Apo E4 Heterozygous (Male) and Keto


Uffe Ravnskov’s book ,The Cholesterol Myths, published in Swedish in 1991 and in English in 2000. That book has been severely criticized, for instance, A typical claim: “Cholesterol is highly protective against cancer, infection and atherosclerosis” and “high TC total cholesterol and LDL levels are beneficial at all ages.” These statements are not only false, they are potentially dangerous to the health of those who believe them.

I’ll admit there is a grain of truth in what they say. The public may falsely perceive cholesterol as some kind of “Great Satan” of heart disease, and diet has been overemphasized, and some doctors may be over-prescribing statins. But there is plenty of evidence from multiple avenues of research to show that high cholesterol is a risk factor for heart disease and that lowering it reduces risk. A Lancet article from December 2007 reviewed trials involving nearly a million people and found that “Total cholesterol was positively associated with IHD [ischemic heart disease] mortality in both middle and old age and at all blood pressure levels.”

Another Lancet meta-analysis of over 90.000 patients concluded “Statin therapy can safely reduce the 5-year incidence of major coronary events, coronary revascularisation, and stroke by about one fifth per mmol/L reduction in LDL cholesterol, largely irrespective of the initial lipid profile or other presenting characteristics. The absolute benefit relates chiefly to an individual’s absolute risk of such events and to the absolute reduction in LDL cholesterol achieved. These findings reinforce the need to consider prolonged statin treatment with substantial LDL cholesterol reductions in all patients at high risk of any type of major vascular event.”


If you researched Dr. Allen Sniderman you would come to the conclusion that he does not push pills. Rather, most of his latest work is about ApoB as a significantly better risk predictor of ASCVD and CAD than the older outdated models of risk.


Wow, you discovered there are risks. Life is a risk, eating a keto diet is a risk. Risk is acceptable if and only if it is outweighed by a greater benefit.

(Danny) #53

Let me repeat a question for you and see if you’ll actually answer it this time…

What say you to this? Because drinking and eating crappy restaurant food, while fun, is also a “risk” to your health. But, based on just my ApoB, I was healthier when living this way.

(Bacon is a many-splendoured thing) #54

Believe it or not, there are actually studies that support these claims. The paper I cited earlier observes as follows:

The ages at death of hypercholesterolemic males and females were compared with those of their normal siblings. The data with respect to 40 dead members of generations IV-VII are shown in Table 12. It will be seen that the normal males tended to live somewhat longer than the hypercholesterolemic males but that this difference was slight and not statistically significant.

Another way to seek an impact of hypercholesterolemia on longevity is to examine the distribution of the ages of the living persons. If the gene is responsible for early death, there should be a significant reduction in the average age of the living persons with hypercholesterolemia. The ages of 206 living persons in generations VI and VII who were classified are shown in Table 13. (Generations VIII and IX were excluded, because they consisted largely of children.) Here it can be seen that there is not a significant difference in the average age of any of the comparable groups.
This result is interesting because it is the clinical impression of most physicians that hypercholes-terolemia is associated with precocious development of coronary artery disease and early death. We may have overlooked some young males who died early of coronary disease. On the other hand, the results may mean what they seem to mean, i.e., that hypercholesterolemia as seen in this kindred is a relatively benign trait.

And from the summary:

Our studies provide no evidence that familial hypercholesterolemia appreciably shortens the the life of affected individuals, either male or female. On the contrary, they show that high levels of serum cholesterol are clearly compatible with survival into the seventh and eighth decades. Although our experience is contrary to generally held concepts, our family does not appear to be significantly different from kindreds previously described, . . . . It is clear, however, that “coronary disease” at an unusually early age is not epidemic in the kindred.

(Bacon is a many-splendoured thing) #55

On the other hand, the Women’s Health Initiative, the Nurses’ Study, the Minnesota Coronary Survey, MRFIT, the Sydney Heart Study, the Framingham study, and other large, well-funded studies either failed to find a correlation between cholesterol and cardiovascular disease or showed a negative correlation, either with cardiovascular disease or with all-cause mortality. So obviously the data are not as iron-clad as commonly supposed.

The Minnesota Coronary Survey and the Sydney Heart Study were both kept from publication for nearly two decades. When asked why that was, Ivan Franz, principal investigator of the Minnesota Coronary Survey told an interviewer, “There was nothing wrong with the study; we were just disappointed in the results.” Ancel Keys had his name removed from that study, because it failed to support his diet-heart hypothesis, and when Franz eventually decided to publish, 17 years later, he picked an obscure journal, not read by anyone in the field. The Sydney study was also published eventually, after a similar delay.

(Bacon is a many-splendoured thing) #56

Reading on in the thread, I am moved to note that it is possible to disagree without being disagreeable. I would urge everyone to re-read our Community Guidelines on the topic of civility.


Try this study: “Familial hypercholesterolemia: A genetic and metabolic study,” Wm. R Harlan, John B. Graham, and E. Harvey Estes ( Medicine, 1966; vol. 45, no. 2).

Not sure why you would reference a 60-year-old study based on only one family tree that the researchers clearly state, they estimated serum cholesterol. Increased mortality does exist in some affected families that have hypercholesterolemia. (FACT). These families are probably characterized by a clustering of risk factors. The environment could also play a huge role.


Not knowing anything about you or you family history, and from a heart health perspective with increased ApoB and increased LDL then yes you have increased your risk. Wait 6 months and re-test. See what the numbers state then. Not everybody’s blood markers improve on Keto. Some get worst and continue to get worst. For others, their blood work improves after a while.

(Danny) #59

I don’t want to beat this to death and I feel like we already have so I think it’s best that we move on. In closing, I just want to say that, regardless of my family history, I sincerely doubt that any medical professional would tell me I should go back to drinking the way I did (20+ drinks per week when ApoB was lower) or eating pub style processed foods on a fairly regular cadence for the benefit of my health.

It’s all just a bit baffling. On one hand, yes, you want to trust your doctor and other professionals in the field that have dedicated their lives to medicine. But on the other, at times, logic seems to conflict with their instructions. Then there’s the known factor of money at play which, of course, plays a role in what they suggest (some more that others I’m sure) as it does for anyone with a job. It’s a big part of the reason we work and, though they do/should have a greater purpose than most, the mighty dollar has the power to sway the most well intentioned people at times.

So, bottom line, I frankly don’t know what to believe. All I know with certainty is, right now on this diet, I feel better than I can ever remember feeling before.


I do not disagree with your points. It is difficult to navigate. Confirmation bias is everywhere. I attempt to be objective. Not always successful. I am very grateful that I have a medical doctor who can admit when he is wrong, and who can admit he does not know everything. My wife is also a doctor. Thus, my level of trust is also high. Money plays a role in everything including medicine. Yes, it does have the opportunity to sway the most well-intentioned people at times. But not always. When somebody quotes a study, I want to read it first before I respond. I will read the abstract first, then the conclusions and then the conflicts of interest last. I will look to see if other scientists have cited the paper in their papers, and finally to see which journal it was published in. This last point is important and should not be ignored. I am a numbers guy. Therefore I see most things via numbers. What do the numbers show? This is my starting point. I have DEXA scans going back 12 years, I have blood work also going back 12 years. When an issue presents itself, via the numbers, I can or rather in consultation with my doctor can take the necessary action(s) to correct it.

I wish you only the very best of health.