How to adjust keto diet to maximize APOE4 health?

[Maria4/4]

Hi everyone

I am on keto for 2 months and I feel that the diversity of my diet is really poor. This makes me unconfortable. I don't eat things that I use to think were healthy, like apples for instance.

I use to eat a mediterranean diet, basicly the same diet that I have now but I removed all the legumes, whole grains and fruit (beside the berries).

My keto diet

When I wake up I drink a coffee. During the day I drink 2 or 3 decaffeinated because 2 years ago coffee started to deeply impact my sleep quality.

I eat breakfast, usually goat iogurt, keto granola (seeds, nuts and erythritol) and berries. I supplement with psyllium husk fiber and collagen. 1.200kcal.
I decided to eat breakfast instead of dinner for 3 reasons:
1) studies that discovered that protein intake is better absorbed in the morning, and I really need to mantain my muscle mass,
2) when I use to have dinner, it was really difficult to finish eating 3h before bed time,
3) sometimes I use a CGM (continuous glucose monitor) and I noticed that my biggest glucose spikes were at night.

I have lunch more or less 5 hours after breakfast. No snacks in between. I usually eat a big soup with a lot of vegetables (no potato) and a big salad: I love these two, but it's always more or less the same thing. The protein is different every day. I try to eat meat only once or twice per week, eggs twice, fish twice and tofu the other days. I use a lot of olive oil and I drink zero sugar kombucha. 680kcal.

Before these two meals I drink a glass of water with a tbsp of apple vinager. It's a hack that I learned with the Glucose Godess (you can see her posts on instagram). It reduces a lot the glucose spikes. I also eat my lunch in the order she recommends to minimise glucose: first the veggies, then the protein and fat (at the end it use to be the starches, but as I cut them...).

I try to not eat the rest of the day, but sometimes at night I eat a little bit of goat cheese or some nuts or some olives. Usually I'm not hungry, but I just have this desire to eat 300kcal.

So, my macros are 75% of fat, 15% of protein and 10% of carbs. 35g of fiber per day.

With exercise (50 minutes 4 times per week + 40 minutes of fast walking everyday) and fasting, my ketones before my first meal of the day are between 1,1 and 2 (higher when I exercise more), so I was thinking to add to my lunch a very small portion of legumes, gluten-free whole grains or fruit. I know that my ketones will drop a little bit, but I feel this would be more balanced.

I also saw the information below that Susan posted in another thread, and it made so much sense to me. I have several portions of fermented food per day to improve my gut health (goat iogurt, kombucha and apple vinager), but I don't know if I am getting enough fiber and the right kind of fiber.

If I added 50g of whole grain rice, my macros would be 70% of fat, 14% of protein and 16% of carbs. 37g of fiber per day.

What are your thoughts about this? What can be improved? Did you also make some changes to the keto diet? Do you have tips to increase the diversity of my diet? Can you please share your experience with me?

I also would love to reduce my APOB, that is 80 at the moment (APOA/APOB ratio 0,4).

Remember that one of the favorite foods of Bifidobacteria is resistant starch? And that Roseburia also likes to munch on carbohydrates like beta-glucans? Maybe we shouldn’t be surprised that this study showed a significant decrease in these important bacteria among both Paleo groups.

Likewise, the relative abundance of Hungatella was significantly higher among the Paleo subjects. After adjusting for age, gender, stool frequency, and body fat, Hungatella abundance was significantly negatively associated with grain intake among the study’s participants, and was also significantly negatively correlated with Bifidobacteria and Roseburia abundance. Although we don’t have a lot of information about Hungatella in relation to human health (not yet, anyway!), we do know that some species originating from the genus Hungatella are associated with choline consumption and TMA production, including at least one species identified in this study. The researchers speculated that some components of grains and/or whole grains either interfere with Hungatella’s TMA production or prevent it from dominating in the gut. And, these components might not be resistant starch, since neither Hungatella nor TMAO was significantly associated with resistant starch intake!
https://www.thepaleomom.com/paleo-resis ... h-heeding/

Thanks a lot for your help,
Maria 4/4

[SusanJ]

Did you also make some changes to the keto diet?

