Apoe4 Gene diet

[ChristinaA]

Hello everyone
I just watched Julies talk on Dr.Bredesens Recode Report. So inspiring and gives me hope for my mom. Just had my moms 23andme decoded by MTHFR and will get results next we but we do know that she has 2 sets of Apoe4. The journey continues....

My mom has been on a keto diet for the last 5 months and I have been giving her coconut oil. Is the only difference to switch to plant based fats and stay high fat/low carb?
So just to be clear, for a 4/4 it is best to keep low carb/keto but use olive oil/avocado oil instead of sat fats??? Like relax not eh bacon and grass fed cheese??

[TheresaB]

If you go to the three dots on the upper right hand side of this page and use the pull down menu to go to the wiki, there's an article about Dr Gundry's Protocol, he has a number of ApoE4 dietary recommendations.

[PBW]

I am a 4/4 with very high LDL(200) and all other lipid markers good( small dense LDL, HDL, Triglycerides). I have been in mild ketosis for 6 weeks and have not used any MCT, coconut oil, or other coconut products because in the past my LDL's have risen when I consume it. Looking at Plant Protocol recipes this am, I wondered if supplementing banana flour A-2 butter or ghee for many of these recipes that call for coconut oil, flour or cream will be ok. I do occasionally use organic canned coconut coconut milk in curry dishes. So much of Dr Gundry's diet includes coconut or MCT and I just don't feel comfortable adding it back to my diet. FYI I am trying to prevent dementia and the only symptoms are annoying occasional short term memory issues( names , repeatedly having to refer to directions for repairs, recipes, specific words or numbers) Any thoughts from other 4/4's on this?

[SusanJ]

So much of Dr Gundry's diet includes coconut or MCT and I just don't feel comfortable adding it back to my diet.

There has been some discussion of Gundry's take on staurated fats - he doesn't recommend it for E4s. You can see his modified food list at:

viewtopic.php?f=16&t=3317&p=40028&hilit ... dox#p40028

[PBW]

Thanks I have the book and that is where I am getting my info. For now I avoid all coconut products except some canned milk for curry a few times per month. I am due for a lipid blood test... my results could be interesting.

[TheresaB]

For now I avoid all coconut products except some canned milk for curry a few times per month. I am due for a lipid blood test... my results could be interesting.

Hi PBW, I too am a 4/4 with high LDL, although never over 200 to my knowledge. 180 was my highest before starting to follow Dr Gundry’s dietary advice. I’ve been a patient of Dr Gundry since 2015. My LDL has gone down to the 140s, although that is still in the “red zone” according to the prescribed range assigned by the lab. In our consults, Dr Gundry, he has only once mentioned my LDL, that was when it went down nicely, otherwise has ignored that marker in favor of others which he considers more important.

Specifically, he focuses on my sdLDL and subsequently oxLDL now that he can test for the oxidized LDL directly. Before he could only test for the sdLDL. sdLDL is what oxidizes thus becoming oxLDL. You didn’t mention what your sdLDL levels are, but indicate that they are good, along with good HDL and Triglycerides. That’s pretty much what Dr Gundry focuses on when he looks at lipids, those plus LP(a) and ApoB to Apo A-1 ratio.* He likes to see a HDL to Triglyceride ratio of 1:1 or better (as in a higher HDL count than Triglycerides). So if those are all good, I’d take Dr Gundry’s lead and not get too wrapped up about LDL alone. Especially if you’re concerned about cognition, ketones provide an alternative fuel for the brain. Dr Gundry himself has been inclined to recommend MCT oil for ApoE4s with cognitive issues.

But there’s more to our health concerns than just cognition. As you probably know, having an ApoE4 allele also predisposes us to cardiovascular disease. sdLDL is the cholesterol that oxidizes ultimately resulting in cardiovascular issues and potentially vascular dementia. That’s why Dr Gundry cautions us ApoE4s on saturated fat. He’s been testing his patients for the ApoE4 allele for about 17 years now and has observed that saturated fats compete for space within the Apolipoprotein 4's molecules ability to recycle cholesterol. This problem doesn’t exist if you’re not an ApoE4 carrier.

This has proven true for my husband who is a 3/4 and myself, we have to work to keep our sdLDL/oxLDL low. We keep saturated fat to an absolute minimum, this means no coconut oil or milk, no butter from any source, no ghee, no cheese, and eating vegan meals most of the time, and the few night a week we don't eat a vegan dinner, we only eat a small portion of wild caught shellfish, whitefish or omega-3 eggs. We eat LOTS of olive oil. Even after following this disciplined diet, we barely come within acceptable sdLDL/oxLDL ranges. But that's us. If your numbers allow you to get away with eating some saturated fat, that's great!

