For the sake of convenience: Commercial sources of prebiotic fibers

Our efforts to obtain prebiotic fibers/resistant starches, as discussed in the Cureality Digestive Health Track, to cultivate healthy bowel flora means recreating the eating behavior of primitive humans who dug in the dirt with sticks and bone fragments for underground roots and tubers, behaviors you can still observe in extant hunter-gatherer groups, such as the Hadza and Yanomamo. But, because this practice is inconvenient for us modern folk accustomed to sleek grocery stores, because many of us live in climates where the ground is frozen much of the year, and because we lack the wisdom passed from generation to generation that helps identify which roots and tubers are safe to eat and which are not, we rely on modern equivalents of primitive sources. Thus, green, unripe bananas, raw potatoes and other such fiber sources in the Cureality lifestyle.

There is therefore no need to purchase prebiotic fibers outside of your daily effort at including an unripe green banana, say, or inulin and fructooligosaccharides (FOS), or small servings of legumes as a means of cultivating healthy bowel flora. These are powerful strategies that change the number and species of bowel flora over time, thereby leading to beneficial health effects that include reduced blood sugar and blood pressure, reduction in triglycerides, reduced anxiety and improved sleep, and reduced colon cancer risk.

HOWEVER, convenience can be a struggle. Traveling by plane, for example, makes lugging around green bananas or raw potatoes inconvenient. Inulin and FOS already come as powders or capsules and they are among the options for a convenient, portable prebiotic fiber strategy. But there are others that can be purchased. This is a more costly way to get your prebiotic fibers and you do not need to purchase these products in order to succeed in your bowel flora management program. These products are therefore listed strictly as a strategy for convenience.

Most perspectives on the quality of human bowel flora composition suggest that diversity is an important feature, i.e., the greater the number of species, the better the health of the host. There may therefore be advantage in varying your prebiotic routine, e.g., green banana on Monday, inulin on Tuesday, PGX (below) on Wednesday, etc. Beyond providing convenience, these products may introduce an added level of diversity, as well.

Among the preparations available to us that can be used as prebiotic fibers:

PGX

While it is billed as a weight management and blood sugar-reducing product, the naturally occurring fiber--α-D-glucurono-α-D-manno-β-D-manno- β-D-gluco, α-L-gulurono-β-D mannurono, β-D-gluco-β- D-mannan--in PGX also exerts prebiotic effects (evidenced by increased fecal butyrate, the beneficial end-product of bacterial metabolism). PGX is available as capsules or granules. It also seems to exert prebiotic effects at lower doses than other prebiotic fibers. While I usually advise reaching 20 grams per day of fiber, PGX appears to exert substantial effects at a daily dose of half that quantity. As with all prebiotic fibers, it is best to build up slowly over weeks, e.g., start at 1.5 grams twice per day. It is also best taken in two or three divided doses. (Avoid the PGX bars, as they are too carb-rich for those of us trying to achieve ideal metaobolic health.)

Prebiotin

A combination of inulin and FOS available as powders and in portable Stick Pacs (2 gram and 4 gram packs). This preparation is quite costly, however, given the generally low cost of purchasing chicory inulin and FOS separately.

Acacia

Acacia fiber is another form of prebiotic fiber.  RenewLife and NOW are two reputable brands.

Isomalto-oligosaccharides

This fiber is used in Quest bars and in Paleo Protein Bars. With Quest bars, choose the flavors without sucralose, since it has been associated with undesirable changes in bowel flora.

There you go. It means that there are fewer and fewer reasons to not purposefully cultivate healthy bowel flora and obtain all the wonderful health benefits of doing so, from reduced blood pressure, to reduced triglycerides, to deeper sleep.

Disclaimer: I am not compensated in any way by discussing these products.

How Not To Have An Autoimmune Condition


Autoimmune conditions are becoming increasingly common. Estimates vary, but it appears that at least 8-9% of the population in North America and Western Europe have one of these conditions, with The American Autoimmune Related Diseases Association estimating that it’s even higher at 14% of the population.

The 200 or so autoimmune diseases that afflict modern people are conditions that involve an abnormal immune response directed against one or more organs of the body. If the misguided attack is against the thyroid gland, it can result in Hashimoto’s thyroiditis. If it is directed against pancreatic beta cells that produce insulin, it can result in type 1 diabetes or latent autoimmune diabetes of adults (LADA). If it involves tissue encasing joints (synovium) like the fingers or wrists, it can result in rheumatoid arthritis. It if involves the liver, it can result in autoimmune hepatitis, and so on. Nearly every organ of the body can be the target of such a misguided immune response.

While it requires a genetic predisposition towards autoimmunity that we have no control over (e.g., the HLA-B27 gene for ankylosing spondylitis), there are numerous environmental triggers of these diseases that we can do something about. Identifying and correcting these factors stacks the odds in your favor of reducing autoimmune inflammation, swelling, pain, organ dysfunction, and can even reverse an autoimmune condition altogether.

Among the most important factors to correct in order to minimize or reverse autoimmunity are:


Wheat and grain elimination

If you are reading this, you likely already know that the gliadin protein of wheat and related proteins in other grains (especially the secalin of rye, the hordein of barley, zein of corn, perhaps the avenin of oats) initiate the intestinal “leakiness” that begins the autoimmune process, an effect that occurs in over 90% of people who consume wheat and grains. The flood of foreign peptides/proteins, bacterial lipopolysaccharide, and grain proteins themselves cause immune responses to be launched against these foreign factors. If, for instance, an autoimmune response is triggered against wheat gliadin, the same antibodies can be aimed at the synapsin protein of the central nervous system/brain, resulting in dementia or cerebellar ataxia (destruction of the cerebellum resulting in incoordination and loss of bladder and bowel control). Wheat and grain elimination is by far the most important item on this list to reverse autoimmunity.

Correct vitamin D deficiency

It is clear that, across a spectrum of autoimmune diseases, vitamin D deficiency serves a permissive, not necessarily causative, role in allowing an autoimmune process to proceed. It is clear, for instance, that autoimmune conditions such as type 1 diabetes in children, rheumatoid arthritis, and Hashimoto’s thyroiditis are more common in those with low vitamin D status, much less common in those with higher vitamin D levels. For this and other reasons, I aim to achieve a blood level of 25-hydroxy vitamin D level of 60-70 ng/ml, a level that usually requires around 4000-8000 units per day of D3 (cholecalciferol) in gelcap or liquid form (never tablet due to poor or erratic absorption). In view of the serious nature of autoimmune diseases, it is well worth tracking occasional blood levels.

Supplement omega-3 fatty acids

While omega-3 fatty acids, EPA and DHA, from fish oil have proven only modestly helpful by themselves, when cast onto the background of wheat/grain elimination and vitamin D, omega-3 fatty acids compound anti-inflammatory benefits, such as those exerted via cyclooxygenase-2. This requires a daily EPA + DHA dose of around 3600 mg per day, divided in two. Don’t confuse EPA and DHA omega-3s with linolenic acid, another form of omega-3 obtained from meats, flaxseed, chia, and walnuts that does not not yield the same benefits. Nor can you use krill oil with its relatively trivial content of omega-3s.

Eliminate dairy

This is true in North America and most of Western Europe, less true in New Zealand and Australia. Autoimmunity can be triggered by the casein beta A1 form of casein widely expressed in dairy products, but not by casein beta A2 and other forms. Because it is so prevalent in North America and Western Europe, the most confident way to avoid this immunogenic form of casein is to avoid dairy altogether. You might be able to consume cheese, given the fermentation process that alters proteins and sugar, but that has not been fully explored.

Cultivate healthy bowel flora

People with autoimmune conditions have massively screwed up bowel flora with reduced species diversity and dominance of unhealthy species. We restore a healthier anti-inflammatory panel of bacterial species by “seeding” the colon with high-potency probiotics, then nourishing them with prebiotic fibers/resistant starches, a collection of strategies summarized in the Cureality Digestive Health discussions. People sometimes view bowel flora management as optional, just “fluff”–it is anything but. Properly managing bowel flora can be a make-it-or-break-it advantage; don’t neglect it.

There you go: a basic list to get started on if your interest is to begin a process of unraveling the processes of autoimmunity. In some conditions, such as rheumatoid arthritis and polymyalgia rheumatica, full recovery is possible. In other conditions, such as Hashimoto’s thyroiditis and the pancreatic beta cell destruction leading to type 1 diabetes, reversing the autoimmune inflammation does not restore organ function: hypothyroidism results after thyroiditis quiets down and type 1 diabetes and need for insulin persists after pancreatic beta cell damage. But note that the most powerful risk factor for an autoimmune disease is another autoimmune disease–this is why so many people have more than one autoimmune condition. People with Hashimoto’s, for instance, can develop rheumatoid arthritis or psoriasis. So the above menu is still worth following even if you cannot hope for full organ recovery

Five Powerful Ways to Reduce Blood Sugar

Left to conventional advice on diet and you will, more than likely, succumb to type 2 diabetes sooner or later. Follow your doctor’s advice to cut fat and eat more “healthy whole grains” and oral diabetes medication and insulin are almost certainly in your future. Despite this, had this scenario played out, you would be accused of laziness and gluttony, a weak specimen of human being who just gave into excess.

