6

votes

Should APoE 4/4 carriers eat more, or less fat?

Answered on August 19, 2014
Created September 03, 2012 at 10:04 AM

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.

De1095b2ba29c1035f00428cbfe3cc7c

(777)

on June 09, 2014
at 09:15 AM

I think she's mainly had MUFA as her source of fat

Here's a link to a good chart showing ApoE4 carriers diets (including Juliegee) their cholesterol breakdown, although not sure whether the whole LDL-P being high is even relevant tbh.

http://apoe4.info/MWiki/index.php?title=Biomarkers...

For mental/memory benefits I'd recommend coconut oil/milk, not sure about CVD risk but from what I've read coconut fat is one of the healthiest things you could eat for your mental performance and your heart.

B121fdbc1aaa6130f5bda3bf84e3ba2d

(952)

on June 08, 2014
at 10:39 PM

What type of fats do you mostly consume?

Cbdc8318738324492f2d5918868ce4c9

(1211)

on July 07, 2013
at 02:52 PM

Hey Juliegee, how do you know it's the fat and not some other dietary nutrient changes?

E253f8ac1d139bf4d0bfb44debd1db21

on February 21, 2013
at 07:00 AM

You could try a low fat paleo template for a couple of months. Also increase exercise - especially anything that increases mitochondrial density. I'll bet that will bring your TG down. If that fails you may need to look at a statin.

3eca93d2e56dfcd768197dc5a50944f2

(11697)

on February 21, 2013
at 06:03 AM

I wouldn't say "it's the diet". I'm doing Paleo for 1.5 years now (VLC too), and my problems remain. Something else is at bay that I haven't discovered yet.

E253f8ac1d139bf4d0bfb44debd1db21

on February 21, 2013
at 12:42 AM

"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"

E253f8ac1d139bf4d0bfb44debd1db21

on February 21, 2013
at 12:40 AM

Now you know its the diet and not the gene!

6120c989fd5b69f42a0834b69b87955b

(24553)

on September 06, 2012
at 06:09 AM

http://www.ncbi.nlm.nih.gov/pubmed/19106443 Haven't read more than the abstract yet, but this looks like it might have some good info about chelation therapies.

6120c989fd5b69f42a0834b69b87955b

(24553)

on September 06, 2012
at 05:39 AM

http://www.ncbi.nlm.nih.gov/pubmed/8914687?dopt=AbstractPlus This isn't exactly a well written abstract, but the cilantro treatment of 100mg./day after mercury filling removal in one subject did seem to mobilize the mercury and move it out of the body.

Cbdc8318738324492f2d5918868ce4c9

(1211)

on September 06, 2012
at 01:38 AM

I'm a fan of dairy, too. I tried no starch once for a couple months and was really fatigued and ended up with shingles, even though it seemed I was eating lots of food and fat. I must have been doing something wrong.

7e1433afbb06c318c4d90860d493c49d

(5959)

on September 05, 2012
at 11:57 PM

Added fat varies. I'm not big on food swimming on grease, but I do sometimes put a pat of butter on steak. Also, my salad dressings usually have either olive or red palm oil (exception is when I whisk together finely chopped raw okra and lemon or lime juice into a frothy slime dressing). I'd say added fat, when I do add it, is around 1 or 2 tablespoons.

Cbdc8318738324492f2d5918868ce4c9

(1211)

on September 05, 2012
at 11:12 PM

Thanks for the tips. I have read Dr. Grace's blog ... some interesting theories.

Cbdc8318738324492f2d5918868ce4c9

(1211)

on September 05, 2012
at 11:04 PM

Thanks Alex, roughly how much oil/fat do you add to the meals? TBSPs?

6120c989fd5b69f42a0834b69b87955b

(24553)

on September 05, 2012
at 05:17 PM

...chance of mobilizing it to the brain and organs the same way it would be if that fat was being broken down quickly for fuel aka ketosis. I had read for years that herbs like parsley and cilantro were very valuable for preventing the build up of heavy metals, but there always seems to be someone yelling "false detoxifier" in the comments section after someone writes that. I haven't looked into it enough to know one way or the other. Dr. Grace has a lot of food for thought about ApoE 4 and environmental contaminants: http://drbganimalpharm.blogspot.com/search/label/Apo%20E4%2F4

6120c989fd5b69f42a0834b69b87955b

(24553)

on September 05, 2012
at 05:09 PM

One of the things I had been trying on that front is taking NAC, supposedly ApoE 4 folks lack cysteine, and introducing it via supplement can help bind and shuttle it out of the body. Another compelling treatment idea I've heard is to make sure there is enough magnesium in the body to block where heavy metals might settle, and to also bind to the metals and help excrete them. I keep running into suggestions indicating that saunas might be preferential to dieting to remove some the of heavy metals that have settled into body fat because it can supposedly be "sweated out", and there is less...