*edit addition -- Another test Dr Gundry likes when evaluating cardiovascular health is the Lp-PLA2 test. However, the lab he used and trusted went bankrupt over a year ago. Other labs tried to take over the test but recent test results have been “suspect” due to this change in labs. Our next consult will be in February, hopefully the issues have been settled. LpP2 activity can be markers of stickiness of inside of blood vessel and a marker that the cap covering the plaque in the blood vessel is thinning and trying to “pop.”

[PBW]

Thanks Theresa, That is all very helpful. The breakdown numbers I have were from Berkeley Labs in 2011 so I am really due for all that testing again. Back then my insulin and homocysteine were high and no one mentioned that as a problem. The LDL, HDL and Triglycerides were 141,106, and 47 respectively. My LDL were almost all small dense, pattern A. Over the years from my own research with input from my FP, LDL's have gone up and down but last spring went highest at 209 on statin drug. HDL and Triglycerides stay around 2/1 ratio at 100 and 50 respectively. For awhile I was reading a lot of Dr Noakes research and consuming much more non CAFO grass fed protein, organic butter and cheese. Also per Dr Terry Wahls eating 6-8 cups Kale, spinach and other brassica veggies daily. Ugh developed kidney stone probably from all the greens and raw organic almonds and had to have a Lithotripsy for removal. Now my diet is similar to yours, but I still haven't eliminated ghee , A-2 butter and cheese, and small portions of meat(grass fed non CAFO). I have gone back to a pastured egg 2-3 times per week and shellfish(eliminated it when I reduced cholesterol and just never went back until reading Plant Protocol ) My diary consumption is a fourth of what it used to be, but I think I may end up like you and your husband eliminating all saturated fats from diary and protein. it is my last hold out.

I called Dr Gundry's office. My sister-in-law lives in Palm Springs and many of her friends have been patients of his for a long time. He is no longer accepting new patients. I have requested my FP to order many of the tests I need. She also is a 4/4. Interested to hear back from her. You and our husband were very smart to enlist Dr Gundry when you did.

In October I added all the active B's(homocysteine concern) and changed magnesium to L-theonate. I was hoping to get other blood tests done as a baseline before beginning many of the vitamins and herbs which I ordered. My exercise, sleep and digestion have always been fine. My siblings are experiencing noticeable dementia. They are older and their diet, exercise and alcohol consumption is very different from mine. It has been a huge red flag for me.

Your input helps me keep moving in a good direction and is motivating. Thank you

[alangreenmd]

Hi ChristinaA,
As used, "saturated fats like bacon and cheese" is a misnomer. Olive oil is an oil. Cheese and bacon are protein and fat. Cheese from milk is rich in amino acids which increase mTOR. This is not to say saturated long-chain fatty acids are good; but difference between something which is 100% oil and something which is fat plus protein. Example is butter is fat, but cheese is fat plus animal protein.

[Kurt]

Hi
I have a question regarding the meaning of “ApoE4”. I suspect that the question has been answered previously, but I did not find it (and/or do not understand it – I have cognitive problems so thanks in advance for your patience). I understand the abbreviated genetic terminology of “e2/e4”, “e3/e4”, “e4/e4”, etc.

The following is a sentence in the ApoE4 Dr. Gundry’s Protocol, under “Dietary Advice for ApoE4s”, (last sentence):
“See Dr. Steven Gundry with diet recommendations for ApoE4 for initial familiarization.”

My question: does ApoE4 mean the diet recommendation is for a person with A) both e4 alleles, or B) only a single e4 allele (e2/e4, e3/e4) carrier?

Thanks ... if this is not the appropriate place this this sort of question, please advise - my first post.

[Stavia]

Hi
I have a question regarding the meaning of “ApoE4”. I suspect that the question has been answered previously, but I did not find it (and/or do not understand it – I have cognitive problems so thanks in advance for your patience). I understand the abbreviated genetic terminology of “e2/e4”, “e3/e4”, “e4/e4”, etc.

The following is a sentence in the ApoE4 Dr. Gundry’s Protocol, under “Dietary Advice for ApoE4s”, (last sentence):
“See Dr. Steven Gundry with diet recommendations for ApoE4 for initial familiarization.”

My question: does ApoE4 mean the diet recommendation is for a person with A) both e4 alleles, or B) only a single e4 allele (e2/e4, e3/e4) carrier?

Thanks ... if this is not the appropriate place this this sort of question, please advise - my first post.

hi Kurt and welcome to our community. Our site is very organic, and we do not follow rigid boundaries in each thread!
The recommendation is for one or two apoe4 alleles. So 2/4; 3/4; and 4/4.