New Test Results: CAC Score and LDL-P

[Russ]

All,

Sorry for my absence so much lately due to plenty of other fun things going on, but time for an important update…

Although I have not been has active since the move from 23andMe to this forum, many will recall that I have been operating under the hypothesis that fat (including saturated) was good, and even the best the 'cholesterol' markers (i.e. LDL-P) might not only be fine but good for APOE4's as long as inflammation was low. Operating under the hypothesis, I continue to feel great and seemingly quite healthy, but decided I had been doing it long enough that it was time to get some real data. After delaying a long time due to concerns about radiation, a few weeks ago, I went in for a heart scan for calcium.

The result was NOT good news. My total calcium score was 811, which puts me in a very high risk category. Whereas since I have no prior baseline, and it's theoretically possible that this score is a decline, that doesn't feel like a good assumption. My most recent LDL-P (Jan 2014) was 2554 (note - after 3 months on resistant starch) - an increase from an already high 1939 in August 2012 (pretty much when I started). My hsCRP has been consistently .4-.7 (low), and I had LP-PLA2 tested for the first time at 114 (low) in April 2014. I have plenty of other details on various tests, but that probably suffices for now unless people have specific questions.

Time for me to rethink some fundamentals wherein I conclude that Spunky is likely right, and I have been likely wrong - LDL-P does matter even if inflammation is low.

The one additional test that might be worth noting is that I did an Omega-Quant "Omega 3 Index" test in April 2014 (when they had a sale), and got a score of 5.6% - which put me smack dab in the middle of 'intermediate.' This was lower than I had hoped (over 8% is best), but may be reflective that I have given in quite a bit to my prior total avoidance of foods that have used vegetable oil when eating out - chips and salsa being my primary kryptonite.

My diet otherwise has been pretty consistent, and when I tracked in detail in April for American Gut (still no results), I was eating 51% Fat, 27% carb and 22% protein that I would largely describe as simply eating organic whole real foods fresh and in season.

Open to thoughts, but seems to me that I have had an important misunderstanding of the specific effects of APOE4 on fats. It's not that we're deficient, we're just different. APOE4's are often actually better at taking up fat from foods (what Spunky calls hyper absorbers) which is a good thing when fat is scarce. This gets us not only the fats, but fat soluble vitamins. It thus makes sense that we should moderate, not increase, fat.

What to do now is complicated. I've been going to a paleo-friendly doc (that ordered the test), but he's 3 hrs from my home, so harder to regularly interact with. From my prior experience, finding another doc in town to work with who can think via science is likely difficult - very likely to want to put me on a statin and/or pursue surgical options. Still seems like worth getting further testing (e.g. stress testing), so will look into that ASAP. My doc suggested possible EDTA chelation via suppository, but this seems to have its own dangers, and not something I will rush in to. Note that he also did recently put me on a very small thyroid does of 5 mg/d due to slightly low thyroid in last blood work, and I remember that our old friend Krikor at 23andMe was big on that, so maybe that's a clue, too?

Meanwhile, diet/lifestyle change seem warranted. eating organic whole real fresh foods in season still seems right, but probably need to knock the fat way down as Spunky and James have advocated. Although replacing with low GI carbs might make sense, feels like I ought to give some thought to Bri's Caloric Restriction as well (i.e. not replace with anything)? I have taken to fasting 2 mornings per week lately and I feel really great when doing so. But I may also do some swaps - out with the pastured eggs and in with steel cut oats and berries when I do eat breakfast.

Supplement wise, I have been taking a D3/K2 blend, which I've worried about a bit of throwing off A/D balance since hearing the Chris Masterjohn talk this spring (reported in another thread). Chris made it clear that too much D compared to A could lead to soft tissue calcification. I've now switched to the LEF Super K Complex with much higher doses of both Mk-4 & 7 K2 plus K1 (which I am still uncertain about), and gone back to fish oil for a balanced A/D. Hoping that this recipe might actually reduce arterial calcium. Of course, have also added back in a daily baby aspirin which I gave up a long time ago.

I welcome other thoughts, but for today, mostly wanted to let y'all know that I think current evidence indicates my prior thoughts have been wrong, so you can factor into your own observations and plans.

[Julie G]

(((Russ))) I'm rushing out the door, but couldn't leave without giving you a cyber hug. Sorry for your news, my friend. I'm really proud of you for doing the CAC and quantifying your current risk. Kudos on you for finding a good doc; that's half the battle. And, much gratitude for sharing with us all. Results from n=1 experiments are an important learning tool for our population.

I look forward to commenting on your hypothesis later today.

[Ski]

Russ -
I can share my experience but Im not sure if Im a good barometer.

I just had my worst NMR which I knew was not going to be bad based on my bad regular lipid result of higher LDL-C and lower HDL I went from my best NMR to my worst in a 3 month time frame.
Im discordant when it comes to LDL-C and LDL-P with the latter always being quite a bit higher (300 points or so).
When I was eating Paleo, even though I had a high LDL-C which ranged from 140-210, my LDL-P was around 1800-1950. I assume the mono fats helped keep the LDL-P down. I assumed this because my latest NMR, where my diet consisted of less mon fats, slightly more saturated fat and more carbs, my LDL-C soared from 100 (on medication) to 177 being off meds and my LDL-P was 2700 and small-LDL 1650!! This was waaaayyyy higher than any of my other tests and everything went in the wrong direction.