If you turn elsewhere for advice, however, and ignore the awful advice from “official” sources with cozy relationships with Big Pharma, you can reduce blood sugars sufficient to never become diabetic or to reverse an established diagnosis, and you can create a powerful collection of strategies that handily trump the worthless advice being passed off by the USDA, American Diabetes Association, the American Heart Association, or the Academy of Nutrition and Dietetics.

Among the most powerful and effective strategies to reduce blood sugar:

1) Eat no wheat nor grains

Recall that amylopectin A, the complex carbohydrate of grains, is highly digestible, unlike most of the other components of the seeds of grasses AKA “grains,” subject to digestion by the enzyme, amylase, in saliva and stomach. This explains why, ounce for ounce, grains raise blood sugar higher than table sugar. Eat no grains = remove the exceptional glycemic potential of amylopectin A.

2) Add no sugars, avoid high-fructose corn syrup

This should be pretty obvious, but note that the majority of processed foods contain sweeteners such as sucrose or high-fructose corn syrup, tailored to please the increased desire for sweetness among grain-consuming people. While fructose does not raise blood sugar acutely, it does so in delayed fashion, along with triggering other metabolic distortions such as increased triglycerides and fatty liver.

3) Vitamin D

Because vitamin D restores the body’s normal responsiveness to insulin, getting vitamin D right helps reduce blood sugar naturally while providing a range of other health benefits.

4) Restore bowel flora

As cultivation of several Lactobacillus and Bifidobacteria species in bowel flora yields fatty acids that restore insulin responsiveness, this leads to reductions in blood sugar over time. Minus the bowel flora-disrupting effects of grains and sugars, a purposeful program of bowel flora restoration is required (discussed at length in the Cureality Digestive Health section.)

5) Exercise

Blood sugar is reduced during and immediately following exercise, with the effect continuing for many hours afterwards, even into the next day.

Note that, aside from exercise, none of these powerful strategies are advocated by the American Diabetes Association or any other “official” agency purporting to provide dietary advice. As is happening more and more often as the tide of health information rises and is accessible to all, the best advice on health does not come from such agencies nor from your doctor but from your efforts to better understand the truths in health. This is our core mission in Cureality. A nice side benefit: information from Cureality is not accompanied by advertisements from Merck, Pfizer, Kelloggs, Kraft, or Cadbury Schweppes.

Cureality App Review: Breathe Sync



Biofeedback is a wonderful, natural way to gain control over multiple physiological phenomena, a means of tapping into your body’s internal resources. You can, for instance, use biofeedback to reduce anxiety, heart rate, and blood pressure, and achieve a sense of well-being that does not involve drugs, side-effects, or even much cost.

Biofeedback simply means that you are tracking some observable physiologic phenomenon—heart rate, skin temperature, blood pressure—and trying to consciously access control over it. One very successful method is that of bringing the beat-to-beat variation in heart rate into synchrony with the respiratory cycle. In day-to-day life, the heart beat is usually completely out of sync with respiration. Bring it into synchrony and interesting things happen: you experience a feeling of peace and calm, while many healthy phenomena develop.

A company called HeartMath has applied this principle through their personal computer-driven device that plugs into the USB port of your computer and monitors your heart rate with a device clipped on your earlobe. You then regulate breathing and follow the instructions provided and feedback is obtained on whether you are achieving synchrony, or what they call “coherence.” As the user becomes more effective in achieving coherence over time, positive physiological and emotional effects develop. HeartMath has been shown, for instance, to reduce systolic and diastolic blood pressure, morning cortisol levels (a stress hormone), and helps people deal with chronic pain. Downside of the HeartMath process: a $249 price tag for the earlobe-USB device.

But this is the age of emerging smartphone apps, including those applied to health. Smartphone apps are perfect for health monitoring. They are especially changing how we engage in biofeedback. An app called Breathe Sync is available that tracks heart rate using the camera’s flash on the phone. By tracking heart rate and providing visual instruction on breathing pattern, the program generates a Wellness Quotient, WQ, similar to HeartMath’s coherence scoring system. Difference: Breathe Sync is portable and a heck of a lot less costly. I paid $9.99, more than I’ve paid for any other mainstream smartphone application, but a bargain compared to the HeartMath device cost.

One glitch is that you need to not be running any other programs in the background, such as your GPS, else you will have pauses in the Breathe Sync program, negating the value of your WQ. Beyond this, the app functions reliably and can help you achieve the health goals of biofeedback with so much less hassle and greater effectiveness than the older methods.

If you are looking for a biofeedback system that provides advantage in gaining control over metabolic health, while also providing a wonderful method of relaxation, Breathe Sync, I believe, is the go-to app right now.

Amber’s Top 35 Health and Fitness Tips

This year I joined the 35 club!  And in honor of being fabulous and 35, I want to share 35 health and fitness tips with you! 

1.  Foam rolling is for everyone and should be done daily. 
2.  Cold showers are the best way to wake up and burn more body fat. 
3.  Stop locking your knees.  This will lead to lower back pain. 
4.  Avoid eating gluten at all costs. 
5.  Breath deep so that you can feel the sides or your lower back expand. 
6.  Swing a kettlebell for a stronger and great looking backside. 
7.  Fat is where it’s at!  Enjoy butter, ghee, coconut oil, palm oil, duck fat and many other fabulous saturated fats. 
8.  Don’t let your grip strength fade with age.  Farmer carries, kettlebells and hanging from a bar will help with that. 
9.  Runners, keep your long runs slow and easy and keep your interval runs hard.  Don’t fall in the chronic cardio range. 
10.  Drink high quality spring or reverse osmosis water. 
11.  Use high quality sea salt season food and as a mineral supplement. 
12.  Work your squat so that your butt can get down to the ground.  Can you sit in this position? How long?
13.  Lift heavy weights!  We were made for manual work,.   Simulate heavy labor in the weight room. 
14.  Meditate daily.  If you don’t go within, you will go with out.  We need quiet restorative time to balance the stress in our life. 
15.  Stand up and move for 10 minutes for every hour your sit at your computer. 
16. Eat a variety of whole, real foods. 
17.  Sleep 7 to 9 hours every night. 
18.  Pull ups are my favorite exercise.  Get a home pull up bar to practice. 
19.  Get out and spend a few minutes in nature.  Appreciate the world around you while taking in fresh air and natural beauty. 
20.  We all need to pull more in our workouts.  Add more pulling movements horizontally and vertically. 
21. Surround yourself with health minded people. 
22. Keep your room dark for deep sound sleep.  A sleep mask is great for that! 
23. Use chemical free cosmetics.  Your skin is the largest organ of your body and all chemicals will absorb into your blood stream. 
24. Unilateral movements will help improve symmetrical strength. 
25. Become more playful.  We take life too seriously, becoming stress and overwhelmed.  How can you play, smile and laugh more often?
26.  Choose foods that have one ingredient.  Keep your diet simple and clean. 
27.  Keep your joints mobile as you age.  Do exercises that take joints through a full range of motion. 
28. Go to sleep no later than 10:30pm.  This allows your body and brain to repair through the night. 
29. Take care of your health and needs before others.  This allows you to be the best spouse, parent, coworker, and person on the planet. 
30.  Always start your daily with a high fat, high protein meal.  This will encourage less sugar cravings later in the day. 
31. Approach the day with positive thinking!  Stinkin’ thinkin’ only leads to more stress and frustration. 
32. You are never “too old” to do something.  Stay young at heart and keep fitness a priority as the years go by. 
33. Dream big and go for it. 
34.  Lift weights 2 to 4 times every week.  Strong is the new sexy. 
35.  Love.  Love yourself unconditionally.  Love your life and live it to the fullest.  Love others compassionately. 

Amber B.
Cureality Exercise and Fitness Coach

To Change, You Need to Get Uncomfortable

Sitting on the couch is comfortable.  Going through the drive thru to pick up dinner is comfortable.  But when you notice that you’re out-of-shape, tired, sick and your clothes no longer fit, you realize that what makes you comfortable is not in align with what would make you happy.   

You want to see something different when you look in the mirror.  You want to fit into a certain size of jeans or just experience your day with more energy and excitement.  The current condition of your life causes you pain, be it physical, mental or emotional.  To escape the pain you are feeling, you know that you need to make changes to your habits that keep you stuck in your current state.  But why is it so hard to make the changes you know that will help you achieve what you want?  

I want to lose weight but….

I want a six pack but…

I want more energy but….

