fish oil and ApoE 4's

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david lerner
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fish oil and ApoE 4's

Post by david lerner »

I’m working with an apo E 3/4 patient, whose lipids just shot up significantly. LDL went from 162 to 234 in a 2 month period, with no apparent change in diet/lifestyle. She’s wondering if it might be from getting more consistent with taking her cod liver oil, and wondering if that might be the offending agent. The fish oil controversy with apo E4 genotypes has been on my radar for a few years now, but I've been of the opinion that it’s likely an issue if combined with excessive oxidative stress. I continue to recommend it to Apo E 4 folks, just making sure that they have plenty of antioxidants on board as well. I found the following article to be quite helpful regarding this topic:
http://www.lmreview.com/articles/view/o ... e-decline/

Curious to know if others think the regular use of CLO may be the reason for her lipid escalation, and if others avoid fish oil?

Thanks in advance!
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Stavia
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Re: fish oil and ApoE 4's

Post by Stavia »

hi David
I personally in a woman with a raised LDL, look at the whole picture including encouraging a coronary calcium score if she can afford it. I've seen too many women in their 50s and 60s with high and indeed very high LDLs and zero scores to rely on LDL alone.
I still prioritise insulin sensitivity in my patients. But I prefer them to get at least half the reconmended DHA via food and top up with supplements to about a gram. I dont prescribe cod liver oil so I have no experience with its effects on LDL.

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SusanJ
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Re: fish oil and ApoE 4's

Post by SusanJ »

I'm a 3/4 and use Nordic Naturals Ultimate Omega capsules - 2 caps/day at 1280 total omegas. No change in LDL.

Just finished the lipids wiki post. You might have already seen these. Here's a 2014 study (N = 136,701) that concluded:
In summary, we found no evidence for a deleterious relationship between lipid biomarkers and the Omega-3 Index by APOE genotype.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4098055/

A 2013 MESA study (N=2340) found:
Borderline significant APOE-EPA interactions were also found for small LDL and mean LDL particle size (pinteraction=0.04, and 0.05 respectively, figures not shown). Specifically, significant positive association between small LDL and EPA, and significant negative association between mean LDL particle size and EPA were found only in the E4 group, but not in E2 or E3 groups.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3640761/

So the effect might be a change in small LDL, which, of course, can be driven by other factors.

Has she retested? Especially with an outlier result with "no changes".
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Re: fish oil and ApoE 4's

Post by Harrison »

My LDL has been raised since starting DHA a couple of years ago. I am currently taking two Carlson Labs Super DHA Mineral Supplement Softgels, 500 mg. With my last NMR, Total Cholesterol was 231, LDL-C was 141, LDL-P was 1144, and smLDL-P was <90. This is about 30 points higher for total cholesterol and LDL-C than before fish oil. I had a coronary calcium scan of zero one year ago, so I feel okay about this for now.
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Re: fish oil and ApoE 4's

Post by Tincup »

Gundry has us on 1g/day DHA (from 5 g total fish oil supplement capsules). Lipids can vary but I've not noticed an association with fish oil - been doing this since July 2015.

July 2017 results.
TC =163 mg/dL
Tg=58 mg/dL
HDL= 67 mg/dL
LDL= 102 mg/dL

More importantly from my and Gundry's perspective is my sdLDL-C was 20 mg/dL.

All labs, including NMR are posted in the link after this one for July 2017 labs.

Mostly I've correlated lipid increases with consumption of sat fat from non veggie sources as well as coconut oil. Also, if I sample after fasting for 5+ days, LDL will increase. From memory it was ~175 mg/dL on the 7th day of a fast, not that this bothers me as I'm obviously burning a lot of stored fat at that point (ketones > 6 mmol/l as I recall).
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Julie G
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Re: fish oil and ApoE 4's

Post by Julie G »

Such a great question, David. I've read studies suggesting E4s have an exaggerated LDL response and studies that have found no such association putting us in "no man's land," common for our population ;). It's important to keep in mind that E4 carriers appear to have a greater need for Omega-3 fatty acids (see our wiki article) so I'm unsure if a transient increase in LDL would be a reason to stop supplementation IF the patient's overall risk profile is low; negative CAC, low oxLDL, high HDL/low TGs, low glycemic markers, etc.

As a data point, I take 1 gram DHA and my last LDL was 79 with an LDL-P of 850. I do eat a ketogenic diet with lots of fiber in the form of non-starchy vegs, 1 scoop of SunFiber, low SFA, high MUFAs and PUFAs (the latter in whole food), combined with a long daily fast and exercise. Optimizing my thyroid made a huge difference as did treating an underlying h.Pylori infection. FWIW, I've never experimented with FCLO. I wonder if there's something specific to that that may have caused the increase?
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Re: fish oil and ApoE 4's

Post by david lerner »

I'm really impressed with the depth of knowledge in this group! You've had to figure your way through uncharted territories, and I really appreciate the responses I've received to my questions.
To fill in some of the gaps that were raised, with any LDL elevation, we always do advanced lipid profiling, regardless of Apo E status. We typically use True Health Diagnostics, so we're always factoring into the mix particle size and amount, oxi LDL, Lp-PLA2, apo B/A ratio, Lp(a), hsCRP, fibrinogen, glucose markers and thyroid status. For assessing plaque, we prefer using a carotid ultrasound (vasolabs) since it gives both calcified and soft plaque, as well a CIMT to assess for arterial inflammation.

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Re: fish oil and ApoE 4's

Post by jkramer65 »

I'm wondering if Fish Oil has raised my LDL. Since August my LDL and Total Cholesterol has gone up 40 points.
I'm taking 2,000 mg of Krill and 1300 mg of DHA daily. Plus I'm eating a lot of salmon, sardines etc. Am I over doing it?????
I eat an incredibly healthy diet and exercise at least 5 days a week. I'm even on a low dose (5 mg) of Crestor.

My HDL is high (75) and my TGs are low (54) so ratio is decent but I'm concerned.

e4/e4

what the heck?!
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