Therapies08 May 2007 07:30 pm

LDL – Bad Cholesterol, Natural ways to reduce it

Submitted by Dr Hemingway

Low-density lipoprotein (LDL) belongs to the lipoprotein particle family. Its size is approx. 22 nm but since LDL particles contain a changing number of fatty acids they actually have a mass and size distribution. Each native LDL particle contains a single apolipoprotein B-100 molecule (Apo B-100, a protein with 4536 amino acid residues) that circles the fatty acids keeping them soluble in the aquous environment. LDL is commonly referred to as bad cholesterol as high LDL levels can lead to cardiovascular disease.

What is the function of LDL

Generally, LDL transports cholesterol and triglycerides from the liver and small intestine to cells and tissues which are taking up cholesterol and triglycerides.

How bad can it be?

Because LDLs transport cholesterol to the arteries and can be retained there by arterial proteoglycans starting the formation of plaques, increased levels are associated with atherosclerosis, and thus heart attack, stroke and peripheral vascular disease. This is why cholesterol inside LDL lipoproteins is called bad cholesterol. Still, it is not the cholesterol that is bad; it is instead how and where it is being transported, and in what amounts over time.
Increasing evidence has revealed that the concentration and size of the LDL particles more powerfully relates to the degree of atherosclerosis progression than the concentration of cholesterol contained within all the LDL particles. The healthiest pattern, though relatively rare, is to have small numbers of large LDL particles and no small particles. Having small LDL particles, though common, is an unhealthy pattern; high concentrations of small LDL particles (even though potentially carrying the same total cholesterol content as a low concentration of large particles) correlates with much faster growth of atheroma, progression of atherosclerosis and earlier and more severe cardiovascular disease events and death.
LDL is formed as VLDL lipoproteins, which lose triglyceride through the action of lipoprotein lipase (LPL), and become smaller and denser containing a higher proportion of cholesterol.
A hereditary form of high LDL is familial hypercholesterolemia (FH). Increased LDL is termed hyperlipoproteinemia type II (after the dated Fredrickson classification).
LDL poses a risk for cardiovascular disease when it invades the endothelium and becomes oxidized since the oxidized form is more easily retained by the proteoglycans. A complex set of biochemical reactions regulates the oxidation of LDL, chiefly stimulated by presence of free radicals in the endothelium. Nitric oxide down-regulates this oxidation process catalyzed by L-arginine. Correspondingly when there are high levels of asymmetric dimethylarginine in the endothelium, production of nitric oxide is inhibited and more LDL oxidation occurs.

LDL recommended range

The American Heart Association, NIH and NCEP provide a set of guidelines for fasting LDL-Cholesterol levels, estimated or measured, and risk for heart disease. As of 2003, these guidelines were:

Level mg/dL

Level mmol/L

Interpretation

<100

<2.6

Optimal LDL cholesterol, corresponding to reduced, but not zero, risk for heart disease

100 to 129

100 to 129

Near optimal LDL level

130 to 159

3.3 to 4.1

Borderline high LDL level

160 to 189

4.1 to 4.9

High LDL level

>190

>4.9

Very high LDL level, corresponding to highest increased risk of heart disease

These guidelines were based on a goal of presumably decreasing death rates from cardiovascular disease to less than 2 to 3%/year or less than 20 to 30%/10 years. Also notice that 100 is not considered optimal, but less than 100, unspecified how much less.
Over time, with more clinical research, these recommended levels keep being reduced because LDL reduction, including to abnormally low levels has been the most effective strategy for reducing cardiovascular death rates in large double blind, randomized clinical trials; far more effective than coronary angioplasty/stenting or bypass surgery.
For instance, for people with known atherosclerosis diseases, the 2004 updated American Heart Association, NIH and NCEP recommendations are for LDL levels to be lowered to less than 70 mg/dL, unspecified how much lower. It has been estimated from the results of multiple human pharmacologic LDL lowering trials that LDL should be lowered to about 50 to reduce cardiovascular event rates to near zero. For reference, from longitudinal population studies following progression of atherosclerosis related behaviors from early childhood into adulthood, it has been discovered that the usual LDL in childhood, before the development of fatty streaks is about 35 mg/dL. However, all the above values refer to chemical measures of lipid/cholesterol concentration within LDL, not LDLipoprotein concentrations, probably not the better approach.

