cholesterol explained

Cholesterol Explained. Also the Curious Case of Mr. Max Powers and Tijuana’s Finest Gentlemen’s Clubs.

   Patients, friends, and guys I meet online often ask me how they can lower their cholesterol levels.  Most the time they say that they’ve been watching their cholesterol intake, or cutting back on their saturated fat, or they send me an inappropriate picture of themselves.  In all cases, they are wrong to do so.  I will now take a minute to explain how cholesterol works.  As a side note, I encourage all my patients to get their cholesterol levels checked before starting a high fat diet, so that they can see for themselves that their numbers really do get better.  Also, if possible get a “particle size” included in your cholesterol test.  Also, get a hemoglobin A1c, testosterone (for males), chemistry panel, CBC, vitamin D, and an iron level while you are at it.

Just to show you that I’m not that far out on a limb here, as of 2015, even the U.S. Dietary Guideline association (DGAC) agrees with me in the belief that the cholesterol that is in your bacon and eggs does not affect the cholesterol levels in your blood.  In their most recent recommendations The DGAC said that cholesterol “is not a nutrient of concern for overconsumption” and eliminated their 2010 guideline recommending less than 300 mg daily.  When the Federal Government reverses its dietary stance on something, it’s usually 10 years too late and after there is way more evidence than needed to support it, and this U turn on cholesterol is no exception.  I predict that fats and even saturated fats will be officially exonerated in the near future, the way that cholesterol was in 2015.

How Cholesterol Works

Our body’s cholesterol is made by our liver.  Our liver makes cholesterol when it senses high blood glucose levels, and not as a result of how much fat or cholesterol we eat.   Some cholesterol is good which is called HDL(high density lipoprotein) and some cholesterol is not good like LDL (low density lipoprotein).

Essentially, all cholesterol is the combination of a protein (which are dense and hard) and a lipid (fat), which is light, think fat floating to the top of gravy, which is why it is called a “lipo-protein”.  The role of cholesterol is to take fats to the parts of your body that need them.  Where is fat needed you ask.  All sorts of things in your body require fats to function correctly, and cholesterol are the Uber drivers who take the fats to and from their intended destinations.  LDL or bad cholesterol Ubers have a passenger (fat) and HDL’s are empty Ubers looking for fat particles to pick up.

Fat is needed almost everywhere in your body, but there are some places it shouldn’t be like our bellies and stuck to the walls of our arteries.  Almost all of our cells need fats to coat their outer shells.  Our hormones like testosterone, estrogen and the nerves and neurotransmitters responsible for our happy thoughts and feelings require fats.   When there is an overproduction of bad LDL cholesterol because of persistently elevated blood glucose, and all of the body’s fat needs have been met, these Uber drivers don’t have any place useful to bring the fats and end up taking them to your body’s version of a dirty Tijuana strip club*.  When deposited at these inappropriate places, your body pays the price, and not just for the cover charge and the watered down drinks, but for some really shady stuff. I think this analogy has run its course,  but one of the shadiest places LDL cholesterol gets dropped off is into the tiny coronary arteries, which are tasked with providing the muscles of the heart with proper blood flow.  To make matters worse, the LDL cholesterol are also dropped off in the even smaller arteries responsible for the blood flow to your favorite male reproductive organ.  If my innuendo wasn’t clear enough, I’m talking about the penis.  These deposits can result in decreased flow and eventually no flow at all #frownyface emoji, and when all blood flow is suddenly stopped to an area of the heart, this is called a heart attack or in medical speak, a myocardial infarction (MI).

Recently, we are starting to learn that a myocardial infarction seems to be also related to inflammation that can make cholesterol deposits, (cardiologists call them plaques) unstable.  These unstable plaques leave the walls of your larger arteries and travel downstream to smaller arteries where they create a blockage or a myocardial infarction (MI), AKA heart attack.

