Rhonda Patrick interviews Peter Attia

[giftsplash]

Rhonda Patrick interviews Peter Attia

Brand new very technical interview with a lot of data on Apoe4.

https://itunes.apple.com/us/podcast/foundmyfitness/id818198322?mt=2

[Julie G]

Excellent interview- full of good stuff on longevity, ApoE4, CVD & AD! The ApoE4 specific chatter starts at 36 mins. Here's a few interesting nuggets:

-Patrick is writing a paper on E4/AD- yay! She & Attia are both huge proponents that lifestyle makes THE biggest impact on whether or not E4 carriers will develop AD and CVD.

-Attia believes lowering insulin is the most important way we can protect ourselves from AD. He wants fasting insulin at 3-4.

-Attia believes that phenotype expression as opposed to genotype expression is what ultimately controls AD risk with regards to ApoE. He's a strong believer that ApoE level (phenotype) is the driver of AD. He makes a major misspeak when he suggests that higher ApoE plasma leads to a higher risk. (He sort of corrects himself later- the opposite has actually been demonstrated.) He's pushing for a blood tests so E4 patients can make dietary interventions, track & tweak levels.

-Attia suggests that 4/4s are destined to have heart disease/MI by age 60 unless they control for LDL-P and/or ApoB. When LDL-P and/or ApoB are controlled for that risk virtually goes away. (His take makes Gundry's stance a little scary for those who can't lower LDL-P and/or ApoB.)

-Heart disease risk is best controlled with 1.) no smoking, 2.) hypertension control, 3.) LDL-P and/or ApoB control.

[GenePoole0304]

"control for LDL-P/ApoB"

having not listened to it does it mean both markers and not the ratio which I have never seen used before.
Yes LDL-P# is correlated with mortality as is ApO-B
http://www.ncbi.nlm.nih.gov/gene/338

so much for expression when it can hit you later in life as Attia is saying.
this is not anything new. I came across a recent research paper about gene expression overcoming genetics.

http://jap.physiology.org/content/104/1/236

[Julie G]

Sorry to be confusing, Gene. Yes, LDL-P and/or ApoB... not a ratio. (I'll fix.)

Great study! Attia, however, was referring to this one indicating that APOE levels (phenotype) as opposed to APOE (genotype) was much more strongly correlated with risk:
http://www.medscape.com/viewarticle/812097

[Cristoforo]

I refound this forum whilst searching about Apolipoprotein B and Apo-E Gene after I watched Rhonda Patrick and Peter Attia's podcast (brilliant people).. and good luck brought me here again.

From what I understood LDL is no longer a reliable indicator for CVD and that instead one should monitor his Apolipoprotein levels.

Unfortunately down here the routine tests are still based on the following indicators:

Cholesterol (Serum) - mmol/L 4.8
Triglyceride (Serum) - mmol/L 0.89
HDL Cholesterol - mmol/L 0.82
Non-HDL Cholesterol - mmol/L 3.98
LDL Cholesterol (Calculated) - mmol/L 3.58
Total: HDL Cholesterol Ratio 5.85

These are the results I got from my latest tests - my diet composition is mainly:

A lot of Coffee; Chicken and Whole Eggs; Salmon and Red Meat; Vegetables and Fruit; and unfortunately I still am addicted to Fries and Bread, which I am trying to phase out in favour of boiled potatoes and gluten-free pasta. Olive oil and coconut oil are regularly intook too.

Considering this diet, the results do not see too bad for an ApoE guy 36-year old eh?

[Julie G]

Welcome back, Cristoforo! I'm glad you found us again. You have a terrific total cholesterol level. Out of curiosity, do you carry one or two copies of the ApoE4 allele?

I translated your results into terms many of us are more familiar with:
TC: 185.6
TG: 79
HDL: 31.7
LDL: 138
HDL/TC: 5.85

Here's a great calculator from the American Heart Association. It suggests that your low HDL and HDL/TC ratio put you at high risk of CVD. The rest of your number are decent. I agree that cutting out bread and fries will be a big help. I'd consider replacing them with non-starchy vegs and healthy fats (nuts, olives, EVOO, avocados) to boost your HDL. I wish I knew about my E4 status at your age. You're perfectly poised to avoid the diseases associated with it.

