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APOE 4/4 Specific diet - Dr. Gundry or not?

Alzheimer's, cardiovascular, and other chronic diseases; biomarkers, lifestyle, supplements, drugs, and health care.
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Re: APOE 4/4 Specific diet - Dr. Gundry or not?

Postby dfmcapecod » Wed Jan 15, 2020 7:35 am

circular wrote:he did a recent podcast on apoe4. You might want to listen to it or read the transcript for his thoughts. He mentions small dense LDL from animal meat being particularly bad for e4. Interestingly, he's also said that higher sdLDL propensity is something people are born with and doesn't change much if at all in their life, so it only needs to be tested once. [EDIT: I got sdLDL confused with Lp(a) ... sdLDL does get retested to keep track, but not normally Lp(a) which is genetically determined.] So here I am with 3/4 and low sdLDL, even when eating a fair amount more animal meat than he recommends. Given, he probably recommends low animal protein for more reasons than just sdLDL (MTOR, IGF1 ...), but sdLDL is something you can measure that he strongly believes links e4 to Alzhiemer's.

His program overall seems to dial down inflammation, which of course is good for preventing all chronic diseases, but so does the Mediterranean diet.


Thanks @circular - I read this and appreciate you following up with the clarification of sdLDL vs. Lp(a). I specifically want to ask you and readers here How do you/we measure inflammation? because this is where the rubber meets the road on whether these diets (any of them) work or not for our particular approaches if we believe that inflammation = increase in cardiovascular risk & Alzheimers.

circular wrote:These days, that is recently, I'm worrying less about the details of diet and supplements (not to say not focused on them) in favor of being far more committed to a strong meditation practice.


Wow this is huge that you mention this, I want to share with you and this group this particular clinical work that comes up with a reason why "contemplative acts" have an actual impact on our wellbeing. Whether it's meditation or yoga or whatever. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6189422/, it may be worthy of its own post on here if it hasn't already been discussed. It talks specifically about how breathing focus (which happens as a byproduct of contemplative acts) stimulates the vagal nerve which reduces our overall stress/inflammation in our system.

What this means is we might have a clinical reason why meditation and contemplative acts have a physiological impact on our actual biology. So your hunch may actually be backed up by science. I really think you will appreciate this paper if you can plow through it. thanks for taking the time to comment.
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Re: APOE 4/4 Specific diet - Dr. Gundry or not?

Postby dfmcapecod » Wed Jan 15, 2020 7:48 am

SusanJ wrote:
On the subject of diets, there is no perfect answer. I have the sense that Gundry plays a little loose and fast with things to make it easier for people to understand what not to eat. I personally cringe every time I hear that cashews are bad because they are a legume.

But, I think the point of any of the diets out there, be it MIND, Mediterranean, Gundry, etc, is to reduce the inflammatory burden on your body by generally eating foods that are not processed. Everyone has different genes and gene expression, so maybe I can eat cashews and someone else might not.


Thanks Susan, I have read through your referenced work and found it educational - my question for you is how do you measure "inflammatory burden"?

SusanJ wrote: So, I hope you don't throw your hands up in frustration. Just focus on eating whole foods, cutting back on the processed ones and see where that takes you on the road to better health. Try a couple weeks without wheat products or dairy or something else you suspect gives you problems and see if you feel any different. As we say here, it's all an N=1 when it comes to what works for our own health.


Absolutely not! I have been focused on making sustained improvements for over four years, which include diet changes, lifestyle changes, health changes that are measured in years in some cases while taking notes and continuing to learn about what science can and can't support. Appreciate your feedback.
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Re: APOE 4/4 Specific diet - Dr. Gundry or not?

Postby dfmcapecod » Wed Jan 15, 2020 8:11 am

Plumster wrote:The best I've found is the review of Gundry's book The Plant Paradox on Red Pen Reviews. Their review is very extensive. You can find it here.

You speak my language with this reference. This was superb. I am still reading this, and its coming back to the concept of "what are we measuring to see if eliminating lectins has any bearing on reducing our inflammation (how is this measured) or reducing our susceptibility to AD". I have not arrived at that juncture yet.