Measurement methods

Chemical measures of lipid concentration have long been the most-used clinical measurement, not because they have the best correlation with individual outcome, but because these lab methods are less expensive and more widely available. However, there is increasing evidence and recognition of the value of more sophisticated measurements. Specifically, LDL particle number (concentration), and to a lesser extent size, have shown much tighter correlation with atherosclerotic progression and cardiovascular events than is obtained using chemical measures of total LDL concentration contained within the particles. LDL cholesterol concentration can be low, yet LDL particle number high and cardiovascular events rates are high. Alternatively, LDL cholesterol concentration can be relatively high, yet LDL particle number low and cardiovascular events are also low. If LDL particle concentration is tracked against event rates, many other statistical correlates of cardiovascular events, such as diabetes mellitus, obesity and smoking, lose much of their additive predictive power.

LDL subtype patterns

LDL particles actually vary in size and density, and studies have shown that a pattern that has more small dense LDL particles—called “Pattern B”—equates to a higher risk factor for coronary heart disease (CHD) than does a pattern with more of the larger and less dense LDL particles (“Pattern A”). This is because the smaller particles are more easily able to penetrate the endothelium. “Pattern I”, meaning “intermediate”, indicates that most LDL particles are very close in size to the normal gaps in the endothelium (26 nm).The correspondence between Pattern B and CHD has been suggested by some in the medical community to be stronger than the correspondence between the LDL number measured in the standard lipid profile test. Tests to measure these LDL subtype patterns have been more expensive and not widely available, so the common lipid profile test has been used more commonly.

The lipid profile does not measure LDL level directly but instead estimates it via the Friedewald equation [1] using levels of other cholesterol such as HDL:

  • LDL – C = Total cholesterol – HDL – C – 0.20 x total triglycerides

In mg/dl: LDL cholesterol = total cholesterol – HDL cholesterol – (0.2 × triglycerides)
In mmol/l: LDL cholesterol = total cholesterol – HDL cholesterol – (0.45 × triglycerides)

There are limitations to this method, most notably that samples must be obtained after a 12 to 14 h fast and that LDL-C cannot be calculated if plasma triglyceride is >4.52 mmol/L (400 mg/dL). Even at LDC-L levels 2.5 to 4.5 mmol/L, this formula is considered to be inaccurate (see Sniderman et al., [2]).
If both total cholesterol and triglyceride levels are elevated then a modified formulat may be used:

  • LDL-C = Total-C HDL-C (0.16 x Trig)

This formula provides an approximation with fair accuracy for most people, assuming the blood was drawn after fasting for about 14 hours or longer. (However, the concentration of LDL particles, and to a lesser extent their size, has far tighter correlation with clinical outcome than the content of cholesterol with the LDL particles, even if the LDL-C estimation is about correct.)
There has also been noted a correspondence between higher triglyceride levels and higher levels of smaller, denser LDL particles and alternately lower triglyceride levels and higher levels of the larger, less dense LDL.
With the decreasing cost, greater availability, wider acceptance and research use of other “lipoprotein subclass analysis” assay methods, including NMR spectroscopy, some research studies have shown a strong correlation between human clinically obvious cardiovascular event and quantitatively measured particle concentrations.

Lowering high LDL cholesterol levels

One of the best things you can do to avoid unhealthy cholesterol levels is to avoid consuming hydrogenated oils. These are artificial oils that have been processed in a laboratory for the convenience of food manufacturers and food marketing companies. They have no business whatsoever in the human body, and yet virtually every snack product in the grocery store is made with hydrogenated oils.
Margarines are made with hydrogenated oils as well. Unless they say, “no hydrogenated oils” right on the label, they contain it. Vegetable shortening, by the way, is pure hydrogenated oil. It is probably one of the single most toxic grocery products you can put in your body. And yet people are out there buying vegetable shortening by the bucket loads and baking cookies with it — something I find absolutely appalling.
By far, the most powerful thing you can do to restore healthy cholesterol levels is to stop eating hydrogenated oils. The next thing that you can do is stop eating trans fat (trans fatty acids) — that means avoid all fried foods. Fried foods just do not belong in the human diet. And if you’re already avoiding red meat and dairy products, then avoiding fried foods is probably a fairly easy step for you. Fried foods are incompatible with health, and if you choose to eat fried foods at any time in your life, even just one meal a week, you’re going to have unhealthy cholesterol levels as a result.

