Is your metabolism sick: 9 ways you may be hurting your metabolism

1.Weight

Let’s start with the low hanging fruit. Research in the 90’s determined that the overwhelming majority of women— 89%—want to lose weight and 3% wanted to gain weight. In contrast, 22% of the men who were dissatisfied with their weight wanted to gain weight. Today Americans are eating more calories than we ever did in the past. More importantly refined sugars and flour make up the larger part of the pie when compared to whole foods i.e. vegetables, fruits, meat, poultry, seafood.

The average woman in the US today weighs 168 pounds. This is approximately the same as an average man in the 1960’s (CDC). Men are up 30 pounds and 20% of children are obese.

As a nation we are addicted to convenient, hyper-palatable large portioned options and it is taking its toll in more ways than one. The prevalence of non-alcoholic fatty liver, diabetes, obesity and cancer move in lockstep with a dysfunctional metabolism. It would be an understatement to say Americans are confused about food choices. Most are perplexed and making personal choices that provide the knockout punch to a struggling metabolism.

2.Overeating

Yes, food choice matters! Deciding to have repeat bagels or cereal instead of eggs and avocado or a shake with healthy fats and protein for breakfast negatively affects your liver and blood sugar. The effects may be less dramatic for some (those with a healthy weight and insulin sensitivity) and accelerate the negative effects for those that are overweight or prediabetic. A perpetual cycle of overeating chokes the liver and creates the perfect environment for systemic inflammation, high triglycerides (TAGs), elevated LDL- particle number, leptin resistance, dyslipidemia, and insulin resistance.

Having a clogged liver is serious business. The liver is responsible for detoxifying the body. In today’s world it is under constant assault from toxicants. In addition to the liver’s detox duties it plays a large role in the conversion of fuel to energy. An overloaded liver creates a slow metabolism. Even worse it fails to recognize insulin signaling and continues to unload sugar into the blood stream. When your liver is struggling and you consume a high carb meal it is estimated that 80% of the sugar in the blood stream has its origin in the liver and not a spike from recently consumed food.

If your liver is clogged it may continue down four stages of disease progression:

NAFL - nonalcoholic fatty liver

NASH - nonalcoholic steatohepatitis

Fibrosis - inflammation causes scar tissue

Cirrhosis - function impaired and can be life threatening

Eat the standard American diet for 5 years and chances are you may fit the criteria for Metabolic syndrome (MetS). MetS comes with a host of risk factors including cardiovascular risk. Click here to read more about the risk of cardiovascular disease.

Abusing stimulants such as caffeine can disconnect you from your natural circadian rhythm and disrupt cortisol patterns. Some people are better at metabolizing caffeine than others. Alcohol in excess can hijack restorative sleep and boost cortisol as well. Everyone is different and women typically produce less alcohol dehydrogenase that breaks down ethanol into acetaldehyde. If you have heard of alcohol flush this is due to accumulation of acetaldehyde and deficiency in aldehyde dehydrogenase 2. The point is you are taxing your metabolic resources.

3.Gut problems

If you are having gut issues, with intestinal symptoms or not, your metabolism and hormonal health may suffer. The renewed interest in our microbiome is a breath of fresh air. The microbes that inhabit the human GI tract play a role in human health and disease. For a tube whose contents are actually outside the body it plays a role in nutrition, digestion, immune processes, the central nervous system and energy homeostasis.

The disruption of the microbiome-gut-brain axis has a wide array of implications. You may be familiar with the term “leaky gut”, irritable bowel syndrome, metabolic endotoxemia or small intestinal bacterial overgrowth (SIBO). Those that have intestinal permeability or a leaky gut may develop food intolerance and fat loss resistance. Give the book Wheat Belly or The Plant Paradox a read if you want to learn more. For those that want the deep dive check out The Mind-Gut Connection.

When the microbiome is restored to a healthy set-point it trains and regulates our immune system. It keeps gut inflammation at manageable levels, limits pathogenic growth, helps prevent allergies, reduces gas and has anti-tumor properties. You may not be aware that 20-25% of T4 is converted to T3 (active thyroid hormone) in the gut.

