Introduction and Help With ApoE4 Diet

Newcomer introductions, personal anecdotes, caregiver issues, lab results, and n=1 experimentation.
sabby123456789
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Introduction and Help With ApoE4 Diet

Post by sabby123456789 »

Hi everyone. I enjoy this site since most LCHF resources mention nothing about the ApoE4 allele. I need some help.

I have ApoE4 / E3 and cholesterol hyperabsoprtion.

Is there anything I can eat besides avocados, olive oil, oily fish, shellfish, lean meat, egg whites, fat free dairy, and non-starchy vegetables?

It seems like all the safe foods for E4s are the ones I do not like and all the restricted foods like full fat dairy and fat meat are the foods I may only eat really small amounts of.

For 4 years, I used to on a daily basis eat 4 eggs, 6 tablespoons of coconut oil (or dairy cream), two chicken thighs with skin, about 150 g of 15% fat ground beef with some kimchi. I do not have any blood work from this time.

One time for several months I ate a lot of egg yolks, butter, and cheese and started to develop angina. This was when I found out about my E4 and hyperabsorber status. My non-fasting lipid panel was:

Cholesterol - 553 mg / dL
LDL-C - 332 mg / dL
HDL-C - 125 mg / dL
Triglycerides - 437 g / dL

Then I switched over to a no oil carnivore diet of fat pork belly for 2 months and my fasting lipid panel was:

Cholesterol - 223 mg / dL
LDL-C - 122 mg / dL
HDL-C - 79 mg / dL
Triglycerides - 109 mg / dL

My angina went away for a while, but eventually worsened. Fortunately, after writing to my primary care physician several times, she contacted a cardiologist who referred me for a coronary CT angiogram with calcium scoring. Fortunately the score was 0 and the angiogram showed no disease.

Now I eat only avocados and fish, but I do not like it. I've never been a fish lover or an olive oil connoisseur. My last lipid panel was:

Cholesterol - 168 mg / dL
LDL-C - 86 mg / dL
HDL-C - 59 mg / dL
Triglycerides - 113 mg / dL

My cardiologist and PCP like my current blood work and told me to continue keeping it from going up.

I do not want to start disease in my coronary arteries, but I really do not like the ApoE4 foods. My triglyceride to HDL ratio as of my most recent lipid panel is 1.9, which means that I am insulin resistant and have pattern B LDL, so I should keep my cholesterol and LDL low.

Is there any way around the ApoE4 diet, or do I just have to sacrifice my tastes to protect my heart? I have recently been eating quite a lot of chicken skins from drumsticks I simmer for 2 hours. I skim the fat off, but still feel doubtful about eating them since they probably have some fat left inside.

It is disappointing seeing all my non-E4 friends and relatives chowing down on saturated fats, fatty meat, eggs, cream, and cheeses while I am stuck with avocados, fish, lean meat, and a few olives only having the restricted foods once in a while. My father is an E4 but he also has an E2 which offsets the effects of the E4, so he enjoys steaks and cream cheese all the time.

Thank you,
Sabby
Always caring, Sabby, ApoE4/E3
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Re: Introduction and Help With ApoE4 Diet

Post by SBee »

sabby123456789 wrote:Hi everyone. I enjoy this site since most LCHF resources mention nothing about the ApoE4 allele. I need some help.

I have ApoE4 / E3 and cholesterol hyperabsoprtion.

Is there anything I can eat besides avocados, olive oil, oily fish, shellfish, lean meat, egg whites, fat free dairy, and non-starchy vegetables?...

... Now I eat only avocados and fish, but I do not like it. I've never been a fish lover or an olive oil connoisseur. My last lipid panel was:

Cholesterol - 168 mg / dL
LDL-C - 86 mg / dL
HDL-C - 59 mg / dL
Triglycerides - 113 mg / dL

My cardiologist and PCP like my current blood work and told me to continue keeping it from going up.

It is disappointing seeing all my non-E4 friends and relatives chowing down on saturated fats, fatty meat, eggs, cream, and cheeses while I am stuck with avocados, fish, lean meat, and a few olives only having the restricted foods once in a while. My father is an E4 but he also has an E2 which offsets the effects of the E4, so he enjoys steaks and cream cheese all the time.

Thank you,
Sabby
Hello Sabby!
Welcome and thanks so much for reaching out to the community:)
It looks like you have made some incredible progress in your blood lipid profile over the past few years by being curious about exploring various dietary options and being disciplined in your implementation! However, I also sense the frustration you are feeling with these restrictive, non-preferred dietary choices and the fact that family and friends are able to eat whatever they desire. Obviously, its important to follow the advice of your physician, but I think you would also agree it's important to find a balanced approach that allows you to create sustainability with your diet and health over the long term!

While I cannot offer specific dietary advice (there may be others on the forum who are able to), I can offer some suggestions for you to explore:
1) If you have not already had a chance to research the Wiki page, it offers lots of research-based topics including diet and cholesterol.
2) Also, there is a free app, Cronometer, that may offer some new sources of protein and fat in various foods that you could try.