The statement that follows the “but” is often a situation or habit you are comfortable with.  You want to lose weight but don’t have time to cook healthy meals.  So it’s much more comfortable to go through the drive thru instead of trying some new recipes.   New habits often require a learning curve and a bit of extra time in the beginning.  It also takes courage and energy to establish new routines or seek out help.  

Setting out to achieve your goals requires change.  Making changes to establish new habits that support your goals and dreams can be uncomfortable.  Life, as you know it, will be different.  Knowing that fact can be scary, but so can staying in your current condition.  So I’m asking you to take a risk and get uncomfortable so that you can achieve your goals.  

Realize that it takes 21 days to develop a new habit.  I believe it takes triple that amount of time to really make a new habit stick for the long haul.  So for 21 days, you’ll experience some discomfort while you make changes to your old routine and habits.  Depending on what you are changing, discomfort could mean feeling tired, moody, or even withdrawal symptoms.  However, the longer you stick to your new habits the less uncomfortable you start to feel.  The first week is always the worst, but then it gets easier.

Making it through the uncomfortable times requires staying focused on your goals and not caving to your immediate feelings or desires.  I encourage clients to focus on why their goals important to them.  This reason or burning desire to change will help when old habits, cravings, or situations call you back to your old ways.
Use a tracking and a reward system to stay on track.  Grab a calendar, journal or index card to check off or note your daily successes.  Shoot for consistency and not perfection when trying to make changes.  I encourage my clients to use the 90/10 principle of change and apply that to their goal tracking system.  New clothes, a massage, or a day me-retreat are just a few examples of rewards you can use to sticking to your tracking system.  Pick something that really gets you excited.  

Getting support system in place can help you feel more comfortable with being uncomfortable.  Hiring a coach, joining an online support group, or recruiting family and friends can be very helpful when making big changes.  With a support system in place you are not alone in your discomfort.  You’re network is there for you to reach out for help, knowledge, accountability or camaraderie when you feel frustrated and isolated.  

I’ve helped hundreds of people change their bodies, health and lives of the eleven years I’ve worked as a trainer and coach.  I know it’s hard, but I also know that if they can do it, so can you.  You just need to step outside of your comfort zone and take a risk. Don’t let fear create uncomfortable feelings that keep you stuck in your old ways.  Take that first step and enjoy the journey of reaching your goals and dreams.  

Amber Budahn, B.S., CSCS, ACE PT, USATF 1, CHEK HLC 1, REIKI 1
Cureality Exercise Specialist

The 3 Best Grain Free Food Swaps to Boost Fat Burning

You can join others enjoying substantial improvements in their health, energy and pant size by making a few key, delicious substitutions to your eating habits.  This is possible with the Cureality nutrition approach, which rejects the idea that grains should form the cornerstone of the human diet.  

Grain products, which are seeds of grasses, are incompatible with human digestion.  Contrary to what we have been told for years, eating healthy whole grain is not the answer to whittle away our waists.  Consumption of all grain-based carbohydrates results in increased production of the fat storage hormone insulin.  Increased insulin levels create the perfect recipe for weight gain. By swapping out high carbohydrate grain foods that cause spikes in insulin with much lower carbohydrate foods, insulin release is subdued and allows the body to release fat.

1. Swap wheat-based flour with almond flour/meal

  • One of the most dubious grain offenders is modern wheat. Replace wheat flour with naturally wheat-free, lower carbohydrate almond flour.  
  • Almond flour contains a mere 12 net carbs per cup (carbohydrate minus the fiber) with 50% more filling protein than all-purpose flour.
  • Almond flour and almond meal also offer vitamin E, an important antioxidant to support immune function.

2. Swap potatoes and rice for cauliflower

  • Replace high carb potatoes and pasta with vitamin C packed cauliflower, which has an inconsequential 3 carbs per cup.  
  • Try this food swap: blend raw cauliflower in food processor to make “rice”. (A hand held grater can also be used).  Sautee the “riced” cauliflower in olive or coconut oil for 5 minutes with seasoning to taste.
  • Another food swap: enjoy mashed cauliflower in place of potatoes.  Cook cauliflower. Place in food processor with ½ a stick organic, grass-fed butter, ½ a package full-fat cream cheese and blend until smooth. Add optional minced garlic, chives or other herbs such as rosemary.
3. Swap pasta for shirataki noodles and zucchini

  • Swap out carb-rich white pasta containing 43 carbs per cup with Shirataki noodles that contain a few carbs per package. Shirataki noodles are made from konjac or yam root and are found in refrigerated section of supermarkets.
  • Another swap: zucchini contains about 4 carbs per cup. Make your own grain free, low-carb noodles from zucchini using a julienne peeler, mandolin or one of the various noodle tools on the market.  

Lisa Grudzielanek, MS,RDN,CD,CDE
Cureality Nutrition Specialist

Not so fast. Don’t make this mistake when going gluten free!

Beginning last month, the Food and Drug Administration began implementing its definition of “gluten-free” on packaged food labels.  The FDA determined that packaged food labeled gluten free (or similar claims such as "free of gluten") cannot contain more than 20 parts per million of gluten.

It has been years in the making for the FDA to define what “gluten free” means and hold food manufactures accountable, with respect to food labeling.  However, the story does not end there.

Yes, finding gluten-free food, that is now properly labeled, has become easier. So much so the market for gluten-free foods tops $6 billion last year.   However, finding truly healthy, commercially prepared, grain-free foods is still challenging.

A very common mistake made when jumping into the gluten-free lifestyle is piling everything labeled gluten-free in the shopping cart.  We don’t want to replace a problem: wheat, with another problem: gluten free products.

Typically gluten free products are made with rice flour (and brown rice flour), tapioca starch, cornstarch, and potato flour.  Of the few foods that raise blood sugar higher than wheat, these dried, powdered starches top the list.

 They provide a large surface area for digestion, thereby leading to sky-high blood sugar and all the consequences such as diabetes, hypertension, cataracts, arthritis, and heart disease. These products should be consumed very rarely consumed, if at all.  As Dr. Davis has stated, “100% gluten-free usually means 100% awful!”

There is an ugly side to the gluten-free boom taking place.  The Cureality approach to wellness recommends selecting gluten-free products wisely.  Do not making this misguided mistake and instead aim for elimination of ALL grains, as all seeds of grasses are related to wheat and therefore overlap in many effects.

Lisa Grudzielanek MS, RDN, CD, CDE
Cureality Health & Nutrition Coach

3 Foods to Add to Your Next Grocery List

Looking for some new foods to add to your diet? Look no further. Reach for these three mealtime superstars to encourage a leaner, healthier body.

Microgreens

Microgreens are simply the shoots of salad greens and herbs that are harvested just after the first leaves have developed, or in about 2 weeks.  Microgreen are not sprouts. Sprouts are germinated, in other words, sprouted seeds produced entirely in water. Microgreens are grown in soil, thereby absorbing the nutrients from the soil.

The nutritional profile of each microgreen depends greatly on the type of microgreen you are eating. Researchers found red cabbage microgreens had 40 times more vitamin E and six times more vitamin C than mature red cabbage. Cilantro microgreens had three times more beta-carotene than mature cilantro.

A few popular varieties of microgreens are arugula, kale, radish, pea, and watercress. Flavor can vary from mild to a more intense or spicy mix depending on the microgreens.  They can be added to salads, soup, omelets, stir fry and in place of lettuce.  

Cacao Powder

Cocoa and cacao are close enough in flavor not to make any difference. However, raw cacao powder has 3.6 times the antioxidant activity of roasted cocoa powder.  In short, raw cacao powder is definitely the healthiest, most beneficial of the powders, followed by 100% unsweetened cocoa.

Cacao has more antioxidant flavonoids than blueberries, red wine and black and green teas.  Cacao is one of the highest sources of magnesium, a great source of iron and vitamin C, as well as a good source of fiber for healthy bowel function.
Add cacao powder to milk for chocolate milk or real hot chocolate.  Consider adding to coffee for a little mocha magic or sprinkle on berries and yogurt.




Shallots


Shallots have a better nutrition profile than onions. On a weight per weight basis, they have more anti-oxidants, minerals, and vitamins than onions. Shallots have a milder, less pungent taste than onions, so people who do not care for onions may enjoy shallots.

Like onions, sulfur compounds in shallot are necessary for liver detoxification pathways.  The sulfur compound, allicin has been shown to be beneficial in reducing cholesterol.  Allicin is also noted to have anti-bacterial, anti-viral, and anti-fungal activities.

Diced then up and add to salads, on top of a bun less hamburger, soups, stews, or sauces.  Toss in an omelet or sauté to enhance a piece of chicken or steak, really the possibilities are endless.  

Lisa Grudzielanek,MS,RDN,CD,CDE
Cureality Nutrition & Health Coach

3 Band Exercises for Great Glutes

Bands and buns are a great combination.  (When I talk about glutes or a butt, I use the word buns)  When it comes to sculpting better buns, grab a band.   Bands are great for home workouts, at gym or when you travel.  Check out these 3 amazing exercises that will have your buns burning. 

