George &
wife Gundry call 7/9/15 {edit 9 other consults with
Gundry with transcripts and labs are linked
here.}
Test Results uploaded in the next few posts.
To set the stage, my
wife & I are basically healthy (BP excellent, no metabolic issues), so our primary focus is mitigating our E4 heart and dementia risk (me 3/4 her 4/4).
Gundry picks up on this quickly. He treats many with much more severe issues. (
Gundry considers himself in the longevity business).
Quick summary :
1. Want to eat to minimize
sdLDL which can oxidize easily (he doesn’t worry about LDL-P). Animal fats oxidize easily will do this (shellfish and Omega 3 or pastured Eggs are OK, as are fish), so minimize animal fats. Coconut oil will spike LDL-P, but that is OK as won’t spike
sdLDL. Shellfish will also help sweep away oxidized LDL, so eat as often as possible. Likewise, polyphenols will help sweep away oxidized cholesterol, so consume a lot. Unfiltered extra virgin olive oil is a great source of polyphenols.
2. Lectins (if sensitive and have adiponectin >16) can create inflammation – bad for both heart and brain, so minimize as much as possible.
3. Want to minimize IGF-1 (insulin like growth factor 1). Best way to do this is to minimize sugars, starches and animal protein. The issue with animal protein (including shellfish and eggs) is methionine, leucine and iso leucine. Glycine can help deal with methionine. TMG (Trimethylglycine) is best source.
4. Want at least 1000 mg/day of DHA. Niacinimide (2x500 mg/day) is best supplement for E4’s for brain health.
Call notes:
Taken care of lots of 3/4’s, 4/4’s & 2/4’s. Has 85 year old o male 4/4 patient who drives a fair distance to see him.
Wife says he’s beginning to forget things.
Gundry tells him, “if you’re 85, 4/4 and all your
wife says is you are beginning to forget things, we’ve won this battle.”
Been looking at ApoE4 for 15 years. Managed lots of people with this as about 30% are carriers. Calls it the frailty gene instead of the AD gene. People with this gene more aggressively oxidize cholesterol – more so than normal. Cholesterol not bad for anybody except when it is oxidized. Oxidized cholesterol likes to stick to things more aggressively. Want to keep the types of cholesterol particles that like to oxidize as low as possible.
• Rule #1, animal fats (inclusive of beef, dairy, poultry, pork) are not your friend. Even a chicken is not your friend. Doesn’t mean you can’t have them, but want 4’s to think of animal protein ias a garnish to the food you eat (e.g. Asian stir fry).
• Olive oil is your best friend. The polyphenols in olive oil binds to oxidized cholesterol. “Only purpose of food is to bring olive oil into your mouth.” New research from Spain. Three groups of people > 65. All on Mediterranean Diet. First group had 1 liter of olive oil/week (he and his
wife together go through 1.5 l/week). Second group put on caloric equivalent amount of walnuts. Third group on low fat Med. Diet. At end of six years only olive oil and walnut groups had preserved memory. Low fat group deteriorated memory. Unfiltered EVOO best. Unfiltered has all the particles that bind to oxidized cholesterol. Did not have favorite brand. Always want to use the olive oil the year following the year it was pressed. Most European olive oil pressed in the Oct-Dec time frame. Now should be using 2014 pressing. All labels have two year expiration date, so want to subtract 1 year from the expiration date and use before that time.
• Shellfish are incredibly good for you. They have plant sterols that lower your absorption of cholesterol. Want 4’s to eat wild shrimp (not farmed – don’t go near farm raised he says), crab, lobster any time they can. Farmed muscles, scallops, clams are OK as they are not fed anything.
• Niacinimide is also your friend. E4 rats given niacinimide will not develop dementia. In some studies dementia reversed when given niacinimide. Can be labeled “no flush” however most “no flush is inositol hexanicotinate which you do NOT want. Some female patients can get flush or itching so start with 500mg and go to 1000 mg/day.
Wife has Factor V Leiden Arg/Gin clotting risk. Should move around on long trips and take baby aspirin whenever traveling.
Wife has 1/2 MTHFR mutation (C677T C/T, A1298C A/C). Her homocystene is fine. So take 1000 mcg methyl folate supplement/day. These mutations (especially double) can lead to anxiety, bipolar, suicide, depression, ADHD, drug abuse. If you give them methyl folate, most will get a whole lot better.
Desmosterol – both are hyper manufactures of cholesterol
Sterol absorption – both are hyper absorbers – so should not take plant sterols to lower cholesterol, can be detrimental.