How do we positively affect the plaques characteristics, so they don’t cause MI’s?  The answer is two-fold and leads us to the definition of High Density Lipoprotein or good cholesterol.  Good cholesterol (HDL) is almost all protein and no fat, which is why it is very dense, hence the name “high density lipoprotein”.  Think of this guy as the Uber driver, riding around in an empty Prius, looking to pick up fats from places they shouldn’t be, like the Tijuana Strip club (coronary arteries) and take them to be recycled in the liver.  Obviously, the more of these good Samaritans you have driving around in your blood the better, because they are cleaning up the streets, AKA your arteries.  Now what does that have to do with plaques?  It seems that if you have a plaque that is soft and fluffy and full of squishy soft fats AKA LDL (bad cholesterol) it is more likely for part of that plaque to fall off and end up causing a heart attack than if it is a hard “stable” plaque.  The way plaques get hard (I’m skipping the obligatory erection joke here) is by HDL Uber drivers showing up and pulling some of those fluffy fats out of the plaques, thus firming up and shrinking that plaque and making that plaque unlikely to break off and cause any troubles. 

In the light of this information, it is no wonder that, recent research has shown that HDL (Good Uber drivers) to be a much more important predictor of heart health than LDL.  A recent study involving 135K patients who had recently had a heart attack showed that over 75% of these heart attack patients had normal LDL (bad cholesterol) but less than 5% of them had achieved a recommended level of good HDL cholesterol.  So why do we care so much about bad cholesterol and talk so little about good cholesterol?  I’ll get there but first I’ll give you another example.  

Case Study
I had a patient a few years ago, 52 year old male let’s call him Max Powers.  Using my diet he lost 20 pounds in 10 months and was able to go off of his blood pressure meds but was disappointed that his cholesterol went up.  Here are his numbers before and after starting his journey to get Healthy As F**k.  

Before   Total Cholesterol 192  HDL 38  LDL 146 **

After      Total Cholesterol 195  HDL 60  LDL 148 **

When Max told me his cholesterol numbers went up, I was disappointed too, and my initial reaction was to blame him, I certainly can’t blame myself, but I had him come to the office and take a closer look anyway.  First of all, he looked great.  He had a fun summer cut and was wearing a tasteful cardigan with sassy lobster print pants.  When I put his numbers into the ASCVD risk calculator (a tool doctors use to determine your risk of a heart attack or stroke) he was looking even better.  I found that his 10 year risk went from 9.2% to 3%!  This was an incredible improvement.  I had to check my math and as always, it was correct.  Part of the reason his risk went down so much was because he had better control of his blood pressure, so I put the numbers in again, but this time not accounting for his blood pressure improvements and his risk still went down by more than 50% from 9.2% to 4.5%.  He was shocked that even though his bad cholesterol and total cholesterol went up, he was way less likely to suffer a heart attack or stroke.  

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So why do we always focus on lowering cholesterol?  Because the things that raise HDL effectively are not drugs but lifestyle stuff.   A colleague recently reminded me that niacin helped HDL a little but didn’t change heart attacks significantly, so that’s out.  We have many expensive drugs that can lower your LDL.  Drug companies make billions of dollars per year lowering your LDL without a huge impact on your overall health.  While I on the other hand, am trying to get you to raise your HDL, and I am doing it for free, so would it kill you to sign up for email updates?  

In conclusion, bad cholesterol is predominantly made as a result of too much sugar and not too much fat.  So, never order an egg white omelet, eat the yolks too.  They are full of healthy fats, nutrients, and according to my daughters are home to the “dippy part” of the egg.  Keep your blood sugar low, by avoiding most fast and processed carbohydrates and your cholesterol will get better without medications and your risk of MI will go down, but please also listen to your doctor.

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Good cholesterol (HDL) can be increased with exercise, healthy saturated fats like coconut oil and grass fed beef, and some alcohol consumption, specifically red wine.  I recommend all of these things, especially exercise.  The complicated part is that sometimes the bad LDL is raised a little by healthy saturated fats as well, but the good HDL is raised more, creating a net positive effect, just like we saw in Mr. Max Powers.  My cholesterol numbers were poor in my 20’s but have been exceptional since starting this diet and have gotten better every year.  Many patients are afraid of all the butter, eggs, bacon, and butter that I recommend, but are elated when their cholesterol improves dramatically.  When you get your numbers back, feel free to share them with me on the site.  Mine will be measured next month and I will be sure to post them as well. 

*Also, you should know that there are no clean or classy Tijuana strip clubs, I checked.  Some references are listed below. 

