I can't seem to lower my cholesterol & triglycerides (~290) after a year of Paleo. And I still have a fatty liver. I'm starting to think that I'm an APoE 4/4 carrier, where a high-fat diet just doesn't work as well as in most others (5% of the population).
How an APoE 4/4 carrier should eat for optimal health and good lipids? Some say that they should stop eating saturated fats, because since these carriers can't utilize fats properly, these become plaque in the arteries and brain (leading to Alzheimer's or atherosclerosis). The other half say that because we can't utilize them properly, we must eat more, otherwise the brain starves. Besides, coconut oil has shown to almost reverse Alzheimer's in some patients (although we don't know if these patients were 4/4 or not). And to take more D3.
So, what to do exactly?
UPDATE: I just got the test back, I'm APoE 3/3.
asked byEugenia (11697)
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on September 03, 2012
at 12:14 PM
The APOE 4/4 allele is considered a "paleo" version of the APOE gene (1). It's hypothesized that carriers of this allele may be more adapted to a paleo diet, intermittent caloric restriction and exercise than non-carriers. In fact avoidance of a paleo diet, intermittent caloric restriction and exercise may cause greater risk of health impairment in these carriers. So if you suspect you are a carrier you should get tested. 23andme (2) is one of a number of companies that provide this test as part of their service.
Having said that, for medical concerns you must consult your doctor. He may not know anywhere near as much about paleo as you or others at PH but he can rule out other (non dietary) reasons that contribute to high cholesterol that may be associated with an underlying disease condition which may need medical attention.
For more interesting information on APOE 4/4 including some benefits it confers see: http://primale4.wordpress.com/
(1) Corbo et al 1999
on September 04, 2012
at 02:03 AM
It's worth pointing out that the question of APOE status versus compensatory diet raises the issue of what a "paleo" diet should consist of, particularly in terms of fat macronutrient composition.
This is particularly relevant for those who partake in a very high level of fat in their diets.
As Eugenie asks, does APOE4/4 mean one should consume more fat or less?
Parenthetically, this question may not be so simple as more fat versus less. There is the constellation of other questions related to fat intake: What about the ratio of saturated to polyunsaturated to monounsaturated fats? What about fatty acid chain lengths and what about the location of the unsaturated bonds (i.e. omega-3 vs omega 6)? Finally what about the contribution of gut bacteria to fatty acid metabolism (i.e. short chain fatty acid generation resulting from high fibre diets)? To compound the complexity of the issue further is other genetic and epigenetic variation that has various levels of responsiveness to changes in diet.
Ignoring this degree of complexity for now, I think it would have been highly unlikely that ancient man would have gorged on fat-rich food multiple times on a daily basis, as some paleo followers seem to believe. The APOE4/4 adaptation, by merit of its cholesterol sparing effect, appears to confer an advantage in environments where there would have been low availability of cholesterol generating nutrients, i.e. fat rich foods. It's notable that APOE4/4 carriers are also more resistant to the plasma lipid lowering effects of statins.
But, clearly, not everyone is so "fat sensitive". This suggests a necessary trifurcation of paleo into a cholesterol sparing type that would benefit from less dietary fat, a glucose sparing type that would benefit from less carbohydrate and a more modern non-sparing type that benefits simply from avoiding excess calories overall. Such a categorisation would be consistent with geographic and climatic variations in flora and fauna.
on September 03, 2012
at 11:01 AM
Eugenia, what exactly are your symptoms? You cannot lower cholesterol based on blood test or something else is going on?
I found that Paleo only is the answer to healthy people. To those that are sick (and have no idea what they are sick with like me) Paleo alone is not the answer. You need to try other options available, like Gaps, Weston Price, Terry Wahls, naturopath, probiotics (two out of four are still alive - yeah!), raw foods, raw grass-fed milk, fermented cod liver oil plus butter oil, quality water, Chinese herbs from a certified herbalist - you have to try different things to see what will work for you.
Have you tried every single one of them?
I hope I do not sound negative because my point is - Paleo is good, but... not good enough for sick people.
I am finally starting to recover after four years of hell. I am feeling better and better every day, but I cannot contribute it to Paleo alone. If you want me to, I can share some things that worked for me and some things that did not work for me, but I don't even know what I have/had/recovering from.
Don't worry. Sooner or later you will find a solution.
on September 04, 2012
at 02:43 PM
I did 23andme testing, and I am E4/E4
With my carbohydrate sensitivity/reactive hypoglycemia, my approach is keeping carbs to around 30% of calories, with a focus on avoiding starch. I have no idea if this is the ideal E4/E4 approach, but it keeps me slender and maintains even blood sugar and energy levels. I've seen Alzheimer's described as diabetes of the brain, and I figure that keeping carbohydrate metabolism running smoothly is the best thing I can do.
on September 03, 2012
at 07:58 PM
Could it be a macro adjustment is in order? I know for me personally, I'm at a point where I know what the fine lines are, but it took lots of tweaking. Too much fat, say 50% or more and I'm experiencing digestive discomfort. Too little (less than 40%) and my thyroid gives me grief and I feel like hibernating like a bear. I also have a seizure disorder, so I can't go too high on the carbs or I get majorly sensitive in the neuro area.
