Today I will discuss how to reduce high Cholesterol.You know, it’s always important to stay on top of your health and check in with your doctor regularly.
Recognizing potential problems early can help your doctors guide you back to good health. So let’s find out how this next man took action when he found out he had high cholesterol. –[Jane] Like most of us, Bob Fogle is careful to check in with his doctor regularly.
I like to think I’m pretty good getting annual physicals and my doctor reminds me if I don’t.
Once or twice a year you find out how it’s going. – [Jane] It was on one of these routine visits about 15 to 20 years ago that his blood tests came back with some concerning results.
One of the things we would check is a blood test to check cholesterol,triglycerides and mine was rather elevated.
All of his values were really out of whack so the good cholesterol,the HDL was way too low his LDL, or the bad cholesterol, was way too high and, interestingly,in Bob’s case his triglycerides were really high.
What’s this non-HCL?
I mean, is that good that it’s lower, or? – Cholesterol and triglycerides are really fat, oily, fat-like substances that are in your blood.
And in order to travel around your blood cholesterol and triglycerides actually travel in these individual particles we call lipo proteins.
There’s different sizes of these particles. If you have a higher level of high density lipo protein cholesterol or HDL, on average you’re actually at lower cardiovascular disease risk.
That’s why we call HDL the good cholesterol. But then if you move to slightly larger particles called LDL cholesterol,or low density lipo protein cholesterol, it turns out that those are positively associated and actually cause most forms of atherosclerosis and atherosclerotic-related disease like heart attack.
The thing about cholesterol and triglycerides is you can’t see it, you don’t really feel it, there are no signs or symptoms other than a blood test.
That’s one of the reasons why the American Heart Association recommends that adults over 20 years old get their serum cholesterol checked every four to six years.
Adopting a heart-healthy lifestyle can do a lot to actually reduce their overall cardiovascular disease risk, even independent of what it does to their cholesterol levels.
[Jane] With his family in mind Bob worked with his doctors to take action and make some changes.
My wife, I wanna be there for her. Got three kids, I wanna be around for them. So if I can modify my behavior, the hope is I’m reducing risk factors.
[Jane] The first step was medication followed by a change in diet. – They’re overweight.
Having a slight calorie-deficit so they start to lose weight and then getting most of their calories from plant-based sources, eating a modest amount of carbohydrates usually in the form of whole grains really trying to minimize simple sugars and minimize high salt foods.
I just try to pay attention to avoiding fats or avoiding sugars. I’m doing my best. – [Jane] Bob’s doctors also encouraged him to get moving.
I have an elliptical machine that I try to do two or three times a week. Trying not to sit on my butt too much is a goal. Moving is better than sitting.
I feel energized as a result.
Regular physical activity can help in multiple ways. Our skeletal muscle use striglycerides, actually as an energy source and so when you exercise and engage your skeletal muscles repeatedly then the trigly cerides that are actually in some of those lipo protein particles get metabolized and therefore the amount of trigly ceridein your blood goes down.
Bob also didn’t have to look far to find an eager workout partner. – We have a Golden Retriever so I walk him.
He’s two years old and strong and likes to walk fast and so I use him as an assistant to get me to walk fast.
Just taking those little moments to be as active as I can, I think, is helpful. – Bob hopes to inspire others to learn their numbers and take action if their cholesterol levels are elevated.
Recognize that you do have control over your diet, your activity. You have to recognize those things that contribute to that risk and take as many steps as you can to alter, reduce that risk.
If there’s some lifestyle changes you have to make they’re well worth it. – Through optimization of his lifestyle, his risk for developing a heart disease are much, much lower.
So I think what’s most important is that people know their numbers and that you have your cholesterol checked at some point.
But you also have to keep in mind the context, as well which means you need to know what your blood pressure is you need to try to maintain an optimal body weight follow a hearth ealthy lifestyle.
It’s something we can do for ourselves, so why not? I think I’m doing well. If I can do it, anybody can do it, that’s for sure.
LDL cholesterol level under 100 milligrams per deciliter is often described as desirable but did you know that LDL and LDL cholesterol are two very different things? that cholesterol itself is not the main problem?
