The lipid/glycaemic seesaw (teeter totter)

[Jafa]

I've just got my apolipoprotein B result back from the lab, 5 weeks after supplying the blood (do not get me started on the delay...) and am not in a happy space.

Juliegee was "talking" with Mac before Xmas and drew the analogy of a teeter totter to explain the impact of interventions on markers of lipids, on one side and on markers of glycaemic control on the other. What was good for lipids could be adverse for glycaemic control, and vice versa.

I'd like to post my numbers and ask for some feedback please. My first set of numbers is from November 2016, when I was following our Heart Foundation healthy diet based heavily on the food pyramid of late last century. The second set of numbers are from late January 2017, after 2 months on a moderate apoE-4 diet (30% calories as carbs, about 80-100g/day), and 50% fat. I do check the cronometer from time to time and these macronutrient numbers have altered a little, generally 80g carbs and fat is up to 55% as I've been upping the nuts and avocados to avoid further weight loss.

Body weight 58kg (128lb) 53kg (117lb)
LDL-c. 3.6 (139). 4.2 (162)
HDL-c. 2.02(78). 1.70 (66)
TG. 0.7 (62) 0.7 (62)
HbA1c. 34 (5.3%). 31 (5.0%)
Fasting insulin 8.4. 5.3

TG/HDL 0.79 (US units). 0.94
Apo-B. 0.97 1.07
The apo-B conversion to LDL-p is a bit fraught as the scatter graphs have a high degree of variance, but approximate figures are an increase from around 1500 to around 1700

At least I know the (easily and quickly available) changes in LDL(C) and TG/HDL ratios are concordant with the changes in apo-B, but my teeter totter has certainly moved. I have better glycaemic control (I can generate ketones of up to 1.3 after fasting AND exercise) but at the cost of higher LDL and lower HDL. So, can I ride this teeter totter to a new sweet spot or do I dismantle and rebuild?

[Julie G]

Congrats on the weight loss and enormous improvement in glycemic markers, Jafa! Well done. Your fasting insulin is still a bit high, but sticking with the protocol should bring that down. Your elevation in LDL-C, ApoB and LDL-P is disconcerting and beautifully demonstrates the teeter totter effect I was describing. Your drop in HDL is not consistent with that picture. Most members experience an increase in LDL-C, HDL-C, and a decrease in TGs. Your presentation is a bit unique and may be reflective of the fact that you're losing/have lost weight. That can temporarily negatively affect lipids. You may want to wait until you've been weight stable for a while and repeat your standard lipids to ensure that your ratios (TG/HDL) are moving in the right direction.

A few other strategies that may be helpful:
-For hyperabsorbers, identifying and addressing underlying infections (like H.pylori,) gut issues, and optimizing thyroid can also help.
-Consider minimizing SFA to 10% or less of total calories
-If you're using coconut oil or MCT, consider the capryllic acid (C8) version.
-Ensuring a high fiber intake (10+ cups of vegetables) will help to absorb dietary fat in the gut.
-Consider SunFiber (guar gum) as an additional source of fiber to both absorb dietary fat and feed beneficial gut bacteria.

[Tincup]

Jafa,

I'm much happier with your improved A1C & insulin. If you are going to look at Apo B, did you also get Apo A1? The Apo B/A1 ratio is a much better predictor as Ivor shows



{edit} the way to read this graph is to compute your Apo B/Apo A-1 ratio. Along the x axis, the numbers 1-10 mean deciles of the population in the study. Below it says "mean." So decile #1 has a mean ratio of 0.48, #2 0.61 & so on. If you have a ratio of 0.6, you'd be in decile #2 and have an odds ratio of about 1.1. If your ratio was 1.56, you'd be in decile #10 and have an odds ratio of ~4.5. In other words you have 4.5 times the risk of a fatal heart attack as compared to someone in decile #1.

[TheresaB]

I think what GeorgeN wrote is relevant. My Apo B measurement is “red” but my doctor didn’t even glance at that, he emphasized the Apo A to Apo B ratio and said if the ratio is under 6, that’s a wonderful thing. My ratio is under 6, so I am unconcerned.

Edit addition: OOPs, the ratio is Apo B to ApoA 1 not A to B. And the ratio should be under .6 (not 6) Apologize for any confusion.

[Jafa]

Thank you Julie for your reply and helpful suggestions. It seems you were right on the money about the negative effects of weight loss on lipids. I was having a blood test this morning for homocysteine and ferritin so thought I might as well add LDL and HDL. Very happy to report the LDL back to the usual 3.6 (139) and HDL up to 1.89 (73). So definitely tracking in the right direction. Also ferritin down from 189 to 113 after first venesection. So 'Happy dance" Haven't got the homocysteine result yet.

Thank you GeorgeN and TheresaB for sharing info about the ApoA1 and ApoB ratio. We can get ApoA1 done here so shall probably get that one next time. It will help me to make sense of what can seem at times to be a confusing set of data.

[Hepoberman]

What is this APOE-4 diet you speak of? To my knowledge, every major health group across the globe suggests less than 30% fat for 3/3 and even less for APOE 4's. You added fat and your cholesterol went up. Your TC is around 250? This elevated cholesterol level will increase the rate at which you grow plaque. Get a certified lipidologist to help you ASAP, your life depends on it.