As per the other thread, I've been tinkering with my diet to add more carbs, heading towards somewhere around 150 grams net carbs per day. In addition to low numbers of certain microbiome strains (that are carb lovers), I also have trouble keeping on weight with keto, even watching total calories. More protein and carbs have helped me fuel my workouts and add a little muscle mass back. Just going slow so as not to spike my blood sugar unnecessarily (and I also find eating carbs last does help manage spikes).

Because I have problems with oxalates, my carb choices are a bit limited. So, I've added winter squash, whole fruit (mostly small amount of apples, pears but smeared with Sunbutter to slow the spike), and some rice/rice products. I tried lentils and chickpeas (low oxalate), but the jury is out whether my body will like them in the long run. I do feel that digestively, I'm doing better with the change.

I also dropped eating coconut yogurt (allergic to all dairy, even goat and sheep), and my last labs showed a drop of about 200 points in LDL-P, and my triglycerides (77) and HDL (83) stayed about the same. It's all a balancing act - my small LDL crept up a bit with more carbs, but not so much to be a problem. You might also look at saturated fats (like your current yogurt) and see if dropping saturated fats some helps with your ApoB numbers.

So, my best advice is to tinker a bit and use some labs to verify what works best for you.

[Maria4/4]

Did you also make some changes to the keto diet?

As per the other thread, I've been tinkering with my diet to add more carbs, heading towards somewhere around 150 grams net carbs per day. In addition to low numbers of certain microbiome strains (that are carb lovers), I also have trouble keeping on weight with keto, even watching total calories. More protein and carbs have helped me fuel my workouts and add a little muscle mass back. Just going slow so as not to spike my blood sugar unnecessarily (and I also find eating carbs last does help manage spikes).

Because I have problems with oxalates, my carb choices are a bit limited. So, I've added winter squash, whole fruit (mostly small amount of apples, pears but smeared with Sunbutter to slow the spike), and some rice/rice products. I tried lentils and chickpeas (low oxalate), but the jury is out whether my body will like them in the long run. I do feel that digestively, I'm doing better with the change.

I also dropped eating coconut yogurt (allergic to all dairy, even goat and sheep), and my last labs showed a drop of about 200 points in LDL-P, and my triglycerides (77) and HDL (83) stayed about the same. It's all a balancing act - my small LDL crept up a bit with more carbs, but not so much to be a problem. You might also look at saturated fats (like your current yogurt) and see if dropping saturated fats some helps with your ApoB numbers.

So, my best advice is to tinker a bit and use some labs to verify what works best for you.

Thank you so much Susan for the excellent tips!

I also have problems keeping my weight with keto, so I will follow your example. My training is really better when I eat some carbs: I can lift more weight and I have more energy, so this change will also help with that .

Regarding the saturated fat, I think you are right, so I removed the cheese that has 25g/100g of saturated fat . The yogurt has only 1g, so I will keep it. I don't eat coconut foods because I really don't like the flavor. I ingest some saturated fat from the organic meat I eat once per week. Let's try this and see the results in two months.

With 150g of net carbs per day, do you easily produce ketones?

[SusanJ]

With 150g of net carbs per day, do you easily produce ketones?

I went back and looked at my last tracking in December. My daily carbs were kinda all over the place, but generally in mornings after a eating in the 50-100 grams range of carbs, my ketones would range over 1, and mornings after eating over 100 grams (max in that period was 145), ketones would trend .5 to .7 first thing in the morning. So, definitely still in mild ketosis.

Think generally you need to track for a few weeks and see where you land. The types of carbs you eat, the time of day you eat them (you're more insulin sensitive in the morning, so it's a good time to eat more carbs then), and your activity level after eating carbs will all have an impact on your readings. So there are lots of variables to tweak and test.

Good luck!

[Maria4/4]

With 150g of net carbs per day, do you easily produce ketones?

I went back and looked at my last tracking in December. My daily carbs were kinda all over the place, but generally in mornings after a eating in the 50-100 grams range of carbs, my ketones would range over 1, and mornings after eating over 100 grams (max in that period was 145), ketones would trend .5 to .7 first thing in the morning. So, definitely still in mild ketosis.

Think generally you need to track for a few weeks and see where you land. The types of carbs you eat, the time of day you eat them (you're more insulin sensitive in the morning, so it's a good time to eat more carbs then), and your activity level after eating carbs will all have an impact on your readings. So there are lots of variables to tweak and test.

Good luck!

Great tips! Thanks again, Susan. So useful!