Hi, I’m ApoE 3/4, and I am interested in this too. I wish the dudes would do a show on it. Here is my concern: The little writing/research there is on this topic says that we ApoE4s should be avoiding fat in general, and saturated fat in particular. I’m not sure what to make of that?? Is it the same old BS advice?? They say that when APOE4s go on a high fat diet, their lipids get out of control and they are more likely to get heart disease. (sorry I don’t have time to add the studies) Ok, well, I’m just not sure about that. In my own N=1 case, I saw a drop in total chol, and LDL, significant drop, when I went keto. My last blood results showed total Chol of 164 and LDL of 90. Much better than when I was a low-fat vegetarian! I’ve had a great response to keto/paleo eating. Reversed my newly dx T2D in 30 days. So, anyway, what I’m hoping is that they are all wrong. I wonder if perhaps they just don’t have the data on APOe4s who were eating KETO?? Maybe the results are for a SAD diet that is high in carbs AND sat fat at the same time?? Perhaps that would leads to bad outcomes for Apo E4s?? So, for now, I’m just assuming the few studies on this don’t apply to me, as they are not done on people eating a keto/low-carb/paleo diet style. I wish the Dudes would do a show about this, it’s really bugging me! We need more research! Maybe Ivor Cummings could dig into this??
Calling ApoE 4s
Thanks, this is helpful to me. I just posted below wondering if Ivor Cummins could ever comment on this. At least a few voices are saying ApoE4s can do well on a HFLC diet.
Have you read Amy Berger’s excellent book? I reached out to her on this question and she was kind enough to send a really thoughtful and helpful reply. I don’t think she would mind me sharing it here:
Thanks for reading my book. Much appreciated!
You sound very educated on the issues, so I’d be surprised if you weren’t already aware of the ApoE4 forum, but in case you’re not, the people there are very knowledgeable. The main admin there (who created the whole ApoE4 site, I think) is Julie Gregory, and she knows more about the ins and outs of ApoE4 than just about anyone, including most MDs.
You probably already know a lot of what I’m about to say, since you said pretty much all of it yourself, but here goes anyway:
First, let me emphasize that I am not an “E4 specialist.” My area of expertise is low carb diet in general, and I am more oriented toward insulin resistance issues than anything else. So all I can do is speculate. That being said:
Assuming that the E4 genotype is one of the oldest, then it’s not entirely out of the question that E4s are not ideally suited to a very high intake of saturated fat. With the exceptions of coconut and palm kernel oils, the most highly saturated dietary fats come from dairy. Looking far back on the evolutionary path (not just “ancestral diets,” in the way of Weston A Price’s research, but going farther back to out hominid past), they would not have had domesticated dairy animals, so these products would not have been a significant part of their diet (if a part of it at all). And they would likely not have been consuming large amounts of coconut or palm kernel oils. They might have been eating whole coconuts in select locations on the planet, but coconut is not native to most regions, and even the people who did have access to coconuts were not extracting the oil and buying it in gallon-size jars the way we can now. 
Fats in wild animals are actually less saturated than dairy fats. Even regular, conventional/CAFO pork is higher in mono-unsaturated than saturated. Beef is almost equal parts saturated and mono-unsaturated, with polyunsaturated making up the small remainder. Seafood is predominantly polyunsaturated, and poultry is mostly mono and poly, with a little bit of saturated. Nuts and seeds are predominantly mono- and polyunsaturated fats. So, gong way back in the hominid record, saturated fat probably wasn’t a huge part of the diet. (Loren Cordain, father of “the Paleo diet” is one of the few who talks about this.)
All that being said, I honestly don’t think the saturated fat issue even matters. Again, I am speculating here, but it seems like the research suggesting saturated fat is “bad” for the E4s comes to these conclusions because cholesterol levels go very high when these folks eat saturated fat (in particular, LDL, and including LDL particle number, not just LDL-C). And we assume that high cholesterol - especially LDL - is “bad” for cardiovascular health. But cholesterol is a surrogate marker. High cholesterol is not a disease. Does high total or LDL cholesterol indicate anything at all when insulin is low, A1c is low, triglycerides are low, HDL is high, and inflammatory markers are low? The jury is out on that. We have almost no research whatsoever on people with very high cholesterol (including LDL) who are otherwise in excellent health.
Are you familiar with Dave Feldman’s work? If not, it’ll blow your mind. I recommend reading this post on the “lean mass hyper-responders.” Lean mass, meaning people are thin/lean, and hyper-responder, meaning, when they follow a low-carb, higher fat diet, their cholesterol soars. This is not uncommon, and believe it or not, many people who are extremely healthy are showing this same pattern. You can read about this here. We are talking about very healthy, very fit and active people, with total cholesterol often in the 300s and sometimes even in the 400s (or higher!), with LDL way above 100, and sometimes over 200. BUT: Everything else looks great. Their insulin is extremely low, A1c is low, trigs are low, HDL is high, all inflammatory markers are low – everything else looks great, they’re in excellent health and are usually very athletic. The only things that give anyone pause out of all this are total cholesterol and LDL, and there is a large and growing community of researchers and physicians who think that “high” cholesterol and even “high” LDL are basically meaningless when all else looks stellar. They might be totally worthless. One thing we know for absolutely certain: high total cholesterol does not cause heart attacks, and having a low total cholesterol or LDL does not automatically protect anyone from heart disease or heart attack. The amount of cholesterol in someone’s bloodstream indicates nothing about the degree of atherosclerosis in their blood vessels.
