Insulin Resistance and the ApoE4 Gene

By: Dr. Deborah Gordon, February 16, 2018

Just by looking, you wouldn’t guess that Julie was pre-diabetic. Tall and slim, consistently athletic, she looked like the picture of health for a woman in her 40’s. She, however, knew that wasn’t the case.

She ran into people in the store who seemed to know her—she didn’t have a clue who they were. Several times while driving on familiar routes she found herself lost. She had to write down everything scheduled or risk missing it. The scariest clue was when= she realized she had to put a post-it note on her dashboard to remind herself to stay on the right side of the road while driving.

Worried about her health, she consulted the Alzheimer’s disease website and a local neurologist. The neurologist confirmed that she had minimal to moderate cognitive impairment and told her that she could only rely on good luck to avoid getting early Alzheimer’s.

Three Strikes

Julie began doing her own research, relying primarily on self-help groups on the internet, poring over reports from people who were in a similar situation. Early in her journey she realized she had three strikes against herself in terms of brain health:

1) she experienced early menopause,

2) her Alzheimer’s genes were unfavorable, she was an ApoE 4/4,

3) despite her own physician’s disbelief—they found she was pre-diabetic with significant insulin resistance.

Her path forward wasn’t easy: her brain wasn’t up to the research task needed to find a way of reversing her disease! She knew she could at least address the insulin resistance component and so she started there. She eliminated sweets and processed foods of all sorts, she cut out grains and focused her diet on healthy fats, proteins, and green vegetables.

She eventually added in many other components of the DIY Brain Health program and subsequently met Dr. Dale Bredesen who has documented  reversal of brain measurements and function of Alzheimer’s patients following his comprehensive program. Within his staff’s teaching program, Julie—with her now healed brain—has become a bit of an expert on coaching the dietary changes ApoE4 patients need to make to reverse insulin resistance and improve brain function.

As you can read about here, ApoE4 individuals process dietary fats differently from most us who have ApoE3 genes. ApoE4’s absorb more fats and make more problematic lipid particles if the fats they’re eating are rich in the saturated fats found in four-footed meat and dairy sources. ApoE3 individuals do much better with truly ruminant, grass-fed meat and dairy, although they can tolerate some conventionally sourced foods as well. ApoE4 individuals can show unfavorable lipid and oxidation markers if they make meat and dairy more than an occasional side dish in their meal plan.

ApoE4 Insulin resistance reversal

ApoE4’s can reverse their insulin resistance if they rely on:

  • Protein primarily from eggs and fatty and cold-water fish, with occasional indulgences in grass-fed meats and small amounts of dairy. Dairy choices should be limited to yogurts, full-fat milks or creams and small amounts of cheese. If an individual shows a high degree of inflammation (an elevated hsCRP or oxLDL on testing), cheese should probably go. (One physician has suggested that all his ApoE4 patients have a strong craving for cheese!)
  • Fats from avocados and olive oil, fish oils, and nuts should all be safe. Coconut oil seems to elicit a variable response: each individual should test their lipid and inflammatory markers with coconut oil alternately in and out of their diet.
  • Carbohydrates can come from all sorts of vegetables, preferring leafy greens and cruciferous sources! Two kinds of carbs should be limited until your insulin resistance is reversed: starchy carbs and fruits. Two kinds of carbs should be sampled only rarely—very rarely—and those are grains and desserts.

Eating for brain health can include a delicious shrimp appetizer, paired with tomatoes and herbs, drizzled in olive oil. Yes, please.

Fasting for your future

An incredibly useful tool in reversing insulin resistance is the inclusion of fasting in your dietary plan. If you are insulin resistant, fasting is the most effective way to jump start the healing of your metabolism, your waistline, and that number on your bathroom scale. (HINT: visits to the scale should be at least ten days apart.)

Dr. Jason Fung and Jimmy Moore have produced a gorgeous, encyclopedic and inspirational book on fasting, The Complete Guide to Fasting. Dr. Fung highlights the science (the problem is too much insulin; high blood sugar is secondary) and the ease (people have been fasting throughout time!) of a medical intervention you can do safely at home.

(The exceptions: please don’t start fasting if you’re pregnant or a child. And a warning for you if you’re on meds for high blood pressure or diabetes, you need to monitor how your body changes in response to fasting. Most common results are quickly lowered blood sugar and blood pressure and meds may need to be adjusted.)

The initial recommendation is a seven to ten day fast, supported with bone broth throughout the day, and one cup of coffee with cream if you want to live gloriously! And as Jimmy Moore points out, if you’re crashing on day five, you can always break your fast! Each long fast is easier than the one you did before. 

Although weight loss occurs during the fast, it is largely reversed when you resume eating, but you have already started to re-wire your metabolic connections. When you include intermittent fasting and additional long fasts, your body stops over-producing insulin and your weight and metabolism can normalize in response to what you wisely choose to eat.

It’s a great book also because real life people tell their stories: anecdotes are always impressive when they are personal.

Julie’s gift

Julie started a website loaded with helpful information for people carrying one or two copies of the ApoE4 gene. If you learn you have this gene (and if you have Alzheimer’s disease in your family history, please get your genes checked), her website, ApoE4.info, is another great place to start learning about what you can do for yourself. And please enjoy all the DIY Brain Health articles on this site.