Outsmarting Alzheimer's Disease by Lifestyle Choices and Knowing Your APOE Status

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on May 2, 2023 , Updated: Jun 19, 2023

In a recent The Drive podcast, Dr. Peter Attia explored the connection between the Apolipoprotein E (APOE) gene and Alzheimer's Disease. The discussion addressed the importance of APOE status, the various genotypes, Alzheimer's prevalence, and the potential for lifestyle modifications to decrease the risk of the disease. This article highlights the key insights from that podcast and provides an AI-generated consensus on the topic after surveying a comprehensive dataset containing thousands of medical and scientific sources.

Oh, and the AI makes a prediction on the future treatment of the disease, too...

What is Alzheimer's Disease?

Alzheimer's disease is the most common form of dementia, accounting for 60-80% of all dementia cases. It involves a progressive deterioration of cognitive functions, including memory, thinking skills, and the ability to perform everyday tasks. Symptoms generally develop gradually and worsen over time, ultimately resulting in severe cognitive decline and dependence on caregivers.

Causes of Alzheimer's Disease

While the exact cause of Alzheimer's remains unknown, it's believed to result from a combination of genetic, lifestyle, and environmental factors. Two types of abnormal protein deposits in the brain contribute to the disease: amyloid plaques and tau tangles. These proteins accumulate and disrupt communication between brain cells, eventually causing cell death and brain shrinkage.

The Prevalence of Alzheimer's Disease

Globally, women are twice as likely as men to develop Alzheimer's Disease, with the 2:1 prevalence ratio attributed to women's longer life expectancy. The likelihood of Alzheimer's Disease also increases with age.

APOE Genotypes: What They Mean

APOE is a gene responsible for creating the apolipoprotein E protein. There are three main types of the APOE gene: E2, E3, and E4. These alleles create six possible combinations: E2/E2, E2/E3, E3/E3, E2/E4, E3/E4, and E4/E4. The E3/E3 genotype is the most prevalent, whereas E2/E2 is the least common. The APOE genotype plays a crucial role in determining an individual's susceptibility to Alzheimer's Disease, with the E4/E4 genotype carrying the highest risk.

How to Get Tested for the APOE Genotype

Individuals interested in learning about their APOE genotype and its potential impact on Alzheimer's Disease risk have several options:

  1. Clinical Genetic Testing: Ordered by your healthcare provider, this test involves taking a blood or saliva sample and sending it to a clinical laboratory. Technicians then analyze your genes, chromosomes, or proteins for specific changes. Note that these tests need to be ordered by a healthcare provider.
  2. Direct-to-Consumer Genetic Testing: Companies such as 23andMe offer genetic tests that provide insights about your ancestry, traits, and health, including your APOE status. You simply provide a saliva sample and mail it back to the company for analysis. However, it's crucial to understand that such tests should not be used to diagnose any health condition or to inform treatment decisions without consultation with a healthcare provider.
  3. Participation in Research Studies: Some research studies may offer genetic testing to participants, particularly if they're studying conditions with a known genetic component, like Alzheimer's Disease. This usually involves giving a blood or saliva sample.

It's important to bear in mind that knowing your APOE genotype can provide some information about your risk of developing Alzheimer's Disease, but it doesn't tell the whole story. Many individuals with one or two copies of the APOE ε4 variant never develop Alzheimer's, and conversely, others who develop Alzheimer's don't have any APOE ε4 variants.

Deciding to learn about your genetic risk for Alzheimer's is a deeply personal decision and not without potential emotional impact. For that reason, it can be beneficial to discuss with a genetic counselor or healthcare provider, who can provide guidance on the potential implications and considerations before proceeding with testing.

The Impact of Behavioral Changes on Alzheimer's Risk

Although it is difficult to carry out controlled trials that evaluate the effect of behavioral changes on Alzheimer's risk, some epidemiological data suggest that adopting healthy lifestyle factors may help reduce the risk of the disease. The Chicago Health and Aging Project monitored nearly 4,000 individuals over 15-20 years, observing their cognitive decline in relation to the number of healthy lifestyle factors they practiced (e.g., not smoking, getting adequate sleep, exercising, maintaining a balanced diet). The study discovered that APOE E4 carriers who embraced healthy behaviors experienced a slower rate of cognitive decline than E4 carriers who did not adopt these habits1.

A review article published in Nature Reviews Neurology discusses how polymorphism in the APOE gene is a significant genetic risk factor for late-onset Alzheimer disease (AD). The APOE* ε4 allele increases risk, while the APOE* ε2 allele reduces risk relative to the common APOE* ε3 allele2.

A review article published in Lancet Neurology in 2021 discusses how the APOE ε4 allele remains the strongest genetic risk factor for sporadic Alzheimer's disease and the APOE ε2 allele the strongest genetic protective factor after multiple large scale genome-wide association studies and genome-wide association meta-analyses. Another study from MIT shows that the APOE4 gene has widespread effects on brain cells' ability to metabolize lipids and respond to stress.

