Thank you all

[Mr. Greenjeans]

While I'm not new to the forum, this is my introductory post. I have been researching Late Onset Alzhiemers Disease for a few years and everything I've found in this forum is reasonable, open minded and understandable. THANK YOU ALL who make this site happen.

I'm a 70yr old, 4/4 married to a 3/4. It was for my wife I sought out Dr. B's books and protocol. She was getting lost in the neighborhood, not contributing to conversations in public much and baffled by anything different or new, especially computer and phone apps. We have been working on this by ourselves for the last 4 years and I can report a remarkable turnaround. She's not gotten lost in years, is a vital part of any conversation and is less bewildered by the vagarities of computers.

While I haven't experienced her cognitive issues, I know the numbers re. 4/4 and want to forestall as long as possible the onset of LOAD. In the meantime there is a conundrum, Dr. Bredesen's Ketoflex diet is great but it does result in my losing weight. One of my concerns is sarcopenia. How does one fight the onset of age related muscle loss and still only eat one or two meals a day?

I have many other questions, but this one seems to be the most pressing. Going into your golden years frail and halting is not a recipe for success.

TYM (Thank You Much)
Mr. Greenjeans (Gill)

[NF52]

While I'm not new to the forum, this is my introductory post. I have been researching Late Onset Alzhiemers Disease for a few years and everything I've found in this forum is reasonable, open minded and understandable. THANK YOU ALL who make this site happen.
...
While I haven't experienced her cognitive issues, I know the numbers re. 4/4 and want to forestall as long as possible the onset of LOAD. In the meantime there is a conundrum, Dr. Bredesen's Ketoflex diet is great but it does result in my losing weight. One of my concerns is sarcopenia. How does one fight the onset of age related muscle loss and still only eat one or two meals a day?

I have many other questions, but this one seems to be the most pressing. Going into your golden years frail and halting is not a recipe for success.

TYM (Thank You Much)
Mr. Greenjeans (Gill)

A warm welcome from an almost 69-year old 4/4 married to a 3/3 (who puts up with a lot of Alzheimer's-focused conversation!)

I am so happy to read of your wife's improvement using the strategies recommended by Dr. Bredesen. As you have found and as researchers recognize more and more, Alzheimer's is a multi-factorial disease with diverse causes and presentations. The good news is that "it" may be more of a "they" as in a spectrum of disease or diseases. The causes may be far different, even when the effects on memory, spatial orientation and new learning appear similar. Researchers in multiple countries now believe as many as 30% of cases of AD may be prevented or delayed significantly by lifestyle and targeted interventions. Or, as Dr. Bredesen terms it "fixing the holes in the roof".

You mention "knowing the numbers re 4/4". I too know the numbers, although they range from "a 30-55% chance by the age of 85" according to an international population-based study from 2017, to the "12x the risk" I first saw in 2012.

Having met researchers and clinical staff as a clinical trial participant and as a consumer reviewer of grants, I hear often that "we know 4/4 raises the risk; but we also about 30-40% of people with ApoE 4/4 never develop MCI or AD, even if they have amyloid beta plaques and we don't fully understand why." Some studies suggest that men with ApoE 4/4 may be less likely to be diagnosed, possibly because they don't have the drastic drop in estrogen that women experience. We have a wonderful man on this forum who is 78 and has been tested by Stanford for 3 years in a row as part of a trial of healthy ApoE4 carriers. After the third year, they told him he showed no sign of any downward trajectory!

I will let others suggest answers regarding the ketoflex diet and weight loss, offering only that some evidence I've seen suggests that 4/4s may need more protein and may need to be sure to "feed their brains" with either glucose or ketones after 65.

In case you haven't already found these resources, here are some suggestions:

The Primer is written by Stavia, a practicing M.D. with ApoE4/4.

The How-To Guide shows how to quote members (use the " icon in the upper right of any post) so they get an email notification of your post. It also shows how to use the Search function for topics, and how to subscribe to topics of interest.