Garlic supplements for cholesterol

On the supplements side, there are a lot of things you can do. You can take garlic supplements, or just eat a lot of whole garlic. One of the things I like to do is take garlic cloves and just bake them. You can eat them baked, put them in pastas or put them on a healthy pizza made with soy cheese and organic crust. Baked garlic cloves are delicious and they’re outstanding for your health. They don’t have the bite of raw garlic cloves.
Garlic supplements are also good, and the best company out there is Kyolic. Buy their aged garlic supplements. I do, and I recommend them to my family and friends. In fact, garlic has many other health benefits beyond cholesterol: the herb also fights cancer and greatly enhances immune system function.

Blueberries, a healthy choice

One of my favorite solutions for fighting cholesterol levels is eating lots of blueberries. Blueberries have now been proven to be more effective than statin drugs in reducing cholesterol levels, and yet they have absolutely no negative side effects whatsoever. You can get blueberries throughout the year if you go to the right stores.
If you can’t find them at a grocery store, check out my book called “Secret Sources,” which gives you the location of an online retailer where you can purchase freeze-dried blueberries, and you can store them all year long and use them any time you want. That’s a very convenient way to take blueberries. It’s a little on the pricey side, but it’s a heck of a lot cheaper than statin drugs! And of course, it’s a fraction of the cost of actually ending up in the hospital with out-of-control cholesterol levels.
Also, all on the nutrition side, as you have already guessed, it is very important to avoid saturated animal fats. You don’t want to be eating any hamburger or red meat at all. In short, if you avoid red meat you will also be doing yourself a huge favor in terms of avoiding environmental toxins. Red meat consumption also promotes colon cancer.
A recent study showed fire retardant chemicals in massive quantities are now being found in the animal fats in red meat. That’s because these fire retardant chemicals tend to collect in the fat tissues. These chemicals are found throughout our environment now. Cows are essentially accumulators and concentrators of environmental toxins. They eat tons of grass, literally, throughout their lives. And, they tend to concentrate any toxic chemicals spread on the grass through pesticides or contaminated well water.
So, when you eat a piece of beef, you are eating, quite literally, a highly concentrated form of saturated animal fat containing environmental toxins that would never be present in those quantities in the natural environment. Thus, in addition to supporting healthy cholesterol, avoiding red meat will also save you from all of the terrible negative side effects of environmental toxins.

Avoid dairy products

Avoiding dairy products is also important for cardiovascular health. Hydrogenated cows’ milk is something that absolutely does not belong in the human body. It is an artificially processed food. It doesn’t have any justifiable purpose for human nutrition. Hydrogenated milk would probably kill baby cows just due to the negative effects of eating homogenized fat molecules. Now, if you feel that you have to drink cows’ milk, if you’re addicted to this substance for some reason — maybe in your past life, you were a baby cow — then what you can do is go out and buy raw, unprocessed cow’s milk from a local farmer (REAL MILK).
You have to live near a farm or have some connections in order to get that product. It will taste very different from processed cows’ milk and it will be a lot healthier for you. You will also find that the fat in the milk will separate. That’s the way it’s supposed to work in the real world… not in the make-believe world of the grocery store where milk has been homogenized and processed to make it look fresh even though it may be quite old.

