A 30-year-old male asked:
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are there any prophylactics (e.g., supplements, special diet, otc or other pharmaceuticals) that you'd recommend for someone heterozygous apoe4?

3 doctor answers
Dr. Ed Friedlander
43 years experience Pathology
Ignore it: No magic pills or food will modify your risk. Truth is, life's too short and difficult already without fretting about your having a common genetic variant that puts you at slightly increased risk for disease in old age. I have not seen strong evidence that supplements prevent alzheimer's. Take the same good care of their arteries / lipids as others do. Enjoy life.
Answered on Dec 10, 2013
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4 comments
Dr. Randy Baker
Dr. Randy Baker commented
39 years experience Holistic Medicine
Thank-you for your clarification Dr. Friedlander. From seeing your work here I know that you are a good doctor; in fact, I have high regard for most of the docs here and commend everyone who donates their time and energy to help patients here. So I was a bit surprised to see the negative tone of your answer. I tend to be very empathetic and can imagine how frightening it would be to learn one had triple the normal risk of Alzheimer's. We doctors are going to be facing questions like this more and more as genetic testing becomes more common. While the exact figure is not known, experts now estimate about 30% of our health is determined by genetics and 70% by lifestyle. I strongly believe that someone with an ApoE 4 gene can minimize the increased risk with an especially healthy lifestyle. There are some people who drink, smoke & eat poorly and live to an old age anyway but this patient is not likely to be one of those! I do understand that you were trying to help this patient and caution him against those who promise miracles based on limited evidence. And I agree that Alzheimer's is particularly challenging to study given the current limits of diagnosis. But I also believe that hope is a crucial aspect of health and that stress is a leading factor in illness. Anything that may help relieve the stress of feeling helpless in this situation is likely to be beneficial! Best wishes to you!
Mar 24, 2013
Dr. Ed Friedlander
43 years experience Pathology
Provided original answer
Thanks Dr. Baker; I agree that my original wording was clumsy. As a ringside doctor I am very much aware of ApoE4. I'll stand by this being a risk for late-onset Alzheimer's and keep my eyes open for any new links to early-onset Alzheimer's. My point is that EVERYONE should take precautions on lipids, regardless of the ApoE4 genotype. I'm reserving judgement on mental exercises to prevent Alzheimer's (this wasn't the question and I actually thought of mentioning it -- glad you did) and waiting for something convincing on the supplements. If this does come out, I expect I will hear it first from a guy like you, a scientific physician knowledgeable about the herbs. The last big review was in Arch Neuro Sept 2011 looking at everything -- diet, tobacco, folate, cognitive activities, physical activities -- the contribution confounding variables are tremendous, the diagnosis is always uncertain until autopsy (and we know it's often wrong), and good studies are very hard to do. The "Arch Neuro" team concluded, "Currently, insufficient evidence exists to draw firm conclusions on the association of any modifiable factors with risk of AD." Did the National Institue of Aging (naturally optimistic) overstate the hope of prevention? Did I (naturally pessmistic after many disappointments) understate it? Is it better to offer hope when the science is so uncertain? It is better simply to urge people to ignore risks they cannot modify and take the same precautions as others do? I've developed a high regard for you while we've worked together, and we can both wish our correspondent the best.
Mar 24, 2013
Dr. Randy Baker
Dr. Randy Baker commented
39 years experience Holistic Medicine
Dr. Friedlander, this variant triples one's risk of getting a devastating disease, which is much more than "slightly increased risk." It also is correlated with earlier onset. If there was really no way to reduce risk then I would agree with your advice to avoid fretting, but actually there is quite a bit of research showing that simple things like exercise & staying mentally active reduce one's risk of Alzheimer's. The National Institute of Aging has prepared a 24 page book "Preventing Alzheimer's Disease." Are you suggesting the National Institute of Aging is scamming us?
Mar 24, 2013
Dr. Randy Baker
39 years experience Holistic Medicine
Many things can help: As you know, your genetics mean you have 3 times more risk than average but the odds are still good that you won't get alzheimer's. There is evidence that regular exercise, healthy diet, mental stimulation, quality sleep, stress management & social interaction can reduce alzheimer's risk. Dha, curcumin, resveratrol & huperzine may also help. Minimize exposure to environmental toxins. See comment:.
Answered on Dec 10, 2013
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Dr. Randy Baker
Dr. Randy Baker commented
39 years experience Holistic Medicine
Provided original answer
If I was in your situation I would definitely take proactive measures to reduce your risk. For more info see http://www.helpguide.org/elder/alzheimers_prevention_slowing_down_treatment.htm & http://www.huffingtonpost.com/jean-carper/post_752_b_695706.html For a free 24 page book Preventing Alzheimer's Disease by the National Institute of Aging go to http://www.nia.nih.gov/alzheimers/publication/preventing-alzheimers-disease
Mar 24, 2013
Dr. Steven Charlap
36 years experience Holistic Medicine
Yes: Although the proof is not definitive, recent studies show a strong correlation between being fit, eating berries and wild fish like salmon rich in omega-3s, and learning new skills. One study last year showed that people who exercise and use their brains at the same time like on some special bicycles do very well.
Answered on Mar 25, 2013
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