Author: Dr. Huber
Cholesterol is a fat produced by the body for multiple functions. Cholesterol is needed to make healthy cell membranes, repair muscle tissue, and is the building block for steroids such as hormones and vitamin D. Cholesterol is moved through the bloodstream inside of protein structures called phospholipids. Phospholipids are simply “trucks” of different sizes that carry their “cargo” of triglycerides and cholesterol to be deposited throughout body tissues.
One of the most recognized phospholipids is called LDL or Low Density Lipoprotein, and is sometimes referred to as the “bad” cholesterol. Remember that LDL is just the cholesterol carrier and is needed for normal physiologic functioning. LDL delivers cholesterol to cells that need it. The other commonly discussed lipoprotein is HDL or High Density Lipoprotein. This is considered the “good” cholesterol as it works to take excess cholesterol away from cells and return it to the liver for removal, which is protective for cardiovascular health.
What are triglycerides?
Triglycerides are simply fats, either saturated or unsaturated, that are used by the body as fuel. They are also carried in the blood stream inside of protein-based phospholipids, called VLDL or Very Low Density Lipoproteins, much the same way as cholesterol. As the triglycerides are distributed to normal cells as fuel, the VLDL particle reduces in size and eventually becomes an LDL particle with very little triglyceride content, and mostly just cholesterol remaining.
When you eat a meal, especially one containing a high amount of carbohydrates, some of the resulting sugars are converted to energy while excess sugars are converted to glycogen and stored in muscle tissue. If you have more glycogen than your muscles can store, excess glycogen can be stored in the liver where it is converted to triglycerides. The more muscle you have, the less triglycerides are formed. High levels of triglycerides can increase your risk of heart disease and stroke.
The higher your triglyceride levels compared to your HDL, the higher your risk is for heart problems.
So if cholesterol is normal and healthy why is it linked to heart disease?
Elevated cholesterol levels generally produce no symptoms, but eventually can lead to health problems like heart disease and stroke only if we place that cholesterol under extreme oxidative stress. This occurs under the influence of sugar, poor sleep, high stress and cortisol, and exposure to external toxins. Cholesterol creates damage to blood vessels when there are excessive numbers of LDL particles (not elevated LDL cholesterol), small sized LDL particles (as opposed to large sized LDL which does not seem to create the same risk), or expose LDL particles to excessive oxidative stress. There are newer tests available today that can tell us more than just our cholesterol level. An NMR (nuclear magnetic resonance) can measure the size of LDL and how many actual particles are present. A small number of large LDL particles is much healthier than a large number of smaller denser particles. These small, dense particles, especially when under oxidative stress, can increase the risk of forming plaque in blood vessels. However, an increase in oxidized large LDL particles can also lead to an increased risk of plaque and heart disease – balance is the key. Plaque formation makes the vessels narrow and hard, and increases the risk of heart attacks, strokes, and peripheral vascular disease.
The simple dynamic between HDL and LDL is greatly affected by your lifestyle habits, diet and genetics and can lead to many health problems including:
- Heart disease and stroke
- Peripheral vascular disease (PVD) - when your blood vessels are not working right
- High blood pressure – your blood pressure should be less than 120/80mmHg or you increase your risk for heart, eye and kidney problems
- Kidney disease
- Diabetes and/or insulin resistance
Other terms to know as you explore your cholesterol
Additional factors that play a role in determining risk for heart disease include the level of Lipoprotein (a), also known as Lp(a). Higher amounts of Lp(a) will increase your risk for developing plaque in blood vessels. The level of lipoprotein (a) is largely dependent on your genetics. For example, people of African descent have consistently been shown to produce higher levels of Lp (a). Despite this genetic influence, your lifestyle habits and diet can help reduce you level.
An additional important cholesterol marker is apolipoprotein A1. Apolipoprotein A1 or ApoA-1 is a component of HDL, the good cholesterol which works to clear cholesterol from artery walls and thus reduce the risk for plaque formation. It’s one of the good guys.
