Dr. Steven Gundry with diet recommendations for ApoE4

Alzheimer's, cardiovascular, and other chronic diseases; biomarkers, lifestyle, supplements, drugs, and health care.
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Re:

Postby LanceS » Fri Jan 23, 2015 2:28 pm

Stavia wrote:Lance - fair enough, I was grumpy and spoke out of boundaries. I apologise and retract. You had every right to call me out on that statement as it was my subjective opinion. However I have listened to every podcast he has done several times each actually, and in a some details I do still objectively believe he recommends interventions with not enough evidence. I actually do admire his enthusiasm and dedication to his work.


Stavia,

I was inappropriate in the way I challenged you and for that I apologize.

I think we on these forums sometimes misunderstand the role of podcasts. I don't believe his audience is doctors or weighers of evidence. He is probably drumming up business and probably trying to reveal a little of his methodology for helping others so that listeners can benefit and disseminate his name etc. If he were to dump everything he does and why he does it on the Internet, where would that leave him except for another pretty face and disposition begging for customers with no source of differentiation. Why would he continue to then forge the boundaries of science for his clients? Good advice should not be free. We should not expect it to be free. Why would you assume when he opens his mouth a (well documented and explained) footnote should fall out? That if a footnote does not fall out it therefore means "he recommends interventions with not enough evidence"? Just because you're not privy to the evidence or haven't found it doesn't mean he is somehow ethically challenged. I feel like we are fortunate that a guy like Gundry has probably made his money and is likely to more fully spill the beans in his next book. I understand that you think it will be just beans, no evidence, and I respect your right to think that way ; ) My bet is on evidence, or more likely new evidence that pushes the boundaries of what used to be accepted.

But my larger problem with the "stuff that has transpired" on this site recently, is that we somehow seem to see ourselves as something more like "arbiters of truth" rather than seekers of wisdom which may help us help us in the interim years before we have a cure, in the years before it is clear what we should be doing to mitigate risk. As Churchill said about Baldwin, he was a man who when stumbled across the truth, quickly picked himself up as if nothing had happened and scurried on with his day. We may not be Baldwins but perhaps we could use a little more humility. We should want a larger community of interested and educated folks who are inclined to help us help ourselves. By calling doctors quacks, running nutritionists off because we think we can ask them everything about a footnoted study they did for a nutritional degree, calling doctors "arrogant" (see... I am not calling you out ; ), etc, we eventually will reap what we sew and fail to become an attractive place for the people whose time and varying perspective we should so highly value.

But lest you think it is just you, I have done this at least once I can remember. Can't remember how bad it was, but I should have just bit my tongue or challenged the work he had done on first principles. But I was undisciplined, didn't feel like arguing online all day, so just said some disparaging things and tuned out of the conversation. Not cool, and I apologize for that. We would be a better community if a guy like that were thinking about E4 issues. Would have been better had I argued about first principles involved in the positions he has staked out. Arguing about first principles helps us all clarify where we stand on issues that are pretty fuzzy in our community. Dumping on someone's credibility does nothing good for our community and doesn't help anyone reduce the uncertainty of life as an E4.

Lot of good stuff on here this week. I particularly enjoyed Richard S's conversation about fats. Lots of folks chimed in and chipped in in a positive way there. Sorry if I played some role in the shenanigans this week. Anyway, enough for today. Online communities can be like a tar pit (take it from me). Get a damn foot stuck in it and might not get out. Well, I did get out... for the weekend. Have a good one all.

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Postby Stavia » Fri Jan 23, 2015 3:36 pm

All good honey. No offence taken.
Agreed we should dissect the statements not the person. And then if the statements don't hold up, IMO that person's credibility is legitimately flawed and we have the right to state that non emotionally in the forum.
It would be sad if we couldnt state disagreement.

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Re: Dr. Steven Gundry with diet recommendations for ApoE4

Postby Tincup » Fri Jan 23, 2015 5:03 pm

Kitano,

George, Cron-O-Meter (https://cronometer.com/#) is amazing easy to track and I'm certain that you're getting 60grams. I've always been accused of just eating rabbit food, but all that good food has a few grams of protein that adds up.


