What's the story with cholesterol? You know we're told to eat healthy fats and
this is actually a lot of debate about how much fat you should eat. Some people
say avoid fat. Others say that's where it's at - eat nothing but fat. And there's
a lot more to the story than just avoiding eggs that was what we used to
think maybe 15 years ago.
There's also actually a lot more to the story than diet alone. If you start
looking at your own cholesterol test, there's a lot of information on it. It's
not just in HDL and LDL. For example, I will look at triglycerides over HDL that
helps me understand whether or not you have problems with insulin resistance,
prediabetes, metabolic syndrome, or even diabetes. LDL is something that's been
debated a lot recently. Some people are beginning to say higher LDLs (LDL or bad
cholesterol levels) are even better. Then there's the folks that have really
high LDL levels (FH - familial hypercholesterolemia). And how many times
have your doctors checked you for LP(a)? That's actually a type of LDL
which has been shown to be a risk for heart attack and stroke. So there's a lot
to cholesterol testing that you probably haven't heard of. People used to talk
about HDL and LDL, and those are still there.
It stands for high-density lipoprotein and low-density lipoprotein. Low-density
lipoprotein (LDL) is actually what gets deposited in the artery walls when you
do have plaque. It may not be so much associated with the level of LDL that's
really becoming much more hotly debated these days. And frankly I don't think it
is it's really more a focus of how much inflammation or burn you have usually
from insulin resistance to the glycocalyx and the intima (the lining of
the artery wall). HDL though still takes that cholesterol up from the artery
walls and takes it back to be digested and burned by the liver.
What is LDL anyway? I mean cholesterol is the same, whether it's HDL and LDL,
isn't it? It is still cholesterol. The reality is that it is the thing that's
different is the type of protein that the body is using to carry those tiny
cholesterol particles. Why does the body do that? Because all in water don't mix
so oil and cholesterol don't mix... I mean water and cholesterol don't mix. Water and
any of the fats don't mix. In fact, people have had what we call an embolus or a
big blob of fat or oils in their blood. When they do, it can kill them, just like
a heart attack or a stroke that happens with major trauma like car wrecks and
multiple breaks. And it happens with other types of trauma like surgery as
well. My old friends Brad Bale and Amy Doneen have used their on little
pictures to demonstrate some of the variation that you see with LDL. Their
point on this one is, "Look, LDL gets all the bad rap, but Lp(a), VLDL, and
some triglycerides... some of these are very dangerous. they're bigger and meaner
but they just don't get a lot of focus." Speaking of VLDL, have you ever heard of
remnant cholesterol? If you haven't, again google it on the internet, there's a lot
of YouTubes, there's a lot of information coming out about remnant cholesterol. I
just had a patient call me up recently concerned about this and it tends to be
focused on VLDL, the very low-density lipoproteins. It tends to have a lot of
impact with the triglyceride activities. If you'd like to learn more about this,
we've got courses on it, we've got free videos on it, and we're going to be
having an event in Louisville on November 8th and 9th where we go over
all of these in detail. So you can take control of your health. Thank you
for your interest. I've had so many patients come to me because they quote
their diet here, "Why don't you take this statin and let's see what happens.
Let's see if a heart attack or stroke happens." No, prevention is a science. We
know what's going to happen, we know what to look for, we know how to prevent it.
Come see us in Louisville on November 8th and 9th. Get your CIMT artery scan,
all your labs. See me and spend two days learning usually what your doctor
doesn't know yet about the science of prevention. Look forward to seeing you.