High energy expenditure and APOE 4

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Nebo
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Re: High energy expenditure and APOE 4

Post by Nebo »

TheresaB wrote:
Nebo wrote:Interesting. This is new to me, are there case reports or any reading on this?
I guess my best advice is to actually understand insulin resistance, (which even most doctors don't) and insulin resistance is more than HbA1c, fasting glucose and fasting insulin, then it can become evident. Some places to go to there: Dr Jason Fung, Dr Joseph Kraft, and Ivor Cummins have explained insulin resistance many times.
I'm not a fan of Fung. I know many people enjoy him and I did at one point but when he started selling "fasting tea" I just couldn't any more. Kraft though I learned a lot from though I wish I could model it in my scenario of T1DM and I wish his test was more commonly administered.

To be sure, are we defining metabolic health the same IE:

Blood pressure
Fasting BGL
Height:waist ratio and/or BMI
Fasting trigs
HDL
?

Reason I ask is I watching videos, like one with Dr. Bruckner (thank you for introducing me to him!) I wouldn't define him as metabolically healthy when he switched to LCHF. That said, you could make the case around for what causes what. Personally I'm in the camp that hyper-caloric intake drives IR which drives obesity and then you get in a bit of a feedback loop. The loop part I'm not 100% sold on. Since I do know, down to the units, how much insulin I take per day it doesn't feel like it's any one variable IE carbs driving anything. If anything, saturated fat kills insulin sensitivity most.
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Re: High energy expenditure and APOE 4

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Josh C wrote:Having scoured the webs, and just recently finished Dr bredesden's book. I find there to be a lack of separation as to who this advice actually applies too!! ...Also the protein recommendations seem to be very low for somebody who is building/repairing tissue at a higher rate than the average being. The protein recommendations themselves are enough to turn heads, with a lack of solid evidence to support such low amounts.

It seems like the protocol is suited towards those who have sedentary lifestyles, with no regards to the Pro/Recreational athletes among us. The physiology of a highly active person is quite different to that of a sedentary being, who has to force themselves to move due to their workplace environment. And I'm just curious as if there is any research on highly active individuals who carry one or two of the APOE4 gene?
Josh, where did you land with this? I'm a competitive age grouper marathoner who carries one apoe4, noticing some cognitive slow down at age 35 likely related as well to having young kids and sub-optimal nutrition.

I am thinking of doing a heavy 80/20 training with mostly slow running and low carb days + fueling with greenish banana, sweet potatoes etc for higher intensity days, and then still taking my gels for goal races. Experiment of 1. I know for the top end of performance few follow Noakes; carbs are proven to help/be most effective, but I am not a top-end performer so trying to find the balance.
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Re: High energy expenditure and APOE 4

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Hello! I'm trying to revive this thread as I have just found out my 4/4 status and am quite new to this group. I too am an endurance athlete (54 yo female), bicycling 150-200 miles/week in the summer and running and weight training during the Chicago winters. When I found out my APOE status a few weeks ago, I immediately changed my diet to low carb and I dropped 15 lbs. For the first 2 weeks, I found long rides (50+ miles) to be difficult as I was used to fueling with carbs before or during a ride. Now 6 weeks later, I seem to be ok without the carbs. I don't race but I'd just like to be able to keep up with my cycling club. It's the fueling during rides that is difficult. I can't exactly pop a piece of salmon out of my jersey pocket when everyone else is eating a gel! Lol. I will look into all the resources mentioned in this thread and I appreciate the insight. Please keep sharing. Thanks.
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Re: High energy expenditure and APOE 4

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Shariross wrote: Mon Jul 24, 2023 1:39 pm Hello! I'm trying to revive this thread as I have just found out my 4/4 status and am quite new to this group. I too am an endurance athlete (54 yo female), bicycling 150-200 miles/week in the summer and running and weight training during the Chicago winters. When I found out my APOE status a few weeks ago, I immediately changed my diet to low carb and I dropped 15 lbs. For the first 2 weeks, I found long rides (50+ miles) to be difficult as I was used to fueling with carbs before or during a ride. Now 6 weeks later, I seem to be ok without the carbs. I don't race but I'd just like to be able to keep up with my cycling club. It's the fueling during rides that is difficult. I can't exactly pop a piece of salmon out of my jersey pocket when everyone else is eating a gel! Lol. I will look into all the resources mentioned in this thread and I appreciate the insight. Please keep sharing. Thanks.
Welcome Shari. I too hope to revive the thread. I proceeded with a normal higher carb diet the last training cycle. I find I am carrying more weight and still experiencing some brain fog.