Hope you are able to find some changes that keep you inspired on your journey! Thanks again for connecting with us :)

Warmly,
Sue
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Re: Introduction and Help With ApoE4 Diet

Post by SBee »

Hi Sabby,
I hope your week is off to a good start!
I just wanted to check in with you to see if you have been able to explore any of the resources on the site or if you have been able to find some answers to the questions you posed on your post. You already seem very knowledgeable and aware of the influence of diet on ApoE4 expression...I am just beginning to explore this area for myself as I recently discovered I have the ApoE4 allele!
Please let us know how we might be able to support you and please feel free to reach out with additional questions.
Warmly,
Sue
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Re: Introduction and Help With ApoE4 Diet

Post by Julie G »

Is there anything I can eat besides avocados, olive oil, oily fish, shellfish, lean meat, egg whites, fat free dairy, and non-starchy vegetables?
Hi Sabby! I'm not quite sure how you arrived at that list of foods, some of which- lean meats, egg whites, and fat-free dairy are NOT foods I would chose as an ApoE4 homozygote. For instance, the yolks of an egg are rich in choline, the precursor to acetylcholine, necessary for memory formation. They aren't particularly high in cholesterol so I'm confused as to why you would exclude them from your diet. I'm so sorry to hear that you don't like the other foods — non-starch vegetables, avocados, oily fish and olive oil. Those are some of my staples. What kinds of food do you like? Maybe we can brainstorm ways to help you devise a diet that tastes good and helps you feel great.
I do not want to start disease in my coronary arteries, but I really do not like the ApoE4 foods. My triglyceride to HDL ratio as of my most recent lipid panel is 1.9, which means that I am insulin resistant and have pattern B LDL, so I should keep my cholesterol and LDL low.
First, congrats on the zero CAC score. That must be very reassuring. If you know you have insulin resistance, why not work to turn that around so you can be more liberal with your diet. Do you know your fasting glucose, insulin, HbA1c? Most of us prioritize glycemic control as that seems to be a primary driver of inflammation that leads to cardiovascular disease. Are you exercising? Able to fast?

I look forward to learning more.
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Re: Introduction and Help With ApoE4 Diet

Post by TheHormonePharmacist »

Sabby, Sbee, and Julie -
I've been wrestling a lot with the same sort of question.

With all the restrictions on a 4/4 diet, I have to ask, "What can I actually eat?"

My wife and I eat salmon all the time . . . but how much can we tolerate? We're already at 2-3 meals each week.

Non-starchy, cruciferous vegetables that aren't loaded with carbs are great, but we've gotten pretty tired of salads. Then there's Steven Gundry, telling us all the foods that have lectins in them (almonds, tomatoes, bell peppers, etc.) and that reduces our list even further.

I'm really struggling with feeling satiated, especially when I don't get enough fat or protein. But I need to avoid animal products?

Seems like there's a tiny list of foods that contain any significant amount of fat or protein that fits with 4/4: nuts, SMASH fish, avocados, and eggs. That's definitely not enough variety for a sustainable diet.

Still doing my research on saturated fat and 4/4 status.
Steve Goldring, RPh The Hormone Pharmacist

I help patients and healthcare practitioners with easy-to-understand patient education resources - mostly about hormone optimization
SimpleHormones.com
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Re: Introduction and Help With ApoE4 Diet

Post by SusanJ »

TheHormonePharmacist wrote:"What can I actually eat?"
IMHO, it's a lot of trial and error.

I'm a 3/4. Throw the need for low oxalate foods on my plate, and you'll see that I really understand your struggle. No nuts, and a good percentage of the preferred veggie list (no spinach, beets, chard, plantains, and sweet potatoes for example) is off the table for me. It's very real for me. I've said the same thing more than once, what can I eat?

I choose to eat pastured chicken and beef, along with fish (usually 3-4 meals per week). Sometimes lamb and pork if I can get it. But not huge quantities. I aim for 75 grams of protein per day. (Note that's the protein value in a serving, not the weight of the meat.) My lipids are slightly high, but my oxLDL is below what Gundry suggests, so I'm okay with eating meat.

I eat three times a day to make sure I get enough calories in about a 9 hour window. I also eat a higher amount of net carbs, like winter squash, sometimes rice, for putting on weight, but I still shoot for at least 50% of my calories from healthy fats. So, I eat foods that are considered high in lectins, but see no changes in my inflammation markers. Even Gundry will tell his patients to see what they can tolerate.

So, eat, test and tweak. Make Cronometer your friend to see how you're doing nutrient wise. It's the best any of us can do.

If the saturated fat in meat messes with your lipids, maybe see if you can reduce the amount or number of times per week. Just keep experimenting.

Don't let the perfect diet be the enemy of a diet that is sustainable for you.
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Re: Introduction and Help With ApoE4 Diet

Post by TheHormonePharmacist »

SusanJ -

Thanks! We'll keep fine tuning our diet as we go. I'm not willing to eat the same meal every single day, but I'll do what I can.

