Statins when you’re homozygous APOE4

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Nords
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Re: Statins when you’re homozygous APOE4

Post by Nords »

EA1979 wrote: Thu Apr 18, 2024 9:07 am @Nords, thank you for sharing all of this information. I'm a data scientist, so love your chart in the first post :)

I was wondering what lifestyle interventions you have found most effective in managing your cholesterol until now - I would also like to put off a statin as long as possible.
You’re welcome. I’m sharing as much as I can because I’m skeptical that statins are as straightforward as my family doctor seems to think, and sharing the info helps me figure out if I’m overlooking something.

My spouse and I have been empty-nesters since 2010, and during that time we’ve cut as much sugar, salt, simple carbs, and bread out of our diet as we find sustainable. I mention the rest in my original post:
Nords wrote: Thu Mar 21, 2024 2:27 pm Other lifestyle parameters:
- I’m surfing 2-3 times per week and chasing my preschooler granddaughter almost daily (including on a trampoline). There’s also breaking sweat on my daily chores of cleaning, home repairs, or yardwork.
- Between my osteoarthritis and repeatedly injuring my hip flexors, I feel maxed out on my exercise levels. The issue is not “move more and sit less”, but rather how much stretching & rolling it takes to avoid repetitive injuries.
- If I added any other exercise to this list, it’d be a treadmill walk of 30 minutes at about 3 MPH. My spouse and I walk all the time when we’re on travel, but I rarely walk at home unless the surf is awful.
- I’d assess my diet as healthy-ish. I don’t use tobacco and I stopped drinking alcohol 13 years ago. I’ve tracked numbers with MyFitnessPal since 2016. We’ve cut out the sugar & simple carbs. I eat fish & chicken nearly every day, and rarely red meat.
- My indulgences are one frozen meal per day (Lean Cuisine, Atkins, Healthy Choice) and a couple dozen high-cacao chocolate chips. I could cut back the saturated fat in my daily serving of Greek yogurt and cottage cheese. I feel mildly guilty about a cup of pad thai for 3-4 lunches per week. I won’t apologize for buying Costco’s BBQ ribs and rotisserie chicken every six weeks.
- I take supplements: a multivitamin, CoQ10, astaxanthin, vitamin E, glucosamine/chondroiton, turmeric, and fish oil.
I’ve tracked my calories & weight with MyFitnessPal since 2016. Over the last couple years I’ve maintained my muscle while I’ve slowly reduced my body fat to a BMI of 25, and I might get that down a little more. I’m more focused on waist size than weight.

I’ve replaced the pad thai with a smaller amount of Thai red curry, and I’ll keep that up for a while. We might also space out the Costco trips a bit more.

My recent epiphany is eating breakfast after surfing, not before. (I surf better on an empty stomach, too.) Next up on my agenda is eating a smaller dinner to see whether I can still sleep through the night without waking up from hunger.
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Re: Statins when you’re homozygous APOE4

Post by AnnieV »

NIH: https://pubmed.ncbi.nlm.nih.gov/34187442/ "Conclusion: We found a significant favorable effect of ACV consumption on FPG and blood lipid levels."

NIH: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2682928/ "Conclusion: Supplementation with at least 500 mg/d of vitamin C, for a minimum of 4 weeks, can result in a significant decrease in serum LDL cholesterol and triglyceride concentrations. However, there was a nonsignificant elevation of serum HDL cholesterol."

Our media driven culture has predisposed us to take a lab-made pill riddled with side effects and legal disclaimers to "solve" a problem. It's killing us and our brains. Lifespans are dropping, not increasing. Grossly obese people on TV ads gleefully dancing around a fountain selling a diabetes drug is the epitome of pure insanity, the catastrophic societal normalization of a deathly condition. It's despotic, it again proves the medical/drug industry is profit driven not health driven. They don’t give a damn about anyone’s health.