Interested to hear about your experience with 2 weeks of low carbs. How low did you go?

If you look up MAF training (Phil maffetone) you might find more about low carb for endurance.
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Re: High energy expenditure and APOE 4

Post by KathleenC »

Tincup wrote: Mon Mar 22, 2021 8:13 pm
Josh C wrote: It seems like the protocol is suited towards those who have sedentary lifestyles, with no regards to the Pro/Recreational athletes among us. The physiology of a highly active person is quite different to that of a sedentary being, who has to force themselves to move due to their workplace environment. And I'm just curious as if there is any research on highly active individuals who carry one or two of the APOE4 gene?
I think the bottom line is to remain insulin sensitive. Exercise and activity can certainly help, but aren't a guarantee. This Peter Attia interview with Gerald Shulman, M.D., Ph.D.: is "a masterclass on insulin resistance." Likewise in this interview with Iñigo San Milán PhD, San Milán studies very high end athletes at the University of Colorado Health Sciences as well as T2 diabetics. He is also the head coach of this year's Tour de France winner. Likewise, he has studied the Team Novo Nordisk, whose members are professional bicycle racers and T1 diabetics. He says the professional bike racers are the most insulin sensitive people. They can consume mass quantities of simple carbohydrates with no negative metabolic effect. What San Milán has learned is that when people do a lot of Zone 2 exercise (defined as a serum lactate level of 2.0), their mitochondrial density can increase up to 4 fold. Additionally, their mitochondria grow larger in size. Ideally, these athletes train at least 80% of their time at this level. This is what most would consider mild exercise. Many recreational athletes train harder than this and do not get these adaptations. Ideally, when training at this level, serum glucose, when measured during or immediately after the training should be decreasing. In many recreational athletes, it increases. Tim Noakes, mentioned above, noted in this story that his glucose levels rose sharply with his intense exercise.

Phil Maffetone's heart rate method is a relatively simple way to implement this (Attia interview's him here). Another, even simpler approach is to just breathe through your nose in all activity. This app uses heart rate variability to see if you are in Zone 2.

An anecdote. A friend is a Berber from Morocco. His village is in the foothills of the Atlas mountains, south of Marrakech. His father herded goats. His father walked up and down the steep hillsides with his goats most of the daylight hours, every day. His father was the only sheppard in the family and most others n the family have T2 diabetes. His father is metabolically healthy, in his 80's. The only other goat herder in the village was quite a few years older than his father. He was healthy until he died, late in life.

My takeaway is that if you are moderately active all day, and eat an unprocessed food diet limiting seed oils, especially if the carbs come from starches, you likely will be insulin sensitive. The sheppards were doing Zone 1 & 2 activity most of the days. In my observation, many recreational athletes spend most of their exercise time exercising too intently and they tend to load up on simple carbs (I was in this category at one point). They get into trouble. Go to a road race and observe, many are not metabolically fit, just by visual observation.
Hi Tincup. I think I misunderstood the exercise guidance in the primer. I took the reference to "moderate" intensity daily aerobic exercise to mean that we should work out at a higher level than zone 2. Since finding out about my E4 gene, I have ratcheted up my workouts to keep my heart rate in my zone 4, as measured by my Garmin watch, which is 136-152 bpm. It sounds like I would be better served to bring my daily aerobic exercise heartrate down to the zone 2 level as defined by Peter Attia, is that correct? Since changing my diet and exercise routine I'm having a really hard time maintaining my weight so I want to get this right. Thanks so much in advance for your help.
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Re: High energy expenditure and APOE 4

