Thank you, thank you, thank you for this incredibly helpful content. I am finding your writings to be invaluable as I work with my current team of doctors, who despite being very lovely have no insight into or training on APOE4. I actually just managed to get my desmosterol levels tested independently, wanted to share with your APOE4 readers that after considerable research the only options I found for testing are the Boston Heart cholesterol balance test or the EmpowerDX at-home testing. I am just an individual patient and have no affiliations with either of these companies! I've been unable to find a practitioner familiar with desmosterol testing or able to order any kind of test for me, so I had to figure this out on my own. If other readers have identified other ways to monitor desmosterol (or any practitioners to guide them) I'd love to hear it! Thanks again Dr. Fenn.
Hi E. I know how hard most doctors work and how difficult it is to be well-versed in every facet of medicine. The ApoE4 data is rapidly evolving but is just subset of what neurologists follow. Hopefully that will change as patients like you ask these questions. The only desomosterol testing site I know of is Boston Heart but I could look into others.
Fabulous article! Thanks so much! The info in your substack is always so accessible, well-organized, & evidence-based. Here's my question: You mention that Zocor & Lipitor may cross the blood-brain barrier & suppress crucial cholesterol synthesis in the brain. Any "intel" on CRESTOR (Rosuvastatin), especially at it's lowest dose of 5 mg. I'm one of those people that did not see a substantial drop in LDL levels following even a strict whole-foods-plant-based diet---with primarily only seeing a drop in my HDL. I don't have familial hypercholesterolemia, & eating a mostly plant-based diet definitely lowers my LDL, but, not to the 73-78 level that Crestor has accomplished. I only started a statin at age 71, & my only regret is that my physician did not suggest it years ago! I'm now a believer! And very low triglycerides also came along with it!
Hi! Thanks so much for your kind comments. You bring up a good question, one I was not able to fit into the already-packed post. Statins can be hydrophilic or lipophilic. It's the lipophilic ones (lipid loving) that cross the BBB and could potentially contribute to low cholesterol there. Zocor and Lipitor are lipophilic; Crestor and Pravachol are hydrophilic and so they don't cross (at least not in measurable amounts). It is probably an issue only when using these drugs aggessively (high doses) to get LDL-C down to really low levels, like under 30.
Long time follower of you! Just joined the membership. You have wonderful content! Have you written about high blood pressure? Thank you for helping us live our healthiest lives!
Hello! I absolutely find this newsletter a must-read as my mother died from Alzheimer’s. One question about stating, I find they consistently raise my blood sugar by about 30 points which I find disconcerting. I'm wondering why this is and are there ways to mitigate this.
Hi Amy. Thanks so much I am thrilled that you find the newsletter helpful. I didn't mention because the article was already a little long, but statins have a side effect of bumping up blood sugar in some people. Usually when this happens the blood sugar has been on the borderline trend. So it doesn't "give you diabetes" but may exacerbate a tendency towards insuling resistance--a message to tackle that risk factor with diet, exercise, and in consultation with your health care provider.
Thank you, Annie! I'm looking forward to the holidays in order to have time to try some of your recipes. I have a lot of risk factors (not exactly sure if I carry the gene) so your newsletter has felt like a real lifeline.
In 2020 when my mom was in the the early stages of dementia she visited a new PCP who did bloodwork and found that her cholesterol was quite high. I don’t recall her numbers but I was surprised that they were SO high. While she had high BP which was managed by medication, she was actually quite physically healthy, ate well and walked regularly before her diagnosis. Her PCP prescribed atorvastatin and said that if we didn’t get her cholesterol down she would progress much faster. Neither her previous PCP nor her neurologist ever mentioned this. Once she began taking it we actually saw a noticeable difference in terms of cognition, awareness and even behavior pretty quickly. Of course, it was clear that she still had dementia but it was interesting that not only did it slow progression, both my husband and I observed the change in daily behaviors and understanding.
Hi Trina. Thanks for sharing this. This is definitely one of the reasons doctors are striving to diagnosis dementia as early as possible--interventions like this! So glad your mom had a sharp PCP.
Welp. Neither my board-certified cardiologist nor my board-certified psychiatrist with a specialty in Alzheimer’s and dementia had any idea what desmosterol is, how it pertains to Alzheimer’s, or what concerns low levels present for people (like me) with an ApoE4 allele. Neither one could tell me any lab where I could go to have my levels tested -- and I live near two major metropolitan areas. The large teaching hospital where my doctor works does not have any way to test for desmosterol. Do you have any suggestions where such a test is available? I have been prescribed Crestor (rosuvastatin) for my elevated cholesterol and LDL levels (and my extremely high LDL small particle numbers), which have not been controlled by almost four years following a plant-based, low-saturated fat diet (along with fish oil and daily exercise). Thanks in advance, Annie.