Maybe play around a bit with the ratios if you haven't already, in addition to your plans on playing with the types of fats (plant vs. animal). Also play around when you eat your heavy fat meals. I eat mine at breakfast and dinner predominately, lunch is when I get most of my carbs. I think it varies for people based on their own sensitivities. Hope you find what works for you.
on July 07, 2013
at 02:22 AM
I'm also a 4/4. My physician has prescribed the Paleo Diet for me with ratios of 65% fat, 20% protein, 15% carbs. I've never felt better, stronger, or mentally sharper.
I hate to hear your experience, R Anne. When I ate a low fat diet, I did experience memory and fatigue issues; but not now. I'm 51 y/o. Out of curiosity, how old are you? How long did you try a higher fat diet?
on July 05, 2013
at 09:12 PM
I am an apoe4/4. It has been a living hell. I was one of those on the forefront of research into how diet affects this genotype. Unfortunately, I have run out of energy and concentration. Although I take a plethora of brain nutrients, I am finding them less and less effective. At one point, they turned my life around and I could read and retain as much as I used to. I lived on steamed, organic veggies, with nothing on them, and organic chicken breast, with nothing on it, for about 7 years. It was absolutely a miserable way to exist. But I looked 10 years younger and my stellar memory was back. At this point, there are many more dietary options. For the first time ever, doctors are becoming much more familiar with this genotype, and no longer say things like "It's all in your head", when I am describing the exhaustion and the loss of memory. I am however, still hoping to find someone who has walked this path, and figured out an effective and live-able diet. I can't eat fish- open to other suggestions. A high fat diet is DEFINITELY NOT the answer. I have experimented on myself. That just plaques up everything.
on February 25, 2013
at 09:26 AM
I am also APOE 4/4 according to 23andme!
on September 04, 2012
at 12:44 PM
I'm APOE4/3 with the same types of questions and sometimes think it's more natural to not add fat to foods. So, eating fatty foods would be fine, but not adding oils/fats.
It's interesting that my trigs are best on a CW healthy diet with higher carb, low fat diet.
08/30/12: TC 398, LDL 301, HDL 81, trig 79 (PHD removed multi/selenium supp, tallow for cream)
04/27/12: TC 407, LDL 315, HDL 76, trig 79, TSH 1.76, fT3 2.53 (PHD 1-year; 30% C, 20% P, 50% F)
02/23/11: TC 226, LDL 142, HDL 78, trig 32 (45-50% C, 30-35% P, 20-25% F; oats, brown rice, lean meat)
02/27/07: TC 226, LDL 149, HDL 65, trig 61 (CW healthy diet)
About coconut oil, I think the benefit has been ketones, but here's one study that made me think ketones might not benefit APOE4:
Study of the ketogenic agent AC-1202 in mild to moderate Alzheimer's disease: a randomized, double-blind, placebo-controlled, multicenter trial
AC-1202 rapidly elevated serum ketone bodies in AD patients and resulted in significant differences in ADAS-Cog scores compared to the Placebo. Effects were most notable in APOE4(-) subjects who were dosage compliant.
on September 03, 2012
at 09:40 PM
I don't think there is any way to speculate about ApoE status on physical experiences or symptoms without actually doing the genetic test. There could be hundreds of different reasons for your current labs, everything from not enough glycogen depleting exercise, food sensitivity, to exposure to a virus, bacteria, synthetic chemical, or heavy metal sometime in your life that impacted your liver function.
The fat clearance part of the experiments about ApoE 4 were a hot mess (none of the diets in the experiment were even HF/LC, so there is zero data on that option). Reading through the same study that supposedly proved this, I came to very different conclusions than the authors of the abstract. Sure you can lower their cholesterol numbers a bit with a very restricted fat diet, but should you?
One of the most glaringly overlooked confounding factors was the assumption that there could not be a good reason for this group to have routinely higher cholesterol levels. It is the allele that developed in areas with low light conditions, and to survive they required more cholesterol to synthesize vitamin D from the little light they got, plus whatever dietary sources were available.
One of the modern dangers of this allele, and why I think it is worth for you to actually take the test is the impaired clearance of heavy metals in this group (a serious concern if you live in a city, use art supplies, or have old plumbing), which can screw up a body in all sorts of scary ways, and set the scene for early onset Alzheimer's.