What can disrupt the gut:

Medications (PPI’s, antibiotics, Birth control, corticosteroids)

Wheat/gluten/lectins

Alcohol and high sugar intake

Parasites and infection

Low stomach acid

Poor intestinal motility

Sleep and Stress

4.Stress and sleep debt

When we are stressed our brain knows. Specifically the HPA axis (hypothalamus, pituitary and adrenals) is busy preparing the body to adapt to the four types of stress:

• Perceived stress e.g.mental/emotional and anxiety and depression)

• Inflammatory signals e.g. GI, allergies or cardiovascular signals

• Glycemic dysregulation e.g.insulin resistance and obesity

• Circadian disruption e.g sleep issues (pain/apnea) or light dark disruption

When we experience stress that lasts for weeks and months chronic levels of high cortisol are stuck in the redline position. There is evidence that chronic stress changes food preferences and leads to insulin resistance. Some researchers have found that people with sleep disturbances, high stress, depressed mood and anxiety are strong predictors of low back pain.

A good night’s sleep will improve glucose metabolism, boost growth hormone secretion, and help normalize and help regulate cortisol levels. Because cortisol is released in a rhythmic fashion it’s not uncommon to see dysfunctional 24 hour cortisol patterns. This can contribute to fatigue throughout the day and difficulty sleeping in the evening. For example if a person has a disrupted cortisol rhythm but otherwise normal cortisol production symptoms may include fatigue, sleep disturbances, and higher perceived stress.

5.Excess Inflammation

Inflammation is a normal response to injury. We rely on inflammation to signal the immune system for cell injury and repair or defend us against bacterial or viral infections. When inflammation becomes chronic - metabolic disease begins to take hold.

Inflammation may be the most important mechanism driving “diabesity” (the one-two punch of diabetes and obesity). Elevated inflammatory markers are predictive of weight gain and insulin resistance. Those with higher levels of inflammatory cytokines and liver inflammation have an increased risk for diabetes. Inflammation of the brain leads to leptin resistance. Women suffering from endometriosis may be surprised to learn that it is best defined as an inflammatory disease. Are you beginning to see why we want to minimize nonessential levels of inflammation?

Food allergies are quite different than food intolerances. Many Americans have food intolerances and unknowingly consume these foods. For example men and women respond differently to grains when it comes metabolic dysregulation. Some may be completely free of intestinal issues while other exhibit a constellation of symptoms such as a thick waist, abnormal cholesterol, high blood pressure, and or problems with blood glucose. Because you need special enzymes to break down gluten, a protein found in wheat and grains, some researchers think that up to 80% of the population lack the necessary enzymes to properly digest gluten. Dairy sensitivity is also common however it seem more problematic when patients have a leaky gut, dysbiosis and consume low-fat non organic dairy products.

In the 90’s we were told to eat more grains and cut the fat. According to the CDC the diagnosis of diabetes has tripled. Even more concerning is the increasing trend in autoimmune disease in general. This includes Hashimoto’s/ Graves disease, Sjogren’s, irritable bowel disease (IBD), rheumatoid arthritis , lupus and celiac’s disease. The unsettling truth is that these autoimmune diseases are on the rise and in some cases are 2-3 times more common than a few decades ago. Experts believe that symptoms of autoimmune disease may be prevented by re-establishing intestinal barrier function.

An improper diet can lead to increased levels of inflammation. This includes diets low in calories i.e. 40% or greater caloric deficits over a 6 week period. Diets that lack comprehensive nutrient profiles such as veganism, fruitarian or vegetarianism are at higher risk of elevated inflammation in the long term.

6.Too much or too little exercise

Regaining metabolic flexibility is directly tied to your diet. Too much exercise, with a sluggish metabolism, is a big stressor. This is especially true if your performing long workouts on a low calorie diet. However, the right amount of exercise can provide some amazing benefits including increased insulin sensitivity, fuel expenditure, muscle health, glycogen production and mitochondrial health. If you are too sedentary and maintain a poor diet your muscles atrophy and you body composition will creep to higher fat and lower % of lean muscle. When that happens your resting metabolism slows down.

It’s very important that you sort out your “chemistry” before exercise is able help you in maintaining a healthy weight. Don’t forget your liver has to process all the calories and fuel you burn up during exercise.

7.Hormone imbalance

Whether you have adrenal fatigue, more correctly referred to as HPA axis dysregulation, excess estrogen, low testosterone, PCOS or diabetes it alters your metabolic machinery. That new metabolism you’re fighting for through diet and lifestyle changes will seem recalcitrant.

