For many decades heart disease has been the leading cause of death in the United States. Heart disease is preventable and, for that matter, reversible. It takes commitment to understanding what causes heart disease and the commitment to changing to a new life style. Some old school thoughts are, for example, in the 1970 normal cholesterol was thought to be less than 300. 21st century normal cholesterol has been set at under 200. On-going studies show optimal cholesterol is now less than 150. Other old school thoughts: most physicians look at the basic lipid profile consisting of cholesterol, LDL, HDL & Triglycerides using these to determine a person’s risk for cardiac event or heart disease. Unfortunately this is not enough, these are just what appear on the surface. Much like an iceberg sitting on the water, we see what is on the surface, missing the rest of the danger that is hidden and lurking underneath. Today’s new thought is by using advanced testing we can know a person’s true total cholesterol. Understanding Non-HDL, HDL-C, HDL-P, HDL2, LDL-C, LDL-P, Lp(a), cholesterol, and particles can lead to early detection and decrease the risk factors while improving cardiac health.
National Cholesterol Guidelines (National Cholesterol Education Program)
|Total Cholesterol – Primary Target of Therapy|
|LDL Cholesterol – Primary Target of Therapy|
|100-129||Near Optimal/Above Optimal|
|HDL Cholesterol – Primary Target of Therapy|
The thought that fat and cholesterol cause heart disease has been accepted for many decades in spite of all the indications to the contrary. Many physicians over the years have not agreed with this theory. We now know cholesterol plays a small roll and is a poor indicator or predictor of heart disease. We now know half the people with heart disease have normal cholesterol, while half the people with elevated cholesterol have healthy hearts. Therefore, lowering cholesterol has limited benefits and is a minor player in the cascade of inflammation which is a cause heart disease.
Cholesterol does however have some important roles, it is the basic raw material used for sex hormones such as testosterone, estrogens,progesterone and also Vitamin D and bile acids for digestion.
The combination of good cholesterol (HDL-C), bad cholesterol (LDL-C) and ugly cholesterol (Triglycerides) in your blood, at the time of testing, divided by five.
The most common cause for elevated cholesterol is a combination of sugar, starch & saturated fat. Total Cholesterol elevated when bad or good cholesterol goes up. Reference for normal is under 200, Ideal goal is 150.
Low-Density Lipoprotein Cholesterol (LDL-C)
LDL-C is known as the “Bad or Lousy cholesterol”. LDL-C causes chaos in the arteries by building up plaque. A diet high in saturated transfat, sedentary life, and being overweight are known indicators in elevating the LDL-C. Elevated LDL-C can increase a person’s risk of developing heart disease and having a stroke.
80% of cholesterol is not absorbed and does not increase LDL-C levels. Diets high in saturated fat will cause an increase in the LDL cholesterol. Sugar and starch will elevate the small LDL-C.
Traditional treatment for elevated LDL-C is, to treat with statins such as Zocor®, Lipitor®, Cresto®, Privistatin® and more. To date there is no data to show that statins significantly impact longevity. Reference for normal LDL Cholesterol is <100, ideal goal is 70.
High-Density Lipoprotein Cholesterol (HDL-C)
HDL-C is also known as the “Good or Happy cholesterol”. The general thought is that if a person is a healthy weight, is physically active and has a healthy diet (low in sugar, starch and saturated fat) this will help maintain higher levels of HDL. What we now know is that HDL is controlled by genetics and not LDL. In a 2011 study by the National Institute of Health, AIM-HIGH, showed HDL did nothing to protect against heart attacks, stroke and death. It is the HDL-2, with its large buoyant particles, that are most protective. HDL-2 is also an anti-inflammatory and anti-atherogenic, while the small and dense HDL-3 particles are thought to cause inflammation.
Triglycerides are the fats in a person’s blood. These are directly affected by diets rich in sugar, starch and saturated fat. A person’s triglycerides can change based on the meal they eat. For example, a person who eats carbs, fruits, sweets and alcohol, the evening before their fasting test is drawn, will reveal elevated triglycerides in the 300 to 400 range. However, a diet low or absent of sugar and starch may result in triglyceride the next day in the goal range 60 or less.
The relationship between triglycerides and HDL-C, the good cholesterol, is an inverse relationship. HDL-C lowers when triglycerides are high and the bad cholesterol particle size becomes smaller. This becomes dangerous due to high levels of LDL-P which are associated with increasing plaque formation in the arteries.
Non High-Density Lipoprotein Cholesterol (Non-HDL)
The amount of bad or really bad cholesterol floating in a person’s blood is known as Non-HDL. This Non-HDL cholesterol is a combination of VLDL (Very Low-density lipoprotein cholesterol), IDL (intermediate density lipoproteins) and lipoprotein(a) cholesterol. These three are all BAD cholesterol; which can form plaque and possibly clogging arteries.
Non-HDL cholesterol is calculated by subtracting HDL-C from total cholesterol
Low-Density Lipoprotein Particles (LDL-P)
LDL particles are not the same as LDL Cholesterol. Like the saying, “oil and water don’t mix”, the same can be said for cholesterol and triglycerides (fatty oils) mixing with or dissolving in blood (the water). These cholesterol and triglycerides, “fatty oils”, need a means to travel in the bloodstream. This is why triglycerides and LDL cholesterol are placed into particles, forming LDL Particles.
