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.

High cholesterol symptoms are not something you are going to notice. In fact they are almost non existent! The real relationship between cholesterol and heart disease kind of forced me to write this article backwards.

high cholesterol symptomsThe truth is that high cholesterol (let’s call anything beyond about 280 mg/dl high) is itself a symptom of other medical problems. You see, cholesterol is made by the body and used in all sorts of important biochemical reactions, some having to do with healing and the immune system.

Cholesterol also serves as an antioxidant as well, and your body will make more of it when you are faced with any kind of a health crisis or trauma, because it’s part of the protective and healing systems of the body.

So when cholesterol is elevated, it can be an indicator that something is wrong in the body, and that the body is attempting to heal or correct the problem.

Are there any real high cholesterol symptoms?

The answer is yes, although it’s not something that you would feel or notice on a day to day basis. It can show up during an eye examination. Your eye doctor may notice a buildup of cholesterol deposits in your eyes.

This CAN be an indicator of high cholesterol (kind of a “silent symptom”) that is itself, a symptom of other medical problems.

Arcus Senilis

There is a condition that affects the eyes called Arcus Senilis where a white or gray ring develops around the cornea of the eye.  It CAN be caused by elevated cholesterol, but not always. The rings come from cholesterol deposits but may be due to a metabolic disorder, rather than very high levels of cholesterol.

If you notice these rings, of course you should have your eyes checked, but again, this does not mean that you necessarily have a high cholesterol level. You eye doctor may recommend that you see another specialist and have the necessary tests done to determine if indeed your lipid profile (fat levels) are really elevated.

In people over 40, this condition is not all that uncommon, but really isn’t a reason for concern. In younger people it can be due to something called familial hyperlipidemia, which is a genetic condition where the person tends to have high levels of fats in their blood. In any case, if you have this condition, the best strategy is to have an eye exam and a full blood lipid screening.

The bottom line is that Arcus Senilis is a normal occurrence after 40 years of age. It’s nothing to get stressed about, but just follow up and get your blood lipids tested by your doctor. If you are a young person, it may indicate a problem with cholesterol metabolism and again should be checked out and dealt with accordingly.

High Cholesterol Symptoms That Are Silent

Again, try not to think of “high cholesterol” in and of itself as THE problem. For the most part, it’s an indicator that your body is trying to deal with another problem and the elevation in cholesterol is just it’s way of doing so. This is known in medicine as “acquired hyperlipidemia,” which means high blood fats due to some medical condition that is causing elevations in your cholesterol levels.

Your body may increase it’s cholesterol levels in response to health issues like:

  • Vitamin-D deficiency
  • Hypothyroid (sluggish thyroid function)
  • Cushings Disease (which causes chronically elevated cortisol levels)
  • Anorexia
  • Problems with your hormones and metabolism
  • Kidney disease
  • Alcoholism and alcohol toxicity
  • Diabetes and pre-diabetes

Obviously these are serious medical conditions and if you have any of these issues, your doctor should be monitoring your blood lipid profile (cholesterol and triglycerides) on a constant basis.

Drugs that Affect Cholesterol Levels

  • Estrogen and Corticosteroids (can raise HDL and Triglycerides)
  • Oral Anabolic steroids ( lower HDL)
  • Birth Control (can raise cholesterol)
  • Beta Blockers (can raise triglycerides and lower HDL)
  • Thiazide Diuretics (can raise cholesterol and triglycerides)
  • Retinoids (can increase LDL and triglycerides)

Of course if you are on any of these medications, you will have to discuss the side effects and risk to benefit ratio with your doctor. Don’t just go off medications without consulting your doctor, because this can have serious consequences.

If you are searching for an healthier or less risky alternative to drugs, that’s great, but you have to do that under the guidance of a physician who knows your medical history and can help you do so safely.

High cholesterol symptoms are a sign that there are important health issues that you and your doctor need to be dealing with. Since most people get routine lipid screenings your doctor should be aware of your lipid profile and it’s implications, but always do your own research and work with your doctor to identify problem areas and find the healthiest solutions you can for them.

The PLAC test is a cutting edge medical screening test that identifies arterial The PLAC Testplaque that is in danger of rupturing. This test, used in conjunction with other cholesterol screening tests can pinpoint your risk of a sudden heart attack with a much greater degree of certainty.

The test actually measures levels of an enzyme in your blood known as lipoprotein phospholipase A2. This enzyme is responsible for a process that can cause damage to your endothelial layer and set the stage for atherosclerotic plaques which can rupture and trigger a heart attack.

When your levels of Lp-PLA2 are elevated, it indicates that you have plaque that can rupture and create a blood clot that results in a heart attack or stroke.