Have you ever checked your advanced lipids? It might be a good idea to get a baseline. In the U.S., it's pretty easy to order them without a physician for around $75. I'm not sure if it's available in your country. Another important test you only need to do once is Lp(a.) It's an independent genetic risk factor that, if elevated, can also raise your CVD risk. It would also be nice to see your A1c, fasting glucose, insulin & homocysteine for us to have a bigger clinical picture. Overall, decent results. Keep up the great work and don't be a stranger .

[Cristoforo]

Many thanks

This is the information I have about the gene:

rs241448(C;C)
Magnitude: 2.1
Frequency: 7.2%
Repute:Bad
References:3
2.14x increased risk for Alzheimer's
(hide) While the ApoE4 allele (rs429358(C)) is widely accepted as the predominant genetic risk factor for Alzheimer's disease, there are likely to be numerous other factors, both genetic and environmental, associated to lesser degrees with susceptibility to the disease. Genes influencing the immune system, and in particular susceptibility to viral infections such as herpes, may be among such factors. This SNP, located in the TAP2 gene and thus implicated in the activation of HIV and HSV-1 viruses, is seen more commonly in ~300 Alzheimer patients than in the same number of controls. The risk allele is rs241448(C). The odds ratio is reported to be 2.14 (CI: 1.02-2.55) for rsrs241448(C;C) homozygotes, and 1.51 (CI: 0.80-1.93) for rsrs241448(C;T) heterozygotes, compared with rsrs241448(T;T) homozygot..

The other hard information I have in hand is fasting BG & classic lipid data since 2008:





Unfortunately, the rest of the tests are not part of the routine tests we can get in Malta and convincing doctors to give you further tests is not easy. I would be particularly interested in knowing about my insulin.

I have a glucose monitor and just made a small experiment. My glucose level was 5.4 with around 2.5 hours from the last meal; ate GF_Pasta (which has a high GI) but with a lot of olive oil and onions and after 30 mins the glucose level went up to 5.9, then the glucose level went down to 5.2* after 60 mins. Not sure whether this spike & fall is normal considering the food and the timeframe. (I got a reading of 4.4 before that but I think something went wrong with the meter)

[Julie G]

From the information you're shared, it looks like you're a heterozygote- one copy of the E4 allele. As a male, that only slightly increases your risk for Alzheimer's disease... but it's still good to have on your radar and practice prevention early.

Terrific record keeping, Cristoforo. Your results for lipids and glucose were good at your 4/7/13 test. Do you have any idea of what kind of diet you were eating in the weeks leading up to that test? Your glucose testing with the GF pasta looks pretty normal. I like that you're blunting the BG spike with olive oil. That helps. It also helps to exercise or walk after meals. It might be even more difficult in Malta, but many of us try not to eat refined carbs like pasta. You might see improvements switching from that towards more non-starchy (not potatoes!) vegetables and healthy fats, like olive oil, nuts, olives, avocados, etc.

[Stavia]

Julie, have you reached out to Rhonda Patrick?
I really, really would like to know her views on apoe4 to add to our body of knowledge.

[Cristoforo]

From the information you're shared, it looks like you're a heterozygote- one copy of the E4 allele. As a male, that only slightly increases your risk for Alzheimer's disease... but it's still good to have on your radar and practice prevention early.

Terrific record keeping, Cristoforo. Your results for lipids and glucose were good at your 4/7/13 test. Do you have any idea of what kind of diet you were eating in the weeks leading up to that test?

Unfortunately I don't have records from that week (unlike nowadays I kept intermittent consumption records at that time) but I have some food logs form June 2013 which might give an indication.

Seems at that time, I was taking a daily "600mg Fish Oil pill" together with some magnesium and B-complex supplements- then amongst the most consumed foods were crackers, almonds and various sugary bread-products (not exactly the most healthy diet around!) hehe.

I think the shift towards higher lipids between 2014 to 2016 is (funnily enough) due to an increased consumption in healthy (?) saturated fats such as eggs (2 a day ) and coconut oil (daily, used to cook slightly the vegetables after I steam them) and a significant decrease in the intake of carbohydrates through crackers, sugar and sugary bread-products.

Without an analysis of what is that LDL broken down into I don't think I can know whether things are okish or going pretty wrong. If I understood well what I read about the matter, the real problem are the VLDLs and till now there is no way to know that in Malta.