Cholesterol

One of the basic principles behind the autoimmune protocol is the Autoimmune Paleo diet - it is basically an ancestries diet, the foods people ate before agriculture was developed, before dairy, grains, and legumes came into being.

This diet includes good quality animal protein, healthy fats and a lot of vegetables. When talking about animal proteins and fats, most people think about high cholesterol.

Overall people have excellent improvements in health and blood test markers on an autoimmune Paleo diet, however some people have noticed since moving to this diet their overall cholesterol went up!

New studies show that eating cholesterol and saturated fats does not increase cholesterol level in the blood for most people. But more importantly that high cholesterol has nothing to do with heart disease.

Only 10%-25% of your cholesterol comes from your food – the other 75-90% is manufacturing in your body, mostly in your liver. “The body tightly regulates the amount of cholesterol in the blood by controlling internal production; when cholesterol intake in the diet goes down, the body makes more. When cholesterol intake in the diet goes up, the body makes less”. ChrissKresser.com

Even this article is not about heart disease, still what cause heart disease if it is not cholesterol?

Science shows that inflammation originating in one part of the body affects the function of the rest of the body system and is a primary driver of many kinds of disease, including heart disease.

Most of doctors and researchers agree that one of the major inflammation in a body caused by high insulin and insulin resistance.

Dr. Ron Rosedale wrote “Hyperinsulinemia (high insulin) adversely affects almost all degenerative diseases. That includes coronary artery disease, hypertension, cancer, stroke, diabetes of course, obesity, autoimmune disorders and mental disease and mental decline.”

What else besides high insulin can cause inflammation? For example the way you personally react on food, infection, trauma (physical or mental), toxins and other stressors becomes a significant factor in the developing of heart disease.

Going back to cholesterol; we know now that cholesterol has nothing to do with heart disease just by itself!

In fact we need cholesterol in our bodies:

· cholesterol is the major building block for many hormones, hormones are a major control system in our bodies

· cholesterol is a key part of immune system and important for tissue repair

· cholesterol helps to build strong bones

· cholesterol helps your body eliminate toxins

· cholesterol helps absorb fat-soluble vitamins (such as vitamin D, Omega 3)

· cholesterol supports brain function

  • That is why people over age 65 with the lowest cholesterol levels have the highest rates of dementia and memory problem.

  • So, if you don’t have enough cholesterol in your body (total cholesterol), all your body’s systems suffer.

  • Studies suggest that low cholesterol can increase the risk of death, especially in women and the elderly.

  • … and about half of the people who suffer heart attacks have normal cholesterol level.

But what is “normal” cholesterol?

· Functional Medicine range: 160-240 mg/dL (US units)

Under 160 mg/dL is not enough to provide a good brain and hormones health

· Another interesting study research of 10 years for about 60,000 people (Europe)

Below 200 mg/dL actually is the highest risk of heart disease and above 280 mg/dL have low risk of heart disease, for women particular (see resources below “Conundrum - Know Your Metrics”)

· Dr. Wahls “The Wahls protocol” … “we don’t know the optimal upper range of cholesterol for ideal brain function: 300 mg/dL may or may not be too high!”

That said, total cholesterol and LDL do not predict heard disease, but the cholesterol RATIOS predicted heart disease very well (ratios are excellent indication of your metabolic health).

If you have your conventional lipid panel done, you can do this calculation:

  • Triglyceride/HDL: below 2, preferably around 1

  • Total cholesterol/HDL: below 4.5, preferably below 4

  • LDL/HDL: below 3.5

  • Triglyceride: below 100 mg/dL

  • HDL: above 40 mg/dL (for men) and above 50 mg/dL (for women)

Is this lipid panel test ordered by your doctor enough for you? If you are uncertain (and 40-75 years old) then consider advanced tests.

Advanced tests

1. Lipoprotein test or Particle number (LDL-P)

The cholesterol transported around the body by special proteins (imagine boats transporting passengers), and these boats will be proteins or called lipoproteins and cholesterol in the boats will be passengers.

Scientists used to believe that the number of passengers in the boat is the driving factor in the development of heart disease. More recent studies, however, suggest that it’s the number of boats in the river (LDL particles) that matters most.

These boats in a river are a crucial test for heart disease risk. That is when we particularly look for numbers if they are elevated.

And important is the particle’s size and type. If it is more big, fluffy and bouncy balls they are not so bad and don’t tend to stick together but small, dense and sticky that can make dangerous plaques.