So, the rationale for limiting saturated fat for the E4s seems to be that their cholesterol goes sky high when they eat a lot of it. What we don’t know is whether or not this is harmful when every other indicator usually gets better. In my opinion, the saturated fat issue is much less important than these people just doing low carb. If I had to choose one as being (potentially) more detrimental to the E4’s health, I would say sugar and grains and much worse than saturated fat. But of course, it is very easy to design a low carb/ketogenic diet that’s lower in saturated fat and higher in mono. It would be delicious, too. So a higher saturated fat intake isn’t “required” to follow this kind of diet if someone is still a bit worried about for whatever reason. But I still think it’s a lesser issue than sugars & grains.
Clear as mud? (As they say.)
Honestly, Julie Gregory is really the best resource for this. She knows much more than I do.
I’m 3/4 , just did my first keto stint for 30 days.
LDL went down about 10%
Triglycerides went down nearly 40%
But the test was on the first day of carbs where I may have just been out of ketosis.
I tried a mix of saturated and poly/mono but bias was definitely towards sat.
I also have rs1799807 and
So that feels like a bit of a relief but what I’m not happy with is as soon as I reintroduced carbs (5 slices of bread and some prunes and water kefir and bits of fruit) I started accumulating oedema in my legs like never before, 3 days later I still have it,pitting Edema both sides.
Perhaps the body is more sensitive to fluid accumulation after a period of keto.
Promethease is offering their services free of charge until Jan, 15. Apoe is easy to find. Just select it from the topics dropdown menu. It’s the first listing:
I have APOE 3/4. Dr. Dale Bredesen, who wrote the book “ End of Alzheimer’s “ says we should take MCT oil only temporarily to help us get into ketosis, then quit. I assume he means the same for coconut oil. I like to use coconut oil for cooking, and I have been taking MCT oil for about 3 months, but plan to quit someday. I also try to eat grass fed red meat only occasionally. APOE 4 also affects CVD. I try to eat only good fats , such as Omega 3’s, EVOO, avocados, and a little coconut oil for cooking. I had the particle size of my cholesterol measured several years ago, and I had the large, fluffy kind that is less harmful than the smaller particles that are deposited into arteries. I do think having HA1c go down to 5.3 is a wonderful result of LCHF or keto plus IF.
Replying to this old thread. I just found out I an ApoE-3 / ApoE-4 and MTHFR in the last week. I have cardiovascular disease but a recent nuclear stress test on a treadmill was negative. The cardiologist said they never see 64-year-olds pumping 10 METS with no symptoms. I was out of breath but no pain at all.
I’ve been lazy keto for 3 years and recently strict keto (<20g) for 3 months today. I do blood work with my PCP tomorrow. I am on a statin and have high BP which I have several genetic markers for and on BP meds. I need to get my meds adjusted. The last 6 months my BP has risen. Over time your body stops responding to BP meds.
I do eat cheese and animal protein. I try to get fatty fish at least 3 times a week. I think I will pick that up to 4.
I exercise 5+ times a week and in the last 3 months have increased the intensity, especially around strength training. Can I combat the decline of muscle tissue as you age. I hope so.
In terms of my weight I have stalled and still have a big belly. Many NSVs around the rest of my frame and my belly is shifting and ready to start to go down (I hope) more.
Been avoiding fasting for the last 10 days to avoid what Dave Feldman’s talks about for fasters and blood lipid tests. I will get back to 18/6 fasting for a week or two them move into longer IF and some EF. In the last 10 days of no IF I have really missed it. IF turned out to be:
- easy
- makes me feel better (can I call this fun?)
- reduces my appetite
In the sat-fat thing and cheese:
Gosh, I’m not sure I can eat a primarily plant-based diet. I can do a lot of other remediation but plant-based. Oh no!
What do you ApoE-4s think?
This is a great site https://www.apoe4.info/
Dr. Steven Gundry , a cardiologist, has written a book called The Plant Paradox, in which he recommends a low lectin diet for optimal health, and also to cure chronic diseases. He has special recommendations for APOE4 carriers. He recommends a ketogenic, low saturated fat pescatarian diet, with high levels of EVOO, and a list of other oils such as avocado, perilla, nut oils, etc. He also recommends eating massive quantities of approved vegetables every day, especially green leafy vegetables and cruciferous vegetables. This is a grain free diet with sorghum and millet being only approved grains. I recommend reading his books . He also has written a cookbook with recipes to help people support this lifestyle. Dr. David Bredesen, author of The End of Alzheimer’s has said in a discussion between the two that he follows this diet.