Dr. Steven Gundry with diet recommendations for ApoE4

[Tincup]

Attrached are the details of Dr. Gundry's latest diet guidelines (for everyone, not just E4's) https://www.apoe4.info/forums/download/file.php?id=280. They were posted on a FB page devoted to his program, Dr. Gundry's Diet Evolution https://www.facebook.com/groups/drgundrysdietevolution/. I communicated with a woman whose husband is E3,E4 and they'd been to seen Gundry. His program for E4's basically excluded all animal fat with the exception of very occasional grass fed beef. It encouraged shellfish, whitefish halibut & sardines. It excludes dairy except whey protein and non-fat yoghurt and cottage cheese from A2 cows. 2g/day fish oil supps. Other supps included baby aspirin, folate or folic acid 600 mcg with DHA, grape seed extract (2) 100 mg/day, magnesium 500 mg/day, B 100, pycenogenol 50 mg/day, 5,000 IU/day D-3.

Here is an interview with Gundry & Jimmy Moore. He talks about E4's starting around 28:30 min http://www.askthelowcarbexperts.com/201 ... od-vs-bad/

Gundry also published on niacin, on why... while lowering cholesterol, it raises the level of LP PLA2, an inflammation marker http://circ.ahajournals.org/cgi/content ... cts/A16318

Another Gundry paper: http://atvb.ahajournals.org/cgi/content ... racts/A310

Lastly: Gundry's approach results in a huge risk reduction (without regard to ApoE status)

"Coronary Artery Disease (CAD) is thought to be progressive; standard treatment protocols call for instituting/instructing a low fat/low cholesterol diet program, exercise, and lipid lowering agents in an effort to slow the onset of recurrent MI’s, stents, CABG’s, stroke, or death. This results in an approximate 30-40% new event rate in 5 yrs."

" Pts have been followed for 1.5 to 10 years (mean 8 yrs). While enrolled, only 6/925 pts (0.6%) have received a new stent, two that were predicted by a rising Lp-PLA2, despite an HDL’s of 110-120 mg/dl. There have been no MI’s, CABG’s, unstable angina, or deaths. One pt underwent carotid endarterectomy for known carotid stenosis; one pt suffered a CVA while in atrial fibrillation. Total CV events over 5 years is 8/925 (0.9%) " http://circ.ahajournals.org/cgi/content ... acts/AP169

[Julie G]

Welcome, George! Thanks for such an informative post. Many of us are eager to learn Dr. Gundry's recommendations for E4s...while others remain skeptical. It's my understanding that Dr. Gundry works with a lot of E4 patients; hence his plan specifically for our population. I'm curious; are you following his dietary guidelines?

Have you been able to locate non-fat yogurt and cottage cheese from A2 cows? If so, I'd love help with brand names. Do you know anything about Dr. Gundry's recommendations re. eggs for our E4 population?

If you are following Dr. Gundry's protocol, would you mind sharing your lipids with us? Many are struggling with higher lipids when adding more dietary fat. I'm wondering if following this specific protocol will improve standard & advanced lipids or if Dr. Gundry has a different set of expectations for our population? Thanks in advance for any further information you can provide.

Ski & others, I appreciate your skepticism and welcome it. IMO, we MUST be cautious. Without sounding too dramatic, our very lives are at stake. How we react to any diet is very much an N=1 proposition. As someone who's loosely followed, Dr. Grundy's protocol (without being aware if it ) and responded WELL, I'm eager to learn more to better protect myself from CAD.

[Russ]

George, Thanks. Good stuff. Especially like the outcome-based data he's accumulating. I'm always pretty skeptical of markers, as bottom line health outcomes seem the best thing to track. Based on what you know, would welcome your further input on our 'questions for Dr. Gundry' thread.

[Tincup]

Julie,

I'm new at knowing I'm an E3/4, just found out around 15 July. I am now following Gundry's diet. But not long enough to report anything. My contact did say her husband could have up to 4 omega 3 eggs/day.

I've been LCHF for 5+ years. Prior to that ate an Ornish type vegan diet HCLF. I'd not had any lipid testing since '07. As a vegan, my lipids were always stellar - TC ~ 150, HDL 45-50, LDL <100, Trigs 40's. Pulled an NMR at the beginning of June and it wasn't pretty. I also got a CIMT in mid-June. Showed some plaque 20-30% on one side 10-20% on the other, some soft. This got my attention and I started pulling other tests. None of these are on Gundry's program.

3 June
NON-NMR
TOT C 226
Trig 98
HDL 52
LDL 154
NMR
LDL-P 1725
LDL-C 158
HDL-C 46
Trig-105
TOT C - 225
HDL-P 30.8
Small LDL-P 609
LDL Size 21.7
LP-IR 32
LP LPA2 - 218

Here is a test as of 2 July
Myeloperoxidase - 218
Homocysteine - 7.4 u mole/L
Fibrinogen Activity - 255 mg/dL
Fasting glucose - 89 mg/dL
Fasting Insulin - 3.4 uIU/mL
HOMA IR - 0.74 (my calculation)
Triglycerides - 72 mg/dL
HDL - 49 mg/dL
VLDL - 14
LDL - 145
A1C - 5.4 vs 5.6
BUN - 22
Creatinine - 1.17
Uric acid - 4.4
HS CRP - 0.2

9 July
LDL-P 2023
LDL-C 125
HDL-C 41
Trig-143
TOT C - 195
HDL-P 30.9
Small LDL-P 741
LDL Size 21.2
LP-IR 62
Lp(a) 53
Lp-LPA2 227
Serum Leptin 1.1

So I purchased a CardioChek device for home testing. It has been interesting. It separately tests TOT C, HDL, Trig. I figure that Trig are the most important out of a std test, so got a lot more of those strips.