Thanks for that info! I'm guessing you are correct.
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Re: Dr. Steven Gundry with diet recommendations for ApoE4

Postby LanceS » Fri Jan 23, 2015 5:57 pm

GeorgeN wrote:So a re-listened to this Nov 2014 podcast, around 14 minutes, Gundry says his target is 10% of calories as protein http://www.healthnutsanonymous.com/hna/episode23, later, around 42 minutes (I'm not great at picking the exact times off my phone), he goes into why he suggest limiting animal protein. It is the methionine and lucine argument Russ wrote about here


George,

That still sounds pretty low. Guessing a 1800-2200 or so cal input turns into 180-220 protein allocation. That is 45-55 grams of protein? Wowsa. I've cut waaaaay back on my protein lately and still feel good. I think the worst thing I do is probably a day here or there where I don't eat meat, but I think average I'm between 60-80g.

Thanks for the encouragement a few weeks back. I was anemic when young but at full height 5-11 and weighed 125-135. I looked like an alien. No exaggeration. Removed anemia and I shot up to 165. Where should I be now? Shooting for 190, but I wouldn't be surprised if I can weigh less than that. I've been 18 days ketogenic diet with no carb cycle. In general I feel pretty good. I don't think I was keto-adapted before. Still working on strength training and running on keto diets. Am guessing the muscles will have to become used to becoming dependent on fat / ketone bodies. All with time.

Had never seen the following studies
ketone ester in 62 year old
http://www.alzheimersanddementia.com/ar ... 6/fulltext
ketone esters in mice
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3360149/

When I read studies like this, I have to say my interest in ketogenic diets (and esters) is piqued. I realize these are n=1 and mice models, but I find it pretty fascinating nonetheless. I really like the methionine leucine TOR argument of reducing protein. I find it fascinating the many intersections though. Leucine, resveratrol, methionine, ketogenic diets, oxaloacetate, CR/IF, NAD/NADH, SIRT, mTOR... these things seem interact in strange and fascinating ways. I used to think a pill or a super sirt slurpee was a science fiction fantasy. I am no longer so sure. Could a ketogenic diet and supplements be more powerful. Sure. But Murica would rather have a slurpee and some TV.

Cheers.

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Re: Dr. Steven Gundry with diet recommendations for ApoE4

Postby Tincup » Sat Jan 24, 2015 6:29 am

Hey Lance,

As a fit, overweight, LFHC vegan, I consumed a lot (sometimes massive amount) of calories. The blood sugar swings could make me ravenous. Don't really know what my protein intake was. When I flipped to traditional LCHF, I'm guessing it was 90-100 gms/day. I don't perceive weakness in my workouts, with my lowered intake now. I will say that being keto-adapted for fiveish years has made all of this much easier.

It is interesting that the benefit of CR may boil down to methionine & leucine restriction (along with low blood glucose).

The impression I get is that Gundry sees his concierge patients (he refers to them as his "club") every three months (as opposed to those who are not concierge). They number at least 1,000 from what he's published. He runs his extensive lab test suite on them and tracks them. They are like his own interventional study. Since these people pay a lot for this, they are more likely to be motivated to follow his program than the average patient a doctor sees. They also wouldn't continue if they weren't seeing results... That one of the variables he looks at is a person's E4 status is a bonus for us.
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Re: Dr. Steven Gundry with diet recommendations for ApoE4

Postby Russ » Sat Jan 24, 2015 10:05 am

George says:

It is interesting that the benefit of CR may boil down to methionine & leucine restriction (along with low blood glucose).


Remember in my notes from Gundry, he said he was using glycine to mitigate methionine (although not recommending to patients (yet). When I looked into that, seemed to be logical evidence to support, although short of proven (why he's not recommending). So maybe the issue is not methionine restriction per-se, but another one of methionine balance. Not knowing any real way to test for impact, I am presently taking 500 mg methionine daily and then an extra 500 mg whenever I eat muscle meat (unless I'm also having a broth-based product). "In the wild," could be just another reason to eat 'nose-to-tail.'