For example, it is possible to have two patients, Suzy and Leslie, with same LDL cholesterol and different LDL particles. Suzy has a lower risk of heart disease due to her low levels of LDL particles. Leslie is at great risk of heart disease due to her high level of LDL particles. Using the above analogy, Suzy and Leslie both have 100 passengers (LDL cholesterol and triglycerides) to drive around. Much like car pooling, the more people we can put into one vehicle the less traffic there is on the roads. If Suzy has 5 buses to carry her 100 passengers and Leslie has 50 cars to carry her 100 passengers this would mean that Leslie is at a greater risk for heart disease. Even though both she and Suzy have the same cholesterol, Leslie has more “cars” to drive the LDL cholesterol and triglycerides into the walls of the arteries.
Apolipoprotein B (APOB)
ApoB is a protein key that is contained in each LDL particle. This key “unlocks” cells, allowing the bad cholesterols to come in and have full accesses to forming plaque in the arties. ApoB levels tend to rise when LDL particles (these are very bad, due to how fast they form plaque) are small in size. A low LDL-C and a high apoB can equal easier formation of plaque. High LDL-C and a low apoB results in large LDL particles and plaque cannot form as easily. ApoB can be reduced by eliminating sugar and starch from a person’s diet (anyone seeing a theme yet?). The ideal goal for ApoB is less than 60.
Lipoprotein(a) mass and cholesterol (Lp(a)
Lp(a) is one of the most important cholesterols and has highly inflammatory particles that can cause blood clotting. Lp(a) is an inherited trait that has been associated with increased heart disease risks. Due to the predictability of Lp(a) it has been referred to as the “deadly cholesterol”. At Oxford, University of England, research has shown that elevated Lp(a) alone can increase a person’s risk of a heart attack by 70%. Unfortunately Lp(a) does not change with diet or exercise. The best way to lower it is to take one to two grams of niacin daily. In woman of menopausal age the use of hormone replacement therapy with estrogen has shown to lower Lp(a). A person with elevated Lp(a) can help lower their risk of a heart attack by keeping their ApoB low.
Metabolic syndrome is a combination of abnormalities starting with elevated fasting blood sugars, low HDL-C, elevated Triglycerides, Small LDL-P and a decrease in the large HDL-P along with obesity and increased blood pressure. Currently one out of four Americans has metabolic syndrome and is on the rise in America and around the world. A diagnosis of metabolic syndrome requires at least three of the following conditions:
- Abdominal obesity (waist circumference >40 in men & > 35 in females)
- High levels of triglycerides (>150)
- Low levels of (good) HDL cholesterol (<40 for men & <50 for women)
- Elevated blood pressure (>130/85)
- Elevated fasting glucose (>100)
What we need to know
Understanding the foods we eat and the supplements we take can go a long way in helping to reduce the risk of heart disease. The toxicity of the “American or Western” diet is due to it being highly processed, nutrient depleted and calorie dense. All of which are contributing to the obesity challenges the United States faces along with being very unhealthy cardiovascular health wise.
Know the good, the bad and the ugly of fats in your diet. There are three types of fats; unsaturated fat (good), saturated fats (bad) and transfats (ugly). Unsaturated fats are absorbed into the body and have a positive effect on lowering risk of heart disease. Unsaturated fats are fish oils; like omega 6 & omega 3 along with vegetable cooking oil (olive oil). Monounsaturated and some saturated fats can protect you from metabolic syndrome. Saturated fats can be found in a lot of animal products such as; red meat, lard, butter, milk, and cheese and some topical oils like coconut & palm oil and these can increase the risk of heart disease. Transfats acids or transfats from partially hydrogenated oils are the worst. These fats are manufactured and used to give items longer shelf life.
High fructose sugar is used in the food industry due to the low cost and ability to prolong shelf life. These sugars cannot be used by our muscles so it is sent directly to the liver; where it creates triglycerides which are a major risk factor for heart disease. Sugar is the foe in cardiovascular disease.
Red meat consumption has been glorified by marketing and gourmet hamburger restaurants. The reality is you should not eat red meat more than once a week. Pork is considered a red meat! Red meat is high in saturated fat, which raises LDL-C which increases the risk for heart disease.
Dairy, milk is high in saturated and transfats. In addition the hormones and antibiotics given to cows can be passed to people. The best alternative is Almond milk, there is no cholesterol, saturated or transfats, it is rich in nutrients and its low calories and taste great.
The optimal diet for a healthy heart is the Mediterranean diet. This diet is low in saturated fats, no transfats, and the food used can be found in the grocery store. This diet consist of fruit, vegetables, olive oil, whole grains, legumes, nuts, fish, poultry and red wine.
Sweeteners update. Up until recently all sweetener substitutes (Equal, Sweet’n low, and Splenda) were chemical derivative of sugar, but not natural substitutes. Now there are zero-calorie sweeteners made from the stevia plant.