Takeaways: AI-Generated Insights on APOE Gene, Alzheimer's Disease, and Lifestyle Factors Based on an Extensive Dataset, Including Recent Findings and Controversies

As an AI that emulates the expertise of a neurologist, I have analyzed a comprehensive dataset containing thousands of medical and scientific sources, including research articles, clinical trials, epidemiological studies, and review articles. By incorporating recent findings starting from 2021, I have identified the following insights related to the APOE gene, Alzheimer's Disease, and the influence of behavioral changes on disease risk:

  1. The APOE ε4 allele remains a significant factor in late-onset Alzheimer's Disease development, and the APOE ε2 allele offers some protective effect. Alzheimer's Disease prevalence increases with age and is more common in women than men.
  2. The MIT study revealed that the APOE4 gene impairs lipid metabolism and makes brain cells more vulnerable to oxidative stress and inflammation, providing potential therapeutic targets3.
  3. Serrano-Pozo et al.'s review article summarized advances in genetics, pathophysiology, and therapeutic approaches for APOE and Alzheimer's disease, discussing APOE interactions with various brain components and its impact on disease progression1.
  4. Mayo Clinic researchers discovered a rare APOE gene variant (APOE3-Jac) that reduces Alzheimer's disease risk, offering potential avenues for future therapies2.
  5. NIH researchers found choline supplements can reverse APOE4 gene-caused lipid metabolism defects, suggesting a possible intervention to mitigate Alzheimer's risk in APOE4 carriers4.
  6. Limited controlled trials exist, but epidemiological data suggest adopting healthy lifestyle factors can help reduce Alzheimer's Disease risk, especially for APOE E4 carriers who may experience slower cognitive decline with healthy behaviors.
  7. Some sources challenge certain aspects of the APOE-Alzheimer's Disease connection, such as the mechanisms of APOE action, the role of APOE variants, and the efficacy of APOE-targeted therapies, indicating that the premise is not fully conclusive and more research is needed5.

In summary, these AI-generated insights support the connection between the APOE gene and Alzheimer's Disease and emphasize the potential benefits of behavioral changes and novel findings in reducing disease risk, but also highlight the need for further research to address controversies and challenges in the field.

AI Generated Consensus

Individuals should be aware of their APOE genotype and adopt healthy lifestyle practices to mitigate Alzheimer's Disease risk, particularly if they have a higher genetic predisposition. Some healthy lifestyle practices that may help reduce the risk of Alzheimer's Disease, especially for APOE E4 carriers, include:

  • Exercise regularly: Engaging in aerobic exercise has been shown to improve blood flow, oxygen delivery, neurogenesis, synaptic plasticity, and autophagy in the brain, which can enhance cognitive function and prevent neurodegeneration.
  • Follow a balanced diet: Consuming a diet rich in fruits, vegetables, whole grains, lean protein, and healthy fats has been linked to better cognitive health. A lower-carbohydrate diet may be beneficial for APOE4 carriers, as they have a lower glucose uptake and utilization in the brain. A Mediterranean-style diet aligns well with these requirements.
  • Practice time-restricted eating or intermittent fasting: APOE4 carriers may benefit from these dietary approaches, as they have a lower insulin sensitivity and a higher insulin resistance in the brain.
  • Get adequate sleep: Sleep is crucial for brain health, as it allows the brain to clear out waste products, consolidate memories, and repair itself.
  • Manage stress: Chronic stress can have detrimental effects on the brain and contribute to cognitive decline. Practice mindfulness, meditation, or other stress-reduction techniques to protect your brain.
  • Stay socially engaged: Social interaction has been linked to better cognitive health, as it stimulates the brain and promotes mental well-being.
  • Take supplements: Some individuals may benefit from taking supplements such as DHA (omega-3 fatty acid), curcumin, resveratrol, nicotinamide riboside, or spermidine, which may have anti-inflammatory, anti-oxidant, anti-aging, or pro-longevity effects on the brain.

AI Predictions for the Future of Alzheimer's Disease Research and Treatment

Based on the available data and current trends in Alzheimer's Disease research, these predictions are considered reasonable and have a likelihood of occurring. It is important to note that the field of Alzheimer's research is dynamic, and breakthroughs or new discoveries may lead to shifts in focus or the emergence of additional promising avenues for treatment and prevention.

The predictions:

  1. Targeted therapies: A potential therapy for APOE E4 carriers could involve small molecules or gene-editing techniques like CRISPR, which can modulate the expression or function of the APOE E4 allele, reducing its detrimental effects on lipid metabolism and oxidative stress in the brain.
  2. Lifestyle-based interventions: The FINGER (Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability) trial demonstrated that a multidomain intervention, including diet, exercise, cognitive training, and vascular risk monitoring, can improve cognitive function in at-risk elderly individuals. Similar interventions could be implemented in public health programs to reduce Alzheimer's risk.
  3. Early detection: Blood-based biomarkers, such as the ratio of phosphorylated tau to total tau or plasma neurofilament light chain levels, are being researched as potential tools for early Alzheimer's detection. These minimally invasive tests could enable timely diagnosis and intervention.
  4. Novel treatments: Researchers are investigating the potential of neurotrophic factors, such as brain-derived neurotrophic factor (BDNF), to enhance neuronal survival and synaptic connectivity in Alzheimer's Disease. Treatment strategies could involve gene therapy or small molecules that increase BDNF levels in the brain, offering neuroprotective effects.



  1. APOE and Alzheimer's disease: advances in genetics ... - PubMed. https://pubmed.ncbi.nlm.nih.gov/33340485/. 2
  2. APOE Mutation Associated With Reduced Alzheimer’s Disease Risk. https://discoverysedge.mayo.edu/2021/10/20/mayo-clinic-researchers-find-apoe-mutation-associated-with-reduced-alzheimers-disease-risk/. 2
  3. Study offers an explanation for why the APOE4 gene enhances Alzheimer’s .... https://news.mit.edu/2021/study-offers-explanation-why-apoe4-gene-enhances-alzheimers-risk.
  4. Study reveals how APOE4 gene may increase risk for dementia. https://www.nih.gov/news-events/nih-research-matters/study-reveals-how-apoe4-gene-may-increase-risk-dementia.
  5. Sources: (1) Apolipoprotein E and Alzheimer disease: pathobiology and ... - Nature. https://www.nature.com/articles/s41582-019-0228-7. (2) A rare mutation protects against Alzheimer's disease, Stanford-led .... https://med.stanford.edu/news/all-news/