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emdurance wrote: Mon Jul 24, 2023 1:45 pm
Shariross wrote: Mon Jul 24, 2023 1:39 pm Hello! I'm trying to revive this thread as I have just found out my 4/4 status and am quite new to this group. I too am an endurance athlete (54 yo female), bicycling 150-200 miles/week in the summer and running and weight training during the Chicago winters. When I found out my APOE status a few weeks ago, I immediately changed my diet to low carb and I dropped 15 lbs. For the first 2 weeks, I found long rides (50+ miles) to be difficult as I was used to fueling with carbs before or during a ride. Now 6 weeks later, I seem to be ok without the carbs. I don't race but I'd just like to be able to keep up with my cycling club. It's the fueling during rides that is difficult. I can't exactly pop a piece of salmon out of my jersey pocket when everyone else is eating a gel! Lol. I will look into all the resources mentioned in this thread and I appreciate the insight. Please keep sharing. Thanks.
Welcome Shari. I too hope to revive the thread. I proceeded with a normal higher carb diet the last training cycle. I find I am carrying more weight and still experiencing some brain fog.

Interested to hear about your experience with 2 weeks of low carbs. How low did you go?

If you look up MAF training (Phil maffetone) you might find more about low carb for endurance.
My own experience is that adaptation continues for quite a while. Peter Attia & Iñigo San Millán discus this in episode #201. Iñigo comments that this is why you don't see professional athletes doing this - they can't afford to. Peter noted that ~10+ years ago, he was keto for about 3 years. Initially he'd lost his "top end." Then about 1.5 years in, it came back and they some. He also started bicycle training seriously about that time (the 1.5 years). He was pushing it very hard and said he could eat up to 600 g of carbs/day and maintain serum ketones (beta hydroxybutyrate- BHB) above 2.0 mmol/L. So you might find you could consume some carbs during an outing and maintain ketosis. I keto/fat adapted in 2009 and have maintained it since (meaning I'll test positive for serum BHB on a morning fingerstick. When I first adapted, I did it the Atkins way- 20g carbs max/day. I recall during the first two weeks I was rock climbing and my biceps refused to contract. It got a lot better and I don't pay much attention now. I've done things like skiing hard off pisté at 12,500' five days fasted. Also leading rock climbing outside in the summer sun also five days fasted (I'm now 68). Yesterday, I did an easy 15 minutes of Zone 2 using Heavy Hands hand weights and rucking with a 60# climbing pack. Then I did nine different isometric lifts, holding them for 90 seconds (TSC or Timed Static Contractions). The protocol is to got at 50% effort the first 30 seconds, 70% effort the next 30 and 100% or "as hard as you dare" (so you don't injure yourself) for the last 30. This can be done with a "Forearm Forklift" strap and no tech, but I have two devices that track force that I have set up in series (one that tracks & plots or will export force over time with max & average and one that just tracks max & average). Lastly, on my ~30 year old Schwinn Airdyne fan bike, I did the "Sugar Cane" protocol (from the Huberman/Andy Galpin 6 part series). As much distance (or calories or whatever the device's computer will track for cumulative effort) for 2 minutes; rest 2 minutes, then repeat and see how long it takes to get the same cumulative effort (2 min 10 seconds, in my case); rest 2 minutes and see how much cumulative effort you can get in the time of the 2nd effort, targeting more than you did the first time. So I did a pretty good job of training each energy system. I was probably 14 hours fasted when I started. This is not an atypical day for me. I had no problem with any of the glycolytic strength training or max glycolytic effort on the fan bike.
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Re: High energy expenditure and APOE 4

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KathleenC wrote: Tue Jul 25, 2023 4:22 am Hi Tincup. I think I misunderstood the exercise guidance in the primer. I took the reference to "moderate" intensity daily aerobic exercise to mean that we should work out at a higher level than zone 2. Since finding out about my E4 gene, I have ratcheted up my workouts to keep my heart rate in my zone 4, as measured by my Garmin watch, which is 136-152 bpm. It sounds like I would be better served to bring my daily aerobic exercise heart rate down to the zone 2 level as defined by Peter Attia, is that correct? Since changing my diet and exercise routine I'm having a really hard time maintaining my weight so I want to get this right. Thanks so much in advance for your help.
My understanding is you'd like to do 80% of your exercise at Z2 to "train your mitochondria" If you've not listened, kn this second Attia interview with San Millán, they go into more detail. That doesn't mean no time in Z4 but limited. The author of the Primer, as a 4/4, had a very serious TBI and she exercised herself back to normal and her exercise was pretty intense.