** There is a third cholesterol component known as VLDL that wasn’t mentioned in Mr. Max Powers’ lipid report but it can be calculated by subtracting the LDL and HLD from the total.  

   

REFERENCES:
Our findings suggest that reduction in serum cholesterol does not prevent the risk of AMI. There was a significant increase in systemic inflammation in AMI patients, inversely correlated with HDL levels, suggesting an important role of inflammatory mediators in AMI. Thus, a decrease in serum HDL and increase in hs-CRP strongly predispose the risky individuals to the event of AMI. We emphasize the importance of HDL and hs-CRP measurements in the assessment of a combined lipido-inflammatory risk factor for the screening of high risk individuals and the prognosis of AMI.
Lipid Profile of Patients with Acute Myocardial Infarction and its Correlation with Systemic Inflammation
Haseeb A. Khan,1 Abdullah S. Alhomida,1 and Samia H. Sobki2


The well-known “HDL hypothesis” suggests that therapies aimed at raising HDL-C concentrations will lower the risk of CAD and MI. In a widely cited meta-analysis of four large studies (total number of individuals studied: 15,252), a 1 mg/dL increase of HDL-C levels was reported to be associated with a 2%–3% decreased CVD risk

http://www.cvriskcalculator.com/calculated?age=52&gender=1&race=0&total-chol=195&hdl=62&sbp=140&dbp=90&treated=1&diabetes=0&smoker=0
http://epadruginitiative.com/files/Get_With_The_Guidelines_2009.pdf


Lipid levels in patients hospitalized with coronary artery disease: An analysis of 136,905 hospitalizations in Get With The Guidelines
ArticleinAmerican heart journal 157(1):111-117.e2 · January 2009 with 350 Reads
DOI: 10.1016/j.ahj.2008.08.010 · Source: PubMed


You up?

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You up for getting healthier, losing weight, and silently chuckling to yourself while reading? Then you may like my website. I’ve been doing research on health, wellness, and weight loss for a long time. I know what works. If you are checking out my site, it’s likely that you want to improve an area of your health. Martin Hall, a famous golf instructor says, “If you keep doing what you’re doing, you’ll keep getting what you are getting”. The same is true with your health, except worse because as we age, maintaining great health can get more and more difficult, but not impossible. Americans keep trying the same things like jogging and low fat starvation diets to get healthy and Americans keep getting fatter, sicker, and less sexually appealing. I am asking you to try something different. Give it three months, it’s a third of an NBA season, and if it doesn’t work, I’ll give you your money back. Except, there is no money. It’s free, so even better. You already know what doesn’t work, it’s what you have been doing. Put your health in my hands and I promise to get you looking, feeling, and looking better than you thought possible. Did I mention “looking” twice? That was a typo.

Every night before I tuck my daughters into their sleep treadmills, I say the same thing, “Kim and Khloe, remember girls, it’s what’s on the outside that counts”. We have a strict “no smiling” policy in my house, as it only leads to premature wrinkles, and ice chips are considered an entrée and a dessert. But seriously, sometimes what we see on the outside is a reflection of what’s going on inside, so we endeavor to improve both. As a disclaimer, if you have been offended by this article or anything you have ever seen on cable television, it’s best you stop reading now, because it’s only going to get worse, and my writing style is not for everyone, specifically you. I’m sure there’s a vegan website or a Jenny Craig somewhere near you that would be more your speed, in fact, here’s a link https://www.jennycraig.com/. They’ve got plans starting as low as 29 dollars and the first week of food is free. You can’t beat that.

Back to me. I am an active Dad who’s over 40 and balancing raising two daughters, a busy career as a physician, a wife who thinks a bottle of wine is a single serving, and a bookie who is best described as “leg breaky”. Despite my hectic schedule, I am feeling and looking better than I have in 15 years. I have lost over 30 pounds, improved all aspects of my well being, and stopped needing medications for my high blood pressure, knee pain, psoriasis, acid reflux, and for occasionally feeling not so fresh, you know, down there. The changes I recommend are simple, life-saving, but totally free.  This is the link to my bio A Bit About Me…More content is coming to the site soon. I am also in the process of writing a book with professional author and physician Dr. Jason Valadao. Check him out and get your copy of his new book at Jasonvaladao.com. Some of this website’s content will be featured in our book.
Above all else, we believe that food is the world’s most powerful medicine. It should nourish the body and soul, and it should be shared with the most important people in our lives. It shouldn’t be ordered from a clown’s mouth, purchased at a gas station, or worst of all, eaten at The Olive Garden.

