Diet Priorities

[lumia]

I'm currently having a "dispute" with my wife over what should be the priority in APOE4/4 management--which is, eventually, associated whether I should have a high-complex-carb or high-fat diet.

Specifically, my wife thinks that ALZ is more associated with Metabolic syndrome and hence more an inflammation issue, so she'd prefer a modification of paleo (Jaminet's Perfect Health Diet to be precise--some grains can be eaten to a limit, but no plant-based proteins unless fermented).

I think controlling dyslipidemia is more important as I always have a elevated (but mild) LDL and APOE4 has an problem keeping lipid droplet sizes in control, so a low-fat diet is preferred.

Of course this's not the kind to dispute that would cause serious problems, but what's your take on the question?

[Stavia]

Hi Lumia and welcome.
Controlling your blood glucose is much more important according to the body of evidence.
Dementia is strongly associated with worse glycaemic control (big doctor word for blood glucose )
Dementia is not consistently or strongly associated with raised lipids.
I know apoe4 is associated with raised LDL but you have to follow the trail further and ask if raised LDL is associated with dementia? Answer is only the vascular type with generally cruddy arteries. And in facr vascular disease strongly correlates with blood glucose control.
The next question to ask if you want to lower LDL to reduce your heart risk - is low fat diet correlated with decreased LDL in an e4? And the answer is for mos of us - no not really. Low saturated fat yes, but not low total fat. But the only way for you to know is to do a month and retest. A month is heaps long enough to know.


We seem a bit obsessed with lipids on this forum precisely because its such an unclear area. And we all take for granted that its imperative we drive down HbA1c as low as possible. So we just don't discuss it anymore.

In my words - glycaemic control trumps lipids. Every time.

[ApropoE4]

Total caloric intake trumps everything.

[lumia]

Total caloric intake trumps everything.

That's not a problem. I'm eating at a caloric intake that at least Sparkspeople consider to be weight loss causing.

[hill dweller]

IMO Stavia is correct. High blood glucose damages the arterial walls, and it is this damage that allows very small lipid particles to penetrate. Plus, if you are an ApoE4 carrier, mitochondrial metabolism of glucose is deficient. You need other food for your brain, and your brain only burns glucose or ketone bodies. So minimize blood glucose first, fine tune lipids later.

[Hubbs]

I have been taking Stavia's and other's advices to heart and focused first on bringing down my BG levels. I have removed almost all fruit and starchy veggies from my diet but even a handful of berries with fish/salad dinner will get my 1h/2h pp levels to 128-158. One small square of 85% dark chocolate eaten with a Salmon Brussels Sprouts dinner brought my BG to 1h pp 170 2h pp 148. Eating mainly green veggies without eating beans or starchy veggies (that was major part of my diet) I had ongoing diarrhea for months which couldn't be a good thing for my guts. Not sure how to succeed on both ends...

Is it time to see a endocrinologist? Consider medication? I don't think I reached diabetic level yet (without all the fasting and diet restriction my HbA1c was 5.6-5.9) but some literature seems to suggest that its better for pre-diabetes be treated with medication instead of waiting till reaching official diabetic level.

My husband who isn't big on medication unless no natural cure, suggest I look into Ayurveda:
http://www.holistic-online.com/remedies ... urveda.htm

Anyone here has experiences with this diet approach?

[Julie G]

Out of curiosity, Hubbs, do you know approximately what percentage of your caloric intake is comprised of dietary fat?

[Hubbs]

Julie, my recent caloric intake is comprised of dietary fat 50-65%. I noticed weight gain after going over 60% for a couple of weeks. After seeing a posting by Lance (?) I lowered my fat intake to around 50% with saturated fat about 10g/day. My average total caloric intake per day is around 1200. Like Stavia, I gain weight easily when go above that.

[Lucy5]

I agree with Stavia, hill dweller & others here; getting blood glucose under control is key - def a first priority. It can be tough for some of us, and let's face it - we all have lives to lead and only so much time/energy (my Achilles heel) to dedicate to diet strategies - so prioritizing lifestyle changes makes things a bit more manageable, I think.

[Julie G]

Hubbs, did you notice that your glucose was better controlled with slightly higher fat, 65% vs. 50%? Also, did your elevated fasting BG improve with higher fat? I went back and found your NMR results and see what you're up against. FWIW, I still think working on your higher glucose numbers will also reduce your small LDL-P.

Lumia, nice to see you posting again . I agree with Stavia & others that in general glucose trumps lipids BUT you mention dyslipidemia. Can you better describe that for us? Dyslipidemia typically refers to high LDL, low HDL, and high TGs... in which case replacing some carbs with healthy (unsaturated) fats should also help with that. Have you checked your advanced lipids? A1c? Fasting glucose & insulin?