cholesterol-particlesHow did we arrive at the conclusion that LDL cholesterol is the villain in heart disease?

Well…once again we see the mistakes made by researchers that lead us to think of LDL as the culprit.

A little history…

It had to do with a machine used in the laboratory, called an analytical centrifuge that created evidence that ultimately mislead researchers and clouded the issue of cholesterol sub-particles.

Invented in 1949 and used until 2004, this device was used to spin blood plasma samples at 40,000 rpm to separate out the cholesterol fractions such as HDL and LDL.

However this spinning process cannot separate the particles with the precision required to identify all of the sub-fractions of cholesterol that are present in the blood. It may have been state of the art when it was first used, but still fell far short in the accuracy required to actually identify all the sub-fractions of cholesterol.

This started the characterization of cholesterol particles as either good or bad cholesterol, depending on the particle density. This was a gross oversimplification that stuck in the minds of the public.

For many years this simplified version of a person’s risk of heart disease based on their ratio of good and bad cholesterol stood as the cutting edge of cholesterol testing and heart disease prevention.

This was accompanied by the now debunked view that saturated fats caused heart disease because of their association with cholesterol. People avoided saturated fats out of a fear that was not founded in good science.

They also consumed statins, the most prescribed class of drugs on Earth due to the same fear of cholesterol and it’s supposed relationship to heart attacks.

Americans have consumed some 14 billion dollars in cholesterol lowering drugs, which some health experts have advocated be given to people of all ages including children allegedly to prevent heart disease.

John Abramson argues in his book Overdosed America that lowering LDL cholesterol has inadvertently become the main focus of preventative medical care in the United States.

Cutting edge thinking about LDL cholesterol

Yet a more recent breakthrough utilizing a new technology called ion mobility analysis has shaken the traditional concept of cholesterol’s role in heart disease to the core, and called the entire LDL cholesterol theory into question.

Ronald M. Krauss, of the Children’s Hospital Oakland Research Institute, is using ion mobility analysis to count cholesterol particles such as LDL and HDL down to the smallest sub particle types using principles of physics.

Even though it’s extremely expensive and not widely available, this technology has helped to rewrite the rules on how we think about cholesterol and heart disease.

Rather than continuing to believe that LDL cholesterol is the bad cholesterol here, we now know that there are four types of LDL particles that factor into the risk of heart disease.

Some LDL particles are benign and others more dangerous. Thus it makes no sense to continue to base diet and drug recommendations on an outdated theory when the science regarding cholesterol particle types is far more precise now.

We could be using drugs that target the wrong particles, and making dietary recommendations that are doing more harm than good at this point, all while dramatically escalating health care costs and actually making treatment less effective!

Low Density Lipoproteins

LDL comes in four sizes:

  • Large (big fluffy particles)
  • Medium
  • Small
  • Very Small

As the LDL particle size decreases the particles become more dense, (and more dangerous). This is because the large fluffy particles can’t lodge in your artery walls as plaque, while smaller dense LDLs CAN!

High fat diets tend to increase the large fluffy LDL particles, while low-fat high carbohydrate diets increase the smaller more dense particles.

From this you can see why the standard medical advice about how we should eat to avoid heart disease is seriously flawed! It was all based on an oversimplified and outmoded concept of the nature of cholesterol particles.

Typical cholesterol tests can’t differentiate between large and small LDL particles. There are also genetic, environmental, and lifestyle factors that affect LDL particle size.

Enter “Ion Mobility Analysis”

Using ion mobility analysis, Dr. Krauss and his colleagues determined that there are some 11 different particles. This was done using a sample of 4,600 healthy men and women volunteers.

Eight percent of the test subjects went on to develop heart disease, and using statistical algorithms the researchers developed a series of three very accurate predictors for who would go on to develop heart disease.

Here are the correlations that Dr. Kraus’s team found:

    1. High levels of small and medium LDL particles with low HDL (called atherogenic lipoprotein phenotype) Also known as pattern B
    2. Low HDL levels
    3. High total LDL cholesterol

So as it turns out LDL cholesterol and the risk of heart disease is a complex relationship that standard cholesterol tests are almost useless to predict.

