Keto with apoe3/4 worsening memory?

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bkkmt7
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Keto with apoe3/4 worsening memory?

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Are there any cases of people who are Apoe3/4 using keto to successfully reverse or halt early memory loss? Alternately, has the opposite happened? My dad's memory has gotten worse after starting Keto on May 24th (2021). Also, any advice in this situation?

My dad (apoe3/4) is 73 and started to have noticeable memory problems about two years ago and began to work with a functional medicine practitioner to do a lot of testing. He began following Bredesen's protocol around that time. Last summer he tried starting Keto for the purpose of improving memory. At the time we were just tracking carbs, not taking readings. The reduction in carbs seemed to coincide with worsening memory, and so we stopped trying ketosis and focused more on continuing to correct some nutritional deficiencies (as shown by testing). He also continued a 16 hour fast daily.
This past spring he decided to try Ketosis to combat memory loss again and to focus on getting a ketone reading over 1, as we have read that can make a difference. He started using the mojo ketone meter and has had a ketone reading of over 1 with three exceptions of a reading of .8 since June 4th.

Another concern is that he is eating so few carbs, we don't see how he can be getting enough nutrition. We were hoping that after reaching ketosis, it would be possible to occasionally add more carbs and stay in ketosis. So far, just a few extra carbs, even keeping ratios (carbs under 5%, protein at 10-12% and fat in the mid 80s) the same causes a lowering of blood ketone levels. And, as stated previously, his memory is getting worse.

Any thoughts or relevant experiences shared would be appreciated.
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Re: Keto with apoe3/4 worsening memory?

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bkkmt7 wrote:Are there any cases of people who are Apoe3/4 using keto to successfully reverse or halt early memory loss? Alternately, has the opposite happened? My dad's memory has gotten worse after starting Keto on May 24th (2021). Also, any advice in this situation?
Welcome bkkmt7,

For what it is worth, I'm 3/4 and have been keto adapted since 2009. I don't try to run any specific level. Day to day BHB is generally in the 0.5 to 0.8 mmol/L. I can maintain this with 100-200g carbs/day, so everyone's metabolic situation is different. I'm 66 and my 4/4 wife is 61 and she does likewise. We've both run our levels up to 8.0 mmol/L on extended water fasts (7 ish days). We are in the camp that notice no difference in our function or cognition no matter what the BHB level is. However we both are cognitively well. My 3/4 daughter can have levels around 1.0 mmol/L on a pretty high carb diet. In her job, she functions at a very high level in a very demanding job.

You could probably construct a pretty low carb diet that was nutrient dense (put data in a program like Cronometer Also, Australian Engineer, Mary Kendall (who I know) has a nutrient optimizer program. I've not done a deep dive, but know his goal is maximizing nutrient density in the diet.

You could also have a different diet and add in caprylic acid (the C8 part of MCT oil) as in Brain Octane.. In our last consult, our doc, Steven Gundry, suggested my wife consume this on a daily basis. It should give a person a mild ketone boost even without as strict a diet. In my opinion, there can be multiple benefits from ketones and ketosis. One is the metabolic benefit of lower glucose and insulin. Second is that BHB is an alternative fuel that produces more energy and lastly, it acts as a signaling molecule, which has been shown to help various areas of the brain communicate better (This paper is discussed here at about 57 minutes). All that being said, doesn't mean it is the optimal choice for your dad.
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Re: Keto with apoe3/4 worsening memory?

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bkkmt7 wrote:
Another concern is that he is eating so few carbs, we don't see how he can be getting enough nutrition. We were hoping that after reaching ketosis, it would be possible to occasionally add more carbs and stay in ketosis. So far, just a few extra carbs, even keeping ratios (carbs under 5%, protein at 10-12% and fat in the mid 80s) the same causes a lowering of blood ketone levels. And, as stated previously, his memory is getting worse.

Any thoughts or relevant experiences shared would be appreciated.
Hi bkkmt7!

Thanks for sharing in the forum. This is a very intriguing question. Each person will respond differently to nutritional changes. I look forward to hearing the other responses. Have you noticed when your dad feels his best when it comes to nutrition? I noticed you mentioned nutritional deficiencies, have those been optimized?

Our Wiki has detailed information on Ketosis and Ketogenic Diet that may be helpful. Keto is a well discussed topic in the forum, you may want to Search the forum for related conversation threads if you haven't done so already.