Also, worth noting per other threads that CR, ketosis and fasting also all share a common benefit in the beta-hydroxybutyrate benefits (seem to recall it was Dr. William Walsh who made this point most sharply).

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Re: Dr. Steven Gundry with diet recommendations for ApoE4

Postby Tincup » Sat Jul 11, 2015 8:45 pm

George & wife Gundry call 7/9/15 {edit 9 other consults with Gundry with transcripts and labs are linked here.}

Test Results uploaded in the next few posts.

To set the stage, my wife & I are basically healthy (BP excellent, no metabolic issues), so our primary focus is mitigating our E4 heart and dementia risk (me 3/4 her 4/4). Gundry picks up on this quickly. He treats many with much more severe issues. (Gundry considers himself in the longevity business).

Quick summary :

1. Want to eat to minimize sdLDL which can oxidize easily (he doesn’t worry about LDL-P). Animal fats oxidize easily will do this (shellfish and Omega 3 or pastured Eggs are OK, as are fish), so minimize animal fats. Coconut oil will spike LDL-P, but that is OK as won’t spike sdLDL. Shellfish will also help sweep away oxidized LDL, so eat as often as possible. Likewise, polyphenols will help sweep away oxidized cholesterol, so consume a lot. Unfiltered extra virgin olive oil is a great source of polyphenols.
2. Lectins (if sensitive and have adiponectin >16) can create inflammation – bad for both heart and brain, so minimize as much as possible.
3. Want to minimize IGF-1 (insulin like growth factor 1). Best way to do this is to minimize sugars, starches and animal protein. The issue with animal protein (including shellfish and eggs) is methionine, leucine and iso leucine. Glycine can help deal with methionine. TMG (Trimethylglycine) is best source.
4. Want at least 1000 mg/day of DHA. Niacinimide (2x500 mg/day) is best supplement for E4’s for brain health.

Call notes:

Taken care of lots of 3/4’s, 4/4’s & 2/4’s. Has 85 year old o male 4/4 patient who drives a fair distance to see him. Wife says he’s beginning to forget things. Gundry tells him, “if you’re 85, 4/4 and all your wife says is you are beginning to forget things, we’ve won this battle.”

Been looking at ApoE4 for 15 years. Managed lots of people with this as about 30% are carriers. Calls it the frailty gene instead of the AD gene. People with this gene more aggressively oxidize cholesterol – more so than normal. Cholesterol not bad for anybody except when it is oxidized. Oxidized cholesterol likes to stick to things more aggressively. Want to keep the types of cholesterol particles that like to oxidize as low as possible.

• Rule #1, animal fats (inclusive of beef, dairy, poultry, pork) are not your friend. Even a chicken is not your friend. Doesn’t mean you can’t have them, but want 4’s to think of animal protein ias a garnish to the food you eat (e.g. Asian stir fry).

• Olive oil is your best friend. The polyphenols in olive oil binds to oxidized cholesterol. “Only purpose of food is to bring olive oil into your mouth.” New research from Spain. Three groups of people > 65. All on Mediterranean Diet. First group had 1 liter of olive oil/week (he and his wife together go through 1.5 l/week). Second group put on caloric equivalent amount of walnuts. Third group on low fat Med. Diet. At end of six years only olive oil and walnut groups had preserved memory. Low fat group deteriorated memory. Unfiltered EVOO best. Unfiltered has all the particles that bind to oxidized cholesterol. Did not have favorite brand. Always want to use the olive oil the year following the year it was pressed. Most European olive oil pressed in the Oct-Dec time frame. Now should be using 2014 pressing. All labels have two year expiration date, so want to subtract 1 year from the expiration date and use before that time.

