By David Blyweiss, M.D., Advanced Natural Wellness

October 21, 2013

• This is when LDL really counts
• Is your LDL big and fluffy?
• 4 tips to protect your heart

Today it seems like everyone over the age of 40 is zeroed in on their cholesterol levels. It’s one of the first of many things my patients ask about. They want to know if their total cholesterol is high and how much “bad cholesterol’ they have.

You see, everybody thinks LDL is the bad guy. But the truth is it performs a very important function in your body.

Low density lipoproteins (LDL) circulate through your bloodstream and patch up damage that occurs on the walls of your blood vessels and arteries. It’s like applying spackling to a damaged wall. LDLs also help build your steroid hormones like testosterone, estrogen and cortisol.

Then HDL comes in and picks up all the debris left behind from the “spackling” project.

If you don’t have enough high density lipoproteins (HDL), they can’t do their job. Sticky patches get left behind and debris continues to accumulate. This leads to plaque buildup and arterial blockages.

So yes… maintaining a healthy ratio of HDL and LDL is important. And you need both HDL and LDL cholesterol. Your body requires them.

But these two measures aren’t the “end-all” when it comes to your heart health. In fact, in many cases they may not even be relevant.

Not long ago a national study revealed some startling news. The research found that nearly 75 percent of patients hospitalized for a heart attack have normal levels of cholesterol.

In other words, high cholesterol levels did not play a role in these heart attacks. The patients in the study didn’t have excessively high LDL cholesterol. And nearly half of them had optimal levels of HDL.

The question, then, is this. Why are people with normal cholesterol levels having heart attacks?

There are a number of reasons. And I’m going to share them with you over the next several issues. You’ll find out exactly why cholesterol isn’t the best predictor of heart risk… and how other factors may be destroying your heart health.

Unfortunately, your doctor may not be testing for them…

Scientists have discovered LDL particles come in different sizes. Some are big, fluffy and bouncy. Others are small and dense.

Thanks to groundbreaking research, they’ve also discovered it’s the small, dense LDL particles that greatly increase the risk of heart disease. So if you have big, fluffy and bouncy LDL particles, that is good.

Now before I go any further, I want to point out that lipoproteins (HDL and LDL) are not cholesterol.

Lipoproteins are particles that carry fats, proteins and yes – even cholesterol and triglycerides – through your bloodstream. And they have the important job of delivering certain nutrients throughout your body.

These small particles tend to slip through the lining of your blood vessels where they can do the most damage. They become oxidized. Inflammation sets in. Plaque starts accumulating and blockages begin to develop.

There is something called Apolipoprotein B (ApoB) which may contribute to the process.

It turns out people with a higher ApoB value tend to have smaller, denser LDL cholesterol particles (yes, that’s the bad kind.)

And research shows high levels of ApoB are more strongly linked with future heart attack risk than LDL cholesterol levels.

Now here’s the thing. When your doctor runs a standard lipid profile, it’s only going to measure four things. This includes your high and low density lipoproteins, total cholesterol levels and triglycerides.

But these standard cholesterol screenings never even look at particle size or ApoB. So doctors are sending patients home with cholesterol-lowering medications that do nothing to solve these heart risks.

This I why I prefer an advanced form of lipoprotein testing, called Vertical Auto Profile (VAP.)

This test is a much better predictor of heart risk and will give you a much more accurate measurement of your cholesterol profile. It measures the factors mentioned above, along with about 13 more lipid components.

In other words, it’s a much better risk assessment when it comes to caring for your heart health.

(The normal range for ApoB is 65 – 145 mg/dL for women and 65-165 mg/dL for men.)

Even if your HDL to LDL ratio is healthy, it’s important to maintain large, fluffy LDL particles. And you’ll be glad to know there are a few very simple things you can do to help with that…

1. Avoid trans fatty acids: Research shows that trans fats are associated with a harmful increase in small, dense LDL particles. So all that margarine and vegetable oil that’s supposed to be good for you is really working against you.In fact, it turns out that diets enriched with saturated fat in the form of butter can result in much larger and healthier LDL particle size. (If you see the words “hydrogenated” or “partially hydrogenated” on the ingredient list, it contains trans fats.)
2. Lower carbohydrate intake: Increased carbohydrate intake leads to an increase in triglycerides and a reduction in LDL particle size. Simple sugars and starches that are high on the glycemic index are the worst offenders. So stay away from sweet, starchy foods and stick with foods having a low glycemic value.
3. Eat a Mediterranean style-diet: I always recommend eating a healthy Mediterranean-style diet as regular practice. This means getting plenty of seafood, nuts, antioxidant-rich vegetables and fresh fruits. This type of diet is high in polyunsaturated fatty acids which significantly increase LDL particle size. This is true even in people who are genetically disposed to smaller particle size.
4. Supplement with niacin: Niacin has long been known to protect your heart. Now we know that extended-release niacin has a specific effect on the smaller, more dangerous LDL particles. Plus it enhances the role of large HDL particles which also reduces cardio risk.

These changes aren’t hard to make. And they’ll help restore healthy, fluffy LDL particles that will protect your heart for years to come.

To learn more about the factors that are really eating away at your arteries and heart health, keep your eyes peeled for the next issue of Advanced Natural Wellness for a discussion on inflammation and heart health.

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Resources:
Amit Sachdeva, MD et al. Lipid levels in patients hospitalized with coronary artery disease: An analysis of 136,905 hospitalizations in Get With The Guidelines, American Heart Journal. 2009; 157(2): 111-117

Apo B — A Better Marker for Heart Attack Risk Than LDL Cholesterol? Special Report. John Hopkins Health Alerts.

Mauger JF, et al. Effect of different forms of dietary hydrogenated fats on LDL particle size. Am J Clin Nutr 2003;78:370-5.

Paul T Williams and Ronald M Krauss. Low-fat diets, lipoprotein subclasses, and heart disease risk.. Am J Clin Nutr December 1999 vol. 70 no. 6 949-950

Siri PW, Krauss RM. Influence of dietary carbohydrate and fat on LDL and HDL particle distributions. Curr Atheroscler Rep. 2005 Nov;7(6):455-9.

Moreno JA, et al. The effect of dietary fat on LDL size is influenced by apolipoprotein E genotype in healthy subjects. J Nutr. 2004 Oct;134(10):2517-22.

John M. Morgan, M.D. et al. Effects of extended-release niacin on lipoprotein subclass distribution. American Journal of Cardiology. June 2003; Volume 91, Issue 12 , Pages 1432-1436, 15