That carb ratio may need to be evaluated. Tips like Tincup mentioned to achieve a state of ketosis will be helpful to explore. From my personal experience as a 3/4 and being helped by Keto, it took a lot of trial and error with my fats, proteins, and carbs to get to where I needed to be. I used the tools mentioned by Tincup like Cronometer to track. Documenting my journey was super important. When my ratios didn't work, I felt awful. I was in Keto by testing my blood, but my brain and body didn't work. I ended up using a combo of the Bredesen Protocol and the Wahls Protocol to create a nutrient dense form of Keto. Dr. Wahls is referenced in the Diet section of the Mitochondria Wiki and there is also a Podcast Interview. Her breakdown of leafy greens, sulfur rich, and colored non-starchy vegetables made a lot of sense to me on what to add in and helped me reach the Wahls and Bredesen version of Keto. That seemed to work really well for my system and my genetics. Fasting also allowed me to increase my vegetable/carbs levels to get more good in.

Enjoy exploring the forum and let us know what insights you've discovered.

Melissa
Last edited by nerdymel23 on Sat Jun 19, 2021 12:16 pm, edited 2 times in total.
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Re: Keto with apoe3/4 worsening memory?

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bkkmt7 wrote:Are there any cases of people who are Apoe3/4 using keto to successfully reverse or halt early memory loss? Alternately, has the opposite happened? My dad's memory has gotten worse after starting Keto on May 24th (2021). Also, any advice in this situation? ...
Another concern is that he is eating so few carbs, we don't see how he can be getting enough nutrition. We were hoping that after reaching ketosis, it would be possible to occasionally add more carbs and stay in ketosis. So far, just a few extra carbs, even keeping ratios (carbs under 5%, protein at 10-12% and fat in the mid 80s) the same causes a lowering of blood ketone levels. And, as stated previously, his memory is getting worse.

Any thoughts or relevant experiences shared would be appreciated.
Welcome, bkkmt7!

Your concern about your dad's memory loss and your efforts to help him with the support of an FM practitioner are truly admirable. I hope you both can find time this Father's Day to reflect on all you mean to each other. I will let others offer advice on his diet, suggesting only that if this change has been marked in the 3 weeks since he started on a strict keto diet, it may be that his brain is asking for some more nutrients. Here is an article from Feb 2021 on a New Zealand study of a Keto diet with people similar to your dad. It used significantly higher protein and slightly higher carbs and while it found only a modest trend towards improved cognition, the participants didn't drop over 12 weeks and improved in other ways:
Patients on the ketogenic diet were instructed to eat all meals from the plan (unless they attended a social event, in which case meal advice was given), with numerous recipe options providing an average macronutrient ratio of 58% fat (26% saturated, 32% non-saturated), 29% protein, 7% fibre, and 6% net carbohydrate by weight. Main dietary constituents were green vegetables, meats, eggs, nuts, seeds, creams, and natural oils..
Compared with a usual diet supplemented with low-fat healthy-eating guidelines, patients on the ketogenic diet improved in daily function and quality of life, two factors of great importance to people living with dementia. Changes in cardiovascular risk factors were mostly favourable and adverse effects were mild..
Randomized crossover trial of a modified ketogenic diet in Alzheimer’s disease

Here is a helpful supplement on the Study diary and foods, with foods, meal recipes and nutrition info starting at p. 9:
The Ketogenic Way - Alzheimers Dietary Study.pdf
Memory is really lots of different things, which can change at different rates in different people.
Sometimes memory concerns become more noticeable over time, not because the person can't access long-term memories, or how to do certain procedures (favorite tools, sports, songs) or recognizing someone or knowing about something, but can't quickly access stored memories and has more trouble storing NEW memories. So over time, your dad may seem to have more difficulty recalling recent episodes, or those of the last 2 years, while being able to describe in detail something from 2000 or the 1990's.

You may want to consider asking him if he'd like to get a free memory evaluation through a local or regional center that can do more extensive testing than his FM practitioner. As someone who is a few years younger than your dad, I am a big believer in empowering people of my generation to ask for and be given the best information about what is going on, so we can make decisions on how best to enjoy every day with our family, friends, loved ones and favorite places.
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Re: Keto with apoe3/4 worsening memory?

