Sarah is homozygous APOE4, the highest genetic risk profile for Alzheimer's disease. Her grandmother had it. Her mother was diagnosed at 58. When she got her own results, she didn't wait.

In this first episode, she traces how a family legacy of Alzheimer's became a five-year personal research project and why the window for meaningful intervention is decades earlier than most people think. She breaks down what carrying two copies of APOE4 actually means, where the science is solid and where it falls short, and how she built a protocol around the pillars most likely to move the needle: nutrition, sleep, fitness, alcohol, and hormones. This is where it all starts.

Show Notes & References

For APOE4 carriers, knowing your risk is only useful if you know what to do with it. In this episode, Sarah walks through her path to developing a baseline, and discusses the labs that actually matter, fasting insulin, homocysteine, hs-CRP, Vitamin D etc. Sarah also discusses why standard functional medicine isn't specific enough for APOE4 biology, and how to interpret baseline data without losing your mind in the process.

Whats in this episode:

• What APOE4 actually is, and what it isn't
• Why the "nothing you can do" frame is the most expensive mistake APOE4 carriers can make
• The research caveat problem: why so many studies don't apply to people like me
• How I built my first baseline with blood work and cognitive testing before changing anything
• Why I started with Parsley Health and then moved to Dale Bredesen's PreCODE program
• What my PreCODE report revealed across metabolic, inflammatory, and cognitive domains
• Why my cognitive scores required more context than just a number on a page (ADHD, breastfeeding, medication status)
• Three practical takeaways for anyone at the beginning of this journey
• Why exercise leads Season 1, even though it wasn't where I started

Show Notes & References

This episode goes deep on the exercise pillar. The four mechanisms connecting movement to brain health, including a 2026 UCSF study that identified a liver enzyme that repairs the blood-brain barrier and what it reveals about why consistency matters at a molecular level.

We also get into why getting stronger is different from lifting consistently, what the SMART trial found when it measured both strength and aerobic capacity in the same participants, and why VO2 max may be the most important fitness number you are not tracking.

Plus my parents as a natural experiment, where my own protocol stands after two years of deliberate changes, and four questions to audit whether what you are already doing is actually building what your brain needs.

The research. The mechanisms. What I changed. What the data showed.

Show Notes

I've had high cholesterol since I was nine years old. I know, because my mom took away my chicken nuggets and put me on a diet. Three months later it came back to normal. Problem solved — or so I thought.

It took until I was twenty-seven, two years into being vegetarian, to see a normal reading again. Total cholesterol of 139. I remember thinking: I finally figured it out. That one number became my proof of concept for the next 15 years.

In this episode, I walk through five years of serious dietary intervention after getting my APOE4 result and a baseline LDL of 220. High Fiber Keto. Bulletproof coffee with MCT oil. KetoFlex 12/3. Extended fasting. Paleo. Plant-based. Supplements. And as of August 2025 — after all of it — my LDL was 149. Still high. Still not where it needs to be for someone with my risk profile.

So I started a statin.

This episode is about what that journey revealed — about the APOE4-specific reasons keto and MCT oil backfired, about why plant-based eating barely moved my numbers, and about what it looks like when the pillar you believed in most turns out not to be the lever you thought it was. I also get into why someone who's been eating well for twenty years shouldn't expect the same results from dietary intervention as someone who hasn't — and why that distinction matters more than most nutrition advice acknowledges.

Note: this is the first of three nutrition episodes. Episode 6 covers the cholesterol mechanism and why APOE4 carriers have a fundamentally different lipid problem than most people. Episode 7 covers the broader nutrition and Alzheimer's prevention research — blueberries, the Mediterranean diet, omega-3s, and what the science actually says.

Show Notes

I was having a glass of wine most nights when I got my Oura Ring. Not a lot, or so I thought. Within weeks the data told a different story. My HRV baseline runs in the nineties. On mornings after drinking, even one glass, it dropped to the thirties or forties. Every time. Without exception.

That data started a three-year experiment I didn't plan to run. And on December 31st, 2024, I eliminated alcohol entirely.

What I expected was clarity. What I got instead, and what eventually led me to the p-tau217 test, a reinfected root canal, and a completely different understanding of why a clean baseline matters, is the story this episode tells.

The research on alcohol and Alzheimer's has shifted significantly in the last few years and most people haven't caught up to it. The apparent protective effect of moderate drinking has largely collapsed under methodological scrutiny. The 2025 ALBION study found that light-to-moderate drinkers had nearly three times the odds of amyloid-beta positivity compared to abstainers. Not heavy drinkers. People who would never describe themselves as having a drinking problem. For APOE4 carriers specifically, one prospective study found that drinking at least once a month was associated with seven times the dementia risk compared to never drinking. Same behavior. Completely different biological outcome depending on what's in your DNA.

This episode covers what the research actually says, why the APOE4 picture is categorically different from the general population, what eighteen months of not drinking actually cost me socially, and the thing I least expected to learn about why elimination matters beyond optimization.

Show Notes