Should E4s eat low saturated fat?

It isn’t very primal, but the Track Your Plaque blog – which generally advocates a fairly primal diet – says that APOE4 fat metabolism responds poorly to saturated fat:

I witness spectacular results restricting carbohydrates, both in the office as well as in my online experiences, such as those in Track Your Plaque. Of course, the diet I advocate is not just low-carb; it starts with elimination of wheat (for a long list of reasons). So the diet is wheat-free in the setting of low-carbohydrate.

But there’s one group of people who can experience unexpected effects with this diet: The 25% of people with apoprotein E4….I hate apo E4. I hate apo E4 because it means I’ve got to dust off the nonsense I used to tell patients about cutting their fat, cutting their saturated fat. But that’s what apo E4 people have to do. But it doesn’t end there.

Apo E4 people also typically have plenty of small LDL particles triggered by carbohydrates. Put fats and carbohydrates together and you get an explosion of small LDL particles. Remove fats, small LDL goes down a little bit, if at all. Remove carbohydrates, small LDL goes down but total LDL (mostly large) goes up. The large LDL in apo E4 does seem to be atherogenic (plaque-causing), though the data are fairly skimpy.

So apo E4 creates a nutritional rock and a hard place: To extract full advantage from diet, people with apo E4 have to 1) go wheat-free, low-carb, then 2) not overdo fats, especially saturated fat.

It still gives me the creeps to tell an apo E4 person that they’ve got to watch their fats, worse than watching Starsky and Hutch reruns.

Information like this will help us narrow in on the optimal diet for our ancestral allele.  I’d like to learn more about what kinds of fat are healthy for E4s, since low-fat, low-carb would mean high-protein, and research suggests that too much protein is hard on the body and not good for life-extension in general.  And too much carbs is not good either (unless perhaps it is root vegetables).  Fat is the best macronutrient – so which fat is best for us?  I posted a comment, we will see if the good doctor responds.