Cholesterol facts you likely haven’t heard of (Part 2)

 
Last edition we saw that supposedly ‘bad’ cholesterol is not one thing. It is comprised of different types of LDL particles. It is the small, dense and volatile LDL (sdLDL) particles that are the concern. This is because their size and density allow them to lodge within the walls of heart (and other) arteries. Once they are trapped, they are sitting ducks for free radicals which oxidise the trapped sdLDL. In response, the immune system sends immune cells to literally eat them. These engorged immune cells then change to foam cells setting off an inflammatory process that results in foam cells being depositing as fatty streaks. Over time, this leads to plaque formation.

Large benign LDL (lbLDL) is different. Their size and density prevent them from becoming stuck in artery walls. The good news is that diet can help reduce sdLDL and increase lbLDL lowering your risk of heart disease. Last week we looked at two tests that can test this. Firstly, a Coronary Calcium CT scan can test whether you are forming plaques. The other test is a new type of blood test that tests for dangerous sdLDL.

Important!

The standard Cholesterol blood tests in NZ tell you nothing about the balance of sdLDL and lbLDL. You can have high LDL but little dangerous sdLDL and therefore low heart disease risk. Likewise, you can have low LDL but have a high proportion of sdLDL and have a high risk of heart disease. Relying on current cholesterol tests to predict heart disease are like relying on the oil level in your car to determine the state of the engine.

Changing risk through Diet

Diet plays a significant role in influencing the ratio of small dense LDL (sdLDL) to large benign LDL particles, thereby impacting cardiovascular risk. Dietary patterns high in simple carbohydrates and sugars are associated with an increase in sdLDL particles.

High intake of simple carbohydrates, such as white bread and sugary beverages, tends to promote insulin resistance and elevated triglycerides, both of which are linked to a higher proportion of sdLDL. Conversely, diets that are lower in carbohydrates and focus on low starch vegetables, healthy fats and proteins can help shift the balance toward larger, less atherogenic LDL particles.

Several studies have shown that adopting a Mediterranean-style diet, which emphasizes vegetables, fruits, legumes, nuts, and healthy fats like olive oil, can reduce sdLDL levels and increase large LDL particles. Similarly, including fatty fish rich in omega-3 fatty acids, such as salmon and sardines, has been shown to favourably alter LDL particle size distribution. Weight loss and increased physical activity, also contributes to a reduction in sdLDL and an increase in large LDL particles.

In addition, reducing saturated fat from animal sources and replacing it with unsaturated fats from plant sources—such as avocados, nuts, and seeds—may further decrease sdLDL concentrations. The overall effect of these dietary changes is a more favourable LDL particle profile, which can lower the risk of atherosclerosis and cardiovascular events. Therefore, dietary intervention is a practical and effective strategy for improving LDL particle size distribution and reducing heart disease risk.

Statins

I have deliberately omitted discussion on cholesterol lower drugs called statins from this discussion. My discipline of Nutritional Medicine focusses on how to correct health problems using diet and supplements. There is no doubt that stains reduce cholesterol, especially LDL cholesterol. They also appear to reduce dangerous the sdLDL we have been discussing. However, the mechanism of stains means they have a significant impact on core energy systems. They impact the function of every energy producing cells in our body.

If you are on statins, please contact me for a Copy of my two-part discussion on the relationship between Co enzyme Q10 and Statins.

My Opinion

We should do everything we can through food, lifestyle and supplements before we consider statin therapy. If I had high LDL, I would consider a Coronary Calcium CT scan as this tells me whether my cholesterol is causing a problem.

Supplements to promote heart health
In most cases I base a supplement programme on Cell eXtra, Vitamin D3/K2 and Omega 3. Depending on circumstances, I may also recommend supplemental Magnesium and Co enzyme Q10, especially for those on statins.

Further reading

Please contact me for an emailed copy of my Cholesterol Programme and my Health Eating Programme. These address the issues raised above.

As always, feel free to contact me with questions or for personalised advice.
 

John Arts (B.Soc.Sci, Dip Tch, Adv.Dip.Nut.Med) is a nutritional medicine practitioner and founder of Abundant Health Ltd. For questions or advice contact John on 0800 423559 or email john@abundant.co.nz.  Join his all new newsletter at www.abundant.co.nz.