Books are written on this topic so let’s touch on the thyroid since it’s a major player in regulating your metabolism, and assuring good general health. Most people wrestling with weight need to address their relationship with grains. In addition to providing high amounts of calories they may lead to intestinal permeability and the body’s immune system attacking itself. For example, people with Hashimoto’s disease are usually put on thyroid hormones. Dr. Kresser uses an analogy of bailing water.

People with low thyroid may need thyroid hormone as a necessary part of the treatment. But unless the immune dysregulation is addressed (plugging the leaks), whoever is in that boat will be fighting a losing battle to keep it from sinking. Meanwhile, that person will struggle with weight loss resistance.

8.Ignoring key body measurements

Time to move away from BMI as it’s not as predictive as other measurements. Waist circumference (WC), waist-to-hip ratio (WHR) and waist-to-stature ratio have larger effects on increased CVD risk compared with body mass index (BMI).

For most of us we get an up close look of our bodies in the shower and when we are dressing. Measurements looking at central obesity, fat deposits in the abdomen, and around the viscera organs are better independent predictors of cardiovascular disease, fatty liver and diabetes.

9.Not testing basic biomarkers

Looking at the blood is an imperfect proxy, but it is one of the better ways to see whats going on under the metabolic hood. Below is a list of biomarkers that I would recommend for a baseline functional medicine workup.

CBC with differential

CMP (includes liver enzymes)

Fasting blood glucose, fasting insulin and HgA1C

Homocysteine

NMR lipoprofile

Full thyroid panel ( TSH , T4 reverse T3, w/Antibodies)

Perhaps a Urinary DPD (assesses bone resorption rates)

Earlier in the article I mentioned Metabolic syndrome or MetS. So what is MetS? The criteria have changed over the years, but here is the general consensus.

ANY three of the 5 Criteria below:

• Obesity -- Waist circumference >40 inches for male and >35 inches for females

• Hyperglycemia -- Fasting glucose ≥ 100 mg/dl or pharmacologic treatment

• Dyslipidemia – Trigylcerides ≥ 150 mg/dl or pharmacologic treatment

• Dyslipidemia (separate criteria) – HDL cholesterol < 40md/dl male, < 50 mg/dl females; or pharmacologic treatment

• Hypertension -- >130 mmHg systolic or > 85 diastolic or pharmacologic treatment.

*Note: LDL particle (LDL-P) number appears to be the most accurate marker for predicting metabolic syndrome. How do you test LDL-P. A test called NMR lipoprofile.

If you have questions regarding any of the topics covered in this article email them to nick@spineandjointoc.com

Soft Tissue Work and Healing

Sometimes people’s muscles hurt. Research estimates that massage therapy was a $16 billion dollar industry in 2017. If you have spent any time in a gym or physical therapy office you have probably seen an increase in foam rollers, massage guns like the Hyperice, “The stick”, Thera Cane, fascia blaster, PSO-RITE Psoas Release Tool and Personal Massager and the list goes on. Muscles hurt for a number of reasons such as joint misalignment, tension, stress, overuse, minor injuries, and nerve dysfunction.

Your body is made up of cells. Together those cells make tissues. Tissues make up organs and organs make up entire systems such as the digestive system or musculoskeletal system. Some cells are specifically programmed to help the body heal from trauma. These are known as stem cells. You have probably heard about stem cell injections as they continue gain more attention.

Trauma leads to:

1. Structural damage (disc herniation or muscle sprain/strain)

2. Inhibits normal circulation to that area

3. Triggers inflammation

Stem cells may respond to trauma and come out of an inactive state. They have the ability to move towards sites of injury and differentiate (change in order to carry out a specific function) into cells required for healing. This means they can become bone cells (osteocytes), chondrocytes (connective tissue), muscle cells (myelocytes) and fat cells (adipocytes).

So where do stem cells live? To name a few sites, they reside throughout the body in brain tissue, muscle tissue, fat tissue, and in a baby’s umbilical cord.

There are 4 main approaches to healing a musculoskeletal injury.

