guilty or innocent? Weighing in on Cholesterol

Cholesterol has been heavy on my heart for the last month... haha! No pun intended there... my cholesterol is actually fine..... but I tend to root for the the misunderstood and the underdog when given a choice. (That's probably why our farm tends to be a haven for rescue dogs and cats.... but I digress!) 

Did you know that approximately 80% of people with acute cornary syndrome....(ie: reduced blood flow to the heart... often leading to heart attack) have NORMAL cholesterol values? What's up with that? 

Cholesterol is one of those underdogs. Bless its sticky little heart..... it's given a bad rap more so than nearly any other body produced compound. What would we do without cholesterol?  That's a good question.... I'm not entirely sure any of us would be around to discuss it if we lacked it in our bodies! It is a major component of cell membranes and is a necessary building block for hormones, fat soluble vitamin D, and bile salts (aiding in the digestion of fats and fat soluble nutrients). Cholesterol is also extremely important to the function of our nervous system. Without it, we'd be bumbling malfunctioning idiots....especially considering that our brains are roughly comprised of 50% cholesterol. So why all the hate?

Our bodies are efficient producers of cholesterol.... producing about 80% of what is in our bodies (the other 20% comes from dietary sources). Cholesterol should not be confused with Triglycerides (perhaps the real bad boys), or the obscure thug that likes to hang on to its buddy LDL..... lipoprotein(a).

Unpacking Cholesterol: The cholesterol in our vascular system is a mixed bag of good and bad. HDL (the good guys) has the job of bouncer.... and it escorts out the shadier gang members, LDL, from our bloodstream. LDL comes in a variety of sizes.... and the smaller sizes (subunits 3 & 4) are really bad news. The bigger ones (subunits 1 &2) are fluffier and are actually pretty helpful. Because they (subunits 3&4) are small, they can easily work their way into the lining of our arteries where the bouncer (HDL) can't reach them. In a whopping 20% of the population (1 in 5) there is something called Lipoprotein(a) that makes LDL 'extra sticky'..... if you carry this genetic characteristic, it is best to know about it early on in life, as it dramatically increases your risk for clogged arteries and  blood clots leading to strokes and heart attacks. It is a serious health risk, and frankly.... should be tested for at least once in everyone's life.
While managing total cholesterol with careful eating habits (avoid processed and 'fast' foods) is important, .... the real culprits we should be monitoring are inflammation, triglycerides, and lipoprotein(a).

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​Triglycerides are produced predominately by the liver. When we eat, the body stores any excess calories as triglycerides in our fat cells. It is particularly fond of doing this with carbs. Later.... between meals.... hormones will signal a need for more energy, and those triglycerides will be released. Herein lies the rub tho..... if you eat more than you exert energy, triglycerides begin building up and you end up with hypertriglyceridemia (HTG), and THAT my friends, is cause for alarm. Even if someone has verified genetic HTG, management can be achieved with responsible ownership of the vessel you reside in:

• Daily physical activity
• Conscious consuming of healthy fats... avoiding processed foods and other sources of "bad fats"
• no smoking
• Optimizing body weight
• Limit processed sugar intake to no more than the equivalent of 6 teaspoons of sugar per day. (The average North American consumes about 200gms or 48 teaspoons of processed sugar in their diet daily)
• Work towards optimal triglyceride lab values of <100 and a triglyceride to HDL ratio of 1:1 to 2:1. 

Lipoprotein(a) is no joke. 73 million people in the USA are estimated to be living with this 'sticky' situation. It is extremely dangerous because the molecule itself is so small, sticky, and it difficult to manage. What makes it even more dangerous is this: most insurance companies refuse to pay for the test that determines if you have it..... and many doctors don't even mention the test to patients because insurance doesn't pay. I have not been able to wrap my brain around the logic of NOT paying for a potentially life saving test.... but there you have it. It's just one more reason to take charge of your own health and ask for the test and pay for it out of pocket, ESPECIALLY if you have family history of heart disease. Nothing..... no vacation, no daily coffee, no new phone.... should be more valuable to you than knowing this information about yourself. Once you know, you have the power to act.... and that can change the trajectory of your life. If you do carry this genetic trait, you will want to have your children tested. They need to learn healthy habits early in life. It's never too young to become a CEO of oneself!

IF you have inherited lipoprotein(a), you'll want to pay very close attention to what you CAN do, because it's time to take your health seriously. Some people do not get a warning, and find themselves diagnosed at the same time their mortality is realized. Lp(a) requires close attention and monitoring. Tools to help in management include: 

• Daily baby aspirin
• High quality Omega3 fish oil.... lots of it... has been found to lower Lp(a)LDL by approximately 10%. (Poor quality Omega 3's become oxidized and can actually do more damage than taking nothing at all. Know your supplement company...not just their name, but how they do business. This is especially important with Omega 3's.)
• High doses of Niacin (1-3 gms/day) ... the flushing kind (ex: Slo-Niacin)... have been found to lower Lp(a)LDL by up to 30%
• Maintain a fasting blood glucose of <100
• Vitamin C @ 3000mg/day
• L-lysine, L-proline & L-carnitine in high doses (L-carnitine helps make lp(a) less sticky)
• Test for and maintain hs-CRP (high sensitivity c reactive protein) at <1. This measures inflammation in the body and high levels are a risk factor for heart attack.
• Control blood pressure ideally at 120/70.
• Consistent exercise
• Abstain from smoking
• Get (regularly) an Advanced Lipid Panel every 6 months w/ the following goals:

1. LDL< 60
2. Triglycerides < 60
3. LDL particle # < 700

I realize this has been kind of a heavy post. I'm sorry about that. It's a heavy topic tho. Most people (even healthcare professionals) don't have a clear understanding of exactly what causes the real problems in our vascular system. Hopefully, you can see that cholesterol itself is not the real monster..... it's actually pretty awesome stuff. Too much of a good thing is bad tho.... no matter what it is. Although I only barely touched on inflammation in this post, it's HUGELY important to this topic too. Sticky Lp(a)LDL is especially fond of a chronically inflamed vascular system.

It is my hope and blessing that this helps someone better manage their own health, and to prompt personal responsibility one's own health. I am not a doctor. Information here is for recommendation purposes only, and not intended to substitute for specific medical advice. Please do use this information as a starting point for your own research, and use as discussion points with your personal healthcare provider.

Love and hugs,  Liz
 

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