Blood tests
Blood tests
I was taking a look at the Primer, specifically at the list of the blood tests that E4 carriers should get. Can you order all of those tests through your primary care doctor? Would it cost a lot? How often should I get blood tests?
Re: Blood tests
Those are all valid questions, and the answers are mostly yes. [For those wondering what blood tests are recommended in the Primer by Dr. Stavia, the list is below with a link.] The info here is my own take on this, and others may have very valid reasons for prioritizing or recommending you budget all the tests. At 29, it's unlikely these tests will be alarming at all--and that's why they could be a great baseline to help you feel confident in your health going forward. But some are easier to get than others and probably also more useful.
Your primary doctor should be willing to have their nurse do blood draws for most of these tests, and your insurance should cover most or all of the cost, minus any co-pays. Most doctors would order MOST of these tests as part of an annual physical. Drawing on my own experience as a parent of three wonderful adults, I know that annual physicals aren't always on their to-do list. But having a baseline lets you know if you see anything that you might to ask about with the doctor.
Below are the terms your doctor may use instead of the Primer list, in order of "likely to get easily" to "unlikely to get except online from a lab". References from the Cleveland Clinic and others offer some more info on some.
1. CBC (comprehensive blood count) = letter "I". At your age of 29 it likely to be perfectly normal and a standard part of an annual physical and therefore covered by insurance.
2. Comprehensive metabolic panel (CMP)= letters "f" and "k" for liver and kidney function. It includes glucose, which isn't as specific as fasting glucose or fasting insulin ("a" in the list) but should give you and your doctor a good idea of whether a fasting test is needed. https://my.clevelandclinic.org/health/d ... -panel-cmp
3. Thyroid Panel= letter "e". Most doctors should be willing to order a thyroid panel ("e" below), especially for someone your age who hasn't had it recently.
4. Lipid Panel = letter "b". With ApoE 4/4, it's possible that you have a tendency for high LDL cholesterol. A standard lipid panel won't give you the "advanced LDL-p" (number of LDL particles) or apoB mentioned in b, but should let you know if any numbers are way out of range and might help you tweak y.our diet. Here's why the standard panel is recommended for people starting in their 20's: https://health.clevelandclinic.org/when ... ol-checked
5. Ferritin= letter "j". Ferritin may be useful in women of childbearing age who have heavy menstrual periods and I think most primary care doctors or your OB/GYN would be willing to order it as a baseline. https://my.clevelandclinic.org/health/d ... ritin-test
6. Vitamins D3= letter "d" Some doctors, especially in northern climates with less winter sunshine, are fine with ordering Vitamin D3 tests. Others may assume that people who eat a healthy diet consume enough Vitamin D3.
7. Vitamin B12= letter "c" This is a test your doctor may not typically recommend and/or insurance not cover. In part that's because the range of "normal" is between 200-950, so only people who have genetic predisposition to store iron in the blood, or are very anemic, are likely to be outside of those ranges. https://www.ucsfhealth.org/medical-test ... -b12-level. But the neurologist and Alzheimer's researcher at a major medical center, in charge of an Alzheimer’s prevention clinical trial, recommended that I take a chewable lozenge of 500 mcg (micrograms) of methylcobalamin daily to get my level from about 450 to above 500 pg/mL (picograms/milliliter). [I order it on Amazon from Jarrow Formulas and test infrequently, since it's always around 650--up from 450.] You could order either a Vitamin D3 or B12 test from online lab companies such as Quest, LabCorp or LifeExtension. But you could also start with your doctor and see if they will order a baseline Vitamin panel and, if normal, just keep doing what you're doing.
8. HbA1C (Hemoglobin A1C) =letter "a" It may be paid for by your insurance if you or family members have a risk profile for diabetes. It's relatively cheap to order online and measures your average blood sugar levels over the last 2-3 months. Some people, even with healthy diets, are prone to high HbA1C levels; I've often had a less than perfect diet and have been fortunate to never have a concerning level. https://diabetes.org/about-diabetes/a1c
9. Homocysteine=letter g This test may be most relevant if you have a family history of early coronary artery disease, since it appears to be linked more to a different gene variation than ApoE 4/4. "
Genetic and environmental factors associated with homocysteine concentrations in a population of healthy young adults. Analysis of the MAGNETIC studyHomocysteine level was most strongly correlated with healthy dietary habits, creatinine, serum folate concentration and the T/T genotype of the C677T polymorphism in MTHFR.
