Should You Test for the ApoE4 Alzheimer’s Gene?
- Dr David Murday
- Sep 9, 2024
- 6 min read
Updated: Sep 15, 2024
My Journey, ApoE4 Gene and What It Means for Alzheimer’s Risk
When Chris Hemsworth learned he carried two copies of the ApoE4 gene during the Disney+ series Limitless, it was a stark reminder of the impact our genes can have on our health. Guided by Dr Peter Attia, Chris was confronted with the reality that his genetic profile significantly raises his risk of Alzheimer’s disease. This resonated deeply with me because, like longevity expert Dr Rhonda Patrick, I too discovered that I carry a single copy of the ApoE4 gene, and it has completely changed how I approach my health.
The decision to test for the ApoE4 gene isn’t simple; it comes with emotional, practical, and psychological challenges. But it also offers an opportunity—one that could empower you to take control of your future. The recent NICE (National Institute for Health and Care Excellence) review of lecanemab, an anti-amyloid drug that was deemed too expensive to be cost-effective for the NHS, makes this topic more relevant than ever. Treatments for Alzheimer’s are limited, and knowing your risk can help you make lifestyle changes that may reduce it.
But should you get tested for the ApoE4 gene? Is the information empowering or anxiety-inducing? Let’s explore the pros and cons of testing, the impact of recent news on Alzheimer’s treatments, and the steps you can take to reduce your risk if you are a carrier.
Understanding the ApoE Gene: What Are the Risks?
The ApoE (apolipoprotein E) gene is essential for the metabolism of fats, including cholesterol, in the body and brain. There are three common forms of the ApoE gene, called alleles: ApoE2, ApoE3, and ApoE4. Everyone inherits two alleles, one from each parent, and these combinations affect your risk of developing late-onset Alzheimer’s, the most common type of the disease.
ApoE2 (found in about 5-10% of the population): The rarest form, ApoE2, is associated with a lower risk of Alzheimer’s.
ApoE3 (found in 60-75% of people): The most common variant, ApoE3, is considered neutral—it neither increases nor decreases Alzheimer’s risk significantly.
ApoE4 (found in 20-25% of the population): This allele is linked to a higher risk of Alzheimer’s. Here’s how it breaks down:
One copy (ApoE3/E4 or ApoE2/E4): About 2-3 times higher risk than those without ApoE4, with a lifetime risk of 20-30%.
Two copies (ApoE4/E4): The risk is substantially higher, with estimates ranging from 50-90%, and onset often occurring earlier.
It’s important to note that carrying the ApoE4 gene does not mean you will definitely develop Alzheimer’s - it simply raises your risk compared to the general population. Genetics is only part of the picture; lifestyle, diet, and other factors also play significant roles.
Pros and Cons of Testing for the ApoE4 Gene
Pros of Testing
Taking Control of Your Health
Discovering your ApoE status empowers you to make proactive lifestyle changes that can significantly reduce your risk. Alzheimer’s isn’t purely determined by genetics; lifestyle and environment play a huge role. By knowing your status, you can take meaningful steps to protect your brain health. Unlike other genetic risks, there are proven interventions that can mitigate this risk, giving you a sense of control over your future.
Personalised Prevention Strategies
If you know you carry ApoE4, you can tailor your diet, exercise, and mental health strategies to specifically address this risk. For instance, studies show that ApoE4 carriers benefit particularly from a low-sugar, high-fibre diet rich in omega-3 fatty acids—something you wouldn’t necessarily prioritise without knowing your genetic risk.
Family Awareness and Planning
Your results can also inform your family. If you carry ApoE4, there’s a chance your children or siblings may as well, and they can decide whether to get tested and take preventive measures. Early intervention is key to reducing the impact of genetic risk factors.
Informed Healthcare Decisions
As new treatments like lecanemab and other anti-amyloid drugs are developed, knowing your genetic risk can help guide future healthcare decisions. However, as seen with NICE’s recent decision, these treatments may not be accessible to everyone due to cost. Prevention remains the best strategy, especially for ApoE4 carriers.
Cons of Testing
Psychological Impact
Learning that you carry the ApoE4 allele can be psychologically taxing. It may cause anxiety, fear, and hypervigilance about cognitive changes. The emotional burden of knowing you are at higher risk for Alzheimer’s is not to be underestimated and requires mental resilience. It’s important to have support, whether from family, friends, or mental health professionals, to navigate these emotions.
Uncertainty in Risk
Testing positive for ApoE4 doesn’t guarantee you’ll develop Alzheimer’s, and testing negative doesn’t guarantee you won’t. Alzheimer’s is a multifactorial disease influenced by genetics, lifestyle, and environmental factors. The results are not definitive but instead provide a risk profile.
Potential for Genetic Discrimination
Whilst understandable the risk of discrimination on the basis of genetic testing in protected in UK and EU law. The implications of sharing genetic information do need careful consideration.