The PLAC Test

There is one test however that can give you a better idea of what your risk is. You can read about it in my article called “The PLAC Test.” This is the latest test that really utilizes our new knowledge of LDL to make more accurate predictions about what your real risk for heart disease is.

Using this test you can make better choices about lifestyle and diet, because they are based upon a more complete understanding of the science of cholesterol particles.

Carotid ultrasound  is a non-surgical and painless test that is used to determine the amount of blockage of your carotid arteries. This is done by using ultrasound to create an image of the inside of the arteries.

carotid ultrasound
This allows the physician to assess the blood flow though your arteries and detect blockages caused by plaque buildup inside the carotid arteries that could put you at risk for a stroke.

This narrowing of the arteries is called “stenosis,” and is considered to be a big risk factor for strokes. There are two such arteries, one on either side of the neck. These arteries carry blood to the brain, and if this blood flow is interrupted, it can result in a stroke.

An ultrasound imaging of your carotid arteries is one of a number of tests that can be done to determine the extent of blockage or stenosis. There are several types of ultrasounds used. If you need this screening procedure, you should discuss with your doctor which version is appropriate for you.

Types of Carotid Ultrasound

There are two main types of tests that are used to image the carotid arteries.

  • Doppler ultrasound: This test actually creates images of the blow flow though the arteries.
  • Standard ultrasound: This test creates an image of the actual structure of the inside of the arteries.

Why are these tests performed?

The doctor may order a carotid ultrasound because he or she suspects there may be blockages or other types of damage to the artery wall that can prevent blood from getting to the brain, causing what is called an ischemic stroke, which is life threatening.

The problem may be a blood clot, or something called an artery dissection which is a damaging split in the artery wall. This condition can impede blood flow, or seriously weaken the artery wall, possibly leading to a stroke.

Another problem can be a narrowing of the artery because of plaque buildup involving bad cholesterol levels, which is called stenosis. This can be indicated by something called a bruit, which is a sound the doctor hears when using a stethoscope to externally examine your carotid arteries.

These abnormal sounds can indicate stenosis, so the doctor uses the carotid ultrasound to further determine just what is happening inside the arteries. There are other things that might cause the doctor to suspect artery disease such as:

  • High blood pressure
  • Advanced age
  • Diabetes
  • Bad cholesterol levels
  • Birth defects that affect the carotid arteries
  • Strokes
  • TIA’s (transient ischemic attacks)
  • Tumors (very rare)

Who would perform the test?

This test is performed by a medical professional called a radiological technician. This is a person trained in both the procedure and preparation for medical imaging scans. The test will sometimes be performed by a doctor called a radiologist. These physicians are experts on performing and analyzing the results of medical imaging scans.

The radiologist will analyze the carotid ultrasound results and give your doctor a diagnosis based on the imaging scans of your carotid arteries.

How carotid ultrasound works

The equipment operated by the radiological technician generates high frequency sound waves that are projected into your body by a hand-held instrument called a transducer. When these sound waves strike your tissue and are reflected back to the transducer, it creates an image of the shape and structure of the tissues being scanned.

The biggest advantage of carotid ultrasound is that it is non-invasive, meaning that no piercing or cutting of the skin surface is necessary, and that the scanning technology uses sound waves which are much safer than other imaging technologies that use ionizing radiation which can damage tissue.

How is this test performed?

This test is usually performed in a hospital or sometimes in an outpatient clinic. It takes about an hour and usually involves the following steps:

1) You dress in a standard patient exam gown sometimes called a Johnny. You can also wear your own clothing as long as the neck area is open and there is no jewelery around your neck.

2) You lie on the exam table, on your back, and the radiological technician applies a gel to your neck that helps the equipment make proper contact with your skin.

3) The tech will then place something called an ultrasound transducer on your skin. This is a hand held instrument that sends the sound waves into your body. As the tech moves it around on your neck it produces an image of your carotid artery and surrounding area. This process is completely painless.

4) When the ultrasound is finished the gel gets wiped off. You will have to wait a few minutes until the tech or radiologist makes sure that the scan is complete, and then they will send you home.

5) Your doctor will then contact you with the results of your scan and the diagnosis he has been given by the radiologist.

The carotid ultrasound is a very valuable test because it allows your doctor to see exactly how much plaque buildup there is in your carotid arteries and then create a treatment protocol based on this precise information. This test could warn you in time to prevent a stroke or other serious medical problem, which makes it one of the most effective tests for prevention there is.