1. Eat nutrient dense foods and remove toxins (processed carbs and medications)

2. Adequate rest to avoid further injury followed by gradual exposure to activity aka “corrective care,” and other stress that create positive adaptations (i.e. sauna, fasting, and supplementation)

3. Correct structural misalignments with specific adjustments and rewire poor movement patterns. This will restore balance to the nervous system that plays a key role in healing through control of the neuroimmune system.

4. Help accelerate the body’s ability to heal by working on the soft tissue (muscles, ligaments, fascia)

I’m not going to expand on number 1 & 2 in this article. However, number 3 should be in a chiropractor’s wheelhouse. To correct a misalignment a specific adjustment should be used. Gross manipulation and a cookie cutter approach fall short in my opinion. Let me give you an example of a specific patient. We’ll call him Mike. Mike plays collegiate baseball. In the last few years he’s torn his quadriceps and his opposite leg’s hamstring. He has worked with the team PT, massage therapist and even a practitioner specializing in myofascial release.

Mike continues to play and his schedule is rigorous. The pain is becoming more frequent and increasing in intensity especially with throwing and hitting.

After evaluating Mike it became pretty obvious what was wrong. He presented with muscle asymmetries in his low back, significant pelvic distortion (rotated and un-level), specific areas tender to palpation, and his non-painful side was severely restricted. His painful side was picking up the slack and overworked. Had Mike decided to continue to play, rely solely on physical therapy and soft tissue treatments without specifically correcting the joint issue - my sense is that he would continue to play injured and below his potential.

Instrument assisted soft tissue mobilization (IAST).

Let’s dive a little deeper into number 4. Using the ceramic spoon is known as instrument assisted soft tissue mobilization (IAST). The instrument is run along the skin, subcutaneous tissue, fascia, muscles and ligaments. This is essentially trauma indicated by bruising (e.g. petechiae) that initiates a cellular inflammatory response.

I’d theorize that the “scraping” may be manipulating the local native stem cells populations at the site of treatment. That said, the literature does not support the theory that you are breaking up scar tissue and I agree with the evidence. This reminds me of a quote:

“If you’re not prepared to be wrong you will never come up with anything original.”

The treatment rationale varies as does the type of tool, force, and application used by the practitioner.

Despite the variations in treatment the general premise is to

• decrease pain,

• enhance myofascial mobility aka connective tissue

• stimulate tissue resorption,

• induce regeneration and repair.

New studies are being published to assess the efficacy and how stem cells work in a clinical setting both in the body and in vitro (outside a living organism)

While we don’t always have perfect information scientists have made great strides understanding how the body works.

Health care solutions when you have decided to stop chasing symptoms.

As a Functional Medicine nutritionist, I think like a detective to help my clients understand the "why" behind their "what" (the diagnosis). Sometimes, the "why" can be revealed in a simple conversation; more often, more investigation is needed (various types of functional testing and lab work).

The following is an example of one hunt for the root cause of a client's problem. It was a simple conversation over dinner. Amy showed me the dry itchy patches on her hands, which I recognized as eczema, the "what" or diagnosis. To really help Amy and keep her away from the stereo typical treatment with cortisone cream, I now needed to know the "why."

Me: How long have you had the itchy dry spots?

Amy: A couple of months

Me: Are you prone to UTI’s or yeast infections?

Amy: I had my first yeast infection a month ago.

My thoughts are that two things are happening within a month of each other, both possibly stemming from gut imbalances.

Me: Have you had a round of antibiotics within the last 6 months?

Amy: No

Me: Are you taking birth control pills?

Amy: Yes

Me: For how long?

Amy: 3 months

BINGO! Birth control pills are notorious for altering gut bacteria. We’d found the smoking gun, the "why."

I already knew that Amy had a history of chronic constipation as well as acne. Before starting the pill, she likely had bacterial imbalances and the BC pills triggered the eczema, which always has its origin in the gut.

Since she wasn’t ready to stop the birth control pills, the best path was to find ways to support her gut flora so that together, her acne, constipation, yeast and eczema would subside.

I recommended cutting out all dairy and adding probiotics and non-dairy fermented foods. For further support, I suggested 50 mg B6, in the absorbable form of pyridoxal -5- phosphate as BC pills deplete B6 (a vitamin that influences energy, metabolism and the formation of neurotransmitters, influencing sleep, anxiety and depression). Lastly, I recommended vitamin D to help modulate the immune system.