So for ONLY 11 days, I cut out all sat fat, except for lean animal protein, increased olive oil and avocado consumption slightly and added nuts into my diet. I also went lower carb with more starchy carb.I also went back to a small glass of wine every night with a meal. I also added psyllium husks with my meals for better clearance. I took another simple lipid test after the 11 days and my LDL-C had dropped from essentially 180-->130. My HDL went from 37-->52. Im assuming my NMR numbers improved, never tested.

Ive now stumped 3 doctors including my cardiologist with how I can influence my numbers in such a SHORT space of time that takes most people months. Whilst I dont like that my body does that, it is what it is. The look on their faces when they are comparing results is priceless though.

So in my case it appears as though cutting out all sat fat, increasing mono fats and cutting carbs is probably MY answer for me. Oh and wine That diet kinda goes in line with what Spunky posted where moderate fats(mono) and low carb is best for E4's. Although a lot of E4's are fine on higher carb too.

Im going back on meds/vitamins to further try and reduce LDL-C as that is the only thing that also really improves my other markers it appears or will bring down my LDL-P to a safer range.

[Welcomeaboard]

I don't think that you can get your Vitamin D to A out of whack by taking 2000 to 4000 units of D3 with K2 a day as Vitamin A is the largest Vitamin in the body, unless you are already at a high level of Vitamin D3 in the body and that takes testing of the 25hydroxy Vitamin D3. Or if you have some type of Vitamin A deficiency issue and are low or drastically low on A and that would take testing.

I think that I would try Russ's idea as you may have from what I have seen the ability to hyper absorb fat and can obtain the proper levels with a minimum of fat due to your specific genetics.

Just a non medical opinion.

[Russ]

Ski, Sounds like my experience is lining up with yours, and thus my next steps. I also know I can manipulate my numbers with diet as I drove my TC way down in the past when doing Pritikin. Couple questions…

1. Why add the wine back? I was thinking of cutting that out on the simple logic of reducing liver load.
2. Anything special to look for in psyllium husk?

Also, for others…

1. Anyone have anything to add re Amla? Seems like that's been getting lots of interest lately.
2. What's the latest on using EVOO for cooking. I have avoided due to oxidation concerns, but maybe that would be good to go to?

WA, Thanks, also. My D3/K2 was 5000/80 mix. Doubt it was the problem, but dosing doesn't seem to have helped drive up D in blood - been pretty flat over time, so not a big regret to drop. I do like superdosing the K2 as from what I think we know about K2 right now, there is no known toxicity, and more should help clear calcium (if enough A and D are present).

Julie, Look forward to hearing your further thoughts which you know I respect deeply.

[Welcomeaboard]

The blood level is 8 to 10.5 that is acceptable if I recall correctly and vitamin d 3 25 hydroxyl is 20 to 100. Think of the 25 hydroxy as what is available to put in the blood if you are deficient in blood, but you are scavenging it from the bone to do that. Eventually you will deplete your bone supply and then the blood supply is my understanding. There are genetics that can create low vitamin d3 as well. You can have ok blood numbers and be creating issues that are not detected unless you check the 25 hydroxy vitamin d 3 levels.

[Welcomeaboard]

You can also take more than 2000 to 4000 units of vitamin d3 and be fine. I was not meaning those numbers to be absolutes, some people need more, some less. It is the testing that determines. I was indicating that most may be fine at 2000 to 4000, but there could be exceptions to that and only testing can determine the answer.

[James]

Eating organic whole real fresh foods in season still seems right, but probably need to knock the fat way down as Spunky and James have advocated. Although replacing with low GI carbs might make sense, feels like I ought to give some thought to Bri's Caloric Restriction as well (i.e. not replace with anything)?

Thanks for posting your results!

To be fair, I've always advocated severely reducing or eliminating cholesterol as the first step for those with ApoE4 to improve their serum lipids. In order of importance: dietary cholesterol > saturated fat > total fat. The science and my own results (as well as others) seem to support this. Reducing sugar and processed carbs is always a good idea.

My own posted results have been very good on a whole-foods vegan diet with both higher and lower fat intake. I actually just had another LipoProfile done and am having another one done Monday, with a few dietary changes that should shed further light on this theory (at least for me, though I'd imagine I can somewhat generalize here).

Calorie restriction is beneficial for serum lipids (and just about everything else) because it leads to body weight and fat reduction, but largely because it uniquely alters metabolic pathways through consistently reduced cellular nutrient and energy availability. Weight and fat loss with mild restriction, or just maintaining a healthy body weight and composition, both separate from true CRON, provides the bulk of the health benefits and is a good idea for everyone. Pushing it further into true CRON is much harder and provides the remaining, smaller proportion of the health benefits.

