In honor of National Heart Month in February, I wanted to share some information about risk factors for cardiovascular disease. Many of my clients are confused about this information and have never had anyone go over it with them.
Before we get to the “know your numbers section,” I want to point out one significant underlying theme.
Inflammation is the driver behind these numbers being elevated and behind many causes of cardiovascular disease. Inflammation is also the root cause of much chronic pain. That’s why in our healthy weight loss program, we guide our patients through an anti-inflammatory dietary approach with meal plans and weekly challenges.
Interested in signing up? Find out more here: (link to program page)
I rarely review this number with my clients, it’s not nearly (if at all) as necessary as the markers below.
LDL “LOW-DENSITY LIPOPROTEIN”
Protein that shuttles cholesterol from the liver to the body for use. Currently recommended <100mg/dL. However, it was recently estimated that 75% of cardiac patients have normal cholesterol, how could this be? It actually may be more important to know the fractionated particle size:
- Pattern A – large buoyant molecules (like balloons or cotton balls) that float “effortlessly” in the blood, in general, associated with no harmful effects and at moderate levels considered a normal part of good health.
- Pattern B- smaller denser particles, like bullets, susceptible to oxidation, slip through and lodge in arterial walls, therefore associated with greater risk of cardiovascular events
INTERVENTIONS TO IMPROVE LDL PATTERNS:
- High intakes of Saturated fat may INCREASE LARGE, buoyant LDL particles. Increasing the level, but making the particles slightly less dangerous.
- Reducing carbohydrates may reduce small, dense LDL particles (high carb diets show a shift from pattern A to B)
- Weight loss improves the LDL pattern, especially inches from the mid-section.
HDL “High-Density Lipoprotein”
Protein that shuttles cholesterol back to the liver for recycling and excretion (literally like a recycle truck), therefore it is thought that this may lower the risk of heart disease. Currently recommended: > 40 for Men, >50 for Women, I usually try to get clients to > 60 for optimal health
INTERVENTIONS TO INCREASE HDL:
- Chose different biological parents (just kidding)—-> primarily determined by genetics, estimates up to 80%
- Consistent moderate to vigorous exercise slightly increases HDL
- Saturated fat intake increases total cholesterol and HDL
- Don’t smoke. Smoking is associated with 5 points lower HDL
- Do not consume trans fat. It has been shown to lower HDL significantly (look for the words partially hydrogenated and avoid them like the plague, common foods include margarine, Crisco, peanut butter, baked goods and elsewhere)
- Moderate alcohol intake, especially wine, may increase HDL (however keep in mind alcohol is still associated heavily with many types of cancers)
- Small studies show a slight increase in HDL with high levels of niacin intake, but little is known about the lasting effects of this, and there are pretty significant side effects, at this time I don’t recommend it as the first line of intervention
The storage form of fat in the body as fat tissue, skin oils, and in the blood. While triglycerides are the primary storage form of fat in the body, the molecule is made of both sugar and fat. It serves to complete the transfer between blood glucose and fat tissue. Strongly correlated with increased risk of heart disease AND type 2 diabetes. The current recommendation is <150mg. Some studies show <100 may be more optimal.
- High carbohydrate, low-fat diets increase triglycerides
- Swap refined carbohydrates for high-quality carbs
- Match your carbohydrate needs to your lifestyle
- Limit alcohol consumption (which is why you don’t want to begin drinking just to raise your HDL)
- Moderate exercise may increase triglycerides
- Increase intake of omega-three fatty acids can decrease triglycerides
- Iron storage issues can increase triglycerides (get this tested before intervening)
- L-Carnitine may lower triglycerides, but I never recommend taking it without also engaging in lifestyle change
VLDL “Very Low-Density Lipoprotein”
It is estimated that a tiny percentage of cholesterol found in the body comes from VLDL; in fact, usually less than 20%. Therefore, it’s not usually the highlight of blood work when it’s reviewed. If determined at all, it’s usually calculated as a percentage of Triglycerides. I’ll admit, I didn’t even know much about its significance until one of my nutrition majors stumped me in class inquiring about it. VLDL produced by the liver to deliver lipids to the body. On average, it is composed of 55-65% triglycerides, 10-15% cholesterol, 20% phospholipid, and 5-10% protein. As lipid exchange with the tissues occurs, its composition changes decreasing in triglycerides and increases in cholesterol, effectively increasing its density and changing the name of it to an LDL molecule.