Hi Mary Ann. The desmosterol finding is very new and so I'm not surprised it's still a bit unknown. Subscriber E., above, gave us some good resources for testing. Based on her research, check out the cholesterol profile offered at Boston Heart or the EmpowerDX home kit. I think of desmosterol as another tool you can use to help optimize these meds without doing harm. Good for you for being proactive about your cholesterol!
Apoe4 gal here. I have lowered my LDL 30% by tightening up my diet, but still have slightly high level. Wondered about your thoughts on Robert Lustig’s assertion that triglyceride/HDL ratio is a good indicator of large fluffy versus small dense LDL cholesterol particles and a better measure of long term risk of ASCVD and Alzheimer’s? By that measure I’m doing great.
Love your book, your posts/articles, and your pictures of JH!
Hi Jane. Good for you! Yes, that ratio has some merit. The newer thinking is more along the lines of: the only ratio that matters is LDL-C / 0 and ApoB / 0.
Hi there — I would like to share this entire article with my cardiologist, who has never heard of ApoE4 or its effect on cholesterol (and despite being on a plant based diet, my numbers have risen dramatically over the last four years). Is there any way to send a “gift” article, so he can read the entire article online for free? I am a subscriber! Thank you!
Yes, use the share button embedded in the article. This is an open access one, but the others are just for paying subscribers. You can send him a gift subscription but there is a charge.
Thank you so much! I’ve been following you for more than a year (since learning from 23andMe that I have one copy of ApoE4), and your research, and science-based writing on brain health have helped me immensely. Can’t wait to pass the knowledge on to my doctor.
Where would red yeast rice fall in here???? I used RYR for about a month or 2 (one bottle of it from Cooper Clinic supplements) and experienced improvement. Sounds good until I read the side effects, so not sure.
Hi Mike. A great question. Red yeast rice is like a supplement version of statins that actually contains a small percentage of the plant-based form of the drug. It can be effective in loweringly LDL-C but like you say there are a long list of potential side effects. I don't have a brand I feel good about recommending, but I would ask your cardiologist if it's a good choice for you and which one to take. He or she may want to follow your liver enzymes.
Thank you, thank you, thank you for this incredibly helpful content. I am finding your writings to be invaluable as I work with my current team of doctors, who despite being very lovely have no insight into or training on APOE4. I actually just managed to get my desmosterol levels tested independently, wanted to share with your APOE4 readers that after considerable research the only options I found for testing are the Boston Heart cholesterol balance test or the EmpowerDX at-home testing. I am just an individual patient and have no affiliations with either of these companies! I've been unable to find a practitioner familiar with desmosterol testing or able to order any kind of test for me, so I had to figure this out on my own. If other readers have identified other ways to monitor desmosterol (or any practitioners to guide them) I'd love to hear it! Thanks again Dr. Fenn.
Hi E. I know how hard most doctors work and how difficult it is to be well-versed in every facet of medicine. The ApoE4 data is rapidly evolving but is just subset of what neurologists follow. Hopefully that will change as patients like you ask these questions. The only desomosterol testing site I know of is Boston Heart but I could look into others.
Fabulous article! Thanks so much! The info in your substack is always so accessible, well-organized, & evidence-based. Here's my question: You mention that Zocor & Lipitor may cross the blood-brain barrier & suppress crucial cholesterol synthesis in the brain. Any "intel" on CRESTOR (Rosuvastatin), especially at it's lowest dose of 5 mg. I'm one of those people that did not see a substantial drop in LDL levels following even a strict whole-foods-plant-based diet---with primarily only seeing a drop in my HDL. I don't have familial hypercholesterolemia, & eating a mostly plant-based diet definitely lowers my LDL, but, not to the 73-78 level that Crestor has accomplished. I only started a statin at age 71, & my only regret is that my physician did not suggest it years ago! I'm now a believer! And very low triglycerides also came along with it!
Hi! Thanks so much for your kind comments. You bring up a good question, one I was not able to fit into the already-packed post. Statins can be hydrophilic or lipophilic. It's the lipophilic ones (lipid loving) that cross the BBB and could potentially contribute to low cholesterol there. Zocor and Lipitor are lipophilic; Crestor and Pravachol are hydrophilic and so they don't cross (at least not in measurable amounts). It is probably an issue only when using these drugs aggessively (high doses) to get LDL-C down to really low levels, like under 30.
Thanks, again Annie! Good to know—& I appreciate the explanation. You’re the BEST!
Long time follower of you! Just joined the membership. You have wonderful content! Have you written about high blood pressure? Thank you for helping us live our healthiest lives!
Hi Amita. Welcome! Yes you will find an article about BP here: https://brainhealthkitchen.substack.com/p/brain-health-homework-check-your
If you go to the homepage of brainhealthkitchen.substack.com you can find all the archived articles.