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bkkmt7 wrote:.
My dad's memory has gotten worse after starting Keto on May 24th (2021). Also, any advice in this situation?
My dad (apoe3/4) is 73 and started to have noticeable memory problems about two years ago and began to work with a functional medicine practitioner to do a lot of testing. He began following Bredesen's protocol around that time.
Any thoughts or relevant experiences shared would be appreciated.
Hi, bkkmt7, Thanks for posting your interesting question about your dad’s worsening memory as he has followed a ketogenic diet. That is unusual; many people notice the opposite effect, with mental fogginess clearing and memory improving when following a ketogenic diet. One thought that I had, which may or may not be at all relevant in your dad’s case, is that out bodies tend to store toxins in our fat. If your dad has had significant exposure to toxins, or if he has a reduced ability to clear toxins, burning fat could have released toxins into his system. A flood of toxins could contribute to cognitive decline. Since your dad is working with a functional medicine practitioner this has probably already been evaluated, but thought I’d mention it just in case.

Best wishes to you and your dad!
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Re: Keto with apoe3/4 worsening memory?

Post by bkkmt7 »

Thank you all. The responses to our questions have been very helpful as we decide how to move forward. We do have a couple more questions.

We are planning to try a nutrient dense diet with more calories and more total carbs, while sticking with a low percent of carbs. We have switched to using chronometer (from carb manager) to track nutrients, and are worrying less about ketosis and looking more at how dad is doing day to day.
We have ordered the Wahls book, as it makes sense to increase vegetables whether or not it benefits his memory.
Is there an actual “Wahls and Bredesen version” of keto? Or is it that we experiment to find whatever works best?

Dad has been doing a nighttime fast of 16 hours for many months and is taking MCT C8:0 8grams C10:0 5grams for the last few weeks.

No one had previously mentioned the possibility of toxins released through fat burning, so thank you so much for mentioning it. The probability of this being part of the problem is high, so it is something we need to address as well. He has started using citrus pectin as recommended by his provider to bind toxins, but I am still wondering: is it possible that he will keep releasing them as long as he stays on a vegetable rich/low percent carb/high total card diet?

And last, the New Zealand study is intriguing and gives us some hope that a low carb diet will be helpful. Is there a way for us to access the file referenced “The Ketogenic Way - Alzheimers Dietary Study.pdf “? It currently says we do not have permission.

Thank you very much to each of you who responded. We greatly appreciate all the information and advice that is shared on this forum and website.
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Re: Keto with apoe3/4 worsening memory?

Post by NF52 »

bkkmt7 wrote:Thank you all. The responses to our questions have been very helpful as we decide how to move forward. We do have a couple more questions. ...
And last, the New Zealand study is intriguing and gives us some hope that a low carb diet will be helpful. Is there a way for us to access the file referenced “The Ketogenic Way - Alzheimers Dietary Study.pdf “? It currently says we do not have permission.
...
Thank you for the kind words!
You can access the NZ Keto Diet Guide by scrolling to the end of the study, past the citations and author information, to a link title Supplementary Material: Additional File 1.
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Re: Keto with apoe3/4 worsening memory?

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bkkmt7 wrote:No one had previously mentioned the possibility of toxins released through fat burning, so thank you so much for mentioning it. The probability of this being part of the problem is high, so it is something we need to address as well. He has started using citrus pectin as recommended by his provider to bind toxins, but I am still wondering: is it possible that he will keep releasing them as long as he stays on a vegetable rich/low percent carb/high total card diet?
Hi again, bkkmt7, My understanding is that releasing toxins is not a problem~ but rather, is beneficial~ as long as they are appropriately bound so that they are excreted rather than reabsorbed. It sounds like your FM practitioner is already addressing that to some extent with the citrus pectin.

Since you have reason to believe that toxins might be a significant factor for your dad, emphasizing those concerns to the doctor would probably be a good idea. Having your dad evaluated for specific toxins could be an important step. (There are specific binding agents that work best with specific toxins.) Modified Citrus Pectin may be sufficient to meet your dad’s detoxification needs. Based on what I am able to read on the internet, there have been some studies showing that it is especially helpful in boosting excretion of heavy metals. It is also reputed to support overall detoxification with no negative side effects.
In my own case, knowing that I have had significant exposure through my work to heavy metals , I tested for heavy metals. Though I have taken MCP for years, I still had elevated levels.
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Re: Keto with apoe3/4 worsening memory?

Post by nerdymel23 »

bkkmt7 wrote:Thank you all. The responses to our questions have been very helpful as we decide how to move forward. We do have a couple more questions.

We are planning to try a nutrient dense diet with more calories and more total carbs, while sticking with a low percent of carbs. We have switched to using chronometer (from carb manager) to track nutrients, and are worrying less about ketosis and looking more at how dad is doing day to day.
I love this plan. Nutrient dense meals and see how your dad feels and responds. Thank you for the updates!
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