BMI of 25 is too high, that's officially "overweight". That's not my words nor my personal judgment at all its the medical community's assessment. The body itself by its very nature seeks to normalize, to heal. We have to remember that. Excess weight is not trying to stay on us, get on us, it's the opposite, the body seeks to reduce and normalize itself. That’s a basic truth no drug ad will ever state. That means we don't have to work to lose weight we just have to stop working against ourselves. And we are working against ourselves in our increasingly addicting and corrupted food/drink diet, mostly unbeknownst to us. We have to discern our consumables and habits far more closely and moreover realize we are being addicted to corrupted consumables for profit. The Americanized diet is corrupted more so than most other nations. It's corrupted by food modifications (distortions), by chemicals, by drugs, hormones, antibiotics, etc. It's said the Mediterranean diet is very good for ALZ candidates. But what those articles never say is the Mediterranean diet the Mediterraneans themselves eat is far different than what Americans’ “Mediterranean” diet is. Their olive oil is pure, their veggies are fresh not GMO’d, not chemically fertilized, their meats and fish are pure, not grain fed, not farm raised on pellets, their dairy is pure not process-corrupted like ours. Etc. etc. That makes all the difference in the world. The drug Ad mantra, “when diet and exercise is not enough” is a concealed lie, a purely natural diet is enough. Nature heals, not a profit driven lab.
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Re: Statins when you’re homozygous APOE4

Post by EA1979 »

Nords wrote: Thu Apr 18, 2024 6:24 pm
EA1979 wrote: Thu Apr 18, 2024 9:07 am @Nords, thank you for sharing all of this information. I'm a data scientist, so love your chart in the first post :)

I was wondering what lifestyle interventions you have found most effective in managing your cholesterol until now - I would also like to put off a statin as long as possible.
You’re welcome. I’m sharing as much as I can because I’m skeptical that statins are as straightforward as my family doctor seems to think, and sharing the info helps me figure out if I’m overlooking something.

My spouse and I have been empty-nesters since 2010, and during that time we’ve cut as much sugar, salt, simple carbs, and bread out of our diet as we find sustainable. I mention the rest in my original post:
Nords wrote: Thu Mar 21, 2024 2:27 pm Other lifestyle parameters:
- I’m surfing 2-3 times per week and chasing my preschooler granddaughter almost daily (including on a trampoline). There’s also breaking sweat on my daily chores of cleaning, home repairs, or yardwork.
- Between my osteoarthritis and repeatedly injuring my hip flexors, I feel maxed out on my exercise levels. The issue is not “move more and sit less”, but rather how much stretching & rolling it takes to avoid repetitive injuries.
- If I added any other exercise to this list, it’d be a treadmill walk of 30 minutes at about 3 MPH. My spouse and I walk all the time when we’re on travel, but I rarely walk at home unless the surf is awful.
- I’d assess my diet as healthy-ish. I don’t use tobacco and I stopped drinking alcohol 13 years ago. I’ve tracked numbers with MyFitnessPal since 2016. We’ve cut out the sugar & simple carbs. I eat fish & chicken nearly every day, and rarely red meat.
- My indulgences are one frozen meal per day (Lean Cuisine, Atkins, Healthy Choice) and a couple dozen high-cacao chocolate chips. I could cut back the saturated fat in my daily serving of Greek yogurt and cottage cheese. I feel mildly guilty about a cup of pad thai for 3-4 lunches per week. I won’t apologize for buying Costco’s BBQ ribs and rotisserie chicken every six weeks.
- I take supplements: a multivitamin, CoQ10, astaxanthin, vitamin E, glucosamine/chondroiton, turmeric, and fish oil.
I’ve tracked my calories & weight with MyFitnessPal since 2016. Over the last couple years I’ve maintained my muscle while I’ve slowly reduced my body fat to a BMI of 25, and I might get that down a little more. I’m more focused on waist size than weight.

I’ve replaced the pad thai with a smaller amount of Thai red curry, and I’ll keep that up for a while. We might also space out the Costco trips a bit more.

My recent epiphany is eating breakfast after surfing, not before. (I surf better on an empty stomach, too.) Next up on my agenda is eating a smaller dinner to see whether I can still sleep through the night without waking up from hunger.

Thanks @Nords! Great advice, I appreciate you posting. I hadn't had my cholesterol tested for awhile until September of last year. Upon seeing all of my high numbers, I have been focused on:
--Losing weight (down about 10 pounds so far, 10 more to go)
--Decreasing saturated fat intake, mainly through less eggs and dairy
--Fish oil
--Increased fiber

All of those things seem to be well accepted as having cholesterol lowering impact. I am getting tested again in a couple of weeks, and we'll see if it has any positive impact!
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Re: Statins when you’re homozygous APOE4

Post by EA1979 »

AnnieV wrote: Fri Apr 19, 2024 8:59 am NIH: https://pubmed.ncbi.nlm.nih.gov/34187442/ "Conclusion: We found a significant favorable effect of ACV consumption on FPG and blood lipid levels."