"Since changing my diet and exercise routine I'm having a really hard time maintaining my weight so I want to get this right. " I assume you mean you can gain weight easily? One thing folks can do is overeat fat on keto. In ketoland, it is sometimes assumed that fat is a "free" food. It does have a lower acute insulin response, but if you eat fat it will be used before your body fat will be used. See this article on fuel oxidative priority. Here is also an article on using a glucometer as a fuel gauge. The author of these articles is an engineer with a wife and son who are T1 diabetics. He has used what he has learned from helping them to apply to non T1's. Doing short bouts (say 15 minutes) of Z2 after meals can also take the edge off any glucose spikes. Exercise has a non insulin approach to bringing glucose into the muscles (translocation of GLUT 4 transporters to the edge of the cell). Intense exercise can also raise glucose by stimulating the liver to excrete glycogen. Z2 is the "sweet spot" where intensity is low enough this does not happen, so blood sugar levels tend to gently fall.
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Re: High energy expenditure and APOE 4

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Tincup wrote: Tue Jul 25, 2023 6:18 am
KathleenC wrote: Tue Jul 25, 2023 4:22 am Hi Tincup. I think I misunderstood the exercise guidance in the primer. I took the reference to "moderate" intensity daily aerobic exercise to mean that we should work out at a higher level than zone 2. Since finding out about my E4 gene, I have ratcheted up my workouts to keep my heart rate in my zone 4, as measured by my Garmin watch, which is 136-152 bpm. It sounds like I would be better served to bring my daily aerobic exercise heart rate down to the zone 2 level as defined by Peter Attia, is that correct? Since changing my diet and exercise routine I'm having a really hard time maintaining my weight so I want to get this right. Thanks so much in advance for your help.
My understanding is you'd like to do 80% of your exercise at Z2 to "train your mitochondria" If you've not listened, kn this second Attia interview with San Millán, they go into more detail. That doesn't mean no time in Z4 but limited. The author of the Primer, as a 4/4, had a very serious TBI and she exercised herself back to normal and her exercise was pretty intense.

"Since changing my diet and exercise routine I'm having a really hard time maintaining my weight so I want to get this right. " I assume you mean you can gain weight easily? One thing folks can do is overeat fat on keto. In ketoland, it is sometimes assumed that fat is a "free" food. It does have a lower acute insulin response, but if you eat fat it will be used before your body fat will be used. See this article on fuel oxidative priority. Here is also an article on using a glucometer as a fuel gauge. The author of these articles is an engineer with a wife and son who are T1 diabetics. He has used what he has learned from helping them to apply to non T1's. Doing short bouts (say 15 minutes) of Z2 after meals can also take the edge off any glucose spikes. Exercise has a non insulin approach to bringing glucose into the muscles (translocation of GLUT 4 transporters to the edge of the cell). Intense exercise can also raise glucose by stimulating the liver to excrete glycogen. Z2 is the "sweet spot" where intensity is low enough this does not happen, so blood sugar levels tend to gently fall.
Tincup wrote: Tue Jul 25, 2023 6:18 am
KathleenC wrote: Tue Jul 25, 2023 4:22 am Hi Tincup. I think I misunderstood the exercise guidance in the primer. I took the reference to "moderate" intensity daily aerobic exercise to mean that we should work out at a higher level than zone 2. Since finding out about my E4 gene, I have ratcheted up my workouts to keep my heart rate in my zone 4, as measured by my Garmin watch, which is 136-152 bpm. It sounds like I would be better served to bring my daily aerobic exercise heart rate down to the zone 2 level as defined by Peter Attia, is that correct? Since changing my diet and exercise routine I'm having a really hard time maintaining my weight so I want to get this right. Thanks so much in advance for your help.
My understanding is you'd like to do 80% of your exercise at Z2 to "train your mitochondria" If you've not listened, kn this second Attia interview with San Millán, they go into more detail. That doesn't mean no time in Z4 but limited. The author of the Primer, as a 4/4, had a very serious TBI and she exercised herself back to normal and her exercise was pretty intense.

