Looking for some tips on diet/life style and lipids

[Davidmoshe8833]

I've been here for a little while now, although I post infrequently. Please bear with me, will try to stay concise.

I'm an apoe3/4 ( male), will be turning 34 in March. My very first high cholesterol reading was when I was 21. Since them at various times I went on and off of RYR, stayed away from a lot of meat, ate more fish and low fat dairy ( but didn't think about the cheese I ate), but every PCP I saw wasn't concerned because my HDL was generally in the low to upper 60s, making my ratio acceptable by the more mainstream standards.

Since 2018 I've increasingly tracked my numbers.

In 2018 I had some health issues ( a weird tremor issue that got worse over several years, but ended up being an iodine deficiency)- so I tried keto with MCTs- before I understood about my APOE4 status.

Just before Keto-
my TC was 204, LDL 123, HDL 64, TG 86. This blood test was done with a preventative cardiologist at Weil Cornell in NYC, she also looked at some more advanced testing

ApoB - 102 mg, optimal being under 90
Lipoprotein A- 22 nmol/L, optimal being under 75
LDL size pattern- A, which is optimal

I was eating very low fat, mostly veggies some fish, and moderate carbohydrates. My lips stayed roughly the same until November 2019- March 2020 when I experimented with Keto. A few months into keto I found out about my APOE4 status and switched out the saturated fats for mostly mono and polyunsaturated, and incorporated more fasting, heavy on the green veggies, my lipid results at their highest were

TC 256, LDL 183, HDL 52, TG 93.

This past November 2021, after being off Keto since April/May 2021, I was on a moderate carb/protein, low sat fat and moderate to higher mono/polyunsaturated fats. Lots of cruciferous veggies, but not avoidant of some of the starchy veggies and legumes, fiber intake for 2-3 weeks prior was 40-50 g ( which I've maintained)

TC: 207, LDL 138, HDL 53, TG 68.

For all of these readings my CRP has been below 0.3, fasting glucose usually in the 80's.
I've been taking Nordic Naturals high DHA fish oil, designs for health multi-vitamin regularly, and I take trazodone 100mg and slow release melatonin at night to help with sleep. I do take other supplements, but not daily ( taurine, alpha-gpc, l-theanine).

I have no known family history of AD, but I know the gene comes from my father's side- his mother passed in early 80s and father early 70s- perhaps too early for it to manifest. My father is in his late 60s now and still OK as far as I can tell.

Trying to figure out a few things

1) how my HDL dropped from the mid to upper 60s to the low 50's?! I'm still very active, not entirely sure what to do about it, any tips - diet, life style etc.

2) I'm considering buying the prodrome plasmalogen to add to my supplementation, and taking a smaller dose because I can't afford $200/month- thoughts on this?

3) Regarding my LDL, I'm actually quite frustrated with it. I have an appointment with my cardiologist Friday, considering trialing pravastatin- lipophilic and from what I've read is less likely to lead to type 2 diabetes, and may even be protective against dementia. For those who've had success lowering their LDL with dietary intervention - how long did it take to lower your LDL? Was it a few months, or gradually over time?

4) I'm looking to get back into IM fasting, and try to get rid of my starches etc, but my work makes this difficult. On top of daily work outs- I'm a physical therapist, two days per week I do homeware and walk anywhere from 6- 12 miles in the city between patient visits. It's not really possible for me to have a planned lunch break, I can't eat salad on the go, and it's hard to get calories - so I end up buying packaged food at times, but it's really a struggle- because I won't get home until after my eating window ends sometimes.


I understand this is a lot- appreciate any and all feedback, hope everyone has a happy/healthy new year!