How to Reduce Alzheimer’s Risk if You Are an ApoE4 Carrier
Discovering you carry ApoE4 isn’t a life sentence; it’s an opportunity to make powerful changes that can significantly reduce your risk of Alzheimer’s. Here are some science-backed strategies:
Adopt a Brain-Healthy Diet
Diet plays a crucial role in managing Alzheimer’s risk, especially for ApoE4 carriers. A Mediterranean diet, rich in vegetables, fish, nuts, whole grains and the healthy fats found in olive oil, has been shown to protect against cognitive decline and Alzheimer’s. Interestingly, ApoE4 carriers might benefit more from food-based omega-3s found in fish rather than supplements, as studies suggest they process dietary fats differently. Limiting sugar and refined carbs is especially important for ApoE4 carriers, as they tend to have a less effective ability to process fats and sugars. A ketogenic diet, which emphasizes high fats, moderate proteins, and low carbohydrates, may also offer neuroprotective benefits and might be worth consideration for some individuals.
Stay Physically Active
Exercise is a cornerstone of Alzheimer’s prevention. Regular physical activity, including both aerobic and resistance training, helps reduce inflammation, improve insulin sensitivity, and boost brain function. Exercise also helps manage other risk factors like high blood pressure and obesity.
Prioritise Quality Sleep
Sleep is essential for brain health – poor sleep is a known risk factor for Alzheimer’s, especially in ApoE4 carriers. Aim for 7-9 hours of quality sleep per night, maintain a regular sleep schedule, and create a calming bedtime routine to improve sleep hygiene. Address issues like sleep apnoea that may interfere with rest.
Manage Stress
Chronic stress can accelerate brain aging and exacerbate Alzheimer’s risk. Incorporating stress-reducing techniques such as mindfulness, meditation, yoga, or even simple breathing exercises can help manage stress levels. Mindfulness has been shown to improve memory and cognitive function, especially in ApoE4 carriers.
Engage Your Brain
Staying mentally active through lifelong learning, socialising, and engaging in cognitively stimulating activities or learning new skills can strengthen brain function to build cognitive reserve and resilience. Social interactions are equally important, as they provide mental stimulation and emotional support.
Monitor Cardiovascular Health
Cardiovascular health is closely linked to brain health. ApoE4 carriers are more susceptible to heart disease, making it vital to manage blood pressure, cholesterol, and blood sugar levels. Regular check-ups and a heart-healthy lifestyle are key to reducing Alzheimer’s risk. What’s good for your heart is good for your brain.
Avoid Smoking and Limit Alcohol
Smoking and excessive alcohol consumption are known risk factors for cognitive decline. If you smoke, seek help to quit, and keep alcohol intake to moderate levels, if at all.
Consider Targeted Supplements
While lifestyle measures, and especially exercise, should be the primary focus, certain supplements may provide additional support for ApoE4 carriers:
Omega-3 Fatty Acids (EPA and DHA): ApoE4 carriers show a different response to supplemental omega-3s versus dietary intake. Research suggests dietary sources like fatty fish are more effective for ApoE4 carriers, while supplemental forms may not provide the same brain-protective benefits.
Curcumin: Found in turmeric, curcumin has anti-inflammatory and antioxidant properties that may help reduce brain inflammation, particularly in ApoE4 carriers. Some studies suggest curcumin can improve memory and slow cognitive decline.
Vitamin D: Low levels of vitamin D are associated with an increased risk of dementia. Ensuring adequate vitamin D through sunlight, diet, or supplements can support brain health.
Psychological Impact of Test Results
Finding out you carry the ApoE4 gene can be an emotional challenge. The knowledge of having an elevated risk for Alzheimer’s can trigger anxiety, hyper-vigilance about cognitive symptoms, and a sense of vulnerability.
It’s crucial to seek support—talking with an expert before and after testing can help you process the information and decide how to approach lifestyle changes. Family and friends can be invaluable sources of support, but so can online communities of ApoE4 carriers who share experiences and strategies.
Remember, your genes are not your destiny—what you do with this knowledge matters more.
Why I Believe the Benefits of Testing Outweigh the Risks
Deciding to test for the ApoE4 gene is deeply personal but, in my view, the potential benefits far outweigh the risks. Knowing your status empowers you to take proactive steps to reduce your Alzheimer’s risk, engage in targeted prevention strategies, and make informed health decisions.
Despite recent setbacks in the accessibility of new treatments like lecanemab, the most powerful tools remain within your reach: a healthy diet, regular exercise, quality sleep, stress management and medical management of your blood pressure and lipids.
Ultimately, knowing your ApoE4 status gives you the opportunity to take proactive steps toward a healthier, longer life. While the emotional journey may be challenging, the chance to make meaningful changes is a gift that far outweighs the burden of uncertainty.
Armed with this information, you can take proactive steps that not only reduce your Alzheimer’s risk but also improve your overall health and well-being. Ultimately, knowing your genetic status allows you to live more intentionally, and that’s a gift worth having.