NIH: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2682928/ "Conclusion: Supplementation with at least 500 mg/d of vitamin C, for a minimum of 4 weeks, can result in a significant decrease in serum LDL cholesterol and triglyceride concentrations. However, there was a nonsignificant elevation of serum HDL cholesterol."

Our media driven culture has predisposed us to take a lab-made pill riddled with side effects and legal disclaimers to "solve" a problem. It's killing us and our brains. Lifespans are dropping, not increasing. Grossly obese people on TV ads gleefully dancing around a fountain selling a diabetes drug is the epitome of pure insanity, the catastrophic societal normalization of a deathly condition. It's despotic, it again proves the medical/drug industry is profit driven not health driven. They don’t give a damn about anyone’s health.

BMI of 25 is too high, that's officially "overweight". That's not my words nor my personal judgment at all its the medical community's assessment. The body itself by its very nature seeks to normalize, to heal. We have to remember that. Excess weight is not trying to stay on us, get on us, it's the opposite, the body seeks to reduce and normalize itself. That’s a basic truth no drug ad will ever state. That means we don't have to work to lose weight we just have to stop working against ourselves. And we are working against ourselves in our increasingly addicting and corrupted food/drink diet, mostly unbeknownst to us. We have to discern our consumables and habits far more closely and moreover realize we are being addicted to corrupted consumables for profit. The Americanized diet is corrupted more so than most other nations. It's corrupted by food modifications (distortions), by chemicals, by drugs, hormones, antibiotics, etc. It's said the Mediterranean diet is very good for ALZ candidates. But what those articles never say is the Mediterranean diet the Mediterraneans themselves eat is far different than what Americans’ “Mediterranean” diet is. Their olive oil is pure, their veggies are fresh not GMO’d, not chemically fertilized, their meats and fish are pure, not grain fed, not farm raised on pellets, their dairy is pure not process-corrupted like ours. Etc. etc. That makes all the difference in the world. The drug Ad mantra, “when diet and exercise is not enough” is a concealed lie, a purely natural diet is enough. Nature heals, not a profit driven lab.
@AnnieV, while I appreciate what you are saying, and feel that lifestyle is very important, there are some items that cannot be solved with diet and lifestyle alone. The ACV study shows statistical significance, but the net effect is a reduction in LDL of 6 points - that is nowhere near the desired levels of cholesterol reduction desired. Assigning personal blame for cholesterol is not helpful, IMO
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Re: Statins when you’re homozygous APOE4

Post by Verbow »

EA1979 wrote: Fri Apr 19, 2024 9:10 am @AnnieV, while I appreciate what you are saying, and feel that lifestyle is very important, there are some items that cannot be solved with diet and lifestyle alone. The ACV study shows statistical significance, but the net effect is a reduction in LDL of 6 points - that is nowhere near the desired levels of cholesterol reduction desired. Assigning personal blame for cholesterol is not helpful, IMO
Absolutely true. I’ve also read ApoE4s often don’t respond to lifestyle measures as well as E3s.

Personally I’ve always had high cholesterol (LDL around 130) despite any lifestyle intervention I threw at it. It suddenly made sense when I received my 23andMe report. I finally agreed to try a low dose statin (5 mg Rosuvastatin) - felt fine - except…

A1C bumped up from 5.4 to 5.7 in eight months! My doctor called it a “nominal increase” and wanted me to stay on the statin - but having an E4 allele there was no way I was going to fool around with insulin resistance. Stopped the statin - six months later A1C measured at 5.3 - and now taking Ezetimibe.