Hello! I absolutely find this newsletter a must-read as my mother died from Alzheimer’s. One question about stating, I find they consistently raise my blood sugar by about 30 points which I find disconcerting. I'm wondering why this is and are there ways to mitigate this.
Hi Amy. Thanks so much I am thrilled that you find the newsletter helpful. I didn't mention because the article was already a little long, but statins have a side effect of bumping up blood sugar in some people. Usually when this happens the blood sugar has been on the borderline trend. So it doesn't "give you diabetes" but may exacerbate a tendency towards insuling resistance--a message to tackle that risk factor with diet, exercise, and in consultation with your health care provider.
Thank you, Annie! I'm looking forward to the holidays in order to have time to try some of your recipes. I have a lot of risk factors (not exactly sure if I carry the gene) so your newsletter has felt like a real lifeline.
In 2020 when my mom was in the the early stages of dementia she visited a new PCP who did bloodwork and found that her cholesterol was quite high. I don’t recall her numbers but I was surprised that they were SO high. While she had high BP which was managed by medication, she was actually quite physically healthy, ate well and walked regularly before her diagnosis. Her PCP prescribed atorvastatin and said that if we didn’t get her cholesterol down she would progress much faster. Neither her previous PCP nor her neurologist ever mentioned this. Once she began taking it we actually saw a noticeable difference in terms of cognition, awareness and even behavior pretty quickly. Of course, it was clear that she still had dementia but it was interesting that not only did it slow progression, both my husband and I observed the change in daily behaviors and understanding.
Hi Trina. Thanks for sharing this. This is definitely one of the reasons doctors are striving to diagnosis dementia as early as possible--interventions like this! So glad your mom had a sharp PCP.
Welp. Neither my board-certified cardiologist nor my board-certified psychiatrist with a specialty in Alzheimer’s and dementia had any idea what desmosterol is, how it pertains to Alzheimer’s, or what concerns low levels present for people (like me) with an ApoE4 allele. Neither one could tell me any lab where I could go to have my levels tested -- and I live near two major metropolitan areas. The large teaching hospital where my doctor works does not have any way to test for desmosterol. Do you have any suggestions where such a test is available? I have been prescribed Crestor (rosuvastatin) for my elevated cholesterol and LDL levels (and my extremely high LDL small particle numbers), which have not been controlled by almost four years following a plant-based, low-saturated fat diet (along with fish oil and daily exercise). Thanks in advance, Annie.
Hi Mary Ann. The desmosterol finding is very new and so I'm not surprised it's still a bit unknown. Subscriber E., above, gave us some good resources for testing. Based on her research, check out the cholesterol profile offered at Boston Heart or the EmpowerDX home kit. I think of desmosterol as another tool you can use to help optimize these meds without doing harm. Good for you for being proactive about your cholesterol!
Is red yeast rice effective in lowering LDL-C cholesterol?
Please see Mike's question and my answer above.
Apoe4 gal here. I have lowered my LDL 30% by tightening up my diet, but still have slightly high level. Wondered about your thoughts on Robert Lustig’s assertion that triglyceride/HDL ratio is a good indicator of large fluffy versus small dense LDL cholesterol particles and a better measure of long term risk of ASCVD and Alzheimer’s? By that measure I’m doing great.
Love your book, your posts/articles, and your pictures of JH!
Hi Jane. Good for you! Yes, that ratio has some merit. The newer thinking is more along the lines of: the only ratio that matters is LDL-C / 0 and ApoB / 0.
Hi there — I would like to share this entire article with my cardiologist, who has never heard of ApoE4 or its effect on cholesterol (and despite being on a plant based diet, my numbers have risen dramatically over the last four years). Is there any way to send a “gift” article, so he can read the entire article online for free? I am a subscriber! Thank you!
Yes, use the share button embedded in the article. This is an open access one, but the others are just for paying subscribers. You can send him a gift subscription but there is a charge.
Thank you so much! I’ve been following you for more than a year (since learning from 23andMe that I have one copy of ApoE4), and your research, and science-based writing on brain health have helped me immensely. Can’t wait to pass the knowledge on to my doctor.
You are a true brain health ambassador.
Where would red yeast rice fall in here???? I used RYR for about a month or 2 (one bottle of it from Cooper Clinic supplements) and experienced improvement. Sounds good until I read the side effects, so not sure.
Hi Mike. A great question. Red yeast rice is like a supplement version of statins that actually contains a small percentage of the plant-based form of the drug. It can be effective in loweringly LDL-C but like you say there are a long list of potential side effects. I don't have a brand I feel good about recommending, but I would ask your cardiologist if it's a good choice for you and which one to take. He or she may want to follow your liver enzymes.