Dr Sam | Harley Street Online | Natural Health Tre

From the desk of Dr Sam Shohet
BDS MGDS RCS(Eng) LiAc MBAcC ICAK

Moving Away from ‘Assembly Line’ Medicine

Enter Mr Average

We all know that medical science tells us everything we need to know about treatment and prevention for someone who does not exist: The Average Person. This is your typical 70 kilogram, 1m75 Caucasian male in his early thirties. If you don’t fit the picture then I am afraid you will just have to simply accept that, scientifically speaking, you are not normal.

Genetic Polymorphisms

Our individuality in health and disease is determined by the reaction of our genes with our diet, environment, lifestyle and emotions. This reaction results in an alteration in one or more letters of our genetic code, producing a variation we call polymorphism – many shapes. So I should like to follow on from last month’s theme about the importance of food in dictating the outcome of our genetic make up or gene expression and expand on it.

Refining the Mediterranean Diet

The Mediterranean diet was singled out to be especially beneficial in ensuring that death from heart disease was reduced by a massive 70%!This reduction was partly due to the fact that this diet included large amounts of fruits and vegetables as well as fish and olive oil. A 70% reduction in death from heart disease is impressive but there is still room for improvement and we need to refine this diet even further in line with what we already know about how genes work.

Apolipoprotein E, APO E

Perhaps one of the more ‘in the news’ polymorphisms and one that is touted quite regularly in cardiovascular circles is Apolipoprotein E of which there are four variants. These polymorphisms transport cholesterol in the blood stream and are associated with variations in cholesterol and triglyceride levels in response to diet. They are therefore associated with risk to heart disease and stroke and to late onset Alzheimer’s disease.

Alleles

Apolipoprotein E comes in three variants: 2, 3 and 4 and the gene line, allele, may come from the mother, the father, single allele, or from both, the double allele. Obviously a double allele makes an outcome much more likely than a single allele. For instance a single APO E4 allele increases the odds of developing late onset Alzheimer’s disease by 2.7, whereas a double allele increases the odds by a staggering 11.2.

APO E4

Thousands of years ago, when food was frequently scarce, people with the E4 allele had an advantage over others since their genes allowed them to absorb more cholesterol and fat from their diet, making them more likely to survive famine.However, in an age where food is available literally around the clock, possession of this gene has become a big liability.

The Framingham Study

In an extensive study in 1994, it was found that E4 carriers had a 153% increased risk of developing heart disease in men and 199% in women. The E4 allele was associated with elevated LDL - the fat being carried from the liver to the rest of the body, including the heart, and sometimes called the ‘bad’ fat by conventional doctors – and decreased HDL – the fat being carried from the organs back to the liver for disposal and conversion to bile.

Dietary Considerations Fat

All this information means that only APO E4 individuals are very responsive to low fat and low cholesterol diets; in fact, twice as responsive as E2 or E3 individuals.

Sugar
It has always been held that sugar consumption was related to increased fat and cardiovascular disease but in a recent study, only APOE2 showed a dose dependent relationship with triglyceride – fat – levels as well as for VLDL (very low density) cholesterol which is the worst kind.

Off the Hook?
No, this does not mean that if you have the E3 or E4 allele you can go out and have a bag of sweets and a pound of sugar in your tea! Remember we are talking about only one aspect of increasing heart disease risk. Consumption of even moderate amounts of sugar will increase the risk of developing insulin resistance diabetes or type 2 diabetes, with its known increased risk of heart disease.

Dietary Fibre

Soluble Fibre
High soluble fibre in fruits and vegetables was found to lower total cholesterol by 6.6% and 5.6% in both E3 and E4 genotypes respectively, but had no effect on APO E2 carriers.

Insoluble Fibre
A diet of whole grains and natural rice instead of white produced an improvement in E3 double allele and in E4 carriers while there was no effect in E2 individuals.

Alcohol
We all know about alcohol consumption and cholesterol. Or do we really?It was found that women who consumed alcohol regularly had lower cholesterol than those who did not drink at all, regardless of APO E type. In men this was different:APO E2 had 12% lower cholesterolAPO E4 had 15% higher cholesterol andAPO E3 double allele had no effect on cholesterol

Omega 3 Fish Oil
This was a very interesting finding of one study into how fish oils affect the variants of the APO E genotype:
 
If we look at these numbers and especially the HDL which we want to see go up against the LDL which we want to see go down, we find that LDL cholesterol actually rises in all the groups and, in the APO E4 group, taking fish oils which are supposed to be beneficial, in fact has the opposite effect by raising LDL and lowering HDL cholesterol!

The True Picture of Fish Oil

Don’t panic just yet. The picture we see is slightly more complex than that. LDL and HDL work in ratios of one to the other as well as to other measurements including total fat or triglycerides.

Also, it appears that LDL is not so important in predicting heart disease risk and Alzheimer’s, LDL-3 or very low density lipoprotein is. This molecule presents the greatest risk of all the fats and as we can see from the table it goes down considerably in all the groups. So back to your 1.5 kilos of oily fish per day, regardless of which group you are in.

PUTTING IT ALL TOGETHER Here is an overview of a tailored approach to reducing cholesterol.

APOE 2/2 2/3	APOE 3/3	APOE 4
Low Sugar & Low Glycaemic Load	Lower Calories40/30/30	Low Fat, No Cholesterol
	Soluble Fibre	Soluble Fibre
Alcohol (in moderation)	Alcohol (in moderation)	No Alcohol for Men
Fish Oil	Fish Oil	Fish Oil
Moderate Exercise	Moderate Exercise	Strenuous Exercise

Remember that we are all different and that there are other parameters that need to be looked at aside from APO E.

Demand to Know Your Type

All you need to do now regardless of whether you have already been diagnosed with high cholesterol and given medication to reduce it, is to demand a test that will, at the very least, establish your APO E genotype.

Save your own life

Then, by using the right diet, lifestyle and exercise regimen, you could save your life naturally and without resorting to any other interventions with their unpredictable and, at times, fatal outcome.

Warmest regards,

Sam Shohet