[Julie G]

Terrific news, Jafa. It can be alarming to see how weight loss temporarily alters lipids. I'm thrilled to see the progress you've made on your glycemic markers. Undoubtably, that will reduce your risk for both AD & CVD. It's worth noting that (with tweaking) many here have achieved a beautiful balance on the glycemic and lipid teeter-totter. It can be done.

My guess is that the ApoE4 diet Jafa is referring to is one that allows her to achieve mild ketosis. Those of us experiencing symptoms of cognitive decline (and even those who aren’t) are experiencing sharper cognition when supplementing glucose with KBs as fuel. As we make clear on our welcome page, quoted below, we are challenging long held beliefs with our N=1 experimentation. Even Dr. Thomas Dayspring has urged us to be very carful about believing the conclusions reached by mainstream science for our genotype as they’re based upon poorly conducted studies with very small E4+ datasets. As always, we appreciate your reminder of traditional nutritional advice especially as it relates to CVD... which is also being challenged by mainstream physicians based upon current evidence. That being said, I believe some of our members are flourishing on a carefully applied LFHC diet. I think everyone here acknowledges the success of the non-E4 specific Ornish/Esselstyn approach as well as that of Dr. Gundry's E4 targeted approach using radically different dietary strategies. We encourage everyone to carefully track and tweak multiple biomarkers, in combination with CIMT & EBT, to minimize CVD risk.

Ask questions. If you’ve already looked for answers, you probably know there are no quick and easy solutions. The reality is that definitive one-size-fits-all advice for APOE-ε4 carriers doesn’t exist. Be skeptical of anyone who claims to have such information. As carriers of the gene ourselves, we fully acknowledge the many unknowns. We believe working on the cutting edge with the scientific community and sharing our own experiences and ideas with one another is our best path forward in our shared quest for answers.

[TheresaB]

What is this APOE-4 diet you speak of? To my knowledge, every major health group across the globe suggests less than 30% fat ...

What are these major health groups you speak of? Are they the ones mentioned in the New York Times September 12, 2016 article “How the Sugar Industry Shifted the Blame to Fat”? https://www.nytimes.com/2016/09/13/well ... .html?_r=0

For years I thought eating fat meant higher cholesterol. In the past I have personally advised folks to watch their fat! I’m now embarrassed that I’ve given folks that advice.

Now imagine you’re a big organization who’s been giving that advice for decades, kinda hard to shift gears, huh?

According to the Nutrition Coalition http://www.nutrition-coalition.org/ a nonprofit advocacy organization, “The Dietary Guidelines” have been shown in many instances not to be based on the best and most current science, and consequently their efficacy In helping people to stay healthy and fight disease has been severely limited. They go on to cite 11 based facts for change, including this one,

At least 14 meta-analyseshttp://www.nutrition-coalition.org/satu ... t-disease/ and systematic reviews of the scientific literature now conclude that saturated fats are not associated with heart disease and/or have no effect on cardiovascular mortality. Saturated fats are part of many natural, unprocessed foods, such as meat and dairy, that contain needed nutrients.

Fellow forum member Daveketo gave a fascinating presentation this past weekend which showed that in a short window of just three days, the ingested fat and resulting cholesterol had an inverse relationship with each other, i.e. the more dietary fat the less serum cholesterol. I’ve attached a screen shot of one person's example from the livestream, ultimately the entire presentation will be edited and available on YouTube.

fm dave keto presentation.png

We, as ApoE4s need to recognize where these big organizations are coming from. That’s why this forum is so good, it challenges and sniff checks everything. Just yesterday, (March 7, 2017) CNN had a piece on how Alzheimer’s could bankrupt Medicare http://www.cnn.com/2017/03/07/health/al ... index.html Ruth Drew, director of family and information services for the Alzheimer’s Association was quoted as saying, "What is driving these numbers is that there is no disease modifying treatment, no prevention and no cure,” (my emphasis) SHAME! The good news is that in the face of such things, we are the knights who say Nee!

My apologies for getting off the subject of this post and onto a soapbox, but we must continue to challenge the health groups that are entrenched by decades of inertia and influenced by special interest groups, a healthful life depends on it.

[Stavia]

So...Jafa's lipid profile hasnt changed at all from her low fat high carb to her lower carb high fat diet. I believe that the reading last week was on outlier, likely reflecting a longer fast with fat stores mobilisation as she has been losing weight. (My LDL doesnt budge either whether I eat low fat or high fat). Hep, total cholesterol is very misleading, Jafa's HDL is an enviable 2 mmol/l. Her TC/HDL ratio is excellent.
Her HbA1c is brilliant.

Sorry but I don't see the panic "life depends on it" whatsoever. Her lipids are unchanged, her Hba1c improved. And there are no certified lipidologists in our country....its purely a USA thing.

[TheresaB]

[quote="Stavia"Sorry but I don't see the panic "life depends on it" whatsoever. Her lipids are unchanged, her Hba1c improved. And there are no certified lipidologists in our country....its purely a USA thing.[/quote]

I was in a hurry and didn't construct my argument well. I wasn't trying to say her life depends on it, I was trying to say OUR lives depend on challenging the status quo because organizations such as the Alzheimer's Association are basically telling folks nothing can be done, and while we know there!s no cure, through this board where we introduce certain studies and share n=1 experiences we're discovering things these organizations won't tell us about.