Russ -
I took another simple lipid test after the 11 days and my LDL-C had dropped from essentially 180-->130. My HDL went from 37-->52. Im assuming my NMR numbers improved, never tested.

Ive now stumped 3 doctors including my cardiologist with how I can influence my numbers in such a SHORT space of time that takes most people months. Whilst I dont like that my body does that, it is what it is.

There is a dietary effect and a weight-change effect on serum lipids. It seems to take 7-10 days to realize the large majority of changes resulting from strict dietary changes, with pretty much complete adaptation by 3-4 weeks. Most patients don't see significant changes earlier than a few months because they rarely make significant dietary changes, and any resulting weight change is often slow and takes many months to become significant.

[Julie G]

Russ, it's a mutual admiration I have to admit your news hurts me. Both, because I care about you & because I wanted to believe you were impervious. I certainly don't have answers. I'm searching for the best diet for E4 carriers along with everyone else here to avoid both AD and CVD.

For me (and most of us,) it comes down to personal experience; how our bodies/bio-markers react to a given diet. And, regarding genetics, much more than our APOE status is clearly at play. I'm also eating a high fat diet, but lower carbs than you & I have NOT experienced a dramatic LDL-P rise My two tests have put me at 1118 and 1089. I agree with you that Spunky is right about E4's reacting to higher dietary fat with LDL increases. The science is pretty decisive there (with G/"Bri" being our exception), but that doesn't necessarily translate to higher LDL-P.

I've conducted multiple n=1 experiments, followed others, and have read much research and I've concluded that the ratio of fats to carbs matters...(maybe a lot) AND the type of fat matters as well. I'll throw a few ideas out there that you can explore or toss as you see fit

-A while back I theorized that it might be important when practicing HFLC to shoot for at least mild keto-adaptation, so that the fats are being used as fuel. Otherwise, with E4's poor ability to clear, they remain in circulation too long and are more likely to become oxidized- that's where real trouble occurs Maybe your ratio of fats to carbs was a part of the problem? The fats too low/carbs too high?

-I think you are on to something with the CR...and I would add daily exercise. IMO, eating higher fat without both is NOT a good idea. Both create more ketone bodies (burning & clearing fat) and increase BDNF production. I agree with your theory that E4s "hyperabsorb" more fat to possibly protect us in times of famine. By staying mildly keto-adapted through CR & exercise, we regularly CREATE that famine. By living a sedentary Westernized lifestyle without ever experiencing hunger; we work against our ancestral genotype.

-E4 carriers exhibit glucose uptake problems decades before symptoms show, in a dose dependent fashion- (4/4s are more severely affected.) Ketone bodies can replace some of that cerebral glucose deficiency avoiding the neuronal death that occurs with lack of fuel. For me, an other justification for HFLC.

-I suspect that type of fat we eat matters. Evidence is mounting, both with research and with my own n=1 experiment, that MUFAs might yield the best results for both brain & heart health- even more so for E4s. I still eat more SFA than Spunky would approve of, but I carefully and purposefully choose the MOST healthful options: pastured eggs (for the phosphatidylcholine) and grass-fed, live cultured kefir/yogurt for the healthful gut bacteria. Like Skibike, I was able to drop both my LDL and LDL-P by 40 and 28 points respectively by switching to more MUFAs.

You know I'm not a scientist, just a 4/4, trying to extend my useful life. Please feel free to knock my theories around I'm truly wide open to learning & figuring out the best path forward, fully knowing that it may not be the same for all of us. Huge thanks to you, Russ, for sharing your results. They reiterate to me the importance of testing often when experimenting with diet. One quick question: Did you do a CIMT before jumping straight to the CAC?

Skibike, I've followed your struggle with agony, my friend. Kudos on improving your numbers with more MUFA. I really think you're onto something there. I'm not that surprised by your rapid improvement. Research demonstrates that E4s (of all APOE genotypes) respond the MOST quickly to dietary changes. Time will tell if this is a significant and lasting effect- fingers crossed. Thanks also to James for making me aware that plant fats vs. animal fats may be an important distinction for us.

[Ski]

1. Why add the wine back? I was thinking of cutting that out on the simple logic of reducing liver load.
2. Anything special to look for in psyllium husk?

Wine? Simply out of curiosity. I always had my best HDL numbers whilst drinking a glass of red wine almost every night. For E4's this is supposed drop HDL and increase LDL...well this doesnt appear to be the case for me....or the other changes trump any effects of the alcohol. So for now, the wine stays! Neuro health.....I cant comment. But, could be a good point on the liver load.

Psyllium husk? No, I just bought plain version, which is essentially Metamucil without the sugar.

In essence my diet change was not huge. Its not like I went from huge amounts of sat fat to none as I really was not consuming much. One thing I forgot to add was that I had been eating more yogurt and kefir which I cut out. I had been eating more beans which I also stopped (even though this is supposed to be good).
So I believe the additional carbs was driving up my LDL-P and small-LDL.

But James is also correct, I was pretty strict about the diet in those 11 days.