Wife has lot of estradiol for being in menopause. Ovaries making a lot of estrogen given high level of FSH.
Insulin like Growth Factor 1 – super old people (100+) who are doing well, run 50-70 ng/mL. We have normal numbers (118 – me, 129 –
wife). Good starting point. Best way to lower this is less sugars and starches, also less animal protein (including fish and shellfish). Talks about this in part 3 of his first book. Methionine (very prevalent in animal proteins, poorly expressed in plant proteins), leucine and iso leucine (later two big in milk and whey products) activate cellular aging switches. Absence of them shuts down cellular aging switches. Glycine blocks mTor from being affected by methionine. TMG (Trimethylglycine) best way to take glycine. He takes 750 mg, 2x/day.
I have low testosterone (276 ng/dL). Make huge amount of sex hormone binding globulin (119 nnol/L), so free testosterone is very low (2.05 ng/dL). Have a lot of “room to play” with DHEA so he suggests take 25 mg DHEA/day. Also ginko biloba (125x2 mg/day) as it is an aromatase inhibitor. Blocks turning DHEA into estrogen.
Omega 3 Index – measures EPA/DHA over last two months in system. Vegan
wife is very low (2.8). ApoE4’s should be at 10-12. Want most DHA/capsule you can afford. Need to watch serving size – some times put two instead of one. Starting goal 1000mg DHA/day. He likes Kirkland Fish Oil Enteric Coated – can buy on Amazon (blue label) – other Kirkland lablelable is yellow & not great. It has 274 mg/capsule so take 4/day.
Says ignore page 1 of HDL report , “designed so we have to put you on a statin drug to get the numbers in the green.” “No evidence ApoE4’s benefit from statin drugs. Seem logical we would but no evidence we do.”
Singulex p2 – Adiponectin. (me – 35.8,
wife – 27.6). Framingham study, skinny women had high rate of AD. Uses elevated adiponectin as a marker for those who are sensitive to lectins. People with adiponectin >16 are sensitive. In his paper,
http://circ.ahajournals.org/content/129/Suppl_1/AP354 shows that if you take lectins away from these people, then inflammation markers like TNF-alpha are OK. If you reintroduce lectins, then the TNF-alpha spikes (his next book, due out right after 1st of the year is all about this). We are both sensitive to lectins. His “Matrix” protocol is the way to reduce lectins (and therefore TNF-alpha – want <3). I’m 2.7, however my PLAC test (or LpPla2), is elevated at 217. Indication blood vessels are “sticky.” Sees this elevated in people who are lectin sensitive as well. Get lectins away, it goes down to normal. Less we eat lectins, the better. Lectins can’t be destroyed by cooking or heating. Fermentation does destroy lectins to a certain extent. Pressure cooking does a decent job of destroying lectins.
http://www.drgundry.com/articles/Lectins/
Asked about why asparagus is not on the list. Said some sites say it has a nasty lectin, others say no and it does have an interesting resistant starch that gut bugs love. Used to have it on list with a question mark and took it off as he got tired of explaining it. Thinks it is safe however, if we were perfect in every other way and were still spiking TNF-alpha or PLAC, he’d say to drop it.
All rest of our inflammation markers are in good shape. I do not have a MTHFR mutation yet my homocysteine is 14. I’d stopped all B vitamins 10 months before because serum B-12 was 1600 (at the time homocysteine was ~7). He said restart and he was ok with B-12 over 2000. TMG will also help here as a methyl donor. This is where TMG got started. He would like homocysteine under 10. I mentioned Bredesen wanted 6 and he said this will be hard because of the niacinimide. Says he’d rather have the niacinimide protecting the brain than worrying about a little homocycteine. Also I was taking 1g/day of Slo-Niacin and niacin interrupts the homocysteine degredation pathway. Some people will really bottom out testosterone in susceptible people. Doesn’t think that niacin is the beneficial chemical for E4’s, it is the niacinimide. Fits into the NADH pathway – probably how neurons use fuel. Also interrupts cancer dividing pathway.
Small dense LDL’s are the ones that oxidize (
sdLDL on the test, me – 24,
wife -31). Objective
sdLDL <30 and as far below 30 as possible. Says reason
wife is a little high is because her triglycerides (Tg’s) are a little high for his taste (78mg/dL). Want between 40 & 50 mg/dL. Tg’s moved around body with LDL. He says Tg’s look back 3-4 days. Experience with fasting animals is that fasting will mobilize Tg’s out of fat stores. So fasting longer than 12 hours is not useful in understanding how you are doing with Tg’s. Says Tg’s and HDL’s are inversely related, so reducing Tg’s will increase HDL’s. Also says minimizing sugars and starches is the best way to reduce Tg’s. Also said I wasn’t expressing
sdLDL.
http://circ.ahajournals.org/cgi/content ... acts/AP169 He does want Tg/HDL <1 (in mg/dL units).