Band Step Out

Grab a band and place it under the arch of each foot.  Then cross the band and rest your hands in your hip sockets.  The exercise starts with your feet hip width apart and weight in the heels.  Slightly bend the knees and step your right foot out to the side.  Step back in so that your foot is back in the starting position.  With each step, make sure your toes point straight ahead.  The tighter you pull the band, the more resistance you will have.    You will feel this exercise on the outside of your hips. 

Start with one set of 15 repetitions with each foot.  Work on increasing to 25 repetitions on each side and doing two to three sets.



Band Kick Back

This exercise is performed in the quadruped position with your knees under hips and hands under your shoulders.    Take the loop end of the band and put it around your right foot and place the two handles or ends of the band under your hands.  Without moving your body, kick your right leg straight back.  Return to the starting quadruped position.  Adjust the tension of the band to increase or decrease the difficulty of this exercise. 

Start with one set of 10 repetitions with each foot.  Work on increasing to 20 repetitions on each side and doing two to three sets. 



Band Resisted Hip Bridge

Start lying on your back with feet hip distance apart and knees bent at about a 45-degree angle.  Adjust your hips to a neutral position to alleviate any arching in your lower back.  Place the band across your hipbones.  Hold the band down with hands along the sides of your body.  Contract your abs and squeeze your glutes to lift your hips up off the ground.  Stop when your thighs, hips and stomach are in a straight line.  Lower you hips back down to the ground. 

Start with one set of 15 repetitions.  Work on increasing to 25 repetitions and doing two to three.  Another variation of this exercise is to hold the hip bridge position.  Start with a 30 second hold and work up to holding for 60 seconds.

The exception to low-carb

The exception to low-carb

I witness spectacular results restricting carbohydrates, both in the office as well as in my online experiences, such as those in Track Your Plaque. Of course, the diet I advocate is not just low-carb; it starts with elimination of wheat (for a long list of reasons). So the diet is wheat-free in the setting of low-carbohydrate.

What does this accomplish? Here's a partial list:

--Weight loss-Specifically, loss of visceral fat, the kind hinted at on the surface as "love handles" or what I call "wheat belly."
--Reduced blood sugar and HbA1c (reflecting prior 60-90 days glucose)
--Marked reduction in small LDL and triglycerides, increased HDL
--Reduced inflammatory measures like c-reactive protein
--Reduced leptin and leptin resistance, increased adiponectin
--Reduced estrogen and prolactin in men, accompanied by shrinkage or loss of enlarged breasts ("man boobs"); reduced estrogen in females accompanied by reduced risk for breast cancer

Pretty impressive. But there's one group of people who can experience unexpected effects with this diet: The 25% of people with apoprotein E4.

Everybody has two genes for apo E; the most common type is apo E 3/3. Around 1 in 4 people have 1, less commonly 2, genes for apo E4.

I hate apo E4. I hate apo E4 because it means I've got to dust off the nonsense I used to tell patients about cutting their fat, cutting their saturated fat. But that's what apo E4 people have to do. But it doesn't end there.

Apo E4 people also typically have plenty of small LDL particles triggered by carbohydrates. Put fats and carbohydrates together and you get an explosion of small LDL particles. Remove fats, small LDL goes down a little bit, if at all. Remove carbohydrates, small LDL goes down but total LDL (mostly large) goes up. The large LDL in apo E4 does seem to be atherogenic (plaque-causing), though the data are fairly skimpy.

So apo E4 creates a nutritional rock and a hard place: To extract full advantage from diet, people with apo E4 have to 1) go wheat-free, low-carb, then 2) not overdo fats, especially saturated fat.

It still gives me the creeps to tell an apo E4 person that they've got to watch their fats, worse than watching Starsky and Hutch reruns.

Comments (60) -

  • Simon

    7/30/2011 10:45:35 PM |

    What does one eat if they are wheat free, low carb, and low saturated fat? Can anyone give a sample day for this plan?

  • Paul

    7/30/2011 11:44:42 PM |

    Have you tried T4/T3 adjustments with apo E4?

  • PeggyC

    7/30/2011 11:48:10 PM |

    How can one find out if one has Apo E4?

  • steve

    7/31/2011 12:38:22 AM |

    Is it possible to have the same reactions to fats such as large increase in LDL, mostly large with little small LDL?  At one point i was 100% small LDL; restrcting carbs and increasing fats of all kind(good ones only) my NMR was 2098 LDL of which 200 were small were small.  HDL was 69 and TRGs 62.  Only way to get these numbers down is to be on statin and zetia.  Thought i was an ApoE 4, but test showed i am ApoE 3/3.
    Perhaps i am a hyper-absorber of fats- maybe as bad as ApoE4?   With statin and zetia i can reduce the numbers to LDL total of 640 and <90 small.    So maybe the high fat diet is not so great even for those who are not ApoE4.
    Thanks for your thoughts.

  • Buckaroo Banzai

    7/31/2011 5:19:21 AM |

    I'm getting my ApoE status tested soon.  I've been quite liberal with the healthy fats (olive, avocado, pastured eggs) and include saturated coconut oil and dark chocolate.  I also have high LDL particles - about 1500, but only 139 are small without statins.  I would love to find out I am 3/3 because I've already restricted grains and a variety of foods that I tested as allergic too including nuts.  I asked Dr. D on the forum if having <10% small particles was good news, but he was still worried about the total LDL.  I guess we will see how worried I should really be shortly.  BTW, I've got high Lp(a) at 26mg/dl, so I really don't need another strike against me in my plaque battle.

  • Might-o'chondri-AL

    7/31/2011 6:35:43 AM |

    Lost a nice technical ApoE explanation  I spent a lot of my time on to "server error" .
    I'll just lurk from now on.

  • Renfrew

    7/31/2011 12:46:17 PM |

    Mighto:
    Please stay here and enlighten us with your comments. Glitches can happen. I made it a habit a long time ago to just copy my text (Ctrl.A, Ctrl. C, on WINDOWS) before sending it. It is easy and takes no time. Text is preserved and you can try again.
    I for one am enjoying your musings tremendously.
    Cheers, Renfrew

  • Beth@WeightMaven

    7/31/2011 2:17:43 PM |

    What Renfrew said. I've run into this problem on blogger regularly where it decides to log me off while posting a comment. Now I always save any longish comment before posting. Better safe?

  • Jolly

    7/31/2011 2:26:04 PM |

    Digging into my 23andMe data, it reports back on APOE e4 status Smile

    You can find this as part of the https://www.23andme.com/you/journal/alzheimers/overview , or just check the rs7412 & rs429358 SNP's directly.

  • Gene K

    7/31/2011 3:39:12 PM |

    I am an APOE 3,4, and here’s what I eat on week days.
    Breakfast.
    Steamed raw vegetables (eggplant, zucchini, bell peppers, mushrooms, Mexican or yellow squash). Add yellow mustard and dry spices.
    Natto twice a week (1 box Mito natto, throw away their soy sauce and mustard packages).
    Frozen blueberries (1/8 cup), 3 tbsp flaxseed meal, 1 cup unsweetened almond milk - all microwaved for 2 min. Add ground cinnamon.
    Half-ounce piece of part skim milk mozzarella cheese.
    Coffee.
    Lunch.
    Frozen vegetables (California blend – cauliflower, broccoli, carrots) microwaved (reheat). Add a boiled egg, 1/4 avocado, yellow mustard.
    Dinner.
    Cooked or baked vegetables (cauliflower, bok choy, green cabbage, rapini).  
    Sautéed or baked fish (tilapia, salmon, perch, trout), chicken breast, or ground turkey meat balls. Add yellow mustard, horseradish, and dry spices.
    Generous amount of raw vegetables (green lettuce, pickles, tomatoes, bell peppers) with hummus.
    Decaf tea with a 1/10 serving piece of 90% dark chocolate, half-ounce mozzarella cheese, and some almonds or sunflower seeds.

  • Gene K

    7/31/2011 3:43:03 PM |

    My daily fruit serving includes a cup of frozen dark berries (blueberries, raspberries, blackberries) from the Costco Three Berry bag.

  • mallory

    7/31/2011 4:18:37 PM |

    back incollege i did a report on cancer and ottowarburg and i remember this gene being incredibly linked to cancer risk....any truth to that?

  • Dr. William Davis

    7/31/2011 4:48:42 PM |

    Hi, Steve--
    There are indeed genetic predispositions outside of apo E4 that can provide for this response, e.g., apo B receptor variants. What is not known is when you've crossed a threshold of mostly or purely large LDL that is undesirable. Despite $2 billion spent on statin drug-related research, we still have no answer on this question.

  • Dr. William Davis

    7/31/2011 4:50:18 PM |

    Hi, Buck--
    Similar issue as the question posed above by Steve: We just don't know what an "allowable" quantity of mostly or purely large LDL particles are. For a working value, I've been trying to keep NMR-derived LDL particle number 1500 nmol/L or less when LDL is purely large, but I have no endpoint data to justify this.