Here are just a few of the links within our new Wiki on ApoE4 Research: Why and How You Can Accelerate Alzheimer's Research for ApoE4 Carriers

4 drugs which may get approval in 3-5 years

Recent Advances in Lifestyle Prevention of AD/RD from Clinical Trials with a 2018 article on strategies for LOAD prevention in ApoE 4 carriers from Dr. Richard Isaacson, the Director of the Alzheimer's Prevention Program at Cornell Weill Medical Center in NYC: Clinical Application of APOE in Alzheimer’s Prevention: A Precision Medicine Approach Here's his top recommendation from the article:
Physical activity

A systematic review of 16 prospective studies concluded that physical activity decreased the risk of developing AD by 45%
Physically active ε4 carriers had an OR [odds ratio risk of Alzheimer's] of 2.30 and sedentary ε4 carriers had an OR of 5.53
Aerobic activity was associated with greater cognitive performance for ε4 carriers compared to non-carriers).
Sedentary individuals who were ε4 carriers had significantly higher levels of brain Aβ and lower levels of CSF Aβ42 compared to sedentary non-carriers, findings associated with AD pathology
...The findings also suggest that physical activity may prevent Aβ accumulation that occurs in the brains of ε4 carriers before clinical symptoms of AD even become apparent

I'm sure I speak for many of us with ApoE 4/4 when I say that I look forward to your continued posts on the forum!

[Tincup]

How does one fight the onset of age related muscle loss and still only eat one or two meals a day?
(Gill)

Hi Gill,

I'm a 65 year old Dr. Gundry patient and his protein recommendations are on the very "thin" side. I've chatted with him about this and he says that when he gets elderly patients off of eating lectins, their serum protein goes up. That being said, fasting researcher, Valter Longo, quotes a study suggesting that 30 g are needed at a sitting to stimulate protein synthesis. I don't have the reference off hand, but could find them, if requested. My interpretation is the bolus is needed, not just more serum protein on a continuing basis.

Personally, make sure I have one or two 30 g boluses of quality (i.e. non veg) protein on a daily basis (a bolus greater than 30g provides no additional benefit). I do fast 16 or more hours most days and sometimes do extended fasts (3/5/7 days). At this time, I weigh what I did in Grade 10, but am leaner than I was then. I do a lot of strength training. I limit extended cardio to a Zone 2/MAF level, see here. as I think that, other than short duration HIIT training, extended training above the Z2/MAF level is catabolic and inflammatory. I'm still at the low end of protein intake, but certainly above what Gundry suggests.

[JD2020]

Hello Mr. Greenjeans,

I have no solution to the issue. I am posting just to let you know that you are not the only one with this concern. After a year trying to make the food plan work, I concluded that I could not do this part of the plan until I get older and my metabolism slows down. I am 58. I went from trying Ketoflex to intermittent fasting but more carbs allowed (per my doc) to a couple of days per week of calorie restriction (not part of the program, but mentioned in an article by lef.org as a way of eating that would accomplish some of the same goals).

With the first, the weight melts off me. I don't think a fat or protein calorie sticks the way a carb calorie sticks.
The second would require me to eat for 7 of the 8 hours.
The third is the fastest way to high ACEs and to a BMI below 18.5.

I started thinking about doing shots of olive oil periodically throughout the day, and then I realized that I was getting way to weird about food.

I also do not want to lose muscle.

So, again....you are not alone. Good luck.

[kayakmac08]

While I haven't experienced her cognitive issues, I know the numbers re. 4/4 and want to forestall as long as possible the onset of LOAD. In the meantime there is a conundrum, Dr. Bredesen's Ketoflex diet is great but it does result in my losing weight. One of my concerns is sarcopenia. How does one fight the onset of age related muscle loss and still only eat one or two meals a day?

I have many other questions, but this one seems to be the most pressing. Going into your golden years frail and halting is not a recipe for success.

TYM (Thank You Much)
Mr. Greenjeans (Gill)

Hi Mr. Greenjeans,

Nice to meet you. Although I'm young and new to the forestalling game, I share your general concern, and have had one eye on the same horizon.

Like the previous poster mentioned, olive oil is a great way to help cram some extra calories into your eating window. I'm not above the occasional shot. Generally trying to increase your intake of calorie-dense, fatty foods--like nuts, nut butters, SMASH fish, avocadoes, etc.--is important, as long as your cholesterol levels keep in check.

At 70, I'd also be keeping an eye on your testosterone--total, free, bioavailable, DHT, etc. I'd really try to get those into the optimal ranges, which is probably well above the averages for your age.

And of course, being diligent with strength training (especially compound barbell lifts) is important for building or even merely maintaining muscle mass and strength.

Those are just general recommendations from a younger guy who's concerned about losing muscle mass in the name of AD prevention, since it looks like aggressive dietary restrictions aren't something we can negotiate on. My apologies, though, if I've just repeated a bunch of things you've already accounted for!

[Mr. Greenjeans]

Than you all, for the warm welcome, and optimism
NF52
Liked "but we also about 30-40% of people with ApoE 4/4 never develop MCI,,,"

There is so much information available on the site, it's a bit like getting a drink of water from a fire hose. But I'm appreciative of the support.