"Since changing my diet and exercise routine I'm having a really hard time maintaining my weight so I want to get this right. " I assume you mean you can gain weight easily? One thing folks can do is overeat fat on keto. In ketoland, it is sometimes assumed that fat is a "free" food. It does have a lower acute insulin response, but if you eat fat it will be used before your body fat will be used. See this article on fuel oxidative priority. Here is also an article on using a glucometer as a fuel gauge. The author of these articles is an engineer with a wife and son who are T1 diabetics. He has used what he has learned from helping them to apply to non T1's. Doing short bouts (say 15 minutes) of Z2 after meals can also take the edge off any glucose spikes. Exercise has a non insulin approach to bringing glucose into the muscles (translocation of GLUT 4 transporters to the edge of the cell). Intense exercise can also raise glucose by stimulating the liver to excrete glycogen. Z2 is the "sweet spot" where intensity is low enough this does not happen, so blood sugar levels tend to gently fall.
Thanks Tincup. I really appreciate all of your advice and will listen the Attia/San Millan podcast you referenced.

My problem with weight is the opposite. I am 5'6" and have weighed around 123 pounds since college (I'm 59). I lost 5 pounds during a bout of food poisoning while traveling in February, dropping me down to 118. I didn't really think it was a big deal, assuming the weight would return to my setpoint like it always has in the past, but it didn't. Then, I found about my APOE4 status in June and I lost a few more pounds when I changed my diet. I am eating over 150% of my target calories as measured by Cronometer and I simply can't gain any weight. My BMI is 18.7. My carbs right now are at around 50 grams per day and my protein grams are at around 90. I am guzzling high Polyphenol olive oil, eating large amounts of nuts and healthy seeds, etc, with no luck in the weight gain category. I eat in an 8 hour window. I'm leaving for a 3 week trip to overseas today and I know I won't be able to maintain the target diet and exercise. I just hope I don't lose any more weight.
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Re: High energy expenditure and APOE 4

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KathleenC wrote: Tue Jul 25, 2023 8:09 am
My problem with weight is the opposite. I am 5'6" and have weighed around 123 pounds since college (I'm 59). I lost 5 pounds during a bout of food poisoning while traveling in February, dropping me down to 118. I didn't really think it was a big deal, assuming the weight would return to my setpoint like it always has in the past, but it didn't. Then, I found about my APOE4 status in June and I lost a few more pounds when I changed my diet. I am eating over 150% of my target calories as measured by Cronometer and I simply can't gain any weight. My BMI is 18.7. My carbs right now are at around 50 grams per day and my protein grams are at around 90. I am guzzling high Polyphenol olive oil, eating large amounts of nuts and healthy seeds, etc, with no luck in the weight gain category. I eat in an 8 hour window. I'm leaving for a 3 week trip to overseas today and I know I won't be able to maintain the target diet and exercise. I just hope I don't lose any more weight.
More Z2 and less Z4 may help as won't be as calorically demanding. Also, my non medical opinion is that excessive endurance training at higher zones may be catabolic. I'm not saying do zero of this level, but be targeted. San Millán said he will do 5 minutes at the end of his Z2 rides. Likewise, I will do a small amount of higher zones. In my case, training in higher zones may have been my path to afib 19 years ago. After a 2 1/2 month episode in the first 4 months, I've managed to keep my AF burden very low. I found that long duration activity at a Z2 level was not an AF trigger, while long duration activity at higher zones was.

From my understanding, consume your protein in boluses of 30 grams or more (if from animal sources - may need materially more if from veg because of amino acid distribution). This will stimulate muscle protein synthesis. A podcast on this topic is Attia with long time protein researcher, Don Layman. My summary is eat at least 30 g at your first meal and again at your last meal of the day.