10. CRP (C-reactive protein) = letter "h".
I can only speak for myself, but having had several very normal CRP scores with ApoE 4/4, I have stopped testing for this marker of inflammation. Associations of circulating C-reactive proteins, APOE ε4, and brain markers for Alzheimer's disease in healthy samples across the lifespanis a recent study from Europe and the UK that suggests that lower inflammatory responses, not higher, may be more of a risk over the lifespan for ApoE 4 carriers.
Here, we examine associations of blood CRP levels, APOE ε4, and biomarkers for AD in a cognitively healthy lifespan cohort (N up to 749; 20-81 years of age) and replicate the findings in UK Biobank (N = 304, 322; 37-72 years of age), the developmental ABCD study (N = 10 283; 9-11 years of age), and a middle-aged sample (N = 339; 40-65 years of age)...Strikingly, both ε4 and [polygenic risk score for C-reactive protein]PGS-CRP associated mainly with blood CRP levels within the low range (<5mg/L)..Thus, we suggest to investigate whether APOEε 4 can confer risk by being associated with a lower inflammatory response to daily exposures, possibly leading to greater accumulation of low-grade inflammatory stress throughout life.
Primer: Blood TestsBlood tests
a. HbA1c, fasting insulin, fasting glucose, 1 and 2 hour after eating (post prandial) blood glucose
b. Lipids - both basic (TC HDL LDL TG's) and advanced (LDL-p or apolipoprotein b)
c. Vitamin B12
d. Vitamin D3
e. TSH, T3, T4 (thyroid function)
f. Liver functions
g. Homocysteine
h. CRP (inflammation) (to define values under 1, a high sensitivity assay is used - denoted hsCRP)
i. Full blood count (FBC) also called complete blood count (CBC) in the USA, measures the red cells, white cells and platelets in the blood.
j. Ferritin (measure of iron stores but also goes up in chronic inflammation)
k. Renal function is usually given as creatinine and electrolytes. In the USA it is still incorrectly called BUN (blood urea nitrogen) as years ago urea was measured instead of creatinine. Sometimes incorrectly it is still called u&e's by British/Europe docs because we also used to measure urea years ago. From the creatinine a measure of renal function can be estimated, called eGFR. It is inaccurate at extremes of body habitus. It overestimates renal function in small people and underestimates renal function in large muscular people. A more accurate measure is the GaultCockroft equation which requires more information
4/4 and still an optimist!
Re: Blood tests
Thank you for this information. What about choline? Isn’t that also important?
Re: Blood tests
You've done your research to know about choline. It isn't in the list of tests recommended by Dr. Stavia, but you may be interested in this topic: Choline Supplement to Offset Affects of ApoE4
Very little research has been done on the best diets or supplements for someone your age. I've talked with Ph.D epidemiologists who point out how difficult it is to retrospectively say what someone did 60 years before that might have affected their risk, unless it's known severe risks like severe head trauma or multiple concussive injuries, or severe malnutrition, or other severe adverse events of childhood. The best researchers I've heard, in international conferences, believe that prevention through lifestyle and novel ways to target inflammation and metabolic health, as well as prevention or treatment of biomarkers like amyloid and tau years before symptoms could occur, are ALL going to be available and widely used in time for my children, who are about 10 years older than you.
At 29, if you are feeling that this knowledge of your ApoE 4/4 status is causing you excessive worry, or doubts about your future, you may want to work with a health coach who is familiar with ApoE 4 and can help you channel your strong knowledge base into feeling empowered.
Nancy
4/4 and still an optimist!
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Re: Blood tests
Hello Eniluap,
My name is Laurie, I am a Support Team Intern here on this forum. I noticed your recent posts and can certainly understand your questioning and concern about how to best care for yourself. I would first like to say that I agree with Nancy's recent response to you in which she gave some really good information and advice... here is what she wrote:
"At 29, if you are feeling that this knowledge of your ApoE 4/4 status is causing you excessive worry, or doubts about your future, you may want to work with a health coach who is familiar with ApoE 4 and can help you channel your strong knowledge base into feeling empowered."
I understand how overwhelming all of the research and decision making can be as you navigate your health journey and action steps moving forward. Speaking with an ApoE4 aware Health Coach would be so helpful. They are skilled in coming along side you, assisting with information and helping you to create the perfect road map to reach your health goals. Just in the posts you shared here, I can see you possess knowledge and wisdom and a determination to figure everything out; having a trained health coach can really support you in that.
I would like to invite you to check out our Wiki , specifically "Section 9 Resources" and then 9.7 for a list of ApoE4 aware coaches.