The most current information we have tells us that using cholesterol levels to determine your risk of heart attack is not very accurate. However medical science has identified a process where LDLs (low density lipoproteins) and Lp-PLA2 particles undergo oxidation by free radicals.

These oxidized particles then attack the blood vessel wall causing damage and making the plaque deposits hard and brittle. This oxidized brittle plaque can then break off and cause life threatening problems such as a heart attack or stroke.

Lp-PLA2 is actually created in atherosclerotic plaques and thus can serve as a marker for inflammation in the artery wall. People who have heart disease show high levels of this marker (Lp-PLA2) which not only indicates they have plaque buildup, but also that the plaque is oxidized and can cause severe cardiovascular events.

Autopsies on patients who died suddenly of heart attacks showed ruptured plaques and high levels of Lp-PLA2 in their arteries.

This has also been see in patients who undergo surgery for carotid artery atherosclerosis. They show the same high levels of Lp-PLA2 that indicates a danger of rupturing plaque.

Those people who showed atherosclerosis of the carotid artery but did not show symptoms had much lower levels of Lp_PLA2. It’s clear from this evidence that this is a very significant and useful marker for predicting sudden cardiovascular events.

Studies done at the May Clinic also found that Lp-PLA2 was a specific indicator of dangerous plaques even in the absence of other risk factors. This indicates that it is inflammation and not merely cholesterol levels that create the risk of sudden heart attacks and stokes, so it is inflammation that we should address in our efforts to prevent heart disease.

Advantages of the PLAC test:

  • The test more accurately predicts the risk of sudden heart attack or stroke than other lipid screening tests.
  • The test directly measure lipoprotein phospholipase levels, a very accurate inflammation marker.
  • The PLAC test is the only medical screening approved by the FDA that indicates both heart attack and stroke risk in patients.
  • The test is relatively inexpensive and convenient.
  • The test can also be used to monitor a patients response to treatment and lifestyle changes.
  • The test is covered by Medicare and private insurance companies.
  • The test does not have to be taken in a fasting state.
  • The test can be used in patients that are currently using Pravachol, Benadryl, and Tylenol

Who should get the PLAC test and when?

Experts recommend a formula for determining who should get the test based on other risk factors and their estimate risk of sudden heart attack within a ten year period. This makes no sense to me at all. We have a test that can specifically identify people who are a high risk for a heart attack or stroke, before this actually happens and give them a chance to lower their risk.

I believe the PLAC test should be used as a standard cardiovascular screen test, because it targets the process that is actually dangerous, rather than cholesterol levels which don’t really give an accurate measure of your risk. Once the test has been done, all that’s left is to determine how to go about lowering the risk, by reducing the inflammation in your arteries.

As to who should have it done, it makes sense to me that anyone approaching middle age would be a candidate for it. Autopsies of US soldiers killed during the Korean War showed atherosclerotic plaques in the arteries of young men in their 20’s. Based on this it seems reasonable that the test could even be done on people in their early 20’s as a way of identifying people who may be at risk and giving them plenty of time to make the lifestyle changes needed to protect themselves.

People with metabolic syndrome which consists of the following:

  • obesity
  • abnormal blood lipid profile
  • elevated blood sugar
  • high blood pressure

are prime candidates for the PLAC test, as it is known that metabolic syndrome involves inflammation and thus raises the risk of heart disease.

The test can be done at followup intervals to verify the success of lifestyle changes and other interventions in terms of lowering the patient’s risk. While I claim no medical expertise, common sense suggests that this test be done early and the person then adapt their lifestyle, nutritional and exercise habits to mitigate this risk. That approach makes the most sense.

How to interpret the test results:

Even though the Lp-PLA2 test is much different than cholesterol screening tests, the levels are somewhat similar:

The 3 risk levels are:

Low:   under 200 ng/mL

Borderline:  200 to 235 ng/mL

High:  over 235 ng/mL.

Lp-PLA2 levels over 200 to 220 ng/mL indicate a very high risk of endothelial damage which in turn presents a very high risk of atherosclerosis.

Medical Interventions:

The PLAC test can be used to identify the magnitude of risk and also to determine how well the treatments used to combat it are working. This is why followup tests are important.

Statin drugs are said to provide a 20-30% reduction in Lp-PLA2 levels. The risk to benefit ration of statins is something you will have to discuss with your doctor.

Niacin used in combination with statins is reported to provide an additional 5 to 20% further reduction of the Lp-PLA2 enzyme.