My wife and I spent this past weekend with my parents. My Mom turned 81 on Monday. She's 3/4 and her dementia is getting a lot worse. The same question 10 times in 10 minutes. It was a real motivator for me to keep moving toward an optimal diet and lifestyle to keep my brain healthy for the long haul.
Steve Goldring, RPh The Hormone Pharmacist

I help patients and healthcare practitioners with easy-to-understand patient education resources - mostly about hormone optimization
SimpleHormones.com
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Re: Introduction and Help With ApoE4 Diet

Post by SusanJ »

I used to be a foodie. Ate out quite a bit and when I traveled to NYC or DC for work, I took advantage of the restaurant scene. I hear your desire to keep food interesting. There are plenty of Paleo and keto food bloggers out there for inspiration for another way to cook salmon. ;)

Here's one of my fav bloggers, with plenty of recipes that can be modified easily, is Danielle Walker.
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Re: Introduction and Help With ApoE4 Diet

Post by Plumster »

The plant-fish keto diet works well for many here, but there are also some of us who are whole foods plant based and not restricting whole grains or legumes. My insulin numbers are in the optimal range and I fast over night 12-16 hours. The Mediterranean diet is another option.
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Re: Introduction and Help With ApoE4 Diet

Post by sabby123456789 »

Julie G wrote:
Is there anything I can eat besides avocados, olive oil, oily fish, shellfish, lean meat, egg whites, fat free dairy, and non-starchy vegetables?
Hi Sabby! I'm not quite sure how you arrived at that list of foods, some of which- lean meats, egg whites, and fat-free dairy are NOT foods I would chose as an ApoE4 homozygote. For instance, the yolks of an egg are rich in choline, the precursor to acetylcholine, necessary for memory formation. They aren't particularly high in cholesterol so I'm confused as to why you would exclude them from your diet. I'm so sorry to hear that you don't like the other foods — non-starch vegetables, avocados, oily fish and olive oil. Those are some of my staples. What kinds of food do you like? Maybe we can brainstorm ways to help you devise a diet that tastes good and helps you feel great.
I do not want to start disease in my coronary arteries, but I really do not like the ApoE4 foods. My triglyceride to HDL ratio as of my most recent lipid panel is 1.9, which means that I am insulin resistant and have pattern B LDL, so I should keep my cholesterol and LDL low.
First, congrats on the zero CAC score. That must be very reassuring. If you know you have insulin resistance, why not work to turn that around so you can be more liberal with your diet. Do you know your fasting glucose, insulin, HbA1c? Most of us prioritize glycemic control as that seems to be a primary driver of inflammation that leads to cardiovascular disease. Are you exercising? Able to fast?

I look forward to learning more.

Hi Julie,

For egg yolks, I watched a video where Thomas DeLauer went through the foods that ApoE4s should not eat and eggs were one of them. https://www.youtube.com/watch?v=EXrwpotTzEE

I have cholesterol hyperabsorption and according to Dr. Thomas Dayspring, those with this problem should decrease egg intake.

I have tried a diet of mostly olive oil salads, fish, shellfish, and avocados before, and while it was doable, I got tired of it after a while. I have eaten macadamia nuts before, but I realized it is best for me not to even get started eating them because they are really addictive.

By and far, beef has always been my favorite meat.

I keep my carbohydrates under 20 g a day.

For a few months, I was eating chicken skins simmered for 2 hours until the fat came out for collagen and flavor but I stopped recently after someone told me that some fat is still left inside the skin and they are high in both saturated and omega-6 fats.

Recently I have been eating 80/20 ground beef with the fat simmered out and coleslaw or broccoli with olive oil. I eat 50 g of protein from the ground beef a day. Not sure if doing this will get rid of enough fat though.

I did come across a Diet Doctor video interview with Dr. Ted Naiman, and he suggested upping protein and reducing fat to improve insulin sensitivity, but he did not mention anything for those with ApoE4. https://www.youtube.com/watch?v=oMI0D_lixvU

The only fish I really like is salmon sashimi, but that would be to costly for me to afford everyday. Also, I cannot seem to find any affordable fish that is clean. I guess I could eat canned wild Alaskan salmon as my main source of protein even though it's not that palatable.

I also do not want to eat so much fish due to the contaminants in them. I am aware that mercury can be offset by the selenium but what about the PCBs, PBDEs, dioxins, and chlorinated pesticides. Although I live in the San Francisco Bay Area, I came across this page from the Washington State Department of Health in which they recommended no more than 2 to 3 servings of fish from the green category and to avoid the skin and fat because that is where all the toxins store up. https://www.doh.wa.gov/CommunityandEnvi ... yFishGuide

For omega-3s, I take a krill oil pill.

I do have a glucose monitor. My 1 hour postprandial glucose is usually in the 90s. Sometimes it goes to the low 100s and once it went to 121 mg/dL despite no change in diet.

My last hemoglobin A1C was 4.9%.

I do not do much physical activity as I am always feeling very tired. I do eat two meals a day but mostly with a 10 hour eating window rather than 8 or less.

Thanks,
Sabby
Last edited by sabby123456789 on Sun Nov 21, 2021 8:48 am, edited 1 time in total.
Always caring, Sabby, ApoE4/E3
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