written by Pamela McDonald, NP

Cognitive decline in old age has been described throughout history. However, it was not until the early part of the 20th century that a collection of brain cell abnormalities was specifically identified by a German physician, Alois Alzheimer , for whom the dread disease was named.

Nearly a century later, a high risk for Alzheimer disease was associated with the Apo E 4 gene. Immediately following this discovery, ethical dilemmas associated with genetic testing led to the conclusion that medical records should be kept private in order to protect the rights of patients. Guidelines for genetic testing for Alzheimer disease determined that individuals should not be tested without their primary medical providers’ support and guidance. In 1997, President Clinton proposed a law that would help make it a crime for employers or insurance companies to discriminate on the grounds of genetic testing data they obtained. While his proposal did not become law, half the states in the United States have adopted this policy.

Not all people with Apo E 4 develop Alzheimer disease, especially those who have created a gene-supportive environment. But without that, 90 percent of the 4/4 combination and 49 percent of the 4/3 and 4/2 variants develop the disease. This is a relatively exclusive Apo E club since it is estimated that only 5 percent of the population has the Apo E 4/4. The percentage of the population with the Apo E 4/3 and 4/2 genotype totals 20 percent.

Conversely, not all people with Alzheimer disease have the Apo E 4 genotype . What I do know from my clinical practice is that Apo E 4s who eat a high-fat diet have a very high cholesterol level. My patients with two copies (Apo E 4/4) consistently have total cholesterol levels in the 300s and 400s with LDL in the 200s and 300s. Extremely high levels of LDL (bad) cholesterol cause high levels of inflammation in the blood vessels, including those in the brain. Therefore, a connection between Alzheimer disease and one’s diet is not surprising.

As with all chronic diseases , Alzheimer disease results from the interaction of genetic, environmental, and lifestyle factors over many years, causing changes in brain structure and function. While it is a complex disease with no single, clear-cut cause, for those with a 4/4 genotype , careful matching of your nutritional environment will ly postpone or prevent the development of Alzheimer disease.

In summary, of the many theories about this disease—from toxic factors aluminum or zinc to smoking being the causative agent—having an Apo E 4 gene (or two) seems to have the strongest connection with Alzheimer disease and provides a connection between elevated cholesterol and fats, with a resulting cellular inflammatory process in the brain.

In my clinical practice I am often able to discern trends in diseases. From these examples, I hope that you can see that the Apo E gene is a powerful component of our total genetic blue...

written by Kathi Casey, ERYT, CPI