A study by the American Heart Association published in 2008 cited there may be further significance to VLDL particle type:
- VLDL1- triglyceride-rich particles, often found in higher qualities in cases of diabetic dyslipidemia, increases the production of small dense (pattern B LDL) particles,
- VLDL2- triglyceride poor particles (in comparison)
As of right now, it simply stands that having increased VLDL is associated with increased Triglycerides & small (pattern B) LDL particles, therefore also associated with increased risk of heart disease. Interventions promoting increased insulin sensitivity, promoting pattern b of LDL, and decreasing to recommended levels, as well as increasing HDL, are though to effective interventions for decreasing VLDL particles. Current recommendation is less than 30mg/dL.
Insulin Sensitivity & Blood Sugar—> see this post on blood sugar control.
Normal values are currently considered less than 120/80. I always tell my clients that blood pressure is one of the aspects of our health, like blood sugar, that we have a great deal of control in normalizing. I view high blood pressure as a two-fold problem: first, as a symptom of inflammation and second, as an indication of potential nutrient imbalances (excess sodium not enough potassium/magnesium).
Interventions to decrease blood pressure:
- All methods for reducing inflammation in the body (see below).
- Consider switching from added sugar or artificial sweeteners to stevia. The preliminary research shows that stevia may contribute to lower blood pressure.
- STOP SMOKING—> Nicotine speeds up your heart rate and causes high blood pressure.
- Engage in stress management training, including mindfulness, meditation, prayer, whatever speaks to you.
- Current recommendations still suggest decreasing salt intake. If you already have blood pressure, you should lower your salt intake, but do so naturally through eating fewer process foods and more fruits and vegetables. (Don’t just stop salting your popcorn and think that will make a difference!)
C-reactive protein (CRP)
Measures systemic inflammation and predictor of cardiovascular events
Lipoprotein-associated phospholipase A2 (Lp-PLA2)
A biomarker of vascular inflammation, which may be predictive of cardiovascular events and stroke.
INTERVENTIONS FOR DECREASING INFLAMMATION
- Increase Omega 3’s and decrease Omega 6’s —> diet choices and supplement with omega 3 (see this post for more tips on that)
- Limit preservatives, chemicals, and pesticides —> stop smoking, check out the dirty dozen & how to eat more real food
- If needed, lose weight, primarily weight that located in the mid-section (produces inflammatory cytokines)!
- Decrease sugar intake overall
- Increase servings of vegetables and fruit (aiming for at least two giant fistfuls per meal), which contain phytonutrients and antioxidants which combat free radicals in the body and fight inflammation.
- Address hormone imbalances (adrenal hormones, sex hormones, and thyroid hormones) and underlying health conditions from a comprehensive approach (see my nutrition counseling website at hungryhobby.net).
- Address any potential food sensitivities.
- Seek advice on a correct supplement protocol for you. Certain supplements can be useful like turmeric, in addition to a few mentioned earlier, like omega-three and L-carnitine. However, supplement protocols should be highly individualized. They can interact with your medication or other conditions, so make sure to seek guidance!
In other words, eat more:
- Fat overall, don’t fear it, or you won’t be full and will turn to carbs.
- Fatty fish, flax, chia, walnuts
- Avocado oil or olive oil for cooking
- Whole grains – especially oatmeal
- Produce – especially non-starchy veggies and fruit
- 100% grass-fed/grass-finished meat and dairy (organic when possible)
- Refined sugar
- Refined carbohydrates
- Omega 6 based vegetable oils like sunflower, safflower, and soybean oil.
- Processed foods with added salt and preservatives.