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Re: Apoe 4/4 and high triglycerides

Posted: Tue Dec 31, 2019 11:08 am
by Tincup
mike wrote:
binxlyostrich wrote:Thank you I will definitely read into them. I do not have diabetes and my blood sugar is always in the normal range. Just another weird thing about my situation.

Hi from another 4/4 and welcome. I had similar situation at your age, but not so high TG. Now at age 59, I've been a Type 2 diabetic for 20 years... Just because your blood sugar is normal, it does not mean that you do not have metabolic issues - your body is able to maintain blood sugar by raising insulin levels. Higher and higher. At some point this no longer works, and you "suddenly" have diabetes. I would get a HOMA-IR test done (basically testing both fasting sugar and insulin) to see how Insulin Sensitive you are. This will tell you if you have underlying metabolic issues (pre-diabetes). I'm guessing you do. If so, then you will want to cut out ALL added sugar.

I must agree with Mike. The late Joseph Kraft MD (he passed at age 96 in 2017) ran about 15,000 oral glucose tolerance tests with insulin assays during his career. The upshot of his work is that 75-80% of people with a normal glucose profile had an abnormal insulin profile (from memory, it has been a while since I read his work). This doesn't count all those with an abnormal glucose profile. Kraft called this "diabetes in-situ." Essentially insulin resistance and T2 diabetes are part of a continuum. Early in the course of the disease, the pancreas pumps out more insulin to keep the glucose in check. Then, at some point this no longer works and you get to full blown T2 diabetes with elevated glucose. In Kraft's test, people were fasted overnight, glucose and insulin tested, then given a bolus of glucose (100g in Kraft's day, usually 70g now). Insulin and glucose were sampled at 30, 60, 120 and so on minutes up to 5 hours. This is Kraft's original paper from the 1970's, reformatted for readability. Ivor Cummins interviewed Dr. Kraft in 2015.

More recently, Catherine Crofts of NZ used Kraft's data for her PhD thesis. She was looking to determine a simpler test than Kraft's 5 hour assay. She came up with just testing insulin at 2 hours after a glucose dose. She concluded that an insulin value of >30 μU/mL at 2 hours after a 100 g glucose dose was diagnostic of hyperinsulinemia. Essentially a "stress test" for the pancreas. She determined this was much better than fasting tests.

Because such a high percentage of Kraft's sample data had a poor insulin response, it would be reasonable to just assume someone with lipid issues has a poor insulin response and proceed accordingly without testing.

Correcting metabolic issues is the low hanging fruit for getting healthy for those with our genetics, in my opinion.

Re: Apoe 4/4 and high triglycerides

Posted: Tue Dec 31, 2019 11:21 am
by ru442
binxlyostrich wrote:Thanks for your feedback everyone. Matisse-I was on prescription fish oil pill (Lovaza) 4 times a day with minimal impact on my triglycerides :( The lowest triglyceride reading I have ever had was 600 something but they said that could be because the machine couldn't read higher than that.

I have not done any lifetstyle changes in the many years i've struggled with high triglycerides though -so i'm hopeful that a combination of lifestyle changes and medicine could really make an impact


Welcome! I also came from the high TG camp, struggled since I was first tested at 40 at 1200, but I got as high as 1800 at times. I never had any LDL issues, it was always my TG's. Statins and such helped a bit but I was never able to get under 300. When I found out I was 4/4 after years of struggling, I found this site and immersed myself into the protocol. I began by eliminating all sugars (including alcohol) and carbs, implemented intermittent fasting with a LCHF diet (mostly greens, veggies, and oily fish/shellfish). My initial supplement stack was simple with 5000mcg of B12, 1000mcg of Folic acid (to reduce my hsCRP and inflammation), and 4G of Lovasa fish oil along with 20mg of Rosuvastatin (Crestor) for my high TG's.