And that’s the problem I have with statins - they’re a double edged sword. Yes they can reduce CVD risk, but potentially at a cost. We keep hearing how important insulin sensitivity is at keeping both Alzheimer’s and CVD at bay (one study showed LP-IR score had a much higher hazard ratio than LDL in regard to CVD) yet statins have the potential to increase insulin resistance - and in some cause frank diabetes.
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Re: Statins when you’re homozygous APOE4

Post by AnnieV »

I speak directly because I see first-hand just how terrible this disease is with my mother for whom I care daily. This is preventable if poor consumption habits are radically corrected early. Later changes are useless. Financial planning principles prove the earlier one starts the far better the returns, the later one starts results are far less useful if at all. Nickle and diming token changes, be those dietary or financial, fail late in life.

I am new to this forum but not new to testing, research, and ALZ care. I am on my 10th year with my 86 year old APOE4/4 mother who is still at home. She’s supposed to be dead by this age. While she’s declined physically mentally she can still comprehend conversation and respond with affirmative answers. Every Sunday, like today, at breakfast I tell her that we are going to Mass, and ask her, “would you like to go to Mass today”? It may take a few tries but each time (so far to date) I get a recognition and an affirming “yes,” “ok,” or “hmmum.” That’s not supposed to happen at this age and APOE4/4 status.

Over time I've made dramatic changes from former "diet" and "lifestyle" habits and remedied what I was told by doctors could not be remedied. My ALZ mother is not on a single pill, drug. “Diet” changes removed the need for every one (from high blood pressure to high cholesterol, and even Aricept now). Along this path I’ve learned a most unfortunate truth, that most doctors today are just pill pushers, they’re not problem solvers. They are not paid to solve problems; they are paid to push pills. It’s the only way most doctors can pay their debts, they now are slaves to the drug and insurance industries, doctors’ former expertise-driven problem solving autonomy of yesteryear is gone. Doctors today just don’t have the time to read, to care, to think, to problem solve, they just have time to see the next patient to collect a fee.

We need to do our own homework, have dive far deeper into "diet" and "lifestyle" beyond the words themselves. The drug industry’s mantra “when diet and exercise aren’t enough” is a lazy lie. We know it’s a lie because primitive APOE4 cultures don’t have the problem the US and other “advanced” nations have, as proven by multiple published studies. Sub Saharan APOE4 cultures are not quaffing drug statins and supplements. The phrasing "there are some items that cannot be solved with diet and lifestyle alone" is a lazy way of not questioning, critically examining every single food and drink one consumes. Neither my mother (nor me) consume any food or drink that is not from nature. No chemicals, nothing unnatural, no corrupted foods (no dairy made from factory processes like homogenization and high temperature pasteurization), no corrupted breads (nothing except ancient, unmolested grain sourdough breads), etc.

Dr. Bredesen is right in his book, the ALZ industry is off track. The ALZ industry is erroneously focused on a singular cause. Dr. Bredesen proves the cause of ALZ is multi-factorial which in turn necessitates a multi-factorial prevention and reversal approach like his RECODE protocol. The drug industry is not stupid, it knows that truth too. But the drug industry can’t monetize a RECODE like protocol because there is no profit in doing so. There is only profit in a pill, a profit pipeline enabled by a patent that will eventually expire thus necessitating a tight time window to maximize profit. The medical industry is profit driven not purpose driven. Dr. Bredesen’s approach is purpose driven which is why profit driven industries, threatened by an alternative problem solving approach, mock, ignore, or fight such proof-based techniques. Shameful.

We need to stop expecting a chronically corrupted medical industry with their equally corrupt colluding government partners to solve our problem. They won’t solve it because there is endless profit in “management” thereof, there is neither profit nor power in prevention, there is only a collapse of profit and power in prevention. The ALZ Assoc. is fatally corrupted, proven so by independent investigations. It’s a fundraising machine, that’s its sole purpose to exist. The last thing that Association wants is a solution because a solution would remove its reason to exist, an end to its revenue stream. We cannot be like Linus waiting in vain for the Great Pumpkin drug industry to rescue us, the solution is in discussion and critical examination of science.
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Re: Statins when you’re homozygous APOE4