What is Cholesterol

What is cholesterol? Among other things it is a very much misunderstood substance that people have been unnecessarily frightened of. They have been told repeatedly by “experts and authorities” that it’s a dangerous substance, that must be lowered in your body before it kills you!

what is cholesterolIn this information website, we will try and demystify this perfectly natural substance and disprove once and for all that it causes heart disease! We will also provide good solid information and easy to implement strategies that will help you prevent heart disease instead of just “lowering cholesterol.”

Let’s start with a discussion of  what is cholesterol…

Cholesterol is a fat (also called a lipid) that is made in the liver. It’s part of a class of compounds called steroids which are made in the bodies of all animals. This substance is vital to your body, is transported through the blood, and is contained in the external layers of all cells.

The origin of the word cholesterol originally comes from the word chole which means bile in Greek. The other part of the word derives from the Greek word stereos meaning stiff or solid. This waxy fatty substance is necessary for your cells to maintain their structural integrity.

This is why it is absolutely vital for life, and in fact your body actually manufactures this substance for use in all of your cells. Statin drugs interfere with the production of cholesterol which is why they cause so many side effects.

What is cholesterol used for?

There are many functions for this amazing substance:

  • It is used in creating the myelin that coats and protects your nerves somewhat like the insulation on a wire.
  • It is used for synthesizing bile acids which your body needs for digestion.
  • Your body uses it to make sex hormones (androgens and estrogens) and also in the synthesis of the adrenal hormones such as cortisol and aldosterone.
  • It’s used in to metabolize vitamins A, D, E, and K (the fat soluble vitamins)
  • It is used in the reactions that synthesize vitamin D from sunlight.
  • It’s essential for maintaining the outer structural layer of your cells and also for keeping the cell membranes permeable so that certain molecules can pass through the membrane and enter the cell.

In order to travel through your bloodstream, it needs to have a protein coating and thus becomes something called a “lipoprotein.” They are called lipoprotiens because they contain both protein and fat.

The four main types of these lipoproteins are:

  1. LDL or low density lipoproteins often called bad and are associated with an increased risk of heart disease when they are high
  2. Chylomicrons (triglycerides) consisting of approximately 90%  fat
  3. HDL or high density lipoproteins (often referred to as the “good cholesterol”) HDL is thought to “protect” the arteries from damage by carrying away LDL particles so they can’t build up on your artery walls.
  4. VLDL or very low-density lipoproteins (often referred to as a very bad form of lipoproteins) These particles are considered to have the highest risk of contributing to heart disease because they are small dense highly inflammatory particles that can damage artery walls.

The role of triglycerides…

Triglycerides are fat molecules that come from the fat in the foods we eat, or can be synthesized from carbohydrates that are not burned for energy. These triglycerides are stored in your body and released to be burned for energy when your body does not get enough food to meet it’s energy needs. The truth is that it is triglycerides that really increase the risk of heart disease!
Hypertriglyceridemia is a term used to refer to high levels of triglyceries in the blood and researchers now know that this is a risk factor for cardiovascular disease. High glycemic carbohydrates can raise levels of triglycerides and greatly increase risk of heart disease.

While this area is still somewhat controversial, it’s clear that triglycerides have a major role in heart disease and they are increased by sugar consumption. It makes sense for this reason to keep your intake of sugar and high glycemic carbohydrates low to avoid setting yourself up for cardiovascular disease.

A Complex Question…

Doctors have been taught to calculate your risk of heart disease using ratios of these lipoprotein particles. They have also been given guidelines for what the “safe” and “dangerous” levels are.  Now these guidelines have been called into question, as new information has changed what the medical community “thought” they knew!

Even though the question of  what is cholesterol is a complex one, you will see that terms like good  and bad cholesterol are misleading and inaccurate. All of these forms of this vital substance have their necessary roles. Instead we should be looking at the effects of chronic inflammation and how we can neutralize it, because it is really inflammation that causes heart disease!