After 2 months on protocol, I had dropped about 20 Lbs. and went in to get re-tested at my PCP. I waited for the results in the office and lo and behold my TG's were at 143 for the first time ever! We high fived as we had been struggling to find the answer and now we had it! In addition I also felt like I was 20 years younger, ton's of energy, improved focus, lot's of endurance. I've since added additional supplementation per the RECODE protocol, and have maintained my numbers. I also had several stress tests to determine if I had any artery blockage, and while my scores were unfortunately high for plague buildup, I have no blockage and my cardiologist indicated this is old plague remaining from my previous unhealthy lifestyle.

You have youth on your side, start with diet, supplements, and exercise for a few months and then re-check your numbers. Work your way up gradually as you can tolerate changes, this is a marathon and not a race. Continue to ask questions here, there are no dumb ones!

My story is here if your interested in my journey: New RU442

Good luck on your new journey!


Re: Apoe 4/4 and high triglycerides

Posted: Wed Jan 01, 2020 2:33 pm
by CindiRN
I am also 4/4 and my triglycerides are 139. I have followed a intermittent fasting diet for about 4 months. I was doing it before I found out a week ago I am 4/4.
Even with that I have never had high triglycerides and that may be because I am active and not obese which can also cause triglycerides to be high.

I initially started with intermittent fasting because I was about 30 pounds overweight. Since finding out I am 4/4 it will continue to be a diet I follow. The diet was hard at first but now it is a piece of cake. I actually do not get hungry at all and when my 8 hour eating window is open I don't eat a lot either now, which wasn't the norm for me because I loved food and often overdid it! It did take me a month or so to get to that point with the hunger and going that long without eating. You may consider giving it a try. :)

Re: Apoe 4/4 and high triglycerides

Posted: Wed Jan 01, 2020 4:46 pm
by BrianR
binxlyostrich wrote: very high triglycerides, often over 1000.

You may find this new paper: Clinical review on triglycerides useful.

They do make some specific food recommendations, but then state "However, randomized control trial evidence for these specific dietary recommendations is lacking." So I would be somewhat suspicious about those recommendations.

Re: Apoe 4/4 and high triglycerides

Posted: Thu Jan 02, 2020 9:07 am
by ru442
CindiRN wrote:Even with that I have never had high triglycerides and that may be because I am active and not obese which can also cause triglycerides to be high.


In my case I've never been obese, I'm 5'7" and weighed ~150lbs when I was tested, and was very active. That was almost 20 years ago when we had no clue about APOE genetics or diet strategies. I remember the PCP telling me to eat better, less red meat, etc. which I did to no avail. So I just hopped on the statin bandwagon cycling through all of them, sometimes taking multiple types with no real results. Alas if we had the information we do now, I would have made very different decisions.


Re: Apoe 4/4 and high triglycerides

Posted: Fri Jan 10, 2020 7:39 am
by SoCalGuy
binxlyostrich wrote:Hello all,

I'm a 33 year old female living in the southern U.S. who just found out through 23andme that i'm Apoe 4/4. My entire life i've struggled with very high triglycerides, often over 1000. My highest triglyceride reading was 1600. I never imagined in a million years that this random genetic test would unveil the reason for my abnormally high triglycerides. I'm currently not on any cholesterol or medications for my triglycerides because I just gave up after years of medicine not helping very much and instead causing me muscle pain.

With the increased risk of late onset alzheimer's, i'm feeling motivated to change my life and start excercising and eating healthy and start taking meds again to help get my lipids under control.

My question is, any advice for getting my triglycerides under control? I have been on just about every cholesterol medicine you can think of and they've all given me muscle ache problems! That's the frustrating bit.

Thanks for any advice.

Regarding the high triglycerides, you may want to listen to this podcast from Peter Attia. He talks with Bill Harris, who is one of the leading researchers in the world on Omega 3 fatty acids. He's done all sorts of research on EPA - part of Omega-3 fatty acids - and their ability to lower Trigs for people with your levels. You should obviously see a doc and discuss this with him/her but it could help get those Trigs under control in the short term while you work on the underlying causes. There are pharmaceutical products or you could use an over the counter supplement, Harris tends to think both are high quality.


Re: Apoe 4/4 and high triglycerides

Posted: Fri Jan 10, 2020 12:23 pm
by Tincup
As well this Peter Attia interview of Rick Johnson on fructose, part of the interview addresses how fructose can impact triglycerides.