  • Dr. William Davis

    7/31/2011 4:51:22 PM |

    Great program, Gene, given your pattern. And I am impressed at your courage to eat natto!

  • Dr. William Davis

    7/31/2011 5:06:39 PM |

    Hi, Mallary--

    Hardly my area, but I believe that the relationship between apo E4 and cancer in various sites is complex and modulated somewhat differently than in other apo E genotypes. Some discussion:
    http://aje.oxfordjournals.org/content/170/11/1415.long

  • Dr. William Davis

    7/31/2011 5:08:35 PM |

    Hi, Simon--

    The full diet is articulated in detail, including scientific rationale, in several reports on the Track Your Plaque website; link above. Chapter 9 of the New Track Your Plaque Guide is also devoted to this.

    As you see, I will be putting out recipes here and on the Track Your Plaque website in coming months.

  • Might-o'chondri-AL

    7/31/2011 7:28:48 PM |

    even 1 reconstructed paragraph just  lost to "server error"

  • Might-o'chondri-AL

    7/31/2011 7:33:54 PM |

    ApoE joins with ApoB and is carried in VLDL and chylomicrons; it is ApoE that binds to tissue cell LDL receptors to start normal uptake. Inside the ApoB with lipids breaks off and heads into tissue cell lysosome.
    Meanwhile ApoE and the LDL receptor head back to that cell's membrane, with ApoE carrying some cholesterol out of that cell to build into an HDL molecule for recycling.

  • Tim Dietz

    7/31/2011 8:32:10 PM |

    I have the worst of both worlds, I think, as I am E2/E4.  Dr. Davis, do you have a specific program for patients with this genotype?

  • Tim Dietz

    7/31/2011 8:49:56 PM |

    So, Gene, I'm curious.  It looks like you have an extremely low intake of protein.  How are your labs and what kind of activity do you do during the day?

  • Gene K

    8/1/2011 4:13:05 AM |

    Eggs, natto, fish, poultry, and nuts are all rich in proteins, correct? I increase my portions of fish and poultry when I go to gym. I also add canned fish on these days like tuna in water or sardines in mustard sauce. I used to consume large amounts of tofu, but stopped recently based on some negative information I learned from a TYP member forum.
    Every weekday I typically walk to and from the train station, 25 min each way. I work out two or three days a week following the slow burn routine; I do cardiovascular, too. I also ride my bike for 2 hrs every weekend.
    I am a software engineer, so I spend most of my business hours in front of a computer.
    Before I learned about my APOE 4, I used lots of olive and canola oil and was a vegetarian, but had already reduced carbs. My labs were pretty bad and actually much worse than when I ate lots of bread and oatmeal every day. In mid-December 2010, I started eating as described above plus taking niacin (500 mg) and Crestor (10mg). I was already taking the standard TYP supplements – vitamin D3, fish oil, iodine. At the end of March 2011, my NMR was the best I had ever had: LDL-P 568, LDL-C 70, HDL-C 55, Trig 24, HDL-P 29.5, Small LDL-P 293, LDL size 20.4, HDL size 9.7, Large VLDL-P 0.7, insulin resistance 16. I don’t have genetic lp(a). I know the results can be better, so I am looking forward to my next NMR due in the fall.

  • TimK

    8/1/2011 7:34:36 AM |

    I'm confused. When you say 1 in 4 have this gene are you saying it's a *problem* in 25% of everyone? As in one-quarter of us should be eating like Gene K (above)? Or is a case where the gene isn't always active or something?

  • Dr. Jack Kruse

    8/1/2011 12:21:31 PM |

    I recently wrote about Alzheimer's on my blog and this question came up in the comment section.  I think about APoE4 completely differently than you do and here is why.  APoE4 confered humans the ability to migrate out of the sahara and north and south to live in climates with less solar radiation.  It allowed us to live with lower vitamin D levels.  Moreover, its presence alone means nothing unless it is accompanied with the epigenetic triggers that make it dangerous.  Dr Davis you and I both know the disease you treat (heart disease) and the one I treat (Cerebrovascular disease) are the same disease just found in different organs.  SO i think we have a lot in common in what we do but how we think about thi sissue is different.  Here is my take.  I posted this answer on another forum and I think it needs to be discussed here.

    I think the ApoE4 story is an interesting one and one I briefly touched upon in my AD blog.......I will revisit it.......but ultimately I dont think it is that important if you live an optimal life from 20-60. ApoE4 means much if you make poor epigenetic choices. I think people who come here do do what the rest of America does.

    The other reason I think it means little is the epidemiology of ApoE4 in those over 80 yrs old. It does not have any major impact on healthy aging once you get to old age. That tells me that the epigenetic signals need also be present for it to matter.

    ApoE4 is like dynamite.......and high insulin and high PUFA consumption and lowered total brain cholesterol (due to altered lipid uptake) are the major lit matches. If they exist by themselves they are harmless......but if they are brought together you are going to get heart disease and AD early and get taken out.

    Dr Kruse

  • Peter Silverman

    8/1/2011 6:24:50 PM |

    So everyone who is eating or planning to eat a high fat diet should get tested for E4, or are there some things that indicate it's probably unnecessary?

  • Jack Kronk

    8/1/2011 8:12:52 PM |

    Dr Kruse -

    It's pretty scary for me to think that maybe I am not supposed to be eating very much saturated fat. If it's true that is unbelievably lame. This is why I'm thinking I need to check to see if I am ApoE4. (How do I test for that?) If I am, then it may explain why, even on a Paleo diet, my LDL is mostly small dense. Are you suggesting that if I keep PUFA very low, like cut out my only remaining source (almonds/pecans), that this could be a key to producing more pattern A LDL? (By the way... I have chosen to eliminate all nuts and nut butters, regardless).

    -Jack Kronk

  • Patri Friedman

    8/1/2011 8:58:31 PM |

    Thanks so much for the thoughts - I am an E4/E4 eating a Paleo 2.0 diet.  As I understand it, high-protein is not a healthy diet, so low-fat & low-carb is not a good idea.  Fat is the healthiest macronutrient, so I'd love your opinion on which types of fat are best for E4s.

    It sounds like you have concerns about saturated fat, and of course I avoid n-6 PUFAs and get lots of n-3s from grass-fed animals & fish oil.  What about coconut oil?  Olive oil?

    What sort of HDL/LDL/etc  numbers would you look for in an E4/E4 as warning signs?  As health signs?

    BTW, I blog occasionally on APOE4 at primale4.wordpress.com, am going to quote your post there.

  • Tim Dietz

    8/2/2011 1:42:49 AM |

    Thanks for that, Gene.  I may need to go your route with my profile.  I'm following TYP pretty religiously and am having my 6-mo labs this month, so hopefully they will be improved from last time.

  • Dr. Jack Kruse

    8/2/2011 3:51:19 AM |

    Jack as I mentioned to you on my blog I think you clearly need context.  I think your epigentics are telling you something.  But here is what I cant tell you and neither can anyone else.......without testing!  You need to be tested to get that context.  I think your diet you posted gave many clues......but even I did not jump to the easy conclusion.  I think your real underlying issue is multifactorial but your VAP strongly points to a leaky gut as a source of the sdLDL.  I think the bananas and cream are problems too.  Your O6/O3 ratio maybe bad and yes......you may have a bad set of allele's for ApoE4......but guess what!  Your HS CRP was very very low.  This tells me that your match is not lit.  So you may only be carrying a stick of dynamite.  Again......carrying dynamite is not going to blow you up.  This is why you need testing to get more context.

  • Dr. Jack Kruse

    8/2/2011 4:05:59 AM |

    We send our ApoE4 patients to an nearby academic lab for testing.  One is likely available in your community because cardiologist and neurologist are ordering this test quite often now.  I think your PUFA content of your diet and of your tissues is critical.  In fact for AD the PUFA content is a major factor.  I believe it is a huge factor for CAD disease as well.  Wheat, Carbs, and PUFA's all drive sdLDL production.  Its not just one part of the diet that does it.  Moreover, the more leaky the gut the more sdLDL one will have as I laid out in my VAP blog that I dedicated to yourself.  I think your case is quite representative to many thousands of people and I am glad we are talking about it here because Dr Davis is a cardiologist and is coming at this issue from a different angle than I am.  I think however when the story plays out.......we will be in the same neighborhood because human biochemistry pathways are constant.  The fuels and hormone status and the situations in our guts are the covariables that make this issue more confusing.  I think people need to know why Apoe4 is important.  It conferred an adaptive advantage to move away from the equator to lower solar radiation and lower vitamin D levels.  This adaptation is seen in many american african americans.  The other interesting finding is that the liver of these patients makes more cholesterol to try to raise the D level and pregnenolone level to offset the deficit.  It never does.  But when this set of circumstance is mixed with a high carb low fat SAD (PUFA rich) it destroys the heart, vessels and brain.  This is what we see today in many parts of the world.  Their diet is now completely mismatched for the original adaptation.  I think if you tweek the diet when you know the epigenetic variables you can easily over come an Apoe4 positive test if youre willing to change.   But you need to test!

