Doctor’s Tip: Apo E genotype and diet — the Bale Doneen Method (BDM)

Dr. Greg Feinsinger
Doctor's Tip
Dr. Greg Feinsinger.

This is another in a series of columns based on Drs. Bale and Doneen’s 2022 book “Healthy Heart, Healthy Brain,” and their 2023 preceptorship.

Apolipoprotein E (Apo E) influences how our body metabolizes cholesterol, fat, and carbohydrates. According to Bale and Doneen and others, diet recommendations for patients should be based on the results of this inexpensive genetic test, done on a blood or saliva specimen. Apo E also predicts lifetime risk for coronary artery disease and for Alzheimer’s.

Apo E has three variants: E2, E3, and E4. We get one of these from our mother and one from our father, resulting in six possible genotypes: Apo E 2/2, Apo E 2/3, Apo E 2/4, Apo E 3/3, Apo E 3/4, and Apo E 4/4.

APO E 2/2 AND 2/3

· These genotypes occur in 11% of the population.

· These people have the lowest risk for heart attacks and strokes compared to other Apo E genotypes.

· You want your LDL (bad cholesterol) particles to be large and buoyant like ping-pong balls; small dense LDL particles are more dangerous. In people with Apo 2/2 and 2/3 genotypes, levels of harmful small, dense LDL paradoxically increase on a low-fat diet.

· Apo E 2/2 and 2/3 carriers lower cardiovascular risk with a low carb diet — avoiding processed carbs is especially important.

· They should be on a 35% fat diet “from heart-healthy sources such as omega-3 rich oily fish or olive oil.

· Up to 1 alcoholic drink a day for women and 2 for men is not a problem for these Apo E genotypes, although for women any alcohol is a risk factor for breast cancer, regardless of Apo E genotype.

APO E 2/4 AND 3/3

· Occur in 64% of the populations.

· These people have an intermediate risk for heart attacks and strokes.

· They benefit from a Mediterranean diet, based on colorful fruits and vegetables, and unprocessed grains.

· They should be on a 25% fat diet from health-healthy sources including omega-3, olive oil, and nuts and seeds.

· Moderate alcohol as described about is beneficial to heart health in these people, although as mentioned above any alcohol in women raises risk for breast cancer.

Apo E 3/4 AND 4/4 Apo E

· Occur in 25% of the population.

· These genotypes are linked to the highest lifetime risk for cardiovascular disease

· People with 3/4 genotypes have 3-5 times the risk of late-onset Alzheimer’s; 4/4 people have 15-20 times the risk. However, you don’t have to be a victim of your genes: There’s a country in Africa where people have the highest rate of Apo E 4 in the world, yet those on a traditional plant-based, whole food diet have one of the world’s lowest rates of Alzheimer’s (it’s not just the genes you’re born with but whether these genes get turned on or off, which is determined by factors such as diet and exercise).

· These people do best with a low-fat diet (20% or less from heart-healthy fats).

· They should limit or avoid alcohol.

Next week’s column will be the last in this series about the Bale-Doneen Method (BDM) of heart attack prevention. It will discuss reconciling the personalized, genetics-based BDM with the one-size-fits-all plant-based whole food diet which has also been shown to be extremely effective in preventing and reversing heart disease.

Dr. Feinsinger is a retired family physician with special interest in disease prevention and reversal through nutrition. Free services through Center For Prevention and The People’s Clinic include: one-hour consultations, shop-with-a-doc at Carbondale City Market and cooking classes. Call 970-379-5718 for appointment, or email

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