Which ironically the folks at Red Pen reached the same conclusion....

I was interested in reviewing this book because I had repeatedly stumbled upon scientific publications that described potentially negative health effects of plant lectins, such as their gastrointestinal toxicity. My hope was that the book would provide a thorough overview of what is—and is not—currently known about the health effects of plant lectins. It did not. While the author emphasizes repeatedly that the Plant Paradox Program is based on scientific evidence, this is clearly not the case. The available literature on the effects of plant lectins on biological processes related to health and disease are almost entirely based on experiments in cell culture or animal models, and no human studies that we are aware of convincingly link lectin intake to obesity or any chronic disease.

We can give the author some credit that he has tried to publish the anecdotal evidence from his clinics in the scientific literature, albeit so far only as conference abstracts. If we assume that the data are as convincing as the ‘Success Stories’ throughout this book suggest, however, it is astonishing that he has not yet published an actual peer-reviewed paper in a higher-quality biomedical journal to date. As it is, the book makes a lot of strong claims based on almost no scientific evidence whatsoever, while at the same time claiming that the program is based on scientific evidence. The extensive list of supplements that are recommended, all available from the author himself at a price tag of several hundred dollars per month, does seem to constitute a major conflict of interest. If a service to patients were truly the mission here, then the proposed mechanisms behind the Plant Paradox Program could easily have been presented as a hypothesis, which is what they are at this point, rather than repeatedly making statements that are not backed by evidence. Had the author presented this correctly as a speculative hypothesis, backed by the anecdotal evidence from his clinical work, this could have opened the door to investigate the relationship between plant lectins and chronic disease further. The lack of scientific rigor in this book will, unfortunately, make it hard for those of us interested in studying the impact of plant lectins on health because it will be seen by many in the field as just the latest diet fad.


It's worth noting that this assessment was published in 2019. Or ten years since the original claim targeting Lectins were the root of all evil. This Dr. is profiting on two fronts, his patients and his supplements through Guthy Renker with this approach. Uggh.

I am going to keep an open mind about Dr. Gundry and his approach, but to me the evidence continues to mount to the contrary that as others have said "fast and loose" or directional, but not exactly science.

I will continue to pick this apart for my own and others future use, because I stand by the bouncing ball assessment that many people come out of genetic testing of APOE wondering what to do. They then stumble across Dr. Gundry and his "science" and products and this community should be more directional to those people about his program(s).
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Re: APOE 4/4 Specific diet - Dr. Gundry or not?

Postby dfmcapecod » Wed Jan 15, 2020 8:17 am

MarcR wrote:I haven't seen much in the way of "blind faith". I think the entire spectrum of Gundry opinions here is represented by thoughtful, intelligent people.


I'm working on coming to that same conclusion but am not there yet. What would you argue is the most compelling intelligent argument that supports the Gundry approach being successful? What quantitative measures would that be? Maybe turn me on to the forum member who best illustrates this, I'm searching and reading myself but if you or others have some breadcrumbs, I do welcome them.

I have already received the breadcrumb of a battery of tests that appear that only Dr. Gundry does. Which is why I continue to press on what it is that we measure for inflammation or other blood tests or stress tests. Or should we be so bold as to say that there should be Tau tracer tests done on Gundry patients before and after he starts his program? THAT would certainly be interesting.
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Re: APOE 4/4 Specific diet - Dr. Gundry or not?

Postby dfmcapecod » Wed Jan 15, 2020 8:31 am

Tincup wrote:Gundry's approach is very much based on his clinical experience. Theresa & I have posted links to seven of our consults with Dr. Gundry, including transcripts of the consults and labs, if you are interested. We haven't posted our two most recent consults as are involved in caregiving for a seriously ill family member and haven't had time.


I really really appreciate you putting yourself out there like this, because I do take it seriously and am fascinated with whether this works or not. As you can see in other parts of this thread, that his "clinical experience" seems to be very much in a bubble, he's not writing papers, he's not peer reviewed. Etc. I think it's worth noting that he has even just recently teamed up with http://www.GOOP.com, which is Gwyneth Paltrow's burgeoning "wellness" conglomerate (I can't believe that's an actual thing).

