APOE4 hyper-responder. LDL off the charts. What to do?


#1

I’ve been doing the keto diet for five months now and I lost 40 pounds. I’d tried it last summer and lost about 15 pounds but I quit when I got my blood work checked any my LDL and total cholesterol had gone up by about 30% from the healthy range and into the unhealthy range. Naturally, I gained most of the weight back in about 4 months. I read up on the keto diet and cholesterol and decided to try again but modify the diet in an effort to mitigate the cholesterol issues. Unfortunately, it didn’t work. I’ve had my blood work checked twice while on this diet and the LDL and total cholesterol keep going up. It’s now well into DANGER territory so I’m going to have to find a new solution. It’s frustrating as this had been working well for me although I had plateaued and not lost any weight for about a month. I felt good on the diet and, after a few rough weeks adjusting to the requirements (planning meals, not going out to eat, spending a lot more on food), I found it easy to follow.

I’ve done a lot of reading on the diet and learned of the hyper-responders subset and the link to the e4 variant of the APOE gene. I checked my 23 and Me data and discovered that I do have the e4 variant as one of my alleles (I’m e3/e4). Bad luck there.

There’s a lot of “info” on the web saying not to worry about LDL cholesterol as it’s the size of the LDL particles that matter more than the levels but much of this seems to be written by advocates of the diet who simply want to believe it 's healthy rather than on empirical data. I would like to get a more detailed set of tests done to determine my risk factors. I’ve asked about getting an NMR test, a CIMT scan, or even a more detailed analysis of my LDL-C nad LDL-P levels done but I live in Canada and my public health drone of a doctor just says no and refuses to sign off on these tests. There are a few private clinics available for CIMT (can’t find one locally for NMR) but they require a referral and I haven’t been able to get one.

Sucks that I have to get off this and I’m not sure what to try instead. My doctor wants me to go on a 15% protein / 85% complex carb/low sugar diet. Basically a slab of fish or fowl with a massive amount of greens. I’ll give it a try but I know that amount of roughage will play havoc with my guts and I likely won’t be able to stick with it long term.

Any suggestions?


(bulkbiker) #2

Read up a lot more on cholesterol…
check out @DaveKeto 's site


Then you won’t be worried any more and you’ll know more than almost any doctor.


(KCKO, KCFO) #3

There is a thread here with several listings of international keto/paleo/primal/lchf drs. and other health care workers. Perhaps one of them in Canada can help you get the referral you need? The note from June 1 by JEY100, has most of the links that might include CA, many of the others are just USA. Good luck.


(Todd Allen) #4

Here’s a podcast that touches on this issue. And it suggests some who don’t respond well to a typical keto diet do better restricting saturated fat and increasing other fats such as extra virgin olive oil.

https://peterattiamd.com/rhondapatrick/


#5

Looks like an excellent collation of resources. Thank you collaroygal.


#6

Hi Brownfat. Thanks. After my initial attempt at keto and the resultant rise in LDL, I did some reading and modified my diet for my second attempt. I did restrict saturated fats and most dairy in favour of unsaturated fats but my LDL still spiked. I made further alterations and cut out all MCT, butter, coconut oil, and red meats but my LDL went up even more.


(KCKO, KCFO) #7

Dude, read Dave Feldman’s protocols. And listen to the podcast, where Carl and Dave talk about their experiences.


#8

Been reading and following Dave’s site for a while. I followed his advice on low/high calorie days prior to blood tests but haven’t seen a drop in LDL or total cholesterol levels regardless of what I try (other than giving up on keto entirely).


(Jeff Gilbertson) #9

I am Apoe3/4.

My mood and motivation was severely affected when I found out two years ago.

I had already been low carb for about seven years. But, my cholesterol just never responded the way I read about other peoples’ responding. ie, my HDL barely budged (high thirties to low forties) and my LDL went from 110-120 to over 170.

My doctor tested me for Apoe4, told me I was 3/4, but never mentioned it was also called “The Alzheimer’s Gene.”

When I googled, I was devastated. I went totally off low carb for several months. I then tried to do a LCHF diet using non-saturated fat (I was doing shots of olive oil).

It was just not sustainable, and I again went off the wagon almost completely.

Needless to say, the weight and the carb cravings came back.

I decided to research as much as I could. Was high LDL really bad?

I came to the conclusion that a keto diet is the most healthiest of all, except for maybe a pure carnivore diet. And, LDL is irrelevant unless it is oxidized by high glucose.

I would advise you watch videos by Dave Feldman, Ivor Cummins, and David Diamond.

Truth is, low LDL is more of a problem than high LDL. All-cause mortality goes up when LDL goes down.

Maybe, then, our genetic variant is a blessing, not a curse.

I’m going to continue to eat LCHF, Keto, and (as much as my wife allows LOL) carnivore.

This will keep my insulin levels under control, which really is what will help prevent disease.
LDL is irrelevant.

I got serious again about my food choices about two months ago. So far, I’ve gone from 162 to 155. I hope to get to 140, eventually. I was 130 pounds when I left boot camp, and was in phenomenal shape. That said, I’m not 18 anymore, but 55. So, 140 is probably a good place for me.

