All About Cholesterol

The science of Lipidology teaches us new and important things about our lipids and cholesterol, and the processes in our bodies that are involved. It's important to understand how this new information affects us on our journey to keep the weight off.

Some of this weeks episode highlights are:

15:21 It's a lot of science. It's a lot of complicated stuff. The most important thing to understand is that you really cannot assess risk looking at the standard cholesterol profile. You really need some of these more advanced numbers. NMR, VAP, Lp(a), APOB100.

16:19 When you stop eating all that processed junk food, and you're eating whole foods, and you're nourishing your body with good proteins, lots of vegetables, healthy fats, this can be nothing but good for your body.

19:15 The standard American diet causes cardiovascular disease. Period. It just does. If you eat fast food and food that comes in packages and boxes, if you drink sugar sweetened beverages, you're at risk. Period. So I want you to think of this stuff in the same way you think about cigarettes. It's just a lot of high risk for a miserable life and an early death, and it's really just not worth it.

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Podcast Episode #30:  All About Cholesterol

You are listening to the Keep the Weight Off Podcast with Dr. Angela, episode #30

Hello everyone! And Hi Marchelle!  --

I got a request in Sugar and Flour Buster’s Society recently to do a podcast on Cholesterol, so I’m fulfilling on that promise today. 

By the way, if you’re not already a member of S/F Buster’s society I’d like to invite you to join us there - this is my Facebook group where I and all of our members support you in your weight loss efforts. It’s a really powerful group of people from all over, but we all have a desire to reclaim our health and get ourselves off processed food. There’s a lot of support, and a lot of menu ideas too. So I hope you’ll join us. We’ll leave a link in the podcast show notes. 

OK so let's talk about cholesterol.  Listeners, my goal here is to inform you, not to offer you any specific medical advice, so if you have any questions about your particular cholesterol levels, please discuss this with your doctor. 

I want to preface this talk by letting you know that I did a LOT of research on this topic in preparation for this podcast!  There is a whole field of study called “Lipidology” and we’re learning more about cholesterol metabolism all the time. There are scientists who have been researching cholesterol for decades now. So we’ve really learned a lot.  Of course, as it always is, the more you know, the more you realize you don’t know.  

So, Marchelle, did you know that when people lose weight, their cholesterol levels will often go up?  

I see it pretty regularly. And I never get freaked out about it.  I’ll explain why, but before I do I have to give you a little background information. 

The first thing I want you to know is what exactly cholesterol is.  Most people have heard that elevated cholesterol levels put you at risk for cardiovascular disease, which is the number one killer of Americans.  

Cardiovascular disease is more than just heart attacks. It includes any disease of blood vessels, so for example when the blood vessels that supply the heart get blocked, that causes a heart attack. When the blood vessels that supply the brain get blocked, that causes a stroke. Aortic aneurysm is another manifestation of cardiovascular disease. This is a weakening of the aorta, the major artery coming from the heart. What I want everyone to understand is that the blood vessel system is a complete system involving the whole body, so if there is disease in one part of it there is likely disease in all of it, which is why if you have a stroke for example, they will check your heart and your aorta looking for disease there. 

So what is cholesterol and how does it cause blockages in the arteries?  

Cholesterol is actually present in all cell membranes, it is an important in creating the structure of the cell membrane.  It’s also used to make hormones, bile acid and vit D. So it’s a really important molecule. 

When you get your cholesterol levels checked, if you get the standard profile, you will get a number for total cholesterol. This is then broken down into various subtypes:  there is the HDL cholesterol. That’s theoretically the good stuff, although more current research is showing that it’s not as important as we once thought it was.  Then there’s the LDL and VLDL cholesterol - generally thought of as the bad stuff.  However it’s not always bad and I’ll explain that in a minute.  The last number we get is Triglycerides, which are fats, not really cholesterol. Triglycerides are made from glucose, or sugar. So if your diet is high in sugar or flour, you will oftentimes have high triglycerides. Alcohol can raise triglycerides too. 

OK so when it comes to these different types of cholesterol, what I want you to understand is that these aren’t actually cholesterol particles.They are transport proteins.  You see, cholesterol doesn’t dissolve well in water, and blood plasma is mostly water.. So in order for the cholesterol to get anywhere it has to be carried on proteins that will dissolve in water.  So the LDL cholesterol that we measure in the standard cholesterol profile is actually a vehicle that carries the cholesterol around.  The cholesterol is made in the liver, gets attached to the LDL cholesterol, then travels through the bloodstream and around to the various cells that need it. Remember, your cells need cholesterol to make hormones and cell membranes. Cholesterol is actually really important. 

The other thing to understand about cholesterol is that the cholesterol in your bloodstream is only a small fraction of the cholesterol that’s in the body.  

So LDL and VLDL cholesterol transport proteins carry cholesterol around and deliver it to cells. When there’s excess, the HDL transports it back to the liver. In the past, it was felt that it’s  about the balance between the LDL and HDL numbers. It was felt that you can have a lot of LDL, but if your HDL numbers are high, you were felt to be at lower risk, and that if you could raise HDL levels you would be at lower risk. However current research doesn’t bear that out. Raising HDL doesn’t necessarily lower risk, so the lipidologists are not as focused on that strategy any more. 