• Shellfish are incredibly good for you. They have plant sterols that lower your absorption of cholesterol. Want 4’s to eat wild shrimp (not farmed – don’t go near farm raised he says), crab, lobster any time they can. Farmed muscles, scallops, clams are OK as they are not fed anything.

• Niacinimide is also your friend. E4 rats given niacinimide will not develop dementia. In some studies dementia reversed when given niacinimide. Can be labeled “no flush” however most “no flush is inositol hexanicotinate which you do NOT want. Some female patients can get flush or itching so start with 500mg and go to 1000 mg/day.

Wife has Factor V Leiden Arg/Gin clotting risk. Should move around on long trips and take baby aspirin whenever traveling.

Wife has 1/2 MTHFR mutation (C677T C/T, A1298C A/C). Her homocystene is fine. So take 1000 mcg methyl folate supplement/day. These mutations (especially double) can lead to anxiety, bipolar, suicide, depression, ADHD, drug abuse. If you give them methyl folate, most will get a whole lot better.

Desmosterol – both are hyper manufactures of cholesterol
Sterol absorption – both are hyper absorbers – so should not take plant sterols to lower cholesterol, can be detrimental.

Wife has lot of estradiol for being in menopause. Ovaries making a lot of estrogen given high level of FSH.

Insulin like Growth Factor 1 – super old people (100+) who are doing well, run 50-70 ng/mL. We have normal numbers (118 – me, 129 – wife). Good starting point. Best way to lower this is less sugars and starches, also less animal protein (including fish and shellfish). Talks about this in part 3 of his first book. Methionine (very prevalent in animal proteins, poorly expressed in plant proteins), leucine and iso leucine (later two big in milk and whey products) activate cellular aging switches. Absence of them shuts down cellular aging switches. Glycine blocks mTor from being affected by methionine. TMG (Trimethylglycine) best way to take glycine. He takes 750 mg, 2x/day.

I have low testosterone (276 ng/dL). Make huge amount of sex hormone binding globulin (119 nnol/L), so free testosterone is very low (2.05 ng/dL). Have a lot of “room to play” with DHEA so he suggests take 25 mg DHEA/day. Also ginko biloba (125x2 mg/day) as it is an aromatase inhibitor. Blocks turning DHEA into estrogen.

Omega 3 Index – measures EPA/DHA over last two months in system. Vegan wife is very low (2.8). ApoE4’s should be at 10-12. Want most DHA/capsule you can afford. Need to watch serving size – some times put two instead of one. Starting goal 1000mg DHA/day. He likes Kirkland Fish Oil Enteric Coated – can buy on Amazon (blue label) – other Kirkland lablelable is yellow & not great. It has 274 mg/capsule so take 4/day.

Says ignore page 1 of HDL report , “designed so we have to put you on a statin drug to get the numbers in the green.” “No evidence ApoE4’s benefit from statin drugs. Seem logical we would but no evidence we do.”

Singulex p2 – Adiponectin. (me – 35.8, wife – 27.6). Framingham study, skinny women had high rate of AD. Uses elevated adiponectin as a marker for those who are sensitive to lectins. People with adiponectin >16 are sensitive. In his paper, http://circ.ahajournals.org/content/129/Suppl_1/AP354 shows that if you take lectins away from these people, then inflammation markers like TNF-alpha are OK. If you reintroduce lectins, then the TNF-alpha spikes (his next book, due out right after 1st of the year is all about this). We are both sensitive to lectins. His “Matrix” protocol is the way to reduce lectins (and therefore TNF-alpha – want <3). I’m 2.7, however my PLAC test (or LpPla2), is elevated at 217. Indication blood vessels are “sticky.” Sees this elevated in people who are lectin sensitive as well. Get lectins away, it goes down to normal. Less we eat lectins, the better. Lectins can’t be destroyed by cooking or heating. Fermentation does destroy lectins to a certain extent. Pressure cooking does a decent job of destroying lectins. http://www.drgundry.com/articles/Lectins/

Asked about why asparagus is not on the list. Said some sites say it has a nasty lectin, others say no and it does have an interesting resistant starch that gut bugs love. Used to have it on list with a question mark and took it off as he got tired of explaining it. Thinks it is safe however, if we were perfect in every other way and were still spiking TNF-alpha or PLAC, he’d say to drop it.