Apolipoprotein B 100 is a final important piece to the cholesterol puzzle. Each LDL particle that carries cholesterol will have one “apolipoprotein B 100” (ApoB100) as a part of that LDL particle. It is this ApoB100 entity that allows LDL to attach to cells and deposit it’s load of cholesterol. It also allows a direct count of LDL, since there is only one ApoB100 protein for each LDL particle. The good news is that there are medications and natural treatments known to lower ApoB100.
Don’t get confused. ApoA-1 is simply a marker of HDL, which is protective to cardiovascular health. ApoB100 is a reflection of how many LDL particles are present and as it rises, trouble begins. So just remember that if your HDL is high and your LDL particle numbers (ApoB100) are low then you are doing well. It’s the ratio that is most important.
CRP-hs is a lab test that is a reflection of the degree of inflammatory cytokines that your body is producing. When we carry excess body fat it makes inflammatory cytokines that cause inflammation throughout or body. Other habits such as poor sleep, excess stress, eating inflammatory foods such as refined sugar and processed foods also lead to increased cytokines and an elevated CRP. Elevated CRP reflects a state in which we will easily oxidize cholesterol, form plaques in our blood vessels and increase our risk for heart disease. Consequently measuring CRP is a great way of predicting your risk for a heart attack and in human studies has been shown to be 3 times more valuable than measuring the standard old cholesterol test that you are familiar with.
CRP levels also correlate with depression and anxiety in individuals with heart disease. Studies show that people with depression often have a much higher risk for heart disease as the same mechanisms that cause depression will also contribute to vascular disease.
What to FOCUS on
As we get your lab results and move forward over time you want to know the status of the following numbers:
- LDL-Particle number (not LDL cholesterol) – the fewer the better
- LDL SIZE – bigger is better
- HDL level – the health cholesterol that clears out vessels
- Triglycerides – as a marker of blood sugar control
- CRP as a marker of inflammation – less than 1 is ideal.
Here are some factors to consider as you work to lower risk for heart disease:
- Cigarette smoking: Smoking can lower HDL levels (the “good” cholesterol), especially in children whose mother smoked during pregnancy
- Oxidative stress from lack of sleep, poor diet choices, excessive stress, environmental exposures
- Elevated homocysteine level from poor B vitamin take
- Thyroid problems
- Inflammation resulting in elevated CRP and fibrinogen
- Diet and lifestyle if it increases systemic inflammation
- Lack of exercise and physical activity
Medications that might elevate cholesterol levels include:
- Progestins, are contained in birth control pills and some hormone replacement regimens such as Provera. They are known to elevate the “bad” LDL cholesterol and lower the “good” HDL cholesterol. They have been shown to increase the risk for heart disease. Interestingly the Bio-Identical hormone options actually do the opposite and work to lower cholesterol levels and improve cardiovascular health.
- Steroids (prednisone, etc) have been shown to cause modest elevations in triglyceride levels and total cholesterol.
- Retinoids used to treat acne can cause slight elevation in cholesterol levels.
- Hydrochlorthiazide and furosemide may rarely elevate triglyceride levels, total cholesterol and LDL levels. HDL is typically not affected.
- Beta blockers (atenolol, metoprolol, nadolol, propranolol, etc) may rarely elevate triglyceride levels and lower HDL levels.
The Thyroid Connection
Thyroid hormones regulate metabolism, nutrient absorption, mood, and energy. Every cell in your body requires thyroid hormone stimulation to work properly and efficiently, including your heart. Low thyroid function, called hypothyroidism, is associated with an increased risk of heart disease.
Subclinical hypothyroidism occurs when your thyroid hormone levels are normal when tested but there is an increase in your thyroid-stimulating hormone (TSH) in conjunction with symptoms consistent with hypothyroidism. TSH is produced in the brain and signals the thyroid gland to produce the thyroid hormone T4 (thyroxine), which is converted in your body into the active thyroid hormone called T3 (triiodothyronine). If this conversion of T4 to T3 is not efficiently occurring (due to other health issues, nutrient deficiencies, or interfering medications) or if the T3 uptake by the cell is inhibited (by thyroid antibodies, low ferritin levels, or low cortisol level, then despite normal appearing lab numbers you may be struggling with poor thyroid function. Subclinical hypothyroidism can lead to an increased risk of heart disease, cholesterol imbalance and other imbalances in your metabolism like weight gain, cold hands and feet, dry brittle hair, sleep problems, chronic inflammation, immune imbalances and memory problems.