References:

Curr Cardiol Rep. 2011 Dec;13(6):544-52. doi: 10.1007/s11886-011-0220-3.
The role of triglycerides in atherosclerosis. Talayero BG, Sacks FM.
Source: Department of Nutrition, Harvard School of Public Health, Boston, MA 02115, USA. btalayer@hsph.harvard.edu

Eggs and Cholesterol – A Pervasive Nutritional Myth!

Many people have heard dire warnings about eggs and cholesterol, but is there any truth to this widely held belief at all? The answer is NO! Eggs have not been shown to significantly raise LDL (low density lipoproteins) levels when eaten in moderation. In fact eggs are actually be considered beneficial  when cooked and eaten properly and in moderate amounts.

eggs and cholesterol

Please note that the term LDL refers to the form considered by cardiologists to be “bad,”  however we will show in other posts that the idea of good and bad cholesterol is a misapplication of the science!.

Lipoproteins are another term for cholesterol. Thus HDL cholesterol is high density lipoproteins, and LDL is used  to refer to “low density lipoprotein.” The type that is believed by scientists to actually cause problems is called vldl cholesterol, (very low density lipoproteins). However even in this case the truth is more complicated than this and we will explain this as we go along.

The Facts about Eggs…

The fact is that egg yolks also contain lecithin which is a phosopholipid compound that actually lowers the amount your body absorbs. Thus the cholesterol in an egg does not have the same effect in your body, that it does when it comes from other sources.

Eggs contain about 185 milligrams of cholesterol (for a large egg), but they are also high in vitamin-d, choline (a b-vitamin) and lecithin. Interestingly, the saturated fat content in eggs is low. Research studies have shown that foods that you eat, does not have necessarily cause high cholesterol levels in your body, and in some cases may actually lower it!

It appears that the eggs and cholesterol myth began when the concern over lipoprotein levels being a factor in heart disease emerged. Researchers jumped to conclusions and people were warned that eggs greatly increased the risk of heart disease, based on this assumption, (based on poorly done research).

Eggs are Essential Sources of Choline

One negative result of this eggs and cholesterol hysteria was that people stopped eating eggs, or at least significantly cut down on egg consumption. The b-vitamin choline is essential to good health, especially of the brain.

The most abundant source of this vitamin in most people’s diets came from eggs. As a result the population as a whole became deficient in choline, leading to other serious health problems like Alzheimer’s Disease, and even increased rates of heart disease!

Choline is vital to the healthy function of the brain and nervous system, which in turn has a huge impact on heart health. Thus by limiting egg consumption and producing deficiency of choline in the diet, people were actually making the situation with regard to heart disease even worse!

What The Research Says…

Some people who have a genetic tendency toward higher levels called (familial hypercholesterolemia) may be affected by the amount they consume in their foods, but the mechanism is not totally clear. In fact the famous Framingham Study of heart disease shows that people with the highest hdl cholesterol levels actually lived the longest!

Recent research conducted on eggs and cholesterol at the University of Surrey by Dr. Bruce Griffin found that two eggs per day consumed by healthy people for a 12 week period actually lowered their LDL levels on average! It was concluded that eggs will not significantly raise cholesterol numbers in a healthy person. In this instance eggs actually lowered their levels!

In face the research subjects in the experimental group actually lost weight as well. This may seem surprising, but in light of the fact that egg yolks contains beneficial vitamins and high quality protein, it supplies your body with vital nutrients, without which you can’t achieve optimal health.

Recent research has also suggested that eggs may act in a way to reduce high blood pressure and that they contain antioxidants that help prevent heart disease. While this evidence is not yet conclusive, it suggests that eggs, far from being dangerous to our health are actually beneficial in preventing both cancer and heart disease!

Nutritional myths about eggs and cholesterol still persist in medicine and are accepted by the public at large, but gradually the word is getting out that eggs are not a bad food at all, in fact you need the beneficial nutrients in eggs for good health, including heart health!

References:

Chamila Nimalaratne, Daise Lopes-Lutz, Andreas Schieber, Jianping Wu. Free aromatic amino acids in egg yolk show antioxidant properties. Food Chemistry, 2011; 129 (1): 155 DOI:
Majumder et al. Angiotensin I Converting Enzyme Inhibitory Peptides from Simulated in Vitro Gastrointestinal Digestion of Cooked Eggs. Journal of Agricultural and Food Chemistry, 2009; 57 (2): 471 DOI: