Is keto less effective in people with APOE-4 genotype?

(Kim Childs) #41

Thanks Saphire. I have been incorporating ACV into my day at least a couple of days. I just can’t seem to figure out my GI right now and like I said, every time I eat, I get uncomfortable and bloat and I know I am not consuming enough calories. I have increased my carbs to 35 g/day to see if it helps with sleep from under 20 g, which I think it has, however, have gained 4 lbs in a week with that protocol. That seems ridiculous given I am not consuming close to 1700 or 1800 cal/d.

(Jeff Gilbertson) #42

I am apoe3/4. This was determined after my doctor (Rocky Patel) was concerned about my bloodwork whilst eating a very low carb, almost carnivore-only diet. My lipids were not responding to what was expected. ie, you always hear “I went low carb and my HDL went way up and my LDL went down.” Well, my HDL went from mid-thirties to low-forties. And, my LDL was higher than he’d like to see. So, he ran the genetic test, and it came back apoe3/4.

Apoe3/4 or apoe4/4 messes with your body’s ability to process cholesterol, which borks your brain in the long-term timeframe.

I have been struggling with what to eat. I changed from almost carnivore-ish to something I hope is more aligned with my genotype … ie, I changed from eating all the saturated fat I could stomach, to eating more olive oil and fish/chicken/turkey.

It’s been a challenge.

I am now at the point to where I’m not going to worry about my lipids. I’ve had two coronary calcium scans … first at 50 and last at 55 (last year). Both of them were zero (no plaque).

So, I’m going to eat what I feel like eating, but sticking with the “eat mostly meats” aspect of the diet. In other words, I’m not going to stress over saturated vs monounsaturated fats.

I’m planning more bloodwork in December. I’ll let you know how it goes.

Concerning the gallbladder …

There are two different types of issues. My wife had the first type, and had her gallbladder removed 6 years ago. I had the second type, and had my gallbladder removed in March.

The first type involves no pain and no stones (per se). The gallbladder just fails to function. This results in the burping and the feeling full after eating a few bites. They need to test for this … feed you fat and monitor how the gallbladder performs. For my wife, they scanned for stones, found none, and told her she was fine. In fact, they wanted to prescribe her an anti-depressant, assuming she was making up or symptoms, or something. After she pressed them, and learned of the second test, they did the test and realized her gallbladder just wasn’t functioning at all. She had it removed, and has been fine ever since.

The second type involves stones and pain. The gallbladder tries to function, and often does, but the stones block the duct and the pain is intense. I had gallbladder attacks that lasted for two days. The first time, I thought I was having a heart attack and rushed to the hospital. The pain is almost the worst I’ve ever felt. Horrible. I saw the pictures after mine was removed. It looked like a lumpy bratwurst. I had three stones that were nearly an inch each (and the gallbladder isn’t much more than three inches long).

My body is adjusting to a high fat diet without a gallbladder. I’m mostly pleased with the progress. Metamucil helps.

Hope this info is helpful.

(Chris) #43

I’d love to specifically hear more about this. @DaveKeto

(Adam Kirby) #44

I am concerned by this idea of eating to genetic markers. It’s a step up from doing a blood type diet and I feel it might lead people down a suboptimal route based on genetic variables that we don’t fully understand.

(Jeff Gilbertson) #45

There is a website devoted to this genotype … apoe4.info

I would recommend starting with this page:

PRIMER: An introduction to ApoE4, biochemistry, and possible prevention strategies

There are varied ideas of the proper diet on that site.
But, ketogenic is one of the ones they follow (maybe, the most commonly followed one?)

For example, this was written by the author of the above Primer:

There are many opinion leaders and scientists who believe that running in nutritional ketosis is beneficial for cognitive functioning and neuro-protection. I feel that the body of evidence from multiple researchers is consistent and plausible and follow this myself.

(Chris) #46

Can you point me to the passage that directly deals with “messing with cholesterol”? What was your LDL number that was “higher than Rocky Patel would like to see”?

(Jeff Gilbertson) #47

April 2008, fairly standard american diet:
HDL 34
LDL 58
Total 111
Trig 117

July 2011, low carb but not necessarily high fat:
HDL 52
LDL 110
Total 176
Trig 72

October 2013, low carb and high (mostly saturated) fat:
HDL 42
LDL 163
Total 234
Trig 147

Obviously, my body doesn’t respond the same as most other people.
And, the apoe3/4 is the reason.

FWIW, here are the NMR results from July 2011:
NMR LDL-P 1173
NMR LDL-C 106
NMR Triglycerides 65
NMR HDC-C 55
NMR Total Cholesterol 174
NMR HDL-P 25.6
NMR Small LDL-P 492
NMR LDL Size 20.9
LP-IR Score 44

(Jeff Gilbertson) #48

Evidence for differential effects of apoE3 and apoE4 on HDL metabolism
http://www.jlr.org/content/43/11/1881.full.pdf

Our examination of the lipoproteins in apoE3/ or apoE4/ mice with similar plasma levels of apoE showed a lower level of HDL in the apoE4/ mice. These data are consistent with the effects of apoE3 and apoE4 on HDL levels in humans (2, 3, 23). Furthermore, a difference in size of the HDL of the apoE3/ and apoE4/ mice fed a high-fat diet was readily apparent when the lipoproteins were separated by size-exclusion column chromatography. The HDL from apoE3/ mice was larger than the HDL from apoE4/ mice.

Apolipoprotein E Isoforms and Lipoprotein Metabolism
https://iubmb.onlinelibrary.wiley.com/doi/pdf/10.1002/iub.1314

Human apoE3 and apoE4 are equally effective at reducing total plasma cholesterol in apoE-null mice but the apoE4-expressing animals have a pro-atherogenic lipoprotein profile (higher VLDL-cholesterol/HDL-cholesterol ratio) compared to their apoE3-expressing counterparts.

(Chris) #49

Thanks!

(Susan) #50

I would love some more information on how APOE genes affect cholesterol when on a Keto diet. I felt great and lost weight on Keto diet, but my cholesterol went up to 306. Got tested and found out I was an APOE 2/4. Integrated medical doc said I need to eat 50% complex carbs 50% Healthy fats. Did that for a few months and gained weight, feel sluggish. I’d love to go back on Keto but I’m afraid of the risks of high cholesterol and refuse to go on Statins. My heart scan shows zero plaque build up. Is there any research out there on if Keto is safe for 2/4 APOE types? Frustrated, just want to know what to do for best health but so many conflicting stories!!!

(Ron) #51
(Susan) #52

Thanks but this does not touch on APOE gene types. These genes vary by individual and have to do with how your body processes fats, carbs, proteins.

#53

I recently listened to this Peter Attia podcast where he interviews Richard Isaacson, who is studying the prevention of Alzheimers disease rather than just treatment of those already diagnosed. I’m not even going to try to attempt a summary.

https://peterattiamd.com/richardisaacson/

(Eric - The patient needs to be patient!) #54

I’ll have to slog through this one. I’ve been avoiding his podcasts lately because he can be such a NOTGOINGTOTYPEITOUT. Amy Burger says that apoe4 is the oldest of the apoe genes and that mostly meat societies has more apoe4 percentage than the general population and societies that have been agriheavy for many hundreds of years has less. The implication is that natural selection has favored apoe4 in the meat eating societies.

#55

At least most of his guests are interesting. :wink: