Research and videos
Standard Keto: the research and Kevin's videos
Is keto good or bad for APOE4 carriers: brain ketones versus higher LDL and ApoB?
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This page has no results from Phoenix members yet. It shows what published research says, and what Kevin and the experts say in his videos.
See what Phoenix members have measuredIs keto good or bad for APOE4 carriers: brain ketones versus higher LDL and ApoB?
A ketogenic diet lowers blood sugar, triglycerides and weight, but it raises LDL cholesterol in many people. For the brain it may help people who already have Alzheimer's, but the trials are small, and in two studies of ketone drinks APOE4 carriers did not benefit. If you try it, a low saturated fat version and repeat lipid tests are what our experts suggest.
What the research says
Grade CAPOE4-specific evidence: limited
Keto clearly improves blood sugar and weight but raises LDL; small trials suggest it may help cognition in Alzheimer's, and the little APOE4 data shows carriers benefiting less.
Key studies
Rong 2024, Journal of Nutrition, Health and AgingGrade C
Meta-analysis of 10 small trials in Alzheimer's: keto improved cognitive scores; trial quality was limited.
Read on PubMed (opens in a new tab)Phillips 2021, Alzheimer's Research & TherapyGrade C
26-person crossover trial: a modified keto diet improved daily function and quality of life in Alzheimer's.
Read on PubMed (opens in a new tab)Henderson 2009, Nutrition & MetabolismGrade C
Trial of a ketogenic medical drink (AC-1202): cognitive benefit appeared in non-carriers, not in APOE4 carriers.
Read on PubMed (opens in a new tab)
3 more key studies
Reger 2004, Neurobiology of AgingGrade C
Single-dose MCT drink raised ketones and helped memory scores in non-carriers but not in APOE4 carriers.
Read on PubMed (opens in a new tab)Bueno 2013, British Journal of NutritionGrade A
Meta-analysis of trials: very-low-carb keto beat low-fat for weight loss but raised LDL cholesterol.
Read on PubMed (opens in a new tab)Morrill 2019, Diabetes & Metabolic Syndrome
Single case: an APOE4 woman with mild Alzheimer's improved her MoCA on keto plus time-restricted eating and exercise.
Read on PubMed (opens in a new tab)
What Kevin and experts say
6 passages for, 5 against
Now showing: Dr. Kevin Tran · 2:05
Open on YouTube (opens in a new tab)For6 passages
The brain can still use ketones when glucose use fails.
“The ketones uptake system stays intact even in Alzheimer's disease.”
Dr. Kevin Tran, Founder of The Phoenix Community, Doctor of Pharmacy, APOE4/4 carrier
One carrier improved a lot on a combined approach.
“A 71y old [APOE4] carrier with [mild Alzheimer's] improved their cognitive score from 21 out of 30 to 28 out of 30.”
Dr. Kevin Tran, Founder of The Phoenix Community, Doctor of Pharmacy, APOE4/4 carrier
Her brain fog lifted a month into keto; she credits normal A1C.
“when I started maybe like a month after the ketogenic diet, my brain fog just totally lifted. I had tons of energy.”
Robin Schweitzer, Phoenix member, board-certified health coach (ReCODE), former US intelligence analyst
Ketones seem to help people with mild impairment.
“having ketones available as an alternative fuel is a is a sensible thing and does seem to improve your function”
Dr. Grant Fraser, Board-certified anti-aging and family medicine physician, APOE4 carrier
A health coach eases people into keto: sugar first, then starches.
Robin Schweitzer
Watch the Short on YouTube (opens in a new tab)
Kevin cycles keto for thinking and carbs around hard training.
Dr. Kevin Tran
Watch the Short on YouTube (opens in a new tab)
Against5 passages
In a ketone-drink trial, APOE4 carriers got no benefit.
“But people with ApoE4, zero benefit. None.”
Dr. Kevin Tran, Founder of The Phoenix Community, Doctor of Pharmacy, APOE4/4 carrier
Correction: that trial tested a ketone-raising drink (AC-1202), not a ketogenic diet; its finding that carriers did not benefit stands.
Read the study (opens in a new tab)Skip bacon-and-butter keto if you carry APOE4.
“Takeaway number one is that generic highs saturated fat keto is wrong for [APOE4] carriers.”
Dr. Kevin Tran, Founder of The Phoenix Community, Doctor of Pharmacy, APOE4/4 carrier
Strict keto is hard to sustain; aim for a balanced, livable version.
“I have never recommended a pure keto diet to anyone because I don't think that that's a sustainable diet to maintain lifelong”
Dr. Ashanthi Gajaweera, Board-certified neurologist, Menopause Society certified practitioner (Healthspan Neurology)
On keto her LDL rose; she is a lean mass responder.
“Found out I'm a lean mass responder, which means that my cholesterol my LDL that stuff go my bad heart stuff goes up if I try ketogenic”
Donna Dorrance, Phoenix member and APOE4/4 carrier, aged 72
In a large ketone-drink trial, APOE4 carriers saw no cognitive benefit.
Dr. Kevin Tran
Watch the Short on YouTube (opens in a new tab)Correction: that trial tested a ketone-raising drink (AC-1202), not a ketogenic diet; its finding that carriers did not benefit stands.
Read the study (opens in a new tab)
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