If these steps do not give us the results we expect to see within a couple months, I’ll recommend a stool test to determine the function of her digestion and to rule out any parasites or pathogenic bacteria.

Instead of giving Amy steroids indefinitely to control her eczema, the conventional method of treating eczema, we’re taking steps to heal her by identifying and treating the root cause.

To read more about gut health and bacteria click here. https://alivingbalance.net/2015/05/invitation-to-a-digestion-party/

Written by: Cindy Dupuie, CN

Edited by: Vicki Ronaldson

www.alivingbalance.net

SATURATED FAT & CHOLESTEROL: THE HEART DISEASE SCAPE GOAT ( Part 3)

Welcome Back! Continuing from part 2. Now we are going to build on the basic info and screening tools. We’ll touch on the more advanced markers to help stratify an individual’s risk for cardiovascular disease. Remember these tests are not bulletproof data points. It’s not a black and white process. A thorough history, review of systems and specific health assessment measures can provide a great blueprint.

Plates not Pills

Armed with that information patients may take the necessary dietary and lifestyle changes to improve how they feel, decrease negative symptoms and see blood markers normalize. You would be hard pressed to find doctors that would deny lifestyle modification as the primary form of intervention. It’s always a good idea to consult with your physician to discuss medication and track your overall heart health.

Useful markers/tests for determining cardiovascular risk

* Included in an Iron panel: serum iron, TIBC, UIBC iron saturation aka transferrin saturation

Two Additional tests that some physicians utilize.

Without a needle or Imaging

If you’re inclined you may want to use one of these two online calculators to give you a basic sense of your risk for heart disease.

If you are over twenty years of age and do not have heart disease or diabetes you can calculate your risk using the Framingham 10-year Risk Calculator. The inputs include: age, gender, total and HDL cholesterol, smoking status, and blood pressure. The Reynolds Risk score might be a better option. It includes family history and C-reactive protein.

If you are ready to minimize your risk, limit your medications and learn what makes up a heart-healthy action plan read on.

In the spirit of heart health

I’ve come up with a mnemonic to help you understand the right approach. PUMP

P - purposeful eating

U - understand your risk

M - measure to be sure

P – participation and lifestyle modification

Over the course of these 3 articles we’ve brushed up on the 3-legged stool of heart disease: (1) why it happens, (2) what causes it, and (3) what’s your risk. Let’s talk about the seat of the stool as it holds all of the legs together and acts as the cornerstone. In this analogy the seat can be divided into 3 parts: Diet, weight management, and exercise.

If you are overweight and want to reduce your risk of heart disease without the side effects of medication eating with purpose will help you lose the weight. Improving one’s relationship with food must be tailored to the individual.

At the core of any diet there are two fundamental truths when it comes to eating for your health.

• Number 1: Avoid processed and refined food

• Number 2: Choose nutrient dense foods and incorporate healthy/traditional fats

Why? Eating this way curbs inflammation, hunger, weight gain, and metabolic syndrome (recall 1/3 Americans are estimated to have MetS).

From a bird’s-eye view the majority of food should come in the form of meat, poultry, fish and shellfish, non-starchy vegetables, starchy tubers, fruit, nuts, and seeds. Sorry guys please don't try and find these items at Olive Garden or Taco bell.

If you are currently floundering on the standard American diet (SAD) this may feel a bit like an elimination diet. How many daily grams of carbs does the average American eat? Take a guess. It’s around 300 to 400 grams of carbs per day! Delicious, I know. However, the lion’s share comes from refined carbohydrates such as breads, cereals, chips, pasta and crackers. A more sensible target, utilizing whole foods, puts one at 50 - 250 grams of carbs per day. So you’re wondering — Is he suggesting that I go on a plant-based, keto, paleo, or an atkins-like diet? Can I drink milk and eat pizza and pasta?

I am suggesting some form of a modified paleo-ish diet. As for dairy it’s best to eliminate for one month and add it back in to see how it’s tolerated. Eliminating grains entirely may be a hard sell, but you won’t know how you feel or how you’re body will change if you don't give it shot. It doesn’t get much attention, but grains contain certain anti-nutrients that can cause digestive problems and other stealth health issues.