In any case, my first reaction to finding out I was E3,4 was to "double down" on austerity. I'd been eating 1x day and prior to getting the E4 test results had been typical LCHF with grass fed beef. I dropped the beef, was cooking for my vegan girlfriend and basically taking in very little protein or carbs. Not a lot of anything. Tested with my home device (morning/fasting) and got TC 245 Trig 168 HDL 44 LDL (calc) 167, Glucose 79, then I hypothesized I was pulling fat out of storage due to low intake. So I had breakfast of whey powder, MCT oil & blueberries, lunch of oysters, then more whey powder, MCT & blueberries plus a LC vegan meal for dinner. Retested the next morning. TC 162 Trig 93 HDL 45 LDL 99 Glucose 85. I've also been trying Kiefer's "Carb Nite" carb cycling program, where once a week, I spike it. Last Saturday night, went to the Indian/Nepalese rest. with buffet. Stayed veg, but did a good job spiking - white rice, various dishes with potatoes, sweet potatoes & even bananas. The morning after - glucose - 70, TC 159, HDL 61, Trig <50 (off scale low for meter) and LDL 88. So the carb spike produced the best results yet. I know better than to eat that way all the time. However Dr. Rocky Patel (E3,3) showed documented reversal on the CIMT while following this program and showing very high LDL-P http://azsunfm.blogspot.com/2012/09/fon ... amily.html

My near term goal is to eat to consistently keep the Trigs low and then retest. I will probably go see Gundry. My local doc is a LC/HF guy but he doesn't have specific E4 advice other than "you have caveman genes so eat like a caveman."

I have learned that lipids are a flux and vary quickly and dynamically in response to input (or lack thereof).

[Sandraz]

Hi.
I guess this is a good place to discourage trusting cardiochek machine. I had been testing and changing diet and trusting results from cardiochek that I was doing the right thing for lipids. Morning of NMR, i did test with cardiochek. Trigs, HDL, TC, calculated LDL.the cardiochek was so far off I was devastated. The NMR showed my TC 80 points higher than the cardiochek!
cardiochek showed these results:

TC 223
HDL 51
LDL 143
Trig 77

NMR showed
TC 299
HDL 64
LDL 205
Trig 87

So for now I am doing NMR instead of home testing with cardiochek.

[Ski]

Sandra
Thats what prevented me from purchasing the Cariocheck as the reviews were not very good.I hope you will post your review about it so that others dont get duped.

George, thats numbers like many have here as well and that Im interested in hearing Dr Gundry;s advice on.
A question would be similar to "okay If I follow your dietary advice and I have very high LDL-P's", whats your recommendation. If you read Peter Attia's in-depth explanation about how important LDL-P is I don't think hes had an answer to the few cases where there has been folks with high numbers but no CVD evidence.

[Julie G]

Sandra, I was hoping you'd chime in with your CardioChek experience. It's very generous of you to share that information in order to protect us all. Thank you.

George & Sandra, feel free to add your lipids to our biomarker spreadsheet. We are collecting data and trying to correlate it with diet. We're going to have to think of a way to offer more space for diet information than we currently have on our spreadsheet- given the growing amount of evidence that diet details may be important... Members regularly add new test results as they gather them. I've found it a good way to track my own progress. https://wiki.apoe4.info/wiki/index.php?title=Biomarkers

[Tincup]

Thanks Sandra!

By the way, in this interview, Dr. William Davis talks about his strategy for ApoE4 starting a little after 22 min http://www.thelivinlowcarbshow.com/show ... iam-davis/ Essentially his metric is small LDL's on an NMR test. He'd like them under 200 and preferentially 0. He says reduce carbs to very low and see what happens, then reduce fat. He doesn't seem to differentiate between animal/veg fat as Gundry does.

[Julie G]

George, you are a fount of information; I can't thank you enough. That interview with Dr. Davis was incredibly informative. I highly recommend it-in it's entirety- for all E4s and for anyone with Lp(a) problems.

Dr. Davis beautifully ties evolution to both genetic issues and arrives at the conclusion that deprivation is the answer. He also thinks that those with high LDL-Ps on LCHF diets also have an unidentified genetic predisposition as being "thrifty" consumers and can also benefit from CR/IF. So many of these top docs: Gundry, Perlmutter, Davis are ALL emphasizing the importance of eating less and less often.

This is an excellent primer for anyone new to advanced lipids and even for those those who have advanced knowledge. He goes into detail with regard to biomarkers that matter for us-even if you can't get advanced lipids done.

My guess is that the "answer" for E4s is going to lie somewhere between Drs.Gundry & Davis's recommendations. I found his message very uplifting. We do NOT have problem genes if we eat/live correctly.

[Tincup]

Juliegee,

One reason I give Gundry credence, that he:

a) routinely tests for ApoE status, along with a few other genetic markers
b) has a mechanism for tracking the status of patients
c) analyzes or has somebody analyze the data

See some of the links in my post here https://www.apoe4.info/forums/viewtopic ... t=50#p5592
Especially the ones on niacin, endolethial function and CV events in patients on his program. In the latter, 0.9% 5 year rate is impressive. So if he says he has good results with 4's, he most likely has data to back his assertions. The 0.9% report followed 925 patients for a mean of 8 years. That is a decent cohort.

This report from Dr. Davis on D3 & K2 and aortic valve calcification is also impressive http://www.cureality.com/blog/post/2011 ... sease.html When I read http://www.amazon.com/Vitamin-K2-Calciu ... 0062320041 she makes the point that A and D aren't toxic in the presence of sufficient K2, there is no upper limit on K2 intake and A is important as it helps "deconstruct" calcification were it is not supposed to be.