The first thing that happens in the development of cardiovascular disease is injury to the artery wall. This is called endothelial damage. The endothelium is the lining of the blood vessel, and the biggest risk factors for endothelial damage are smoking and high blood pressure. High blood sugars will also damage the blood vessel endothelium, so that’s why it so important to manage your blood sugars if you have diabetes. 

When the endothelium is damaged, it gets leaky, and cholesterol can build up in the wall and cause a plaque to form. Eventually the plaque ruptures, and a blood clot forms. This is what causes the blockage that causes heart attacks and strokes. I’m simplifying this a lot, but this is essentially what happens. 

Now here’s what I want you to understand. In the setting of a damaged blood vessel wall, if you have high levels of LDL particles that are in the bloodstream for extended periods of time, they can get stuck in the vessel wall and create plaques.  But when we do our standard tests, we’re not measuring the LDL particles, we’re measuring the transport proteins. Elevated LDL cholesterol transport proteins are not what’s causing cardiovascular disease.  It’s the LDL particles that increase your risk of heart disease.  LDL particles are carried on the LDL cholesterol transport protein but some people have lots of these particles floating around freely, getting up into the blood vessel walls and causing blockages.  So it’s possible to have very normal cholesterol levels and actually be at high risk of cardiovascular disease. 

Science is also coming to the understanding that it’s not just how high the LDL particle concentration goes, it’s about how LONG they are in the bloodstream.  The quicker they get flushed out by the liver, the less likelihood they have of getting stuck in the artery wall and causing a plaque. 

So really, to truly assess your risk, you need an advanced cholesterol profile, a more in-depth test. This is called the NMR profile. Quest Labs calls it the Cardio IQ.  Another name for it is a VAP test. There may be others, but those are the ones I’m familiar with. 

I call the standard cholesterol test the kindergarten test. I would never make any decision about cardiovascular risk based on that standard test.  You really need an advanced test, what I call the college cholesterol test - either the NMR or the VAP or the Cardio IQ, so you can find out what your LDL particle number is. This is a very important number. Normal is less than 1000.  There are 2 other numbers that are also extremely important, one if them is the ApoB100. This is a protein that wraps around the LDL particle, and when this number is high, you are at high risk. The other number is called Lp(a).  This one is more genetically determined. In families where lots of people have heart attacks at young ages, often there are high levels of Lp(a). Some experts are recommending that everyone get screened at least once with an advanced test to find out what their Lp(a) numbers look like, so they’ll know if they are at high risk.  

Now here’s what can happen when you lose weight. Inside the fat cells, the triglyceride fats are stored with the LDL transport proteins, and when you lose weight, the fats are burned for energy, but the LDL cholesterol can hang around for a while. What’s interesting is that almost always, the size of that transport protein changes, from small dense and dangerous, to a larger protein that can handle more LDL particles, thus actually lowering cardiovascular risk.  

What I want everyone to understand is that when you’re in the weight loss process, when you stop eating processed food and you are eating whole foods, this can be nothing but good for your body.  Don’t worry if your LDL cholesterol goes up for a little while.  Get an advanced test, get the NMR or the VAP or the cardio IQ and find out what your real risk is. 

It’s interesting because I’m one of those people who, if you look at my standard cholesterol profile, I look great. My LDL is low, my HDL is high my total cholesterol is fine. But so was my mother’s. And she ended up with a triple bypass when she was 58 years old. She’s a skinny little thing too. Not someone you’d ever expect to have heart disease.  And my father had heart disease too. So I was concerned.  And I had the advanced testing done, and I found that my LDL particle number was high and my LDL cholesterol was the small dense stuff that’s dangerous.  So I made some more changes in my nutrition. I got even more careful with my carbs and I started a meditation practice so I could reduce my cortisol levels, which reduces insulin levels. And you know what, that was all it took for me. Other people need more aggressive intervention to get that LDL particle number down, and some people do need to take a statin medication. 

So my advice to anyone listening to this podcast would be - don’t freak out if your cholesterol levels go up while you’re losing weight.  AND, especially if you have a family history of heart attack, stroke, aortic aneurysm, if you have insulin resistance or diabetes, consider getting the advanced testing done.  But wait until you’ve lost weight and you’re not eating crap food very often. Then you can get a clearer sense of any genetic risk.   The standard american diet causes cardiovascular disease, period. If you eat fast food, and food that comes in packages and boxes, if you drink sugar sweetened beverages, you’re at risk. Think of this stuff in the same way you think about cigarettes.  Just a lot of high risk for a miserable life and an early death.  It’s really just not worth it! 

Marchelle, do you have any questions about this?  It’s  alot of science!

Ok so here are the main points:

First, if your LDL cholesterol goes up while you are losing weight, do not be concerned. 

Second, talk to your doctor, but I would not start a statin medication based on the information you get from a standard cholesterol test. You need an advanced test to find out what your real risk is. 

Third, the metrics that indicate high risk include ApoB100, LDL particle number (which is different than LDL cholesterol), LDL size, and Lp(a).

Elevated Lp(a) is felt to be genetic and many experts are recommending that everyone be screened, especially when the family history shows a lot of early cardiovascular disease. 

Lastly, processed food and sugary beverages are very dangerous for your heart and cardiovascular system.  Begin to think of this stuff in the same way you think about cigarettes. If you can make some significant changes in the way you feed your body, you can oftentimes greatly reduce your risk for cardiovascular disease without taking cholesterol lowering medications.  

That’s all for today - we’ll see you next week!

Dr. Angela

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