Cholesterol - The Good and the Bad

First, the Bad News: LDL Cholesterol, Large and Small

How does an artery become damaged? Understanding how our body's vascular plumbing system-especially the arteries-becomes damaged by imbalances in the cholesterol it creates is critical to understanding what causes chronic heart disease. LDL's job is to carry cholesterol and fatty acids from the liver, where it is synthesized, to the cells where it is used by your body in a variety of ways. This sounds reasonable, so how does LDL get such a bad rap?

Well, first you need to know that LDL cholesterol comes in seven sizes, called type I, IIa and IIb, IIIa, IIIb, IVa and IVb (the larger the number, the smaller the size). LDL's bad rap comes from three of these. The first is IVb, the smallest of the stew. If you have elevated levels of IVb, you have a much greater risk of developing artery damage. But that's not all-having more than 15-20 percent of the IIIa and IIIb types also puts your arteries at risk.

So why are these three smaller ones bad for you? They are so small that they can easily slip in between the cells that line the insides of your arteries. In fact, they are twice as likely as the larger types of LDL to do this. When they do this slippery thing, they cause the arteries to become inflamed in reaction to the invasion, and that's not good.

One way to think of these culprits is as little metal chips with spikes on them that, once they get inside the artery's lining, make a multitude of cuts that then need to be healed by your immune system. The smaller the chip, the more places it can cause damage. When the inflammation reaches a certain level, your immune system becomes overwhelmed. Plaques of hardened calcium and cholesterol then form in your arteries in a misguided attempt to seal the damage off.

Here's where the Apo E genotypes come in. They determine what happens to the different types of fats, proteins, and carbohydrates that you eat. For example, if you have the Apo E 4 gene-either the 4/4, 4/2 combination or the 4/3-and eat a lot of fat, the likelihood of inflammation in your arteries is higher. To a lesser extent, arterial inflammation occurs with the Apo E 2 gene-either the 2/2 or the 2/3 combination.

Each genotype has both an ideal kind and combination of fats, proteins, and carbohydrates for arterial health-and hence heart health-so knowing the right balance for your particular genotype is crucial.

The Good News: HDL2b

While the various components of the LDL pot carry cholesterol out to your cells, HDL carries the surplus back to the liver where it is recycled. In this way, HDL provides our body with a natural artery-cleaning service. You simply cannot have too much of this good type of cholesterol, and later we will see how the Apo E Gene Diet and exercise program can cause even more HDL to be produced.

In my experience, the Apo E 2 and the Apo E 3 genotypes tend to have higher levels of HDL, especially HDL2b. So how does HDL2b relate to artery disease? If you have too much bad LDL and not enough good HDL, especially HDL2b, your body can't clean its arteries properly, and the cholesterol accumulates and causes them to narrow-and thus begins cardiovascular disease.

HDL2b works for the body's vascular system in at least two ways. It lowers blood "thickness"-a tendency to clot inappropriately-and it is a powerful antioxidant that stops molecular damage to the vascular system. Having levels of HDL2b greater than 20 percent for men and 30 percent for women contributes to optimum artery health. To achieve these levels I advise patients to first be tested for HDL2b because despite high HDL levels, I often see very low HDL2b levels. Unless your HDL2b levels are normal or above, your ability to clean your arteries is hindered.

It's important to know that not all advanced cholesterol-testing methods are the same-some can be off by as much as 40 percent-leading to the wrong treatment plan. Once you know your true levels you can make any necessary dietary and lifestyle changes.

apoegenediet.com Pamela McDonald is a leading Integrative Medicine Nurse Practitioner, who specializes in the prevention of heart and Alzheimer's disease, and chronic illness. To learn more about her ground breaking book, and program - visit apoegenediet.com apoegenediet.com To subscribe to her free APO E Gene Diet Health Notes - send a blank email to