Here is from The End of Alzheimer's Program book:

EXCESSIVE WEIGHT LOSS We’ve found that some patients have difficulty maintaining their weight, which can become counterproductive. While body mass index is a rough measure, taking into account only height and weight, there is a lot of room for personalization based upon your body frame and muscle composition. We recommend maintaining a minimum BMI of 18.5 for women and 19.0 for men if under age 65 and higher for those over age 65. If your weight drops beyond that, you are at increased risk of sarcopenia (the loss of lean muscle mass) and osteopenia (the loss of bone), both of which accompany aging and are correlated with an INCREASED risk of cognitive decline. (We’ll talk more about this in chapter 13.) For now, understand that you must adjust your strategies if your weight drops too low. Here are some helpful tips. Strategies for Gaining Weight Consider shortening your fast. Still try to stop eating several hours before bed, but feel free to eat in the morning following the KetoFLEX 12/3 food pyramid. Use more healthy fat! Add an extra tablespoon or two of high polyphenol extra virgin olive oil (EVOO) to your salads and veggies. This is an easy way to add extra calories. Enjoy an extra handful (or two) of nuts. Nuts are extraordinarily healthful and delicious. Freely enjoy. Macadamias and pecans are especially helpful for weight gain.

Add ghee, coconut oil, or MCT to your coffee. This is a simple way to increase calories and induce ketosis. The exogenous ketones from coconut and MCT oil may be especially helpful for those trying to gain weight, as low body fat may prohibit the creation of endogenous ketones. If you develop GI symptoms, consider the use of digestive enzymes. But see the cautions about this in chapter 8. Ensure that you’re getting enough protein in your diet (review the suggestions in chapter 10). Your body cannot synthesize or store the protein it needs for essential body functions. You should include it in your diet, or your body may cannibalize your muscles—not good! While you are healing your digestive system and recovering from toxic exposures, you may have additional protein requirements. Equally important is adequate stomach acid to ensure proper digestion of protein. Be strong. Be sure to concentrate on building strong muscles and bones. Devote a part of your exercise program to strength training and weight-bearing exercise. Don’t forget resistant starches. Add a small amount of cooked and cooled legumes, root vegetables, or tubers at each meal. By using EVOO or ghee as a delicious topping, you’ll both blunt any glycemic response and add extra calories. You can also cycle out of ketosis once or twice per week, with sweet potatoes, for example, to avoid further weight loss. Get involved in meal planning and preparation. Scour recipes to find innovative ways to make your favorite foods to stimulate your appetite. If you’re cooking for someone affected with Alzheimer’s, involve him or her in the meal planning and preparation. Seeing, touching, and smelling the food promotes the secretion of our digestive enzymes and prepares our bodies to eat. Relax while eating. Turn off your TV and your phone. Put away your work. Make mealtime a nurturing and relaxing ritual. Slowly enjoy your food. Linger over a second helping. You’re worth it.

Bredesen, Dale. The End of Alzheimer's Program (pp. 97-99). Penguin Publishing Group. Kindle Edition.

Our own Julie G helped write this book and her BMI is in the 18 range.
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Re: High energy expenditure and APOE 4

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Tincup wrote: Tue Jul 25, 2023 11:05 am
KathleenC wrote: Tue Jul 25, 2023 8:09 am
My problem with weight is the opposite. I am 5'6" and have weighed around 123 pounds since college (I'm 59). I lost 5 pounds during a bout of food poisoning while traveling in February, dropping me down to 118. I didn't really think it was a big deal, assuming the weight would return to my setpoint like it always has in the past, but it didn't. Then, I found about my APOE4 status in June and I lost a few more pounds when I changed my diet. I am eating over 150% of my target calories as measured by Cronometer and I simply can't gain any weight. My BMI is 18.7. My carbs right now are at around 50 grams per day and my protein grams are at around 90. I am guzzling high Polyphenol olive oil, eating large amounts of nuts and healthy seeds, etc, with no luck in the weight gain category. I eat in an 8 hour window. I'm leaving for a 3 week trip to overseas today and I know I won't be able to maintain the target diet and exercise. I just hope I don't lose any more weight.
More Z2 and less Z4 may help as won't be as calorically demanding. Also, my non medical opinion is that excessive endurance training at higher zones may be catabolic. I'm not saying do zero of this level, but be targeted. San Millán said he will do 5 minutes at the end of his Z2 rides. Likewise, I will do a small amount of higher zones. In my case, training in higher zones may have been my path to afib 19 years ago. After a 2 1/2 month episode in the first 4 months, I've managed to keep my AF burden very low. I found that long duration activity at a Z2 level was not an AF trigger, while long duration activity at higher zones was.

