feeling any better as a result?

[SusanJ]

Slacker, good to hear your story, congrats on getting off statins, and sorry about your brother's diagnosis. It is a roller coaster, isn't it?!?

[Stavia]

hi Slacker!! Great to have a fellow health professional on board. I look forward to your contribution to our discussions
What supplements are you stacking?

[Starfish77]

Hello Slacker,
You certainly got into the program in a big way. Congratulations on working your way off statins. You've already made so much progress. Looking forward to hearing about your journey.
Starfish

[Lucy5]

Welcome slacker (who is clearly NOT a slacker...!). Found your story so interesting. And so sorry to hear about your brother; I can only imagine how tough it would be to cope with that diagnosis in a sibling who is so young.

Great to have you join us...looking forward to hearing more about your progress; sounds like you've made so many changes already. I esp liked your comment relating to stress mgmt "accepting what is and letting go". I'm also working on that...!

[Ruth]

Welcome, Slacker! So sorry to hear about your brother.

[slacker]

Thanks to all for empathy and kind greetings! Julie, I feel no better on my daily supplements which include:
DHA 580/EPA 860 (will get higher DHA next time)
MultiVitamin with methyl forms of B12 and folate (plan to increase from "half" dose due to lab results as below)
NAC 600 mg
Alpha Lipoic Acid 300 mg
Unknown amount of Ashwaghanda and Bacopa in "proprietary blend"
Vit D 2000 IU

I am adding on Turmeric when it arrives in the mail. (Still enjoy getting things by snail mail!)

My preliminary fasting labs arrived today! Hitting the highlights (good, bad, and ugly):
Insulin 2.4 (yowzer!)
A1C 5.5% (need to cut back on my best friends grains and legumes)
LDL 145
LDL-P 1597 (yup, it's those carbs)
HDL 72 (thank you exercise)
Trigs 125 (carbs again)
Vit D 42 (will up my supplement a bit)
Homocysteine 8.5 (will up my B's in MVI)
RBC Mag 5.2 (sort of borderline but will get more in increased MVI dosing)
AM Cortisol 22.7 (Dr Bredesen suggests between 7-18; and this was drawn 2 days after 10 day meditation retreat! Probably higher now)
Pregnenolone 26 (my notes indicate that Dr B suggested over 50-80; not sure if that is right)
DHEA 39 (no lab "normal range" and my notes are silent on recommended level)
everything else looked pretty good from what I can tell
***I did not get estradiol or progesterone since I am menopausal and not on any replacement)

I can't wait to get the bill! I have no professional experience treating hormones other than thyroid, so planning to blow more $$ visiting a Functional Medicine MD in Georgia who is currently working with the Bredesen protocol and seems to know what she's doing with bioidentical hormone replacement. Hope to get in by end of the year. And looking forward to getting the long promised and awaited software tool from MCI Cognition that helps with analysis of lab results.

[Julie G]

Your labs look decent, Slacker. You have a good handle on what you need to work on. Until you get your MPI software, here’s a good guide for optimizing hormones from Sara Gottfried- someone Dr. Bredesen respects.

I'm really glad that you're considering bHRT. As you know from the training, that's an important intervention for post-menopausal women who are showing symptoms. (Do you see my hand waving?) Out of curiosity, did you have a rough transition through menopause, hot flushes, etc? I did and felt much better (day/night) once I started bHRT. I wish you had someone close by whom you could see. Many mainstream gyns (especially those specializing in post-reproductive patients) regularly prescribe and optimize these levels.

Did you order turmeric or curcumin? Many of us use the latter, a bio-available form. There's some evidence that getting a blend with piperine also boosts efficacy. That one made a huge difference for me. You may want to consider Acetyl-l-Carnitine (500mg.) I take that in the AM with 200 mg of alpha lipoid acid, then another 200 mg of alpha lipoid acid at night. I also divide my NAC in divided doses- 400 mg AM & PM.

You are most definitely NOT a slacker. I''m proud of you for quantifying your numbers and beginning to work on things. You will be an amazing MPI practitioner following the protocol yourself! You'll recall me encouraging ALL of the physicians at the last training to do the same.

[KatieS]

Welcome Slacker. Many of us have been involved with engineering and/or healthcare, but you have gone beyond with your Dr. Weil fellowship. We are so pleased to have you join us.

Sad to hear about your brother. My only 3/4 brother might be progressing from our view, but he is not willing to alter his lifestyle.

Like you, extending the overnight fast was a challenge, but now I know why they call it "Keto-clarity" and why my 98 y/o mom loves to fast.
It seems to mimic the feeling after competitive races when I was younger. Although I still exercise daily, it's just not at that extreme intensity. so fasting during this exercise replicates it.