HDL is not good cholesterol? and even LDL is not bad per se? fat and water don’t mix so our body found a solution to transport fats in our bloodstream: lipoproteins. “lipo” means fat.
so alipo protein is basically a ball of fat and protein. you know at least two of them: low-density lipo protein or LDL and high-density lipo protein or HDL.
Okay, how exactly does this nerdfest help me with my health? your lab results usually don’t show LDL, they show LDL-cholesterol level so what’s that?
Lipo proteins like LDL carry different types of fat. cholesterol is one type. so LDL-cholesterol is the cholesterol carried in LDL lipo proteins imagine each LDL lipoprotein is like a car driving down the road.
LDL- -cholesterol are the passengers in those cars. and HDL-cholesterol, which you also have in your lab results, is of course the cholesterol traveling in the HDL lipo proteins.
What do you get if you add up all the cholesterol, all the passengers in all the cars in your bloodstream?
Total cholesterol! which you also have in your lab results. the other thing on your labs are triglycerides, which is another type of fat that also travels in lipo proteins in our bloodstream.
So they’re another type of passenger. okay, so now you know the difference between LDL and LDL-cholesterol.
One is the vehicle, the other is the passenger. why does any of this matter?
We’ll find out in a second.
What about the story of good cholesterol and bad cholesterol?
Where does that come from? let’s start with LDL-cholesterol.why do people say it’s bad? we know that lab animals with high LDL-cholesterol level can form artery plaque.
Okay, but mice also like to run in wheels. how do we know this has anything to do with humans?
Population studies show that people with high LDL-cholesterol level also tend to have more heart disease.interesting,maybe people with low LDL- cholesterol level are health freaks and they exercise more and smoke less and have kale smoothies and meditate all daylong.
so we want to avoid jumping to conclusions just based on population studies.
By now you probably know the drill.we need to randomize people to different groups, lower LDL-cholesterol level in only one and see what happens this has been done many times using different drugs including statins and many others and in study after study the group that gets the drug and has its LDL- cholesterol level lowered has less heartdisease.
If instead of drugs you use diet you get a similar result as we saw in the saturated fat . okay, so high LDL- cholesterol level is a problem in lab animals and in population studies and if you lower it experimentally you lower the risk.
This makes a very strong case that high LDL-cholesterol level is an issue. but there’s even more evidence:
We all have different genetics, that’s why we’re all a little different. some are taller some have wavy hair some have big noses.
Hey! our genetic differences also mean that we have different levels of LDL-cholesterol among each other.
so scientists studied people who have lowLDL-cholesterol level from birth and they have much less heart disease than the average population, up to 10 times less in some cases.
This does not mean that your LDL-cholesterol level is a hundred percent determined by your genes and there’s nothing you can do, period. that’s a common belief and it’s not factual at all. genes play a role, just like in everything else but there’s a lot we can do with lifestyle.
For example, we just saw that the saturated fat we eat is a major player. we’ll come back to this. all this evidence accumulated over decades is why scientists are very confident that high LDL-cholesterol level spells trouble check out the wording in this study:
“there is no longer an LDL-cholesterol hypothesis, but established facts that increased LDL-cholesterol level is causally related to atherosclerotic cardiovascular disease (that’s plaque in the arteries) and that lowering LDL particles and other apoB- containing lipo proteins(we’ll see what that means in a minute) as much as possible reduces cardiovascularevents.
so that’s very striking language because scientists are usually tentativein how they phrase their findings.
When we publish papers we write things like”the data indicates” or “this suggests that” but here the wording couldn’t be any stronger.
So who are these authors? is it some fringe vegan scientist? no, these are the official guidelines from the European Society of Cardiology and it’s the same thing all over the world.
Here’s the American Heart Association:”established a causal role of cholesterol- containing lipoproteins, particularly LDL,in the genesis of coronary heart disease” so now we understand the why.
What evidence led to these conclusions. it’s not some doctrine down from above.okay, so high LDL-cholesterol level causes heart disease, right?
I think I got it! uh, not quite. plot twist! see, LDL-cholesterol is not the main problem the main problem are the lipo proteins themselves, the vehicles.
As these authors explain, their work suggests that “it is the number of lipo protein particles rather than the amount of cholesterol ortriglycerides per se that is the important driver of heart disease”.
Heartdisease is caused by lipo proteins getting stuck in the artery wall and potentially causing a blockage so what causes a traffic jam is an excess of cars, not passengers.