Let’s talk turkey (of the sea)

The average American eats a ratio of anywhere from 12:1 to 25:1 Omega 6 to omega 3 fatty acids. This creates a highly inflammatory state. Usher in some cold-water fish. Some studies suggest that eating 8 oz of fish / week (we’re not talking tilapia; it’s farmed and high in omega 6) would equate to 20,000 few deaths from CVD and 4,000 fewer nonfatal strokes. It’s been speculated that regular fish consumption may reduce total mortality at a higher rate then statins (statins garner 40 billion dollars a year and is a article in itself).

So if not tilapia? We want fish high in omega 3 such as salmon, mackerel, herring, sardines, anchovies, and bass, as well as shellfish like oysters and mussels. The single highest seafood source of EPA and DHA is caviar or fish eggs. I could not eat fish eggs if my life depended on, but if you like them more power to you.

If you want to hit a clinically relevant range of omega 3’s you want to eat 3.5 EPA plus DHA per week. This may reduce heart disease by as much as 25%. A good goal would be to eat between 10-16 oz of fatty fish/shellfish per week. Make up any short fall with a high quality fish oil supplement.

When it comes to other healthy fats olives, olive oil avocados, and macadamia nuts provide healthy monounsaturated fats. Remember monounsaturated fats have been shown to reduce LDL and Triglycerides, decrease oxidized LDL, lower blood pressure, decrease thrombosis, and reduce incidence of heart disease.

You might be familiar with the term antioxidants. If you recall shortages in antioxidants may contribute to an increase in oxidized LDL, which is associated with arterial plaque build up. Food companies do an excellent job with their packaging to seduce the consumer. The supplement and nutraceutical industry is vying for you to seek out their pills. While supplements may be beneficial in some situations, it’s preferable to get these nutrients we need from whole foods, Mother Nature, and not isolated synthetic sources like ascorbic acid.

There is mixed support in the medical literature on antioxidant supplementation. You may have heard that treatment with beta-carotene, vitamin A and vitamin E may increase mortality. For reasons we that have not been fully discovered whole foods appear to be more effective than supplements in meeting nutrient requirements.

Foods high in antioxidants (lower oxidative stress and inflammation) include leafy greens and berries, but there is more to the story. Red meat and organ meats are also rich in antioxidants that are not found in significant amounts in plant sources.

I don’t want to go any deeper into the nutritional weeds. Remember there is no one-size fits all approach. Ultimately, a heart healthy diet requires some attention. It starts by eliminating processed foods and switching to nutrient dense whole foods. There should be an emphasis on cold-water fatty fish and shellfish, healthy fats, antioxidants rich foods, polyphenol-rich foods, soluble fiber, nuts, fermented foods and occasional alcohol. If you decide to supplement be selective. For example, it’s better to take folate then the synthetic folic acid. Much of folic acid is never converted to folate.

Back to the stool analogy

Earlier I broke the stool seat into 3 parts, diet, weight management, and exercise. For most people combining diet and exercise will help you reclaim a healthy weight. The evidence is pretty straightforward and suggests that regular moderate exercise prevents the build up of arterial plaque, improves lipids and reduces vascular symptoms in people with heart disease. Exercise is a great way to reduce stress, and you may have heard me cite stats on the interplay of stress and risk of cardiovascular disease. I’m not proposing everyone flock to the nearest HIIT gym or LA fitness. Make small changes based on your current activity level and attempt to log 10,000 steps a day.

Questions

If you have any specific questions regarding this 3-part educational series (testing, supplementation, lowering high blood pressure, or statin drugs) please contact me at nick @spineandjointoc.com

SATURATED FAT & CHOLESTEROL: THE HEART DISEASE SCAPE GOAT (Part 2)

Now that we know a little more about cholesterol and saturated fat it’s time to refocus on the villains. What factors lead to an increase in LDP particle number and oxidized LDL?

 An increase in LDL particle number has been directly associated with Metabolic syndrome (MetS). Research estimates that people with MetS are approximately 3x more likely to have an elevated LDL particle number.

 So what is MetS? The criteria have changed over the years, but here is the general consensus.