Tincup wrote:My autoimmune issues improved 80%. I've since fine-tuned within his list on things that I'm still sensitive to. I've improved the 80% to about 95%. I can't say this is optimal for all or all 4's but it has made a big improvement for me. Also, as a patient, or in his books he doesn't push his supplements.


OK - how did you measure your autoimmune issues or is that subjective? Or is that part of his PULS tests?

Tincup wrote:His supplement marketing partner is Guthy Renker, I'm sure they are very good at what they do, but I do agree their approach is obnoxious. I look at his diet/lifestyle advice as separate from the supplements.


I am reading more and more of Dr. Gundry's work, while keeping this in mind, trying to separate the two, but it's pretty difficult, I have to admit!
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Re: APOE 4/4 Specific diet - Dr. Gundry or not?

Postby MarcR » Wed Jan 15, 2020 10:25 am

dfmcapecod wrote:
MarcR wrote:I haven't seen much in the way of "blind faith". I think the entire spectrum of Gundry opinions here is represented by thoughtful, intelligent people.

I'm working on coming to that same conclusion but am not there yet.
"Blind faith" is believing in something without any plausible reason for doing so. I intended my remark as a mild clarification to soften a potentially insulting rhetorical flourish. I did not expect you to double down by explicitly doubting the thoughtfulness and intelligence of your fellow forum members.

From the overall context of your remarks, I think you're interested in learning about independently verifiable evidence for Dr. Gundry's theories and the overall efficacy of his program. I think it's possible to explore that question without suggesting that those who value his perspective are dumb.
What would you argue is the most compelling intelligent argument that supports the Gundry approach being successful?

Anecdotally, Dr. Gundry's actual clinical results appear to be strong. Some people who follow his advice perceive significant improvement in subjective well-being and symptom abatement.

Dr. Gundry is a clinician, not a scientist. I think his personal and patient experiences drive his recommendations more than published research. Because in his practice and via his books he focuses primarily on getting people to make difficult lifestyle changes, communicating his prescriptions persuasively is critical to his success. Key elements include

  • Compelling, lay-accessible stories explaining his perspectives regarding lectins, inflammation, fasting, grains, dairy, etc. See his books.
  • Extensive testing - explained by the stories, the unusual tests he uses and the per-patient custom prescriptions driven by those tests reinforce his credibility with patients.
  • The high costs of consultation and testing harnesses patients' innate desire to avoid cognitive dissonance: "If I'm paying so much, the advice I get is special, and I better follow it!"
I don't expect to find persuasive science to support all of his perspectives. That may sound like a criticism, but I don't intend it that way. I don't perceive Dr. Gundry's clinical approach to contravene the most persuasive science; I just think he is comfortable making intuitive leaps beyond the current level of high-quality evidence.

I see Dr. Gundry the clinician adopting the language of science while eschewing the methodology in order to persuade his patients to adopt lifestyles that seem to be greatly increasing their health spans. He has an exceptionally loyal base of patients, and for me that is the bottom line.
What quantitative measures would that be?
I am aware of no independently verifiable metrics. That said, common sense tells me that his program helps some people. It's too rigorous to follow for long if it isn't useful.

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Re: APOE 4/4 Specific diet - Dr. Gundry or not?

Postby Tincup » Wed Jan 15, 2020 10:59 am

dfmcapecod wrote:OK - how did you measure your autoimmune issues or is that subjective? Or is that part of his PULS tests?


The 80% is subjective. I've had nasal congestion all my life. In addition, some foods would cause itching in the roof of my mouth as well as my rectum. The latter two went away 100% and the congestion decreased 80%. In addition, I used to be very sensitive to airborne allergens. That has decreased about 99% subject to changing my diet.