The book and website are funny and sometimes ridiculous reads that just happens to contain life-changing new information based on the most up to date nutritional science. That’s what we call a teaser in the publishing game. I hope you keep reading. This is the best place to start. You Should Start Here… START HERE: The Basics. 10 Keys to Getting Healthy as F%$#!


A Bit About Me

While the prospective graduates of my medical school class were in the midst of selecting a specialty to pursue, a professor gave us a piece of advice. She said, “Select the area of medicine where you see the greatest injustice, and focus your efforts there.” For some members of my class this was pediatrics because of the number of children without access to healthcare and to give a voice to those who can’t yet speak. Others selected psychiatry because of the often forgotten plight of the mentally ill. Still others chose plastic surgery because of the unfair disparity in breast size in America and because they yearned to own a yacht that is much larger than their father’s very large yacht. I have my own ideas about what the greatest injustice in health care is. Mine is rooted in the belief that the most important factor in your overall health is what you choose to eat. Most people don’t know that food is this important, but it truly is. Also, most people (and this probably includes you) do not know which foods are good and which foods are bad. This speaks to the injustice we see. Americans are fat, chronically ill, and dying because of wrong information and lies. Who is putting out this wrong information, and what are the right and wrong foods to eat? I think you will be surprised by the answers. We will get there, just keep reading.

Thanks for taking the time to read this.  I’m Jimmy Westbrook, a board certified family medicine physician.  I attended medical school at Florida State University College of Medicine, but originally I am from Seattle.  Before getting my M.D., I spent 9 years as a pilot in the U.S. Navy.  I have been writing recreationally all of my life to include serving as a film critic to a small newspaper in Key West, researching and writing an article on the Mediterranean Diet published in a semi-prestigious medical journal, and the primary author of my family’s R rated Christmas letter.  Most notably, I am in the throws of writing a book on my style of healthy eating.  It is co-authored by my good friend Dr. Jason Valadao.  Jason also has a new book out and you can read up about him at his website, https://jasonvaladao.com/.    I give medical talks in the arena of health, nutrition, longevity, diabetes, physician leadership, and various other medical subjects.  I have a comedic, down to earth, and snarky tone to my writing that is not often found in the world of medicine, nutrition, and health.   I have a dirty sailor’s mouth and sometimes this spills into my writing on this webpage.  If you are offended by this, I apologize…for nothing.

My last flight in the mighty SH60

Because I wasn’t always in medicine (did I mention that I spent the first 9 years of my post-college life as a Navy Pilot, see the above picture), I am able to better gauge what an intelligent but non-medical audience needs or wants to know about these subjects.  I try to explain things in a way that makes people laugh, is easily understandable, and believable.  On a personal level, I enjoy red wine, scotch, golf, watching football, cooking, and gambling.  I love pop music, fantasy football, and am terrified of rats and clowns, also I overshare.  Because I  came to medicine later in life, I have the perspective of being able to speak in a relatable way without being condescending to the reader and without using a bunch of words that require a textbook to decipher.  In medical school, I was frustrated by unnecessary medical terminology.  For instance, why do doctors have to use the word “epistaxis” for nosebleed or “hematochezia” for bleeding from your butt?  Why can’t we just call it a nosebleed or rectal bleeding? Then patients and doctors could be on the same page about what substance is coming out of which of the patient’s holes.  I think doctors use this terminology to help us sound smarter than non-doctors.  I will try to avoid using these types of words and explain things as if we are talking to very smart people who did not attend medical school, that’s you.  This site does not have a political or ideological slant.  And I promise that I won’t try to get you to go vegan, get a food scale, or buy any meal replacement shakes.  I will try and get you to purchase my upcoming book for all of your friends, family, work related acquaintances, and Tinder hookups.   Thanks again for visiting my site. Read More