  • Dr. William Davis

    8/2/2011 11:01:58 AM |

    Hi, Tim--
    Very rare, as you likely know.
    I believe that you simply deal with this on a practical level, i.e., deal with the small LDL and insulin resistance issues and postprandial abnormalities from apo E2 as you ordinarily would. Then deal with the LDL-accumulating aftermath from the apo E4 component.

  • Dr. William Davis

    8/2/2011 11:07:23 AM |

    Thanks for the insightful thoughts, Dr. Kruse.
    I'm not sure how your approach folds into mine, though fascinating. I do agree that apo E4 is made much worse by the means you cite, i.e., polyunsaturates, carbohydrates that trigger small LDL. This is why, despite the LDL-accumulating effect of apo E4, I focus first on reducing the small LDL component, in effect an anti-inflammatory, glycation-reducing, oxidating-reducing approach, followed only then by dealing with any large LDL-increasing aftermath.
    What is not clear to  me is how atherogenic the large LDL is at higher levels in the setting of apo E4. As you know, one of the greatest concerns in apo E4 is that its effects may not be confined to lipid effects, but may extend into non-lipid effects. But that is such poorly charted territory.

  • Dr. William Davis

    8/2/2011 11:12:52 AM |

    Hi, Patri--
    The formal data on the various fat fractions and apo E4 are, unfortunately, very skimpy.
    Saturated fat clearly increases whatever LDL dominant form there is. However, other forms of fat, even omega-3 fatty acids, also increase apo E4. This become a problem, for instance, when we try to use high-dose omega-3 fatty acids to reduce Lp(a) in the presence of apo E4.
    As I commented above in response to Dr. Kruse's comments, as a practical matter I believe it is best to address the worst fraction of LDL particles first, i.e., take dietary steps to reduce small LDL particles, meaning reduce carbohydrate triggers of small LDL. Then deal with the large LDL that emerge by varying fat intake and gauging effect.
    Odd thing: Even among apo E4 people, fat intake yields variable LDL-increasing effects, quite variable sometimes.
    Also, recall that health extends beyond LDL. So there may be benefits to monounsaturates or omega-3 polyunsaturates, say, that extend to issues like brain and liver health.

  • Melinda

    8/2/2011 2:57:02 PM |

    Hi Melinda,
    Please copy and post this in previous thread for ApoE4 … .
    Continuation about ApoE4:
    % of ApoE4 messes dynamic inside tissue cell so that ApoB turns to use Scavenger Receptors to try to start cascade which gets signal transducer (Specificity Protein 1) to up-regulate the cell membrane transporter protein ( ABCA1, ATP binding cassette transporter A1) that puts excess cholesterol out from that cell. I believe this is where Doc Davis’ stated ApoB irregularities add to the problem with ApoE4 (since normal human ApoE3 works all by itself to get that signal transducer to bind to ABCA1 to work shucking cholesterol) . When cholesterol gets to build up inside the cell the large LDL can acetylate and form excessive “droplets” in that cell’s cytoplasm; while the small LDL can oxidize from CuSO4- and load up inside that cell’s lysosome.

    Meanwhile % of ApoE4 doesn’t just dock with tissue cell LDL receptors and so the macrophage scavenger receptors pick up too much cholesterol laden ApoB/ApoE lipo-protein carrier molecules. Once in the macrophage the same problem of oxidized LDL piling up in lysosome and acetylated LDL burdening cytoplasm occurs; and for that matter, in macrophages, it is down to ApoB to get the signal transducer going if any cholesterol is to be put out by cell membrane transporter protein ABCA1. This is the recipe for risky pro-atherogenic “foam cell” formation; while the individual genetics of ApoE, ApoB, assorted receptor types, signal transducer and transport protein all make it hard to predict how ApoE4 plays out.

    Dr. Kruse broaches ApoE4 in alzheimers and this is in large part because ApoE4 causes the brain neurons to get less than optimal cholesterol from the brain’s astrocytes. It is ApoA1 working in HDL complex that controls the astrocyte cholesterol balance and when there is inflammation there is a risk of ApoA1 mis-folding to foster amyloid aggregations. Low intact ApoA1 and ApoE4 together increase the risk factor for cognitive problems and dementia several fold.

    Diabetics with ApoE4 have that % of ApoE4 as an additional limitation; however, irregardless of the ApoE iso-form diabetic dementia risk arises from their glucose loads impairing kidney tubules, and thus fostering the uremic environment that stymies ApoA1 bio-synthesis. The normal role of ApoA1 is to bind to the transport protein which secures cholesterol into a safe bond with HDL; so low ApoA1 from any factor will challenge the brain neuron over time. I suggest there are individuals whose age impaired kidneys contribute to senile dementia from impairing ApoA1 levels being made and also possibly speeding up the normal 4-6 days kidney elimination of ApoA1 ; and so Patri’s comment on limitation of high protein intake is relevant due to it’s demand on aging kidneys.

    Reply

  • Melinda

    8/2/2011 3:01:05 PM |

    The above comment was written by Might-o'chondri-Al.  He asked me to post it in this thread as he is having trouble posting here.

  • Jack Kronk

    8/2/2011 4:52:20 PM |

    Ok I will test! But I have been asking around how to test and still don't know how? Is this something that I would just ask my doctor about? Maybe I go to the same lab that did my VAP? Since I got my results 3 weeks ago, I have made the following changes: zero bananas, reduced my cream intake by about 70% or so, lowered my overall fruit intake signigicantly, added 2 teaspoons of red palm oil daily, decreased caffeine intake (and now I am doing no coffee in August). I have also decided to eliminate all nuts and nut butters as of 2 days ago. Now my only real source of PUFA left in my diet is bacon, occassional chicken, and avocado. It's weird too, because on SAD, I was probably getting 10 times the PUFA, at least. I cooked in canola, ate loads of grain bread and corn products like tortillas. Maybe adding the saturated fats makes everything more amplified. The only thing now that I am VERY reluctant to give up is starches like potatoes and white rice. If I do, I will surely be VLC again, as I don't eat breads and very little fruit now, and rarely ever indulge in sweets. This means, by default, that most of my calories would then be sat and mono fats. Isn't that not good if I am ApoE4? What a mess! Dr Davis is right about being between a rock and a hard place. Jeez!

  • Jack Kronk

    8/2/2011 5:01:51 PM |

    "high protein is not a healthy diet". you mean specifically for ApoE4 folks? I haven't been tested for it yet, but I suspect I may be ApoE4. I take whey protein daily and eat lots of eggs and beef. I do this on purpose because I do weight training 5x per week and am building muscle. Could it be true that people who are ApoE4 are not supposed to build much muscle? (logically speaking, due to the restriction on protein)

  • Might-o'chondri-AL

    8/2/2011 5:20:02 PM |

    Is server cooperating now ?

    ApoE4 degrades more readily than ApoE 3 or ApoE2; ApoE4 protein fragments that get into a tissue cell's cytosol can have bad effect on that cell's mitochondrial membrane lipid binding . This decreases the mitochondrial efficiency  when they try to perform glycolysis for generating energy.

    ApoE4 degradation in a cell cytosol can  decrease the level at which that cell advances it's bio-genesis of  robust mitochondria; this is due to how ApoE4 fragments depresses PPAR gamma expression & PPAR gamma is what promotes making good mitochondria. (Specificly in the case of human fat tissue PPAR gamma is what regulates transcription of pre-adipocytes differentiation into true adipocytes. Hence Avandia & glitazone drugs that target the receptor of PPAR gamma do short out adipocyte differentiation;  and yet risk the side effect of increasing heart disease due to mitochondrial impairment.)

    In Alzheimers the form of ApoE makes a difference; and the brain amyloids react to insulin differently with different ApoE iso-forms. The ratio of insulin in cerebro-spinal fluid as compared to insulin in plasma changes with different genotypes of ApoE.   Alzheimer patients tend to have lowered glucose utilization in their brains with  less insulin and insulin-like growth factor receptors, despite the Alzheimer brain harboring fewer insulin degrading enzymes. Which engenders a paradox whereby diabetic brain neuro-pathy experimentally improves with administration of nasal insulin; and similarly,  individuals  with ApoE4  receiving nasal insulin improved their cognitive function, with the boost being higher in ApoE4 carriers than folks with any other alleles of ApoE.

    Higher amounts of Alzheimer amyloid  formed tangles are seen in Type 2 diabetics and in those with ApoE4; leading to the conclusion that "normal" ApoE3 fortuitously forms a complex with brain amyloids.
    Apparently ApoE iso-forms other that ApoE4 can more readily bring an amyloid to where the molecule LRP-1 (lipo-protein related protein 1) can move that amyloid out across the brain blood barrier .