I hear your curiosity in questioning a number of things regarding, plastics, dry cleaning and non-alcoholic beer. Small exposures to these items is not a cause for alarm. Specifically I can say that occasional use of plastics is ok, but heating food up in them or using them when consuming hot food causes the greatest exposure to toxins. But as I am sure you have already learned in your research, there are a number of things you can do with nutrition and lifestyle changes that help to mitigate those small exposures.
I commend you for taking such a positive, proactive approach to make sure you live a life that will help maintain your health, cognitive strength and longevity. Please know, that having an Apoe4/4 is not something to fear but something to be aware of and empowered in, because you do have the knowledge and power to prevent any future declines or issues.
All of us here at Apoe4.info, can assure you that we all know of and work with many people who also are Apoe4/4 and continue to live amazing lives well into their 60's, 70's, 80's and beyond! I have no doubt seeing your determination and resilience, that you will find the answers to all your questions. And if you choose to work with a health coach, that coach will be able to help you navigate the process of finding your perfect action steps
Please know, you are definitely on the right track and will find the answers to all your questions. I encourage you to seek out a trained health coach and allow them to help you take it one step at a time.
Kindly,
Laurie Sotro
Support Team Intern
Re: Blood tests
Hi Laurie,
I will definitely look into seeing a health coach. Do you think it beats seeing a genetic counselor? I just had an intake call with one from Columbia University Medical Center (I live in NY). Based on what she told me, it seems like seeing her would be a waste of time and money. If she can't tell me what my individual risk is, or how to prevent myself from developing Alzheimer's, then what's the point? Would an APOE4 aware health coach be able to give me a more individualized plan?
Thank you
I will definitely look into seeing a health coach. Do you think it beats seeing a genetic counselor? I just had an intake call with one from Columbia University Medical Center (I live in NY). Based on what she told me, it seems like seeing her would be a waste of time and money. If she can't tell me what my individual risk is, or how to prevent myself from developing Alzheimer's, then what's the point? Would an APOE4 aware health coach be able to give me a more individualized plan?
Thank you
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Re: Blood tests
Hello again!Eniluap wrote: ↑Thu Oct 10, 2024 8:36 am Hi Laurie,
I will definitely look into seeing a health coach. Do you think it beats seeing a genetic counselor? I just had an intake call with one from Columbia University Medical Center (I live in NY). Based on what she told me, it seems like seeing her would be a waste of time and money. If she can't tell me what my individual risk is, or how to prevent myself from developing Alzheimer's, then what's the point? Would an APOE4 aware health coach be able to give me a more individualized plan?
Thank you
I'm happy to help you with these questions.
It's clear how in tune you are regarding your situation and needs. So while trying to determine your best course of action, I'd say simply trust your gut If something doesn't feel right or aligned with your values, thoughts and feelings, try another route.
I understand these decisions your making early on can seem overwhelming, so I'd like to provide some additional information that I hope will help to clarify a health coaches role.
Here's an overview from our Wiki , explaining what health coaches do and how they can support you.
"Health coaching is a client-centered (individualized) process in which the client determines their own path and the coach provides the support and encouragement to make positive and lasting lifestyle changes. Coaches guide the client to create a vision for their health and help them set goals to achieve that vision. Coaches can supply information and education, work with clients to explore options, brainstorm, prioritize, set goals, help them stay accountable, explore barriers, and celebrate successes. For improving or preventing cognitive decline, health coaches can support clients as they learn about healthier lifestyle options and work to improve their diet, exercise, sleep, relaxation, social engagement or any other habits to reach their health goals. Note: coaches will most likely not be physicians, physician assistants, or nurse practitioners, so will not be ordering or interpreting lab tests, or prescribing medicine." (parenthesis and underline emphasis is mine)
Here is the direct link to see some Apoe4 aware health coaches that are interested in supporting our members.
https://wiki.apoe4.info/wiki/ApoE4-Awar ... th_Coaches
I can't speak for every health coach BUT for the most part, health coaches allow for a free discovery call. This would give you a chance to see what a particular coach can offer you and see if you feel they would be a good fit for you. And you can have a discovery call with more than one coach to make sure you feel comfortable. So there is no risk in researching that option. I call that a win/win, right?
In closing may I say, don't ever settle for a "what's the point?" solution. Keep digging until you find just the right plan for you! And also, don't focus on "what's my risk?", focus on prevention and empowering yourself with answers/solutions that will keep you healthy, strong, sharp and enable you to live an amazing life!!
As always, this support team is here to help if you have any other questions.
Kindly,
Laurie Sotro
Support Team Intern