All rest of our inflammation markers are in good shape. I do not have a MTHFR mutation yet my homocysteine is 14. I’d stopped all B vitamins 10 months before because serum B-12 was 1600 (at the time homocysteine was ~7). He said restart and he was ok with B-12 over 2000. TMG will also help here as a methyl donor. This is where TMG got started. He would like homocysteine under 10. I mentioned Bredesen wanted 6 and he said this will be hard because of the niacinimide. Says he’d rather have the niacinimide protecting the brain than worrying about a little homocycteine. Also I was taking 1g/day of Slo-Niacin and niacin interrupts the homocysteine degredation pathway. Some people will really bottom out testosterone in susceptible people. Doesn’t think that niacin is the beneficial chemical for E4’s, it is the niacinimide. Fits into the NADH pathway – probably how neurons use fuel. Also interrupts cancer dividing pathway.

Small dense LDL’s are the ones that oxidize (sdLDL on the test, me – 24, wife -31). Objective sdLDL <30 and as far below 30 as possible. Says reason wife is a little high is because her triglycerides (Tg’s) are a little high for his taste (78mg/dL). Want between 40 & 50 mg/dL. Tg’s moved around body with LDL. He says Tg’s look back 3-4 days. Experience with fasting animals is that fasting will mobilize Tg’s out of fat stores. So fasting longer than 12 hours is not useful in understanding how you are doing with Tg’s. Says Tg’s and HDL’s are inversely related, so reducing Tg’s will increase HDL’s. Also says minimizing sugars and starches is the best way to reduce Tg’s. Also said I wasn’t expressing sdLDL. http://circ.ahajournals.org/cgi/content/meeting_abstract/127/12_MeetingAbstracts/AP169 He does want Tg/HDL <1 (in mg/dL units).

Wife’s A1C is 5.0 – great number. Doesn’t see need to try hard to get below 5, though he says he has people who try. Says my 5.3 may have been impacted by the niacin.

My free T3 & T4 are OK. TSH is too high. Suggest increasing intake of iodine to 500 mcg/day or eating seaweed, chlorella or iodized sea salt.

My elevated cortisol level. Use Relora as a supplement to reduce cortisol. 250mg 3x/day is standard dose but he typically suggests 2x/day. Relora also blocks the mammalian target of rapamycin (mTor). Helps sleep, too. Got into it as a sleep promoter. Amazing promoter of sleep.

Cystatin C is high tech way of testing kidney function. He says will supplant BUN & creatinine in the future.….

More we stay away from animal protein and fats, the better. “What can we get away with and keep sdLDL nice and low.” “What can I eat and keep my inflammation or sticky markers normal (i.e. lectin avoidance).” Niacinimide 2x/day 500 mg. Both start with one at night to minimize issues, then increase.

Like Grape Seed Extract, take at least 100 mg/day.

Also French Maritime Tree Bark aka pychnogenol 25 mg/day. Says Trader Joe’s has lowest price.

I asked about hormesis and intermittent fasting (IF). Says IF a very good way of lowering insulin like growth factor 1 (IGF-1). Study said IGF-1 not lowered by calorie restriction but was lowered by animal protein restriction. Probably why Seventh Day Adventists do well in longevity. Not a huge fan of multi-day fasts. More you rest your gut & don’t eat for an extended period of time & he thinks 22 hours a day is an extended period of time. Now know that gut bugs only go through the wall when digestion is actually happening (he has said he eats 1x/day from Jan – May every year).

Best resistant starches. Okinawans – 80% of their diet blue sweet potato. Does cooking plantains destroy resistant starch - answer no. Jicama is great – uses them for dipping guacamole (without tomato in guac). Likes peeled tiger nuts – a south African tuber. Taro root. Also yuca fries. Should cut into fries, the boil first, let dry, then put in olive or coconut oil, then bake.