Cbdc8318738324492f2d5918868ce4c9

(1211)

on September 05, 2012
at 12:32 PM

Happy Now, do you have a good reference for how to remove metals from the body?

7e1433afbb06c318c4d90860d493c49d

(5959)

on September 05, 2012
at 12:11 PM

I start my day with coffee with some local organic pastured heavy cream. Next meal is meat/fish/poultry/eggs, with or without some vegetable. Afternoon snack is berries with a Brown Cow Farm full-fat fruit yogurt. Evening snack is vegan... carrot sticks, salad, hippy, gluten-free seed crackers, etc. Every day I drink a bottle or two of the local lemon/ginger kombucha, and I make my own sauerkraut.

Cbdc8318738324492f2d5918868ce4c9

(1211)

on September 05, 2012
at 12:54 AM

Alex, I remember seeing you posting pretty decent lipids and I'd be interested to see more details on foods you eat ... do you have a public Fitday link you'd be willing to share?

6120c989fd5b69f42a0834b69b87955b

(24553)

on September 04, 2012
at 05:17 PM

Just lowering carbs didn't really seem to change my triglyceride level much on its own or help with my own insulin resistance either, although my thyroid and blood sugar liked it. I had to add things to help my liver like milk thistle and NAC (N-acetyl-cysteine) for 6 months to really make progress with it. And then there was improvement without much more tweaking to my own diet other than upping pastured lamb, and limiting bacon, poultry (except liver) and olive oil (because of concerns of counterfeit oils being mixed in and throwing off my omega 3:6 ratio).

3eca93d2e56dfcd768197dc5a50944f2

(11697)

on September 03, 2012
at 09:21 PM

You're mistaken. The number I gave was for my triglycerides, not cholesterol. Triglycerides ARE attributable to APoE4.

121a16aded2bed8dca492d3c9662ef4c

(1327)

on September 03, 2012
at 08:42 PM

I second Harry on this. You write that you "suspect you are 4/4". Guessing about stuff like this -- if it is informing your choices -- is dangerous. The elevation in cholesterol attributable to ApoE4 is limited, and there are many other genetic factors that can elevate cholesterol. That said, I would be still be concerned about a cholesterol level that high. How much do you exercise?

3eca93d2e56dfcd768197dc5a50944f2

(11697)

on September 03, 2012
at 06:10 PM

From what I read, APoE 4/4 goes way back, further than Paleolithic times, at a time where primates were eating mostly veggies, and a few fish maybe. So I'm not convinced that a high fat diet is the way to go, since it didn't work for me (I went to ketosis and my thyroid sent me to hibernation for months). I think I will be trying a mixed diet: raw vegan for most of the day, and normal Paleo for dinner. This way, I could give my body both of what it needs and suggested. Not sure it will work though.

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10 Answers

5
77877f762c40637911396daa19b53094

(78467)

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

(2) 23andme

3eca93d2e56dfcd768197dc5a50944f2

(11697)

on September 03, 2012
at 06:10 PM

From what I read, APoE 4/4 goes way back, further than Paleolithic times, at a time where primates were eating mostly veggies, and a few fish maybe. So I'm not convinced that a high fat diet is the way to go, since it didn't work for me (I went to ketosis and my thyroid sent me to hibernation for months). I think I will be trying a mixed diet: raw vegan for most of the day, and normal Paleo for dinner. This way, I could give my body both of what it needs and suggested. Not sure it will work though.

3
77877f762c40637911396daa19b53094

(78467)

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.

E253f8ac1d139bf4d0bfb44debd1db21

on February 21, 2013
at 12:42 AM

"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"

3
F5a0ddffcf9ef5beca864050f090a790

(15515)

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.

Love,

VB

1
7e1433afbb06c318c4d90860d493c49d

(5959)

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.

Cbdc8318738324492f2d5918868ce4c9

(1211)

on September 05, 2012
at 12:54 AM

Alex, I remember seeing you posting pretty decent lipids and I'd be interested to see more details on foods you eat ... do you have a public Fitday link you'd be willing to share?