ANY three of the 5 Criteria below:

Obesity -- Waist circumference >40 inches for male and >35 inches for females

Hyperglycemia -- Fasting glucose ≥ 100 mg/dl or pharmacologic treatment

Dyslipidemia – Trigylcerides ≥ 150 mg/dl or pharmacologic treatment

Dyslipidemia (separate criteria) – HDL cholesterol < 40md/dl male, < 50 mg/dl females; or pharmacologic treatment

Hypertension -- >130 mmHg systolic or > 85 diastolic or pharmacologic treatment.

 *Note: LDL particle (LDL-P) number appears to be the most accurate marker for predicting metabolic syndrome. How do you test LDL-P. A test called NMR lipoprofile. More on this later.

 For those that meet this criteria there are some common themes. Increased LDL particles (more triglycerides to shuttle around), leptin resistance, insulin resistance and excess body fat. If you have metabolic syndrome and insulin resistance your risk of heart disease is elevated even with subclinical levels of LDL cholesterol and total cholesterol.

In addition to MetS there are several other factors that may contribute to increased particle number. These include infections, poor thyroid function, and genetic mutations (familial hypercholesterolemia or ApoE4).

Similar to elevated LDL–P an increase in oxidized LDL has four primary causes.  

1.     LDL particle vulnerability (the type of fatty acids in the membrane may account for increase in LDL oxidation). Think omega-3 vs. omega-6 ratios

2.     Antioxidant shortage (Eating processed foods without the right cofactors and enzymes)

3.     High levels of oxidative stress (smoking, stress, lack of exercise, environmental toxins and infections)

4.     Time (poor LDL clearance from the blood stream)

Here is where the rubber meets the road.

How to assess your risk of heart disease.

It doesn't hurt to take an honest look at your body composition, weight and physical fitness. Next a standard lipid panel. Never mind its inadequacies, it’s an okay starting point (see sample result.)

 What is a normal cholesterol level?

There is some debate, but in the US the cutoff for total cholesterol is 199 mg/dl. Here is where some context comes into play. Studies looking at traditional populations around the world appear to tell a different story. When you look at the Massai tribe of east Africa, Inuit, Kitiva, the Tokelau, and Pukapuka we see cholesterol levels anywhere between 140 and 250 mg/dl. The kicker is they are all relatively free or completely free of heart disease.

Err on the side of caution

If some of your cholesterol levels are out of range further testing is recommended.

·      Total cholesterol >299 mg/dl

·      Cholesterol/HDL ratio > 4 or HDL < 40 mg/dl

·      Triglycerides >125

Since total cholesterol and LDL cholesterol are not always reliable markers it’s best to avoid taking a statin based on a single standard lipid panel. This is especially true if you intend to make lifestyle changes such as increased exercise and dietary modifications.

 Keep in mind that a single cholesterol test is of limited value. Why? Your total cholesterol can fluctuate by 35 mg/dl up or down. Triglycerides exhibit greater variability 40 up or down mg/dl. Let me be very clear that high quality large research studies indicate that LDL particle number, and not LDL cholesterol (measured on standard lipid panel), is the more significant risk factor.

One way to use the standard lipid panel and extrapolate risk would be to look at your Triglycerides (TG). If levels are below 125 mg/dl LDL particle number and LDL cholesterol coincide. However as that TG number climbs (>125) LDL particle number and LDL cholesterol diverge. The relationship stops and particle number rises. 

Life after a standard lipid panel

If your numbers are outside of the medical ranges you may want to retest with an NMR lipoprofile. This test can be ordered through most blood labs (Quest, Lab Corp, and U.S. Healthworks). As with the standard panel there’s a lot of variation with LDL particle number so it’s important to consider retesting subsequent changes in diet and lifestyle. It important to note that your doctor may order a test for apolipoprotein B (ApoB). This is an indirect way to of measuring LDL particle number. ApoB is what forms LDL or low-density-lipoproteins. 

If you’ve made it this far you’re probably wondering should I test for oxidized LDL. Based on what I’ve read Oxidized LDL is a strong risk factor for heart disease; however, measuring it directly is problematic, and it doesn’t appear to add any additional predictive value above and beyond LDL particle number. When analyzing one’s risk for heart disease some combination of looking at the big picture and using more micro-level blood markers will serve you well.

In part 3 we will talk about some other markers that may be relevant when understanding cardiovascular disease.

Disclaimer:

Please note that this information is not meant to provide medical advice or take the place of medical advice or treatment from your physician. I offer this for educational purposes.