  • Might-o'chondri-AL

    8/2/2011 5:31:26 PM |

    Hi Melinda,
    Thanks for repost, looks like Doctor D hammered his server into shape again.

  • Dr. Jack Kruse

    8/3/2011 4:57:17 PM |

    With regards to the large LDL content.  Again I am not a cardiologist, but a neurosurgeon.  The heart and brain work on the same principles of biochemistry.  And since these two organ take up much of the CO in the body they share much in common.  It is also why when we see neolithic disease affect the heart their is also a similar effect in the brain.  The Apoe4 story is one such case.  But so is the large LDL story.  Cardiology CW today believes that LDL matters.  In neurosurgery today its clear in neurodegenerative disorders we are lacking LDL and cholesterol more often than not.  This is incongruent to biochemistry.  Dr davis has said here in this thread the jury is out on large LDL in his field.  I am submitting that LDL matter little in any field.  Why?  If it did the body would have a specific detailed regulatory control method in place to deal with it and it does not.  In nature, with the consumption of organic, unprocessed parent essential fats rather than adulterated oils (PUFA's) and transfats, LDL cholesterol is supposed to be made up of significant amounts of properly functioning “parent” omega-6, linoleic acid (LA), and is not supposed to be harmful. It is the natural transporter of parent omega-6 and parent omega-3 into the cells. It is thus not critical to lower LDL cholesterol, nor is the absolute LDL number as important, if the diet contains sufficient unadulterated parent essential fats. These are unadultered PUFA's of both the omega 6 and 3 variety for clarity sake.  Also take note that the body has no natural “cholesterol sensor” in the bloodstream—it would if its levels had to be maintained within exact limits; such as, sodium, calcium, and glucose levels are monitored in many systems. For example, glucose levels are maintained to an amazingly tight 0.1% in each of us!  So Nature implemented biological mechanisms if required. There is no need for a cholesterol sensor because the absolute number is irrelevant.  That was my advice to Jack Kronk three weeks ago when he posted his VAP numbers and when I blogged about his numbers.  I understand that Dr Davis may not want to go out on a limb as I have here.  But I dont view it as a limb when the biology and biochemistry support my beliefs fully that LDL cholesterol levels are completely irrelevant to heart disease propagation.  This is why I advocate copious amounts of coconut oil to patients with heart disease and all neurodegenerative disorders including brain tumors and seizure patients.  In fact, my literature is loaded with thousands of papers supporting my belief made here.  I think its long over do that cardiologists start reading "other pathways" of data to reach conclusions that their own field muddies.  As a neurosurgeon, I read Dr Davis literature quite a lot and in comparing the two it is clear that our two fields are on a collision course from two different paths.  I got extreme clarity reading circulation over the last thirty years that cholesterol has nothing to do with heart disease.  Dr Davis has reach conclusions that are quite different from most of his fellow cardiologist as well.  I applaud him.  I just think he is still caught in the lipid hypothesis nightmare and that is the only reason he is not traveling down the road with me in unison.  Since he is a fine doc and one who clearly is ahead of his peers......i'll gladly wait for him on that road because we need him to alter what ails his branch of medicine to get to where we both need to be going for all patients.

  • Davide

    8/4/2011 2:24:29 AM |

    Dr. Kruse,

    What is your response to the fact that people with familial hypercholesterolemia (FH) have an exaggerated risk of CVD versus those who are not lacking ldl receptors? Why do so many of them have cardiac events in their 20's and 30's? Surely, you would not relegate this phenomenon to increased consumption of PUFA's and/or higher insulin?

  • Dr. Jack Kruse

    8/4/2011 4:21:16 PM |

    There are five major classes of FH due to LDLR mutations.  FH is a collection of genetic defects.  Many believe that the end result of these defects (IE high LDL or cholesterol) cause the diseases associated with it.  I do not.  Why?  When these people live past their 6th decade they have extremely low levels of neurodegeneration.  I believe the cause of the early on set  CAD is tied to secondary effects of what the primary genetic disease does to the liver to alter its function.  If one looks at FH patients and their VAP results one sees a pattern of chronic gut inflammation that is the real source of the atherosclerosis that causes higher incidences we see in FH.   These patients all have altered gut biofilms and some of the lowest levels of Vit K2 and vit D.  They also have extremely low DHEA S and pregnenolone levels are pointing to a chronic inflammation......due not to the high cholesterol level but to an altered gut axis.  Read my blog on this here.    http://jackkruse.com/your-vap-brain-love-not-war/   My views on this topic are radically different because even with severe LDL lowering treatments the disease patterns these people face remain unchanged.  Why?  because their gut remains the source of the inflammation that damages their arteries for their entire life.  We need to focus our efforts on the gut side of the equation and not the LDL side.  Ironically Dr Davis has done this with his assault on wheat.  Wheat drives sdLDL via what mechanism?  It screws up the liver and increases gut permeability to cause issues.  His current ideas and mine are very close.......but no one is tying this together.  I think my VAP post on the gut provides you the link.

  • Might-o'chondri-AL

    8/4/2011 10:55:40 PM |

    Genetic high total cholesterol is related to the over 50 amino acid variations of PCSK9 (pro-protein conertase subtilisn/kexin 9,  which comprises 692 amino acids). Individuals producing an excess of PCSK9 more extensively degrade their cholesterol receptors with surface defects; and so don't readily take up LDL out of circulation, which lets blood levels of LDL rise higher. Conversely, those making sparse PCSK9 can't degrade their LDL receptors, which pull lots of cholesterol into a tissue cell where it can pile up over time in that cell's lysosome; and blood levels of LDL seem to drop.


    PCSK9's worst version is D3744; where total cholesterol trends to 4 times normal and risk of death is estimated to be even +/- 10 years sooner than even other problematic PCSK9 genetic variations that affect maybe 1 in 500 westerners and account for +/- 5% of all pre-mature coronary heart disease. As regards the "older" age survival ability of those with familial high cholesterol  this may be due to the way over time plaque holds less lipid content and acquires more collagen with calcium infiltration. In other words younger plaque is less stable and more likely to burst free and be perilous.

    If fretting about plaque be aware that the average duration of carotid plaque is +/- 9.6 years; according to Carbon 14 dating from autopsies. Plaque may even form multiple times during one's life and the statistically dangerous symptoms take 5 - 15 years to manifest. Increased levels of circulating plasma insulin accelerate the rate that plaque forms; and also adds to a plaques instability (ie: potential to rupture) due to insulin's interaction with genes involved in the immune response;  like how those with insulin resistance make more pro-inflammatory cytokines. This bolsters Doc Davis' insistance to control glucose, since the down stream result is a more stable plaque.

    Noteably, there is the so called "protective cytokine" TGF beta which can allay plaque rupture. This is hard to predict for individuals because we have no way to assess who has what types of TGF beta receptors around , since normal and then plaque ridden blood vessels can harbor different TGF beta receptors. TGF  is considered a vital player inside vascular smooth muscle cells because it forms part of the interactive sequence that stops the smooth muscle cells from altering; and it bears mentioning that excess cholesterol can inhibit some TGF beta pathways.

  • jegesq

    8/5/2011 4:28:04 AM |

    For those who asked (Jack Kronk, Peggy, et.al.) about where and how one can get tested for ApoE it's simple:   Virtually any large commercial lab in the U.S. can do the test, e.g., Labcorp, Quest, etc.   Also, Atherotech (VAP) and Berkeley Heart Labs will do the test as well.   Since it's a genetic test, it's only run once during a person's lifetime.  The test can run anywhere from around $100 on up, depending on which lab runs it for you.

  • Dee

    8/5/2011 1:49:05 PM |

    In my last lipotropen test, I do not absorb chol not do I make it.  Am I a closed system?  My lp[a] is 41.  I am very puzzled.

    Dee

  • Dee

    8/5/2011 2:20:34 PM |

    That was from the Boston Heart lab.  I am a AP03/3.

  • George Zachary

    8/6/2011 12:21:32 AM |

    Super interesting!

    Do you know what SNP is PCSK9 ?  I'd like to look up it in my 23andme info.
    Thanks,
    George

  • Dee

    8/6/2011 12:29:15 AM |

    Plasma PCSK9 levels correlate with cholesterol in men but not in women
    Purchase
    $ 41.95


    References and further reading may be available for this article. To view references and further reading you must purchase this article.


    Janice Maynea, , , Angela Raymonda, Anna Chaplinb, Marion Cousinsb, Nadine Kaefera, Charles Gyamera-Acheamponga, Nabil G. Seidahc, Majambu Mbikaya, Michel Chrétiena and Teik Chye Ooia, b

    aHormones, Growth and Development Program, Ottawa Health Research Institute, The Ottawa Hospital, University of Ottawa, Ottawa, Ont., Canada

    bClinical Research Laboratory, Division of Endocrinology and Metabolism, Department of Medicine, The Ottawa Hospital, University of Ottawa, Ont., Canada

    cLaboratory of Biochemical Neuroendocrinology, Clinical Research Institute of Montreal, Montreal, Que., Canada

    Received 29 June 2007.  Available online 18 July 2007.