So can we count cars? because normally our lab results only show passengers.
LDL-cholesterol, triglycerides… yes, we can. we can measure something called apoB which is one of the proteins carried by LDL.
So if we count how many apoB proteins there are we know the number of lipo proteins that carry it. another test is called LDL- P, where P stands for particle, and it’s literally a count of the number of LDL lipo proteins.
So both of these are ameasure of cars, not passengers, and they’re not done routinely by primary care physicians but if you’re seeing a cardiologist for example and if he or she thinks it makes sense they might request it.
Okay so if the number of LDL lipo proteins (the vehicles) is the main cause of heart disease but normally our lab results only show passengers (the cholesterol),what’s the point?
Is LDL-cholesterol level useless?
for most people these metrics go hand in hand more lipo proteins in our blood normally means more cholesterol being carried inside them.
In a percentage of people(around 20% give or take depending on the study) there can be a disconnect and that’s worth bearing in mind but for the majority of us LDL-cholesterol level is a decent estimation and it’s still considered an important parameter even by cardiologists.
Another metric is non- HDL cholesterol which is just the total minus HDL-cholesterol so it’s all the cholesterol not carried by HDLlip oproteins and it’s also commonly used by doctors.
I swear to God if this guy shows one more acronym I’m going back to cat videos. I know this is a lot of different terms so we’ll do a quick review in a second.
so if your LDL-cholesterol level is good, chances are your LDL particle number is also okay but if you have concerns and you want to make sure, maybe if you have family history, see your doctor and consider seeing a cardiologist.
And I’ll try to have one on here soon so we can ask additional questions you guys may have.okay, I think I got it! so lipo proteins carry cholesterol and other fats, lipo proteins can cause heart disease if there are too many of them,especially LDL, and LDL-cholesterol is just the passenger but it gives us an idea of the number of LDL lipoproteins.
Alright! and HDL is good, right? actually…plot twist! this guy’s worse than Dan Brown… in the population studies people with high HDL-cholesterol tend to have less heart disease, that’s why people started calling it good cholesterol.
But when scientists tried to confirm it,raising HDL-cholesterol with drugs didn’t help at all. their risk did not improve.
And people who have genetically high HDL-cholesterol aren’t better off either. so this was a huge surprise but it’s actually very consistent. this study concludes: “although observational studies (that’s the population studies we lookedat) might suggest a simplistic hypothesis for HDL-cholesterol, namely that increasing its level reduces cardiovascular events, substantial trials do not support this concept”.
And they pulled 39 trials for this analysis done with three different drugs so it pretty much looks like a dead horse.
Now that doesn’t mean HDL is useless! not at all. we know the HDL lipo proteins (the vehicles) play many physiological roles like for example pulling cholesterol from plaque.
But this simplistic idea of trying to raise HDL-cholesterol I hear people all the time “how do I get my HDL higher?”
And they say HDL but they really mean HDL-cholesterol, the value we see in our lab results,right?
And now you know the difference. trying to raise our HDL-cholesterol, there’s no evidence that it helps at all. in fact this gets even worse.
Some studies suggest that a very high HDL-cholesterol level is associated with higher cardiovascular risk so this idea that having high LDL-cholesterol is fine as long as your HDL-cholesterol is also high, looking at all the evidence .
There’s no reason to believe that idea so are you saying HDL-cholesterol is bad?no, I’m saying we should avoid thinking in those terms altogether.
This almost cartoonish idea of the good and bad cholesterol doesn’t match the evidence.but simplicity sticks, so a lot of people still think this way.
In fact LDL isn’t bad either! we all have LDL, we all have LDL-cholesterol, as we should, it’s only when it gets off the charts that it becomes a problem.
some people have high glucose or high potassium and we don’t say potassium is bad. if you look at your lab results almost every parameter has arange.
Above a certain level it starts to get too high and it can lead top hysiological problems.
LDL-cholesterol is no different. if you want more details on lowering your cholesterol with healthy foods including specific recipes,we just put together this step-by-step program based on the best available science.
It gradually transitions you over the course of seven days to acholesterol-lowering menu where every recipe is designed to get your blood lipids to ideal levels.
we’ll continue looking at cholesterol,including ideal ranges and some common misconceptions, so write your questions below, we’ll try to address as many as we can.