Wife’s A1C is 5.0 – great number. Doesn’t see need to try hard to get below 5, though he says he has people who try. Says my 5.3 may have been impacted by the niacin.
My free T3 & T4 are OK. TSH is too high. Suggest increasing intake of iodine to 500 mcg/day or eating seaweed, chlorella or iodized sea salt.
My elevated cortisol level. Use Relora as a supplement to reduce cortisol. 250mg 3x/day is standard dose but he typically suggests 2x/day. Relora also blocks the mammalian target of rapamycin (mTor). Helps sleep, too. Got into it as a sleep promoter. Amazing promoter of sleep.
Cystatin C is high tech way of testing kidney function. He says will supplant BUN & creatinine in the future.….
More we stay away from animal protein and fats, the better. “What can we get away with and keep
sdLDL nice and low.” “What can I eat and keep my inflammation or sticky markers normal (i.e. lectin avoidance).” Niacinimide 2x/day 500 mg. Both start with one at night to minimize issues, then increase.
Like Grape Seed Extract, take at least 100 mg/day.
Also French Maritime Tree Bark aka pychnogenol 25 mg/day. Says Trader Joe’s has lowest price.
I asked about hormesis and intermittent fasting (IF). Says IF a very good way of lowering insulin like growth factor 1 (IGF-1). Study said IGF-1 not lowered by calorie restriction but was lowered by animal protein restriction. Probably why Seventh Day Adventists do well in longevity. Not a huge fan of multi-day fasts. More you rest your gut & don’t eat for an extended period of time & he thinks 22 hours a day is an extended period of time. Now know that gut bugs only go through the wall when digestion is actually happening (he has said he eats 1x/day from Jan – May every year).
Best resistant starches. Okinawans – 80% of their diet blue sweet potato. Does cooking plantains destroy resistant starch - answer no. Jicama is great – uses them for dipping guacamole (without tomato in guac). Likes peeled tiger nuts – a south African tuber. Taro root. Also yuca fries. Should cut into fries, the boil first, let dry, then put in olive or coconut oil, then bake.
Asked about coconut oil raising my LDL-P off the wall. Said, yes they will do it but don’t worry about it ‘cause won’t effect slLDL. Says there is an East Coast faction (uses LDL-P to scare everyone onto a statin) on cholesterol and a West Coast faction (trained by Berkely Heart Labs). West Coast guys think using high dose statins to drive LDL-P<1000 is crazy.
He asks us to do a 6 month follow up. This also indicates we are basically in pretty good shape. His standard follow-up is 3 months.
Also see Russ’
Gundry report:
https://www.apoe4.info/forums/viewtopic ... dldl#p8504 and tests:
https://www.apoe4.info/forums/viewtopic ... ulex#p8972
This is a summary of a lot of
Gundry links. Also the whole thread is good. There are more podcast links in the thread and you can search on
Gundry podcast for more in other threads:
https://www.apoe4.info/forums/viewtopic ... t=50#p5592
His latest “Matrix Diet” is attached. Again this is generic. For E’4s you’d minimize all things animal – beef, poultry & dairy (even “A2” dairy & goat), but shell & white fish plus omega3 or pastured (best) eggs are OK. Everything in the fish column bolded is OK.
We do plan to follow up in six months.
Gundry is very data driven – individual prescriptions based on his extensive testing. Wants to minimize
sdLDL, IFG-1 and inflammatory markers. Though
Gundry is not a fan of repeat coronary calcium testing. We do plan on repeat EBT tests, though not sure a what interval as per this thread (our recent tests showed low risk but some calcium me-17,
wife – 3):
https://www.apoe4.info/forums/viewtopic ... ium#p14806
Here is the most recent version of his “Matrix” diet, including lectins to avoid:
Matrix051315 E4 mods.pdf
Here is a link to his first book (second, focusing on lectins & inflammation due out Dec 2016):
http://www.amazon.com/Dr-Gundrys-Diet-E ... 0307352129 The "Matrix" can be considered an extension of the third phase diet in the first book. He has said the food list in the book was a compromise with his publisher vs. what he actually used on his patients.
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