Over the last nine years, I’ve collected various links about LCHF.
You can find them at http://jeff.gilbertson.info

Whites and African-Americans in the lowest quartiles of total cholesterol, non-HDL cholesterol and low-density lipoprotein cholesterol (LDL cholesterol) were approximately twice as likely to die as those in the highest quartile (White HR: 2.2, for lowest total cholesterol quartile; HR: 2.3, for lowest non-HDL cholesterol quartile; and HR: 1.8, for lowest LDL cholesterol quartile.


(Todd Allen) #10

Here’s a review study suggesting high LDL is good:

Lack of an association or an inverse association between low-density-lipoprotein cholesterol and mortality in the elderly: a systematic review
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4908872/

Conclusions
High LDL-C is inversely associated with mortality in most people over 60 years. This finding is inconsistent with the cholesterol hypothesis (ie, that cholesterol, particularly LDL-C, is inherently atherogenic). Since elderly people with high LDL-C live as long or longer than those with low LDL-C, our analysis provides reason to question the validity of the cholesterol hypothesis. Moreover, our study provides the rationale for a re-evaluation of guidelines recommending pharmacological reduction of LDL-C in the elderly as a component of cardiovascular disease prevention strategies.


(Gabe “No Dogma, Only Science Please!” ) #11

Very interesting @jgilberAZ! My LDL-C is high, but that’s not what worries me. LDL-P is 2151, up from 1581 last August. I’m seriously concerned. The particle sizes are NOT good. I’m particularly concerned because Peter Attia, whose view I respect, says keto isn’t for everyone and he’s taken hyper-responders off the diet.

Having said that, all my other biomarkers are great. Calcium score zero. Weight stable (albeit not as low as I’d like). Hba1c varies from 4.7 to 4.9. Glucose around 90. Fairly normal GTT.

I simply don’t know what to make of the NMR lipoprofile figures, and I haven’t asked to have ApoE tested yet.

What are your thoughts? And the thoughts of others around here? Maybe I should tweet at Dr Attia and see what he thinks too(?)


(Jeff Gilbertson) #12

I don’t think LDL is important at all.

http://cholesterolcode.com/cholesterol-endgame/

When looking at only LDL, then one can find a weak correlation with CVD/CHD. But when looking at LDL alongside HDL and triglycerides (TG), it becomes nearly meaningless. HDL & TG together are just a far stronger measurement compared to LDL alone.


(Jeff Gilbertson) #13

My calcium score at 49 and again at 54 were both zero.

I am not concerned with LDL at all.

Insulin resistance is my primary focus.


(Gabe “No Dogma, Only Science Please!” ) #14

Interesting link. A quick glance at my numbers shows my HDL has been tested (or calculated) at 45 twice and 58 once in the past year. My LDL is high. Triglycerides all over the place – 59, then 150, then 70.

No idea what to make of any of it.


(Cindy) #15

I have the exact same problem as you, Mugwump - APOe4 gene and high cholesterol. But a lot of research says that what actually matters is the ratio of triglycerides to HDL, which for me started off really bad but is getting better and better with the keto diet. So I’m sticking with the diet. Also, after a lot of thinking and soul searching, I’ve come to the decision that I would rather die quickly of a heart attack than slowly of Alzheimer’s, so everything about the decision to stay on keto works for me. I have so many bad genes in my family that it’s all a balancing act for me, so I’m having to make some of those kinds of decisions. But everything about keto makes me feel better, healthier, more energetic, more mental clarity, and it increases my functionality immensely. If I stay fully functional till I suddenly keel over with a heart attack, I will feel super lucky.


(Gabe “No Dogma, Only Science Please!” ) #16

Can you guys talk to me about how you had ApoE tested? Did you ask your doctor? Is it a blood test? Talk to me.


(Cindy) #17

You can get it through 123me.com or lef.org . They both have specials at times, so check them both out and go with whichever one costs less at the time.

I wanted to do it myself because I didn’t want it on my official health records with my doctor. Plus my insurance denies every request. My mother died of breast cancer, and they turned down my request for BRAC testing! It didn’t cost that much to get the APoE testing.


#18

My HDL:Triglycerides ratio is good and getting better but LDL is suffering. I’m going to go get a CIMT scan done next week (hopefully, if they ever call back). There’s just not enough reliable data out there right now to make an informed decision so hopefully the scan will give me some idea as to whether I’m doing long term damage or not.

Last test.

Total cholesterol: 6.46 mmol/L (249.8 mg/dl)
LDL: 4.50 mmol/L (174 mg/dl)
HDL: 1.66 mmol/L (64.2 mg/dl)
Triglycerdies: 0.67 mmol/L (59.3 mg/dl)


(Cindy) #19

Gosh Mugwump, your numbers look perfect!!! Why is your doctor telling you their not. It’s a danger for LDL to get down to 150. It does damage to the brain. Your doctor is using very old information!!!


#20

Can you cite anything on that? I’ve never heard that one before.