Cbdc8318738324492f2d5918868ce4c9

(1211)

on September 05, 2012
at 11:04 PM

Thanks Alex, roughly how much oil/fat do you add to the meals? TBSPs?

Cbdc8318738324492f2d5918868ce4c9

(1211)

on September 06, 2012
at 01:38 AM

I'm a fan of dairy, too. I tried no starch once for a couple months and was really fatigued and ended up with shingles, even though it seemed I was eating lots of food and fat. I must have been doing something wrong.

7e1433afbb06c318c4d90860d493c49d

(5959)

on September 05, 2012
at 11:57 PM

Added fat varies. I'm not big on food swimming on grease, but I do sometimes put a pat of butter on steak. Also, my salad dressings usually have either olive or red palm oil (exception is when I whisk together finely chopped raw okra and lemon or lime juice into a frothy slime dressing). I'd say added fat, when I do add it, is around 1 or 2 tablespoons.

7e1433afbb06c318c4d90860d493c49d

(5959)

on September 05, 2012
at 12:11 PM

I start my day with coffee with some local organic pastured heavy cream. Next meal is meat/fish/poultry/eggs, with or without some vegetable. Afternoon snack is berries with a Brown Cow Farm full-fat fruit yogurt. Evening snack is vegan... carrot sticks, salad, hippy, gluten-free seed crackers, etc. Every day I drink a bottle or two of the local lemon/ginger kombucha, and I make my own sauerkraut.

1
F0a9dea438e7943fa05da318773e785e

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.

0
167c2d78e3123c1738a3927fd82c047f

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?

Cbdc8318738324492f2d5918868ce4c9

(1211)

on July 07, 2013
at 02:52 PM

Hey Juliegee, how do you know it's the fat and not some other dietary nutrient changes?

B121fdbc1aaa6130f5bda3bf84e3ba2d

(952)

on June 08, 2014
at 10:39 PM

What type of fats do you mostly consume?

0
F2eba204a1b0d10865d89705320c0bd0

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.

0
B121fdbc1aaa6130f5bda3bf84e3ba2d

(952)

on February 25, 2013
at 09:26 AM

I am also APOE 4/4 according to 23andme!

0
Cbdc8318738324492f2d5918868ce4c9

(1211)

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

Conclusion

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.

0
6120c989fd5b69f42a0834b69b87955b

(24553)

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.

Cbdc8318738324492f2d5918868ce4c9

(1211)

on September 05, 2012
at 11:12 PM

Thanks for the tips. I have read Dr. Grace's blog ... some interesting theories.

6120c989fd5b69f42a0834b69b87955b

(24553)

on September 06, 2012
at 05:39 AM

http://www.ncbi.nlm.nih.gov/pubmed/8914687?dopt=AbstractPlus This isn't exactly a well written abstract, but the cilantro treatment of 100mg./day after mercury filling removal in one subject did seem to mobilize the mercury and move it out of the body.

6120c989fd5b69f42a0834b69b87955b

(24553)

on September 06, 2012
at 06:09 AM

http://www.ncbi.nlm.nih.gov/pubmed/19106443 Haven't read more than the abstract yet, but this looks like it might have some good info about chelation therapies.

Cbdc8318738324492f2d5918868ce4c9

(1211)

on September 05, 2012
at 12:32 PM

Happy Now, do you have a good reference for how to remove metals from the body?

6120c989fd5b69f42a0834b69b87955b

(24553)

on September 05, 2012
at 05:09 PM

One of the things I had been trying on that front is taking NAC, supposedly ApoE 4 folks lack cysteine, and introducing it via supplement can help bind and shuttle it out of the body. Another compelling treatment idea I've heard is to make sure there is enough magnesium in the body to block where heavy metals might settle, and to also bind to the metals and help excrete them. I keep running into suggestions indicating that saunas might be preferential to dieting to remove some the of heavy metals that have settled into body fat because it can supposedly be "sweated out", and there is less...

6120c989fd5b69f42a0834b69b87955b

(24553)

on September 05, 2012
at 05:17 PM

...chance of mobilizing it to the brain and organs the same way it would be if that fat was being broken down quickly for fuel aka ketosis. I had read for years that herbs like parsley and cilantro were very valuable for preventing the build up of heavy metals, but there always seems to be someone yelling "false detoxifier" in the comments section after someone writes that. I haven't looked into it enough to know one way or the other. Dr. Grace has a lot of food for thought about ApoE 4 and environmental contaminants: http://drbganimalpharm.blogspot.com/search/label/Apo%20E4%2F4

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