Angiotensin-converting enzyme (ACE) inhibitors are also reported to lower Lp-PLA2 levels, and medical scientists have speculated that the effectiveness of all cardiovascular drugs may actually depend on their ability to successfully lower Lp-PLA2 levels

Niacin and omega 3 fatty acids (fish oil) also show an ability to reduce levels of Lp-PLA2.

Tumeric spice (also called circumin) has been found to reduce a form of phospholipase in animals, and thus may be of value to humans in reducing Lp-PLA2 levels, but the study results are not in on this yet. My guess is however that turmeric is most probably of value in human as well.

Conclusion:

Since heart disease is the nation’s number one killer, preventing it is vitally important to a long and health life. Medical screening tests such as blood pressure and cholesterol are not enough to accurately predict who is a risk for a heart attack or stroke.

The PLAC test is relatively inexpensive, non invasive, and very accurate in predicting who is at high risk for a sudden cardiac event like a heart attack or stroke. It really represents a cutting edge approach to identifying people at high risk and helping them make the changes that can save their lives.

What are optimal cholesterol numbers? Doesn’t this contradict the latest theory that cholesterol does NOT cause heart disease. The truth is that it is a “factor” but not the “cause”!

cholesterol numbersHow do we establish what the optimal levels for LDL and HDL are? These are important questions because the idea that cholesterol specifically causes heart disease is so deeply ingrained in the average person (and most doctors as well).

This is a difficult question to answer definitively because the issue is just so complex. I can tell you what some of the guidelines are, and of course they vary from one source to another. There is a generally accepted “optimal range” for cholesterol numbers.

Here are the guidelines issued by the American Heart Association.

 

Desirable Borderline Risk High Risk
Total Cholesterol 200 or less 200-239 240 and over
HDL 60 or higher 40-59 40 or less (men)
HDL 60 or higher 50-59 50 or less (women)
LDL less than 100 130-159 160-189
Triglycerides less than 150 150-199 200-499

 

 

 

 

 

Keep in mind that these guidelines somewhat reflect the influence of the drug industry and their attempts to increase their market for cholesterol lowering drugs called “statins.”

The recommended cholesterol numbers keep being adjusted downward, in my opinion in order to get doctors to prescribe more statin drugs which of course boots revenues of the drug industry.

In addition, there are other tests which are called “inflammatory markers,” that have a direct bearing on your risk for developing heart disease, and these tests should also be used to more accurately determine what your overall risk of cardiovascular disease is.

Once you know your level of risk based on the latest tests and analysis of particle types, then you can target your lifestyle strategies (exercise, diet, and stress reduction) to protect your heart health. This should always be the end point of ANY testing…a program to address whatever risks the tests have identified.

What really DOES Causes Heart Disease?

Here’s a simplified explanation. Heart disease is caused by inflammation. That is what actually damages the lining of your arteries. As Dr. Stephen Sinatra likes to say “Cholesterol is found at the scene of the crime, but it’s not the perpetrator!”

When arteries are damaged, your body uses LDL to try and repair the damage, kind of like patching holes in a wall. Obviously the LDL did not cause the damage, but gets attached to the artery walls and accumulates eventually clogging the artery. This is called an “occlusion.”

When the LDL particles that stick to your arteries become oxidized and thus inflammatory, the process of arteriosclerosis begins. This is where the small highly inflammatory LDL particles called HP(a) come in.

So again, the cholesterol did not initiate the process of heart disease, but it IS an important factor in the progression of heart disease. With that out of the way, lets move on…

Focus on Particle Size and Type, Not Just Cholesterol Numbers

The real focus should be on the type and particle size NOT just the levels. According to Dr. Stephen Sinatra, an integrative cardiologist who is board certified by the American College of Cardiology, if your LDL particles are large and fluffy then you really don’t need to worry so much about your LDL levels.

However if the LDL’s are small dense highly inflammatory particles, then your risk is greatly elevated. There is a test that measures for these small inflammatory particles (HP(a)), called the Lipoprotein Particle Profile (LPP) test.

The LPP test measures the level of HP(a) which is a small dense LDL particle which is very toxic and inflammatory to the blood, potentially causing your blood to become “hyper-coagulated” which is another word for sticky and more likely to clot.

The takeaway message is that if you have this dangerous inflammatory LDL particle, then obviously the higher your total cholesterol numbers, the more of this dangerous particle you have, and the greater your risk. Simply stated, high levels matter when you have dangerous LDL particles in your blood.

So in closing, optimal cholesterol numbers are totally dependent on particle size and type. If your cholesterol particles are the small dense inflammatory type, then you need to make a greater effort to lower your levels.

If your LDL type is large and non-inflammatory, then your total levels are not something to be overly concerned about. You should take the time to consult with an integrative cardiologist to determine how best to manage your heart health.

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