In my post above, I linked our master post where we've linked to posts with redacted copies of our labs. The PULS test is a recent addition. In these labs, Gundry tests for many interleukins, heart measures of inflammation, TNF-alpha, adiponectin and on and on. At one point, he tested to see how we dealt with sterols. You are correct that he doesn't publish subject to peer review. It is understandable, he's a doc in private practice and nobody funds him to do this. He has published unreviewed papers or presented posters on various topics to the AHA (American Heart Association). Primarily, he'll look at a series of patients and publish the outcomes. These aren't ideal study designs, but are reasonable given his resources. In my master post, I recall linking to some of these papers.

I recall several years ago, my wife ate gluten twice in the last two weeks of Dec. On labs that were drawn in the second week of January, Gundry could see this in her lab results. This compares to prior labs when she was completely compliant. He told her that her body reacts as if she had celiac, however she doesn't have celiac genetics (which he also tests for).
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Re: APOE 4/4 Specific diet - Dr. Gundry or not?

Postby dfmcapecod » Wed Jan 15, 2020 11:28 am

MarcR wrote:I intended my remark as a mild clarification to soften a potentially insulting rhetorical flourish. I did not expect you to double down by explicitly doubting the thoughtfulness and intelligence of your fellow forum members.


That was not at all how my comment was intended whatsoever. It referred to my own attempt to reach some kind of conclusion on Dr. Gundry's approach and had nothing to do with attacking the thoughtfulness and intelligence of fellow forum members. Zero.

MarcR wrote:I without suggesting that those who value his perspective are dumb.


Once again, this is your interpretation, and not at all my intent. AT ALL.

Maybe next time if you think that I'm doing such things, you could leverage the PM function or a simple email, rather than trashing me openly. If you thought something I said was too caustic or could be misconstrued, I could have edited it after we discussed it.

I would have thought the forum decorum rules regarding respect stemmed from extending me the same, even if perhaps giving me the benefit of the doubt since I decided to participate rather than lurk. I guess not.

In reading the forum rules, it specifically says that attacking the IDEA is permissible, not the person. Yet here you are trashing me. My idea is that Dr. Gundry's protocol and Guthy Renker, Gwyneth Paltrow partnership should be examined incredibly skeptically, and here we are on the very best forum on earth to do exactly that. Where I'm asking for help understanding WHY his protocol and diet, and supplements deserve respect. And in that effort, I'm targeted as calling people dumb and insulting their intelligence.

I am willing to continue to remain OPEN to the possibility that there is lots of goodness inside the Dr. Gundry approach to APOE4 living, and I'm attempting to find those arguments, openly and honestly.
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Re: APOE 4/4 Specific diet - Dr. Gundry or not?

Postby dfmcapecod » Wed Jan 15, 2020 12:39 pm

Tincup wrote:In my post above, I linked our master post where we've linked to posts with redacted copies of our labs. The PULS test is a recent addition. In these labs, Gundry tests for many interleukins, heart measures of inflammation, TNF-alpha, adiponectin and on and on. At one point, he tested to see how we dealt with sterols. You are correct that he doesn't publish subject to peer review. It is understandable, he's a doc in private practice and nobody funds him to do this. He has published unreviewed papers or presented posters on various topics to the AHA (American Heart Association). Primarily, he'll look at a series of patients and publish the outcomes. These aren't ideal study designs, but are reasonable given his resources. In my master post, I recall linking to some of these papers.

My genuine thanks to you for sharing this, I have read through these on and off and will continue to dig deeper into them. I personally understand better myself how inflammation is measured now from reading something extensive in Dr. Dale Bredesen's work, which does help me apply some empirical quantitative mechanism to compare the Gundry diet to any other diet should I want to take this on myself. As I mentioned earlier, if I am to cut out lectins, what exactly am I going to see happen that will reduce my AD risk? If someone said "reduce your inflammation metrics" that might be a good argument. I think it could be an accurate argument. To which I would ponder how much inflammation could be reduced without paying for supplements or visits to Gundry, etc. etc.

If we have a cost effective way of measuring inflammation, might that be a good way to compare diet effectiveness for APOE gene carrying patients? I think from where I understand things now, the answer is "yes", that this would be a good place to compare effectiveness. A start anyway.