From my understanding, consume your protein in boluses of 30 grams or more (if from animal sources - may need materially more if from veg because of amino acid distribution). This will stimulate muscle protein synthesis. A podcast on this topic is Attia with long time protein researcher, Don Layman. My summary is eat at least 30 g at your first meal and again at your last meal of the day.

Here is from The End of Alzheimer's Program book:

EXCESSIVE WEIGHT LOSS We’ve found that some patients have difficulty maintaining their weight, which can become counterproductive. While body mass index is a rough measure, taking into account only height and weight, there is a lot of room for personalization based upon your body frame and muscle composition. We recommend maintaining a minimum BMI of 18.5 for women and 19.0 for men if under age 65 and higher for those over age 65. If your weight drops beyond that, you are at increased risk of sarcopenia (the loss of lean muscle mass) and osteopenia (the loss of bone), both of which accompany aging and are correlated with an INCREASED risk of cognitive decline. (We’ll talk more about this in chapter 13.) For now, understand that you must adjust your strategies if your weight drops too low. Here are some helpful tips. Strategies for Gaining Weight Consider shortening your fast. Still try to stop eating several hours before bed, but feel free to eat in the morning following the KetoFLEX 12/3 food pyramid. Use more healthy fat! Add an extra tablespoon or two of high polyphenol extra virgin olive oil (EVOO) to your salads and veggies. This is an easy way to add extra calories. Enjoy an extra handful (or two) of nuts. Nuts are extraordinarily healthful and delicious. Freely enjoy. Macadamias and pecans are especially helpful for weight gain.

Add ghee, coconut oil, or MCT to your coffee. This is a simple way to increase calories and induce ketosis. The exogenous ketones from coconut and MCT oil may be especially helpful for those trying to gain weight, as low body fat may prohibit the creation of endogenous ketones. If you develop GI symptoms, consider the use of digestive enzymes. But see the cautions about this in chapter 8. Ensure that you’re getting enough protein in your diet (review the suggestions in chapter 10). Your body cannot synthesize or store the protein it needs for essential body functions. You should include it in your diet, or your body may cannibalize your muscles—not good! While you are healing your digestive system and recovering from toxic exposures, you may have additional protein requirements. Equally important is adequate stomach acid to ensure proper digestion of protein. Be strong. Be sure to concentrate on building strong muscles and bones. Devote a part of your exercise program to strength training and weight-bearing exercise. Don’t forget resistant starches. Add a small amount of cooked and cooled legumes, root vegetables, or tubers at each meal. By using EVOO or ghee as a delicious topping, you’ll both blunt any glycemic response and add extra calories. You can also cycle out of ketosis once or twice per week, with sweet potatoes, for example, to avoid further weight loss. Get involved in meal planning and preparation. Scour recipes to find innovative ways to make your favorite foods to stimulate your appetite. If you’re cooking for someone affected with Alzheimer’s, involve him or her in the meal planning and preparation. Seeing, touching, and smelling the food promotes the secretion of our digestive enzymes and prepares our bodies to eat. Relax while eating. Turn off your TV and your phone. Put away your work. Make mealtime a nurturing and relaxing ritual. Slowly enjoy your food. Linger over a second helping. You’re worth it.

Bredesen, Dale. The End of Alzheimer's Program (pp. 97-99). Penguin Publishing Group. Kindle Edition.

Our own Julie G helped write this book and her BMI is in the 18 range.
Thanks so much Tincup. All good suggestions. I'm going to switch to a 12 hour eating window to fit in more meals and fatten up. I won't be able to exercise very much on my trip so hopefully that will also provide an opportunity to gain weight. I'm traveling with 3 pounds of nuts, cans of mackeral, and packets of olive oil. Fingers crossed 🤞.
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