Cleveland Clinic’s Dr. Caldwell Esselstyn, Jr has had the best success of any doctor in the nation in reversing coronary artery disease.  His secret? A vegan no-fat diet.  David Perlmutter, Dr. Oz’s neurologist and likely the top neurologist in the country, recommends “Eat fat, eat fat, eat!”  The brain is 70% fat.  Who is right?

    Maybe we don’t have to sacrifice the brain for the heart or vice versa.  Perhaps we can decipher a code to determine who needs what.  What is that code?  DNA.

    We are entering an era when we will all be learning about our genes.  Already, for $99, we can send off saliva and determine how much Neanderthal we have and who is related to the most movie stars!  But we also get information on over 200 genes that tell us about our risks.  That information can be mined to provide a treasure trove of ways to personalize and optimize our health!

    The single most important gene in the ‘brain vs. heart’ debate is gradually becoming famous – the APOE allele.  Most of us – 60% as it turns out – have gotten the APOE3 allele from each parent, which puts us at a standard risk.  The APOE2 allele is uncommon and only 2-3% may have both of these alleles.  The kicker is the APOE4.

    Dr. Esselstyn’s research was on 16 patients who cardiologists and cardiothoracic surgeons were more than happy to dump into his lap; they were ones that had failed stents and cholesterol-lowering medicine, and undoubtedly a source of frustration.  What Dr. Esselstyn found was that any fat – ANY fat – in these individuals was immediately turned rancid, damaging the coronary arteries.  The clue for an unresponsive patient was that he still ate almonds (I’m not kidding!); almonds have what normally is considered healthy fat but Dr. Esselstyn found for that individual, it was damaging his coronaries.  Should we be avoiding all fats including almonds?

    In his pioneering work at Naples, Florida, David Perlmutter worries that his patients are not getting enough fat.  As you suspect, he is not talking about fat from fast food.  He wants his clientele on health fats like coconut oil, olive oil, and fish oil.  He knows that fats are the building blocks of the brain.  In fact 53% of our brain is made out of a complex fat called…CHOLESTEROL?  That’s right!  And to further make Dr. Perlmutter’s case, the most powerful messengers in our body that keep all our organs and tissues strong, including both the heart and brain, are hormones.  And hormones are made from…CHOLESTEROL?  This seems a real dilemma!

    There just may be a way out.  APOE4.  One quarter of us have one of these alleles, and 2-3% have two APOE4s, which is a gene involved in fat transport.  This individuals do not do well with dietary fat.  We think that, as in Dr. Esselstyn’s experience, they convert good fat into dangerous fat.  The result is a much greater risk of cardiovascular disease.  They also may be less responsive to cholesterol-lowering medicine.  Were many of Dr. Esselyn’s patients APOE4?

    APOE4 it turns out is also a high-risk gene for Alzheimer’s dementia.  Who would want to know if they are high-risk – why not live wildly if in this category?  The reason is there may be an answer – actually, many answers.  But the most important may be exercise.  Studies are showing exercise neutralizes APOE4 risk for the brain. Those exercising moderately for thirty minutes a day five days a week, on autopsy, had brains identical to those without the APOE4.  And my APOE4 patients who exercise I find do quite well!  One who has one APOE4 allele is 91 with a good brain!

    The lesson may be that information is power.  Perhaps it is worth you sacrificing that little bit of saliva and the 99 bucks to find out.  Get online and order your kit.  Information is kept confidential.  For an extra kick then download the raw data and upload it on where for a $10 donation you can find out about other really important genes such as MTHFR, COMT, and CBS.

    So the answer?  It’s the way you were designed.  So find out how you were designed!  But always – stay away from fast food, transfats, and wild women (and men)!