For other readers on here, who may not have the health insurance, or the financial ability to pay for someone like Dr. Gundry for services or supplements, I think it behoves everyone to extrapolate what it is that we're actually doing with these diets to prevent or treat AD.

From Dr. Dale Bredesen's work, here is what he has to say on inflammation measuring and goals:

From the End of Alzheimers
There are several key measures of inflammation:

    1 .C-reactive protein: CRP is produced by the liver in response to any type of inflammation. Specifically, you want to know your hs-CRP (highsensitivity CRP), since the standard CRP test is often too insensitive to distinguish optimal from mildly abnormal. Your hs-CRP should be below 0.9 mg/dL. If it is higher, you want to determine the source of the inflammation. This may be from too much sugar and other simple carbohydrates, or bad fats (for example, trans fats), a leaky gut (more on this later), gluten sensitivity, poor oral hygiene, specific toxins, or any of many other sources. When the source is located, it should be removed, and the hs-CRP rechecked.

    2. The ratio of albumin to globulin in your blood (A/G ratio): This is a complementary measure of inflammation, and is best when it is at least 1.8.

    3. The ratio of omega-6 to omega-3 in your red blood cells: While both of these fatty acids are important for health, omega-6s are proinflammatory while omega-3s are anti-inflammatory. The ratio of omega-6 to omega-3 should be less than 3 but not below 0.5, which increases risk of hemorrhage.

    4. Interleukin-6 (IL-6) and tumor necrosis factor alpha (TNFα): Your internal police force uses a number of dispatchers to coordinate its
    response, and these are called cytokines Two of the many cytokines that may be increased in inflammatory (type 1) Alzheimer’s disease are IL-6 and TNFα.

GOAL:
hs-CRP < 0.9 mg/dL
albumin ≥ 4.5 g/dL
A/G ratio ≥ 1.8.
OPTIONAL TARGETS: omega-6:omega-3 ratio = 0.5–3.0; IL-6 < 3 pg/ml
TNFα < 6.0 pg/ml.


These appear to be medically universal metrics that can be used to compare one diets individual n=1 study and wellbeing to another while reducing your AD risk profile in addition to base bloodwork that all of us get in annual physicals, but I don't know how that varies around the world at all.
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Re: APOE 4/4 Specific diet - Dr. Gundry or not?

Postby SusanJ » Wed Jan 15, 2020 2:05 pm

dfmcapecod wrote:...my question for you is how do you measure "inflammatory burden"?


The list in Bredesen's book provide a good place to start for labs. In addition, don't underestimate keeping a log of the day-to-day, week-to-week measurement of how you feel.

When I was under the care of a rheumatologist, he did specific labs to track disease activity, and also subjective measures of impacts on daily activities (standard rheumatology stuff). I quit going to the rheumatologist when all my labs continued to be normal (from day one), but impacts on daily life were still there. A friend suggested I go off gluten, because it helped him. Lo and behold, without gluten my joints felt better. A few years ago, I had X-rays done on my hands and feet just to make sure, but it turns out my decision was a good one because my joints show no erosion, and it kept me off of methotrexate and DMARDs when in reality, I didn't need them.

A functional medicine doctor I went to about 7 years ago, did a bunch of labs and after a long intake, suggested I look at IBS as the problem to treat given my symptoms. And lo and behold, by treating IBS, my remaining joint and nasal symptoms improved.

If you've done any research as to lab tests for GI problems, you will find this area is in its infancy at best, so watching and rating symptoms - gas, constipation, diarrhea, pain, etc - are probably the best place to start. I tracked symptoms daily, along with food, exercise, stress, and nasal symptoms. I started to narrow down on what foods could improve my gut health, and along with some supplements my doc reccomended to help with gut repair. I felt better than I had in quite some time. And it's clear that if my gut symptoms are low, my joints are happier.

Are things perfect now? Nope. Just going through another round of taking some foods back out of my diet that I thought were okay, and adding in some supplements to help deal with gas and pain issues, which are linked to my joint symptoms.

So consider both doing labs and tracking how you feel to see how your experiments go.


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