Q&A: APOE gene testing for Alzheimer's; the best magnesium; osteoporosis medications; & is it too late for HRT?

🧠💊🦴🤷‍♀️

ICYMI 👉

• Post-Election Distress: How to Move Forward with Purpose & Hope (Regardless of your Politics)

• Need Better Sleep? Start here.

• When Crisis Hits Your Family

---

In this week’s reader-submitted Q&A, we’re tackling these questions:

• Should I test for the APOE4 gene mutation with a family history of Alzheimer’s?

• Which type of magnesium is best for sleep and constipation?

• Should I take osteoporosis medications?

• I missed the boat on HRT. Is it too late to start?

---

📣 Send me your questions for a future Q&A! 📣

• Click here to write me your question. ✍️

• Click here to record your question directly from your phone or computer. 🎤

Disclaimer: The views expressed here are entirely my own. They are not a substitute for advice from your personal physician.

Photo by Robina Weermeijer on Unsplash

The following subscriber questions have been lightly edited for length and clarity.

QUESTION #1: APOE4 GENE TESTING FOR ALZHEIMER’S

Hi Dr. McBride, my mother and grandmother both had Alzheimer's. When, if ever, do you recommend a patient find out their APOE status? I am prone to health anxiety, but I also hear there are lifestyle interventions you should take if you carry an APOE4 gene. Thanks!

-Carrie

Dear Carrie,

Great question. As you know, the APOE4 gene test is primarily associated with Alzheimer's disease risk assessment. The variant of the APOE gene called “APOE4” (also known as an “allele”) is considered a risk factor for late-onset Alzheimer's disease.

What does it mean if you have the gene variant? It’s important to note that having the APOE4 allele does not guarantee the development of Alzheimer's. Conversely, many people with Alzheimer's do not have the APOE4 allele. In other words, screening for Alzheimer’s is much more complicated than a single test. 

Why wouldn’t you want to know your APO4 status? There are ethical considerations and potential psychological harms associated with APOE4 testing. The knowledge of the presence of the APOE4 variant can be emotionally difficult. Because APOE4 status doesn’t necessarily change the management of a symptom-free patient at risk for dementia, this test is typically best suited for clinical trials focused on Alzheimer’s treatments.

What can you do to prevent Alzheimer’s, regardless of APOE4 status? A lot. We know that lifestyle modifications such as engaging in regular physical exercise, maintaining a healthy diet rich in antioxidants and omega-3 fatty acids, and staying mentally and socially active can reduce your risk for dementia. We also know that screening for cardiovascular risk factors, such as high cholesterol, hypertension, and diabetes can protect your cognitive health, regardless of APOE4 status.  

The upshot? It's crucial to understand the limitations of APOE4 testing. Like many other diseases, the development of Alzheimer’s reflects a complex interplay of genetic, environmental, and lifestyle factors—some of which we cannot control, and some of which we can.

---

If you would like a paid subscription but it’s not in your budget (or if you are a family member, friend, or patient who should be getting it free!), please message me directly. ❤️

---

QUESTION #2: THE BEST MAGNESIUM

Can you explain which Magnesium is the best to take to help with sleep & constipation?

-Barbara

Dear Barbara,