Cardiovascular exercise

And lastly, I have to mention the importance of cardiovascular exercise and physical fitness. Your level of physical activity has a strong influence on your cholesterol levels. In a simple sense, you could say that cardiovascular exercise converts LDL cholesterol (the bad cholesterol) into HDL cholesterol, which is the good cholesterol. I know that’s a simplification, but the point is still valid. When you exercise on a regular basis, you will lower your LDL levels and raise your HDL levels. And remember, it’s the ratio of these two that is the predictor of cardiovascular disease.
It is essential to get on a regular cardiovascular exercise program. Remember, it doesn’t have to be outrageously strenuous in order to be effective. All it has to do is get your heart rate up. You might be a person who is overweight and you have a hard time walking up the stairs. Well, that’s fine. Walking up a flight of stairs is good exercise for you if it gets your heart rate up.
If walking 400 yards, just down the street and back, gets your respiration up and your heart beating, it is good for you. That’s good cardiovascular exercise. Ideally, you want to engage in exercise that lasts about 45 minutes a day. However, if you can only do 30 minutes a day, then do 30. If you can do an hour a day, then go for an hour. But aim for 45 minutes a day of cardiovascular exercise — and make it medium in level of effort. Of course, always be sure to check with a health professional before engaging in an exercise program just to make sure there is not some other health reason why it would be dangerous for you to do so.
With all of that in place: getting lots of water into your diet, avoiding processed salt (sodium chloride), consuming garlic and blueberries and other natural substances such as red yeast rice and combining it with moderate levels of cardiovascular exercise, you will quite readily and noticeably reduce your LDL cholesterol levels, bringing them back into a healthy balance.

NCEP guidelines

Part of the U.S. National Institutes of Health, the National Cholesterol Education Program (NCEP) is designed to optimize prevention and enhance the management of heart disease. This involves a systematic approach based on an individual’s long-term or short-term risk of heart disease.
As with previous recommendations, reduction of low-density lipoprotein (LDL) cholesterol continues to be the primary strategy. However, the NCEP now defines desired LDL levels based on the risk for developing coronary artery disease or having a cardiac event, such as a heart attack.
For healthy people, the NCEP recommends an optimal LDL cholesterol level of 100 milligrams per deciliter (mg/dL). This guideline, however, is not sufficient for patients already at higher risk of having a heart attack. For higher-risk patients, goals for LDL levels are set according to each patient’s risk category. These “therapeutic goals” in milligrams per deciliter (mg/dL) are:

Risk Category

Primary Therapeutic LDL Goals

Secondary Therapeutic LDL Goals

Very High

Less than 100 mg/dL

Less than 70 mg/dL

High

Less than 100 mg/dL

n/a

Moderately High

Less than 130 mg/dL

Less than 100 mg/dL

Low/Moderate Risk

Less than 160 mg/dL

Less than 130 mg/dL

A “therapeutic goal” is the target that physicians hope to reach through therapies to lower their patients’ LDL. Such therapy usually includes lifestyle changes (e.g., diet and exercise) and the use of cholesterol-reducing medications. The two stages of therapeutic goals (primary and secondary) give physicians the option of a lower goal for some patients.

Risk categories are determined by the National Heart, Lung, and Blood Institute (NHLBI) and based on a person’s likelihood of having a heart attack in the next 10 years. These risk factors include:

  • Age (45 years or older for men; 55 years or older for women, or premature menopause)
  • High blood pressure
  • Diabetes
  • Smoking
  • A diet high in saturated fat
  • Obesity
  • Lack of exercise
  • A family history of cardiovascular disease

The NCEP also promotes a series of dietary and fitness guidelines known as Therapeutic Lifestyle Changes. These include:

  1. Reduce dietary intake of saturated fat (less than 7 percent of total calories) and cholesterol (less than 200 milligrams a day).
  2. Achieve and maintain a healthy weight.
  3. Increase physical activity.
  4. In addition to Therapeutic Lifestyle Changes, cholesterol-reducing drugs may be advised to lower LDLs to desirable levels.

Medications and LDL levels

If changes in diet and lifestyle are unsuccessful in lowering cholesterol, medications may be prescribed. Often, the medication will be a cholesterol-lowering statin. These medications have shown excellent results in improving cholesterol ratios, but not everyone can tolerate them.
There are five main categories of cholesterol reducers: statins, bile resins acid, nicotinic acid, fibrates and ezetimibe. Most are available only by prescription, while nicotinic acid, a form of vitamin B3 (niacin), is available over-the-counter. However, niacin should only be taken under the care of a physician to monitor any side effects that could arise, such as severe upset stomach (nausea) and flushing.

Sources: wikipedia, newstarget, ivillage

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