Dr. Huber will monitor this very closely during your assessment in the Virtuoso program and offer strong guidance to assure an optimal outcome.
Supportive elements that work to improve cardiovascular risk
A word of caution here: there are many supplements available in the open market and many are poorly made, contain contaminants or even adulterated with adverse compounds. I only use pharmaceutical grade supplements from reputable manufacturers that meet stringent standards with impeccable record of consistent delivery of purity and efficacious product. To walk into a store and just pull things off the shelf or off a webpage can be an invitation for not only disappointment but also
potential problems. The items listed below are for educational purposes only so that you can gain some insight as to how these elements work. It is not intended that become responsible for your own treatment. These elements if employed, should always be used in conjunction with a qualified physician to oversee and guide appropriate treatment.
Niacin has been shown in studies to have the following impact:
- Increase HDL – the good cholesterol that removes excess cholesterol from the body and returns it to the liver for breakdown.
- Decrease triglycerides – actual fat in the blood circulation.
- Decrease lipoprotein(a) – thus helps reduce plaque formation.
- Decrease LDL cholesterol – the bad chlesterol
- Reported to decrease apolipoprotein pattern B (LDL) and increase pattern A (HDL the good cholesterol).
Red Yeast Rice – isolated from Monascus purpureus
- Your liver produces 1000 mg of cholesterol daily with the help of an enzyme called HMG-CoA reductase. This self-made cholesterol is handled differently than the cholesterol from your diet. Red Yeast Rice is a fermented product that works by inhibting the action of HMG-CoA reductase enzyme thus lowering your own internal cholesterol production.
- Will lower the LDL-Particle number while improving the size of the particles.
- Red Yest Rice has been reported in clinical studies to decrease total cholesterol, LDL, triglycerides while increasing HDL.
- Improves Triglyceride to HDL ratios.
Tocotrienols – are 4 members of the vitamin E family, naturally found in food, and work together as strong antioxidants to improve vascular health.
- They decrease inflammation and oxidative stress and can decrease LDL oxidation.
- Reported to decrease liver production of triglycerides and VLDL secretion.
- Decreases CRP levels which reduce inflammation in the heart and blood vessels.
- Helps decrease apolipoprotein pattern B, which is the bad cholesterol.
Omega 3 Fatty Acids from fish oil – are anti-inflammatory and protective of blood vessels and the heart.
- Reliably decreases triglyceride levels as they help reduce the blood sugar and improve blood sugar management.
- Reduce total cholesterol and increase HDL levels.
- Help increase the size of the LDL particles. Remember that large particles are less problematic and less likely to stimulate vascular disease.
- Decrease oxidative stress and chronic inflammation associated with LDL oxidation. Fish oil is a great antioxidant and reduces inflammation throughout the body.
I realize that there is a lot of information here. You don't have to memorize this but I want to offer you the ability to be in the game and understand your body a little better. If you can follow this mechanism and grasp the basic concepts here then you will be smarter than a lot of health care professionals. This is a game of numbers and lifestyle. Pick the right lifestyle and watch the numbers fall in line. Eat garbage, torture your sleep cycle, sit on the couch and allow stress to run wild and you will meet a nice cardiologist in the ICU some day. The choice is yours and the time is NOW.
- Just keep learning. Get rid of old tired notions that your “cholesterol” is the cause of heart disease and recognize that you hold the power to alter the real issues behind heart disease.
- Be empowered and take control of your diet, sleep, exercise and stress to manage your heart. Every day counts.
- Don’t live in fear of heart disease no matter what history you have. Even a person with prior heart attacks can stop this process in its tracks and live with confidence and the expectation that they have the ability to reverse a bad situation.