Apo E4 Heterozygous (Male) and Keto

(Danny) #1

Hey all,

I know there are a number of Apo E4 threads on this forum but all I found are pretty old and, as we all know, science and opinions change with time. Also, I have some specific questions I’d like to ask the community about my particular situation so, please, don’t hate me for creating a new thread on this topic :slight_smile:

Many of you have responded to a couple of my previous threads found HERE and HERE and it’s been immensely helpful - Thank you! Now that I have some new info, I’m turning, once again, to you incredible people for your thoughts and guidance.

I just learned, yesterday, that I’m Apo E3/E4 (heterozygous) from my cardiologist. As a result, he’s concerned about my current Apo B number of 144 and my LDL of 210… Even though my Calcium CT score was 0 and my fasting insulin is currently 2.31.

These are my current numbers for quick reference… They’re also in my other linked posts but let’s make this easy.
Total Cholesterol: 298
LDL: 210
HDL: 69.2
Trigs: 92
ApoB: 144
Fasting Insulin: 2.31

After doing some research, I read that (no news to anyone here, I know) saturated fats aren’t good for folks with this genotype… It leads to increased LDL cholesterol which, again, according to what I read, is bad for long-term cognitive function and risk of atherosclerosis in this case. Mainly because this genotype causes more absorption of sat fats than one would otherwise absorb.

However, I’ve also read, elsewhere, that a ketogenic diet, by contrast, HELPS with cognitive function in people actively living with AD and/or dementia… So I don’t understand stand how both of these claims can be true at the same time. Or if I’m missing a factor somewhere in the equation.

So, my question for the community is, for someone like myself that’s Apo E4 heterozygous, do you feel it’s wise to stay the course on standard keto? Or is it a better idea to cut back on saturated fats and lean more into monounsaturated fats, as many publications on the matter suggest?

Bottom line… I prefer animal protein over fish all day, every day and my wife doesn’t eat fish so it makes it hard to incorporate. Also, I REALLY don’t want to give up cheese!! :rofl:

Thank you all, in advance!

(Bob M) #2

That pretty much ends the analysis for me, although your HDL and trigs are good too.

I mean if your LDL or ApoB is killing you, how is it doing it? Certainly not through atherosclerosis, since a CAC score of zero means you have little to none (CAC isn’t perfect, but it’s really quite good at gauging risk).

(Robin) #3

My ldl and total are twice as high as yours. But trigs/HDL and everything else are excellent. I just “got over it”. There’s nothing more I can do plus I feel great and am in a very good maintenance groove. I say, Carry on!

(Danny) #4

Is there not a concern/risk that having a sustained higher LDL/Apo B could lead to that CAC score not being zero down the road? I don’t know, just inquiring as it seems plausible.

(Danny) #5

Are you also Apo E3/E4?

(Robin) #6

No clue. Whatever the answer is, I am staying the course.


Difficult question to answer. I am not a medical doctor. Your ApoB at 144 is that milligrams per deciliter? If so, then get on the meds right away to lower as much as possible. The research on those who present the gene variant Apo E4 heterozygous does show an increased risk of Dementia and Alzheimers. The research as to what diet would be beneficial seems to point towards a higher carb and low-fat intake.

(Danny) #9

The high carb diet recommendation is for the rare E4/E4 or E4 homozygous genotype carriers… Which I am not.

(Joey) #10

There’s always a concern about arterial calcification (= hard plaque) getting worse over time (although it can actually be reduced, but that’s not a relevant issue in your case - because zero is zero). But you have NO detected calcification.

There are other tests that can detect soft plaque (which is regarded the more dangerous plaque that can come loose and cause clots, etc.), but a CAC (CT scan) only picks up calcified (hard) plaque.

I know it’s easy for me to say (because I don’t know my ApoB status - ignorance is protective :wink: ), but if I had a zero CAC score and your HDL/Trig profile, I wouldn’t be worried about my LDL. In fact, my LDL and Tot Cholesterol are higher than yours and I’m pleased given my HDL/Trig profile.

If you’re still worried about animal saturated fat, consider getting an NMR lipid profile - which will reveal the relative size of the LDL particles. It’ll likely provide more reasons to chill over the LDL issue.

For me, the key is to restrict those unhealthy pesky carbohydrate foods - to ensure your body is properly metabolizing the fats/proteins you’re enjoying.

Your angst is understandable. But the research that’s truly “on point” to your low-carb eating in conjunction with your Apo status is fairly meager, as best as I understand. If I’m mistaken, please point us to that relevant research and we’ll learn more along with you!