You can actually order these tests by yourself, but do your research first:


· www.labcorp.com NMR (Nuclear Magnetic Resonance) or LDL-P

· www.questdiagnostics.com

Different technologies but same info

What cause LDL – P elevated at least 5 causes:

· Insulin Resistance and Metabolic Syndrome – high blood sugar is very inflammatory

· Poor Thyroid Function (here something to do with liver produces excess cholesterol)

· Infections

· Leaky Gut — Leaky heart

· Genetics

2. Carotid artery and coronary calcium

The 2 best ways to verify your actual heart disease status is to use the best technology – a technology that can actually see this disease in your body (we are referring to calcification).
Your body tries to repair itself by depositing calcium in the damaged areas of the arterial wall. This growing calcium becomes a huge problem it can be real risk for sudden death. This calcium is different from the calcium in bones and isn't related to too much calcium in the diet.

Your doctor can prescribe one of these tests:

· CAC scan – coronary artery calcium

· Carotid artery evaluation ultrasound (women - neck area, man - heart area) - calcium score (I did this test)

Which is better?

… “We propose that CACS assessment is useful in the diagnosis of, and as a surrogate marker of ASCVD in asymptomatic high-risk patients. Our results also suggest that carotid artery evaluation may have a valuable predictive method in primary and secondary ASCVD prevention and risk assessment. Therefore, although there are no synergic effects of combining carotid artery evaluation and CACS, carotid ultrasound seems to be a better predictive method for assessing ASCVD events in high-risk populations than CACS” (see reference below “Carotid artery evaluation and coronary calcium score”).

Summary

I am not going to advice you here how to improve your cholesterol level, it is not my specialty. What I am trying to teach you is that eating cholesterol and saturated fat does not increase cholesterol levels in the blood for a majority of the population and is not the cause of cardiovascular disease. HOWEVER when you combine your cholesterol with:

· high blood triglycerides

· high level of inflammation (CRP)

· hypertension

· insulin resistance

· obesity

· low HDL

· family history

It can indicate increase risk for cardiovascular disease!

Important! Not everyone responds to dietary cholesterol in the same manner, there’s some variation in how individuals respond to dietary saturated fat. If we took ten people, fed them a diet high in saturated fats, and measured their cholesterol levels, we’d see a range of responses that averages out to no net increase or decrease. If dietary saturated fat does increase your total or LDL cholesterol, you may try the inexpensive genetic test (see resources below “23 and Me”).

A particular gene, ApoE4, dictates people’s abilities to handle saturated fats and they tend to have higher cholesterol and slightly higher rates of coronary heart disease.

In this case you may want talk to your doctor plus do it yourself:

· Consume more plant-based fat from avocado, olive oil, and nuts

· Eat less animal fats and more fatty fish and eggs

· Eat less cheese

· Eat more high fiber whole carbs

· Get more Omega 3

· Get more sun exposer

· Do more resistance exercise

· Also you must POOP regularly - It's the only way to remove cholesterol from the body

· Reduce LDL, naturally – garlic, red yeast rice extract (natural statin to lower cholesterol), Omega 3, niacin (B3).

References

· Ivor Cummins and Jeffry Gerber, MD “Eat rich, live long”

· Dr. Wahls, MD “The Wahls protocol” (multiple scloses)

· Sarah Ballantyne, PhD “The Paleo approach”

· Mark Menolascino, MD “Heart solution for women”

· Chris Kresser, “The diet-heart myth” e-bookCholesterol

· Conundrum - Know Your Metrics (for Total cholesterol start at 6:20)

https://www.youtube.com/watch?v=YRFRRqe0vrE

· The Diet-Heart Myth: Why Everyone Should Know Their LDL Particle Number

https://chriskresser.com/the-diet-heart-myth-why-everyone-should-know-their-ldl-particle-number/

· What Causes Elevated LDL Particle Number?

https://chriskresser.com/what-causes-elevated-ldl-particle-number/

· CAC, Coronary calcium test could help clarify heart disease risk – and control cholesterol

https://www.heart.org/en/news/2018/11/13/coronary-calcium-test-could-help-clarify-heart-disease-risk-and-control-cholesterol

· Understanding Coronary Artery Calcium (CAC) Scoring

https://www.cardiosmart.org/Heart-Conditions/High-Cholesterol/Content/Coronary-Artery-Calcium-Scoring

· Carotid-intima-Media thickness test (ultrasound)

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3583351/

· Carotid artery evaluation and coronary calcium score: which is better for the diagnosis and prevention of atherosclerotic cardiovascular disease?

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4694372/

· 23 and Me (www.23andme.com) offers a genetic test

· Women’s heart summit, “The #1 Killer of women: Heart disease”. Dr. Tom O’Bryan Q&A with Mark Menolascino

· Interconnected Series, Microbiome

· Diabetes Summit 2019, Ivor Cummins “Reducing cardiovascular risk with diabetes” www.thediabetessummit.com