My Test Results: Cholesterol and APOE

**Disclaimer: I am not an expert and this is not intended as medical advice; it is my personal experiences and research. I feel very strongly that while there may be some changes that everyone could benefit from, there is no "one size fits all" when it comes to health.**

I found out that my cholesterol levels were not ideal when I found out about my PCOS. The doctor gave me the standard advice that you think of with cholesterol. In fact, out of curiosity, I googled how to manage high cholesterol without medication. Here are the recommendations that the Mayo Clinic gives:

1. Lose weight.
2. Eat heart-healthy foods.
• Choose healthier fats. "Saturated fats, found in red meat and dairy products, raise your total cholesterol and low-density lipoprotein (LDL) cholesterol, the "bad" cholesterol... choose leaner cuts of meat, low-fat dairy and monounsaturated fats--found in olive, peanut, and canola oils..."
• Eliminate trans fats.
• Limit the cholesterol in your food.
• Select whole grains.
• Stock up on fruits and vegetables.
• Eat foods rich in omega-3 fatty acids. 
3. Exercise on most days of the week. "...exercise can reduce cholesterol...better yet, moderate physical activity can help raise...HDL." 

For the most part, I was doing all of those things; so I continued life without changing much. I think I was partially in denial because of my already "healthy" diet and lifestyle. And at the time, the PCOS diagnosis was what I focused on. But the doctor told me that she would recommend medication to manage my cholesterol if I could not manage it without medication. A few years go by. In October of 2013, I had a few labs done for the wellness incentive program at work. I was reminded again of my cholesterol, and it was a bit of a wake up call. But really, it was still fairly low on my list of priorities. A year later, I had the labs done again for the incentive program. After almost a year on the Paleo diet, my numbers had barely changed. I was very discouraged. This doctor also mentioned medication, but in the context of not wanting to prescribe medication if we would be trying to start a family anytime soon. But I was at a loss for what to do. Paleo had let me down in this area. Was my only choice to have oatmeal or cheerios for breakfast and never eat bacon or egg yolks again?

Before I share my results, there are a few things that I'd like to point out about cholesterol:

• According to the American Heart Association, cholesterol is one of the major controllable risk factors for coronary heart disease, heart attack, and stroke. 
• BUT, cholesterol itself isn't bad. Your body makes all of the cholesterol you need and circulates it through your blood. But cholesterol also exists in animal products. 
• Your body responds to saturated and trans fats by producing more cholesterol. 
• Cholesterol is transported through your blood by carriers calls lipoproteins. The two types of lipoproteins are low-density, or LDL, and high-density, or HDL. 
• LDL cholesterol is considered the "bad" cholesterol because it contributes to plague. It is plaque that can clog arteries and cause heart attack or stroke.
• HDL is considered the "good" cholesterol. It helps remove LDL from the arteries. Experts believe that HDL carries LDL away from the arteries and back to the liver, where it is broken down and passed from the body. A healthy level of HDL may also protect against heart attack and stroke, while low levels have been shown to increase the risk of heart disease. 
• Your total cholesterol is determined by the total of your LDL, HDL, and one fifth of your triglyceride level. 
• Triglycerides are another type of fat that is used to store excess energy from your diet. 

My tests at Vine confirmed what I already knew. But this set of labs, Boston Heart, gave me even more insight and information than total cholesterol, LDL, HDL, and triglycerides. And from my research, it seems that other markers can be more even more accurate for measuring your risk. This panel is several pages long, but here is one of the relevant sections.

Regardless of whether you know what any of these things mean (believe me, I've done lots of googling), that is a lot of red and yellow and very little green.

Here is where the blessing of testing and guidance from a medical professional who can customize your care comes in. From my genetic testing, I discovered that I have the E3/E4 variation of the ApoE gene. This is a gene that everyone has (E3/E3 is the neutral and most common genotype, expressed in 60% of the population), but it can mean very different things depending on which variation you have.

Clearly we will be ignoring the advice about medication at this point.

This makes such a big difference in my understanding of why I have high cholesterol in spite of my healthy lifestyle and even in spite of my Paleo diet. Without knowing about this gene variation, I honestly would have been at a loss for what to do. Most likely I would have had to choose between cholesterol medication and developing cardiovascular disease. This video gives an excellent, concise explanation about ApoE, even in the context of Paleo and why there is no "one size fits all" in treating disease.

Here is another post about ApoE that I found helpful, as it also gives some more specific recommendations based on each variation.

In my research, I found the book The Perfect Gene Diet (also known as The Apo E Gene Diet). Here is a video from the author, Pamela McDonald, and this an overview of some of the information in the book.

This book has a wealth of information not only about what the Apo E gene and its variations are and what they mean, but what to do once you know which variation you have. There is a very good chance that I have left lots of holes in trying to explain this gene and how it affects/can affect me, or maybe I'm repeating myself and this is overkill, but here are a few summary points:

• First, what Apo E means. McDonald explains:

"Our body has evolved a...method of moving fats around inside it...Apo is short for apolipoprotein. It has the letter "E" because it's one of a whole series of apolioproteins--A, B,C, etc...In a larger sense, the Apo E gene is involved in the energy system of the body...The Apo E gene can provide good health if the body is given the correct foods and other gene-supportive environment factors for its Apo E type. On the other hand, the Apo E gene can impair good health if the body is given the wrong foods and other gene-unsupportive environmental situations. The Apo E gene is the key to making the right match...to determine the environment that will best support...a safe, optimal level of cholesterol in your system."

• "The Apo E 4s have the greatest difficulty clearing fats from their bodies, especially the more complex inflammatory fats, and must significantly limit saturated and trans fats."
• My variation does put me at increased risk for cardiovascular disease and Alzheimer's, but "It is important to realize that the presence of Apo E 4 does not cause cardiovascular disease and other conditions like Alzheimer's disease. Nor does it necessarily mean that the person will develop such diseases. What is important is matching your diet and lifestyle to the needs of your genes." 
• "Of the three kinds of Apo E genes, the 4s...are the most sensitive to high-fat diet and need more carbohydrates than the other types."
• Apo E 4 does better with plant-based sources of protein and fat (versus animal). 
• "Apo E 4 has a very limited to no ability at all to clear toxic substances absorbed from our diet.
• It has been proven repeatedly that individuals with any of the Apo E 4 combinations will respond better to dietary changes than the other genotypes..."

I'm sure I've just scratched the surface of what there is to learn about this. Coming up: what I'm doing about it and an update on how I'm doing after some follow-up labs.