Asked about coconut oil raising my LDL-P off the wall. Said, yes they will do it but don’t worry about it ‘cause won’t effect slLDL. Says there is an East Coast faction (uses LDL-P to scare everyone onto a statin) on cholesterol and a West Coast faction (trained by Berkely Heart Labs). West Coast guys think using high dose statins to drive LDL-P<1000 is crazy.

He asks us to do a 6 month follow up. This also indicates we are basically in pretty good shape. His standard follow-up is 3 months.

Also see Russ’ Gundry report: https://www.apoe4.info/forums/viewtopic.php?f=29&t=526&p=8527&hilit=gundry+sdldl#p8504 and tests: https://www.apoe4.info/forums/viewtopic.php?f=29&t=526&p=8972&hilit=gundry+singulex#p8972

This is a summary of a lot of Gundry links. Also the whole thread is good. There are more podcast links in the thread and you can search on Gundry podcast for more in other threads: https://www.apoe4.info/forums/viewtopic.php?f=5&t=570&hilit=gundry+podcast&start=50#p5592

His latest “Matrix Diet” is attached. Again this is generic. For E’4s you’d minimize all things animal – beef, poultry & dairy (even “A2” dairy & goat), but shell & white fish plus omega3 or pastured (best) eggs are OK. Everything in the fish column bolded is OK.

We do plan to follow up in six months. Gundry is very data driven – individual prescriptions based on his extensive testing. Wants to minimize sdLDL, IFG-1 and inflammatory markers. Though Gundry is not a fan of repeat coronary calcium testing. We do plan on repeat EBT tests, though not sure a what interval as per this thread (our recent tests showed low risk but some calcium me-17, wife – 3): https://www.apoe4.info/forums/viewtopic.php?f=5&t=1355&hilit=ebt+calcium#p14806

Here is the most recent version of his “Matrix” diet, including lectins to avoid:
Matrix051315 E4 mods.pdf


Here is a link to his first book (second, focusing on lectins & inflammation due out Dec 2016): http://www.amazon.com/Dr-Gundrys-Diet-Evolution-Waistline/dp/0307352129 The "Matrix" can be considered an extension of the third phase diet in the first book. He has said the food list in the book was a compromise with his publisher vs. what he actually used on his patients.
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Last edited by Tincup on Wed Jun 29, 2016 2:42 pm, edited 7 times in total.
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Re: Dr. Steven Gundry with diet recommendations for ApoE4

Postby Tincup » Sat Jul 11, 2015 8:48 pm

My results:
HDL
2015 Jul Gundry HDL G p 1 4.pdf

2015 Jul Gundry HDL G p 5 6.pdf

Singulex
2015 Jul Gundry Singulex G.pdf
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Re: Dr. Steven Gundry with diet recommendations for ApoE4

Postby Tincup » Sat Jul 11, 2015 8:50 pm

Wife's results:

HDL
2015 Jul Gundry HDL Wife p1 to 4.pdf

2015 Jul Gundry HDL Wife 5 7.pdf


Singulex
2015 Jul Gundry Singulex Wife.pdf
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Re: Dr. Steven Gundry with diet recommendations for ApoE4

Postby circular » Sun Jul 12, 2015 2:09 am

GeorgeN, wow, thanks for all this! I've just read the beginning but really need to go to bed, so look forward to reading the rest.

In the meantime:

"2. Lectins (if sensitive and have adiponectin >16) can create inflammation – bad for both heart and brain, so minimize as much as possible. "

I'm a bit confused here. My Boston Heart labs a little over a year ago said adinopectin was 24.1 "optimal". They say > 13 is "optimal". I really don't know anything about this marker, but I wonder how it is they diverge so much on it. I am very sensitive to lectins I think, although I'm not sure exactly what Gundry means by that.
ApoE 3/4 > Thanks in advance for any responses made to my posts.


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