(Chuck) #11

While I don’t know where you live or your family history, I do know here in the USA doctors get kick backs from pushing drug companies medicine. Also doctors are not really taught nutritional facts, and the farming industry controls the government Dietary Guidelines and of course they are pushing grains, and add to that the food industry that produces crappy processed foods are also heavy hitters in the push for guidelines on the standard diet requirements. I have learned over my 75 to trust my on experience and not pay much attention to most the crap I have been told. I was raised to listen then verify everything I hear and or being told.

(Danny) #12

I actually did an NMR back in Jan. This was when my LDL was 172 and Apo B was 117.

LDL-P = 1594
Small LDL = 446
Large VLDL = <1.5
HDL Particle Number = >41
Large HDL = 8.5
LDL Particle Size = 21.4
VLDL Particle Size = 44.4
HDL Particle Size = 9.1

(Bacon is a many-splendoured thing) #13

Given that your ratio of triglycerides to HDL is a fantastic 1.33, it would appear that you have nothing to fear from cardiovascular disease, especially since you mention that your CAC score is 0. The ratio you have guarantees that an NMR analysis of your LDL would show the healthy Pattern A. Pattern A and a ratio of 2.0 or less indicate minimal cardiovascular risk, regardless of LDL cholesterol level (which is a calculated number, in any case).

Saturated fat in the diet, according to Dr. Phinney, actually lowers saturated fat levels in the blood, because it increases the rate of fatty-acid metabolism. (Saturated fat in the diet also raises HDL, whereas dietary carbohydrate raises triglycerides and lowers HDL.)

Remember that arterycloggingsaturatedfat is a nutrition science meme that has outlived its usefulness. Our fear of it was promoted by Ancel Benjamin Keys, who cherry-picked the data he published, from a much larger data set. The published study reported data from seven countries that fit a very nice statistical curve, but the data from all 23 countries fail to show any correlation between saturated fat and cardiovascular disease. Not only that, but Keys disregarded a strong correlation between sugar intake and cardiovascular disease, a correlation seen both in the seven-country data and in the full data set. (Interestingly, at the time, the Sugar Foundation was paying several of Keys’s friends to play up the dangers of eating fat and play down the risks of eating sugar.)

Also, the Women’s Health Initiative, a large study conducted by the U.S. National Institutes of Health, showed no reduction of cardriovascular risk from eating a diet low in saturated fat.

(Joey) #14

Just compared @DannyG’s NMR stats (above) to reference ranges and yes, he’s deep into Pattern A territory.

(Danny) #15

Thanks, @PaulL - Do you know if this logic still applies to those with the Apo E4 heterozygous genotype? That’s my main concern at this point. Had I not learned I had that, this wouldn’t even be a question in my mind given what I’ve learned from my research and great folks like yourself in this community.


Multiple discordance analyses have shown that when non–HDL-C was high but apoB was normal, cardiovascular risk was not high, whereas when non–HDL-C was normal but apoB was high, cardiovascular risk was high. ApoB, therefore, is superior to non–HDL-C as a marker of cardiovascular risk. TG/HDL ratio is not protective when APOB is elevated, and the ratio has next to no meaning for the Black community. Your TG/HDL ratio, standing alone, will not protect you from heart disease.

(Bacon is a many-splendoured thing) #17

Your Agatston CAC score is a measure of calcified plaque. If you have another one done and it still remains 0, then your cardiovascular risk is truly minimal. If you are worried, ask your doctor for a CIMT (coronary intima media thickness) scan, which measures arterial blockage. Though it is likely to show little cardiovascular risk, as well.

Most of these genetic anomalies are still being sorted out. And it is important to remember the distinction between genotype and phenotype. For example, having the breast cancer gene does not mean that a woman (or a man, for that matter) will automatically get breast cancer. For one thing, if Thomas Seyfried is right, and all cancers are caused by metabolic damage, that means that eating a low glucose diet is likely to minimise the risk of breast cancer to the extent possible. And for all we know, Dr. Seyfried might well be right; after all, breast cancer was extremely rare before the promulgation of the dietary guidelines.

(Bacon is a many-splendoured thing) split this topic #18

8 posts were split to a new topic: ApoE-4 and temporar ischaemic attack

(Joey) #25

@PaulL Dear Admin - I sense we’ve got very different individual situations intertwined here, each of which certainly warrants its own thread (one about Apo E4 and other about recent TIA). Might it be possible to disentangle them and split into two before the exchange becomes confused?

(Bacon is a many-splendoured thing) #26

Done. See the thread “ApoE-4 and temporary ischaemic attack.”

(Danny) #27

Just got a very frustrating message from my cardiologist who I thought was a keto believer.

I’d asked him if he felt it would be a wise route for me to cut back on the saturated fats in my keto diet due to my E4 finding.

In his response, he said we could try that and retest but that my Apo B of 144 and LDL of 210 are high enough that we may want to consider a trial medication…

Very disappointed that he’d even mention medicating… I don’t know that he an I will be working together any longer.