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AnnieV wrote: Sun Apr 21, 2024 12:49 pm I speak directly because I see first-hand just how terrible this disease is with my mother for whom I care daily. This is preventable if poor consumption habits are radically corrected early. Later changes are useless.
An individual is not guaranteed to prevent the disease by correcting poor consumption habits. The individual will reduce his/her risk of getting this disease by taking any number or combination of actions. I suspect that I am not the only one to bristle at the comment that later changes are useless. I live a healthy lifestyle, so it is not for me that I bristle. We all have different histories and genetic makeups, and for some, changing consumption might not solve an issue, and in fact, an Rx might be required. As previously posted, assigning personal blame is not helpful. As for the rest of your post, I will speak only for myself. I am aware. That is why I am here.
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Re: Statins when you’re homozygous APOE4

Post by AnnieV »

"APOE ε4 Is Not Associated with Alzheimer’s Disease in Elderly Nigerians"
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2855121/

Dr. Bredesen's quest is prevention and reversal, not "management".
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Re: Statins when you’re homozygous APOE4

Post by SusanJ »

AnnieV wrote:Dr. Bredesen's quest is prevention and reversal, not "management".
Do understand you are preaching to the choir here. I'd say most of us here have seen the devastation of Alzheimer's on our loved ones. I currently have 3 family members struggling with dementia (one of which lives in assisted living at age 81 and been battling this for almost 14 years - my husband provides oversight for her care), not to mention my own father who died in 2009 (and from whom I likely got my E4) and others in his family who died from it. We do get it, and are similarly motivated to live our healthiest lives.

Several of us here have been interacting on this site (and earlier on 23andme) for a decade or more. And after that length of time reading research, discussing the implications, and yes, interacting directly with Dr. Bredesen, many of us also know sometimes the answer is in using medication, especially when needed to address one of Bredesen's "leaky holes" as it were. It's not always just about changing our food consumption, but sometimes the effects of other genes we've inherited that stack up to cause problems. There is no shame in accepting medication when lifestyle changes take us as far as it can.

You are doing great things for your mom, and I'm happy to see that she has responded to your interventions. Hope you can find some other ideas on the site that might contribute further to her improvement.
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Re: Statins when you’re homozygous APOE4

Post by Nords »

A month ago on this thread, my family doctor was politely pushing back on my long-term trend of rising cholesterol. I also scored a moderately high Lp(a) of 107 and a moderately high ApoB of 106.

Coincidentally, the week after those results came back, a family friend (a retired Marine) had urgent triple bypass surgery. He’s in his mid-50s and he still exercises like, well, a Marine, but he frequently felt tired during the day and had less stamina.

He went to his local clinic on Friday afternoon for a routine checkup. One question led to another, a stethoscope check led to an EKG, and the data was alarming enough that they operated on Monday morning. He’s recovering just fine with his substitute cardiac arteries, but I felt like I was supposed to pay attention to a not-so-subtle message about risk factors.

I’ve just finished my coronary artery calcium scan. It’s... all right... at 194 with “mild non-obstructive coronary artery disease” and “mildly calcified plaque resulting in minimal stenosis of the left anterior descending artery.”

For those who aren’t familiar with the process, we spent extra to do the CT scan with an iodine contrast (Iohexol). The techs spent about 15 minutes fussing over the setup and the first set of scans while monitoring my blood pressure. (Apparently people get pretty upset in the machine with a combination of white coat syndrome and claustrophobia, but I’m a submarine veteran.) After consulting with the duty doctor, they decided my blood pressure was good enough (115/60!) to administer a nitroglycerin tablet (under my tongue) to dilate my blood vessels. The effect feels like a tingly hot flush, and it dropped my BP down to 105/53 with a pulse of 52.

The scans are synchronized to record images when the heart’s between beats, so a slow heartbeat meant that the entire test moved faster. I was only in there for another 15 minutes.

The scan also showed no blood clots and no valve degeneration.

However the trend is the important part, not so much the score. Or, as my family doc wrote, “You do have some narrowing of your main coronary artery. Your total score was 194, which places you at moderate risk for future cardiac events. It would be my recommendation that we lower your cholesterol to mitigate risk of progression.”

As I’ve written before, the risks are relatively low over the next decade-- but a little scary in the context of three decades.

Since all of the indicators are heading in the same direction, and since there’s slightly more evidence that APOE4s can tolerate statins than not, I’m willing to experiment with a low dose.

As others have mentioned, the doctor and I going to chat about a hydrophilic one-- probably rosuvastatin.
Last edited by Nords on Tue May 21, 2024 5:51 pm, edited 1 time in total.
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