    Abstract
    Proprotein convertase subtilisin kexin-like 9 (PCSK9) is a secreted glycoprotein that negatively regulates low density lipoprotein receptor (LDLR) levels. Several single nucleotide polymorphisms (SNPs) in PCSK9 have been linked to autosomal dominant hypercholesterolemia (ADH). Conversely, hypocholesterolemia associates with both ‘loss of function’ nonsense and missense SNPs in PCSK9. We examined the association of plasma PCSK9 with lipoprotein parameters in 182 normolipidemics. For men (n = 98) plasma PCSK9 averaged 6.08 ± 1.96 μg/ml and Spearman analysis revealed significant correlation between it and total cholesterol (TC), LDLC, and TC/high density lipoprotein (HDLC) (r = 0.276, 0.282, and 0.228, respectively). For women (n = 84) plasma PCSK9 averaged 6.46 ± 1.99 μg/ml having no correlation with TC, LDLC or TC/HDLC. The ratio of plasma PCSK9/LDLC increased in men carrying ‘loss of function’ PCSK9 variations. Our results suggest a gender difference in PCSK9 regulation and function with PCSK9 correlated to TC and LDLC in men but not women.

    Keywords: Plasma PCSK9; Loss of function; Hypocholesterolemia; Hypercholesterolemia; Single nucleotide polymorphisms

    Article Outline
    Materials and methods
    dI found this on the internet, I'm not sure if this is what you need?  

    Dee

  • Dr. K

    8/6/2011 8:27:02 PM |

    All patients with FH need to have their thyroid optimized.  This issue was hashed out at the Ancestral Health Symposium on August fifth at UCLA.  Jack Kronk's VAP is helping many patients learn how to raise their HDL to increase endotoxin clearance from the portal circulation to prevent oxidation of slow moving cholesterol because of A lack of their LDL receptor.  Thyroid optimization can overcome this to a degree but it requires a physician who knows precisely how to do this and not create an unsafe situation.  Their diets has to be a strict low carb moderate protein paleo diet high in coconut oil.

  • Dr. K

    8/6/2011 10:05:56 PM |

    This too can be assessed by looking at thyroid beta receptors......it is associated with down regulation or resistance of this specific thyroid receptor.  A company in Denmark has a clinical trial on going about this specific receptor.  Thyroid hormones bing to both thyroid alpha and beta receptors.  But disease that affect the LDL receptors seem to preferentially knock out the thyroid beta receptor.

  • Dee

    8/6/2011 11:28:44 PM |

    I apologize if I sent the wrong ifo.  Didn't read it through.
    Dee

  • Jack Kronk

    8/8/2011 2:28:15 PM |

    Dr K. -

    I am inquiring with the my Doc about getting tested for ApoE. I will let you know how that goes.

    Regarding hypothyroidism, yah the issue that I'm running into is that "it requires a physician who knows precisely how to do this and not create an unsafe situation".

    This is the problem with our medical system in America. I live in San Diego, one of the biggest, most advanced cities on earth, and I am having trouble finding anyone over here that can truly help me with this. My doctor situaiton is pathetic. Sorry to say that, but I'll call a spade a spade. All they want to do is put me on Lipitor and go low fat whole grain. So then I am stuck with doing my own diligent research, and appyling knowledge that I can learn from people who actually know what they are talking about, and right now, for me, that means the internet. Incredible when you think about it.

    When you say low carb, do you mean no starch as well, not even potatoes? By the way... the name of this post is "The Exception to Low Carb". So... that's why this is so confusing. Some very knowledgable people think it's best to raise my intake of starches and lower my fats. If my body is creating more LDL (even small dense) because of my saturated fat intake, then it makes sense to replace sat fats with something else. I already get enough protein, so then I am left with carbs. If it has to be carbs, isn't safe starch my only real option? It can't be 'sugar'. It can't be 'fructose', or grain starch, right? Should I eat loads of salads? Or I am on the wrong track completely? Should I look at upping my mono fats in place of saturated, like using mac nut oil for cooking? Or would mono fats be just as problematic?

    You see? Honestly, I know this stuff stone cold. I know what *most* people do well with, but if we don't figure out how being pre-disposed to having issues with LDL receptors really changes things, we are going to (deservedly) get hammered by the low-fat whole grain camp when a fair amount of people who thought they had it all figured out are dropping dead from eating fats because they are ApoE and had no idea.

    I'm genuinely glad that my example is helping people. No doubt I am. But I'd be alright with feeling like I'm getting somewhere with all this in my personal case as well. At the moment, I can't really say that I feel that way just yet.

  • Dr. K

    8/11/2011 12:38:34 AM |

    Patients with apoe4 have a higher rate of AD and AD is associated with a cholesterol deficiency in the brain.  So for me apoe4 is a signal to load with the MCT of coconut oil which has massive benefits to the brain metabolically.  I find it hard to believe this is bad for the heart at any level because CAD tends to mirror CVD across all measures.  I think only cardiologist have this problem with Larger particle LDL because of the faulty lipid hypothesis.  cAD is an inflammatory condition.  It ha little to do with cholesterol itself.  If the cholesterol is oxidized then there are issues but this can be followed by acute phase reactants from the liver like HS CRP.  When it's up HDL tends to be low......and it's low because the liver is being bombard by gut endotoxins and this is a direct measure of the oxidation potential of an overwhelmed portal circulation.  To further the point......thyroid hormone, testosterone, estrogen, and high vitamin D levels all raise liver HDL and this is how they protect against heart disease.  I maintain large LDL confers no risk without inflammation.......and a low HDL is a great way to know if your liver is being overwhelmed in the portal circulation.  This is why vitamin K2 confers a great cardiac benefit.......it comes from a healthy gut biome.  vAP tells you a ton about your portal circulations inflammatory burden.

  • majkinetor

    8/14/2011 2:59:37 PM |

    M-Al, just copy your text prior to the post, or write it in the editor. I don't know which browser you use, but in Chrome if you use "back" on "server error", it will return what you typed in a reply.

  • Peter Silverman

    8/16/2011 5:08:49 PM |

    Following your diet I took an NMR last summer and this summer.  The small LDL particles went down (835 to 709) but the total particles went up (1800 to 2100).  Should I stick with your diet (low carb, no wheat, D, omega3's), one Walmart glucometer) or go back to rice and beans?

  • Jack Kronk

    8/24/2011 7:29:11 PM |

    I got quote at $390 for just an ApoE genetic test. Is that normal?

  • Adriana

    10/5/2011 12:33:30 PM |

    Have you seen any reduction in your LDL following this diet?

  • Eric

    7/9/2012 6:43:01 PM |

    I've been eating paleo/primal for about a year, dropped 10 pounds, and brought my triglycerides down from a high of 325 three years ago to 130. Unfortunately, my LDL-p is over 2600 (first time it was checked), and I found out I'm APO e4/e4.

    The doctor says e4/e4 should go vegan, which seems about as anti-primal as you can get.

    Any suggestions for where to start looking for eating guidelines?

  • Gary Mullennix

    5/4/2013 4:38:16 AM |

    My goodness, how very confusing!!  I'm hypothyroid.  My HDL is 95. My total C is 285. Ny LDL is 186. But my LDL fractions are mostly big and plumb and my small total 23. So, I think I'm ok...buy my doc thinks I should go vegan. I want coconut oil, little red meat.  I evercise 5x week. My heatt stress tests were all 'well within'   So, it sounds as though I need to get the E4 tested   More?

  • Mario

    3/9/2014 9:46:46 AM |

    I would be deeply grateful for your advice. I am doing my best to understand how to cope with my aPOE 3/4 status. I have Alzheimer's on both sides of my family, which has killed or is in the process of killing several relatives, including my father and maternal grandmother. Unsurprisingly, I have received much conflicting data.

    I am 46. I eat a strict Paleo diet (grass-fed, wild-caught, etc.) except for some resistant starch in the form of parboiled rice and unmodified potato starch. I consume approximately 50-60% fats (majority saturated fats including daily MCT oil), 30-40% protein and 10-20% carbs. I exercise vigorously and non-vigorously -- but not every day. (Incidentally, over three years I naturally increased my testosterone by 38% using this approach, going from the low 3's to 5.3.)

    My LDL is 128. My HDL is a distressingly low 33. Triglycerides are 59.

    MY NEXT MOVE: Seek out an LDL particle-size test. If that reveals my LDL particles to be of an unhealthy size then I will need to consider a different approach in regard to sat fats. Also, looking  to improve my sleep, which has been my Achilles' heel (consistently get only around six hours). Finally, using super-consistent exercise and increasing oyster intake to boost the HDL.

    I would appreciate any guidance.(!)

    Best / Mario

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