LDL Receptor Activity

Try this: the LDL particle is a cargo ship. It is supposed to land at various docks to deliver over the goods. However, it is also supposed to protect the goods so that they are in good shape when the ship gets to the dock. However, there are often pirates at sea, and they may attack both the people at shore as well as the cargo ships. If they block entry to the dock, the ship cannot refuel or purchase more ammunition for defense. If the ship is thus left at sea, it runs out of ammunition and the pirates are then able to effectively sabotage it, ruin its goods, and purposefully plant explosives and release infectious diseases on the boat. Then, when it does get near shoreline, the folks at the dock catch illnesses and are caught in terrorist explosions. Thus, the immune system, like a navy and national guard, rescues the cargo ships that have been attacked (oxidized LDL), and quarantines them and any toxic factors released from them in something like a superfund site, where the surrounding community is protected as best as possible.

The above is quoted from Chris Masterjohn, an expert on lipids and someone who does not appear to be selling anything. I like guys who are not flogging me supplements or Statins and clearly have something interesting to say.

The above is taken from an interview he did with Chris Kresser. What he is saying in the above is that landing at docks simply means delivering cholesterol to the various cells that need it and also being taken eventually and promptly out of the blood stream by the liver. The ammunition and defence taken on board are antioxidants needed to fight off oxidisation of the LDL membrane which has a polyunsaturated element to it. The LDL is capable of fighting off this oxidisation for a while but if it stays in the blood stream too long this ability breaks down and then oxidised LDL, the main cause of heart disease via plaque build up (quarantine), prevails.

This prolonged stay in the blood stream of LDL happens when we have a deficient LDL receptor activity and one of the main promotors of this is leptin resistance. Notice we have not mentioned Cholesterol at all. He makes a fascinating point when he cites the guy (name escapes me) who probably got the whole ball rolling on cholesterol back in the 1920’s when he performed experiments on rabbits. He induced plaque build up very similar to that found in humans by feeding them a high cholesterol diet. This experiment has been much criticised as irrelevant to humans as rabbits do not normally consume cholesterol and are therefore bound to have ill effects. However what he also found was that when you injected cholesterol into the rabbits nothing happened. The processing of cholesterol into LDL particles was required to induce plaque build up hence the clue that the LDL particle is the main problem not the cargo on board.

If all this Somalian pirate talk sounds pretty confusing then simply get the DVD out with Tom Hanks in the lead role. Eat some sea weed (iodine) and Brazil Nuts (selenium) whilst watching the film, your Leptin will thank you.

India South & North

India has far greater incidence of heart disease in the north than in the south and yet looking at the lipid levels of the two populations seems to show that LDL may not be the culprit. Average levels of LDL for 40 to 50 year olds stood at 3.05 mmol in both regions. Not outrageously high by most standards. HDL however in the south averaged at 1.6 mmol whilst in the north it averages at a miserable 0.8 mmol. Triglycerides are also high in the north at 1.8. There is no data for the south generally but in Gujarat it stands at 1.2.

This seems to add weight to the hypothesis that HDL and Triglycerides are more important than LDL cholesterol in connection with heart disease. Drug companies have not surprisingly focused on LDL as it is more easily manipulated by chemical means.

You can take a look at the data here

http://medind.nic.in/gaa/t09/i2/gaat09i2p25.pdf

More Vitamin C

I have posted before about the Linus Pauling Vitamin C hypothesis to curing heart disease. The idea that heart disease is really a form of arterial scurvy and that as one of a handful of species that cannot produce its own vitamin C we are more vulnerable than those that can. In fact species that produce their own Vitamin C do not seem to get heart disease.

here are some supporting figures taken from a large scottish study and published in the British Medical Journal

Ascorbic acid intake (mg/day)
14.9 34.7 44.2 54.5 70.2 116.1 50 10.9 30.5 42.1 55.2 72.3 118.5 30
All CHD 1 0.87 0.83 0.63 0.52 0.85 (0.80 to 0.91) *** 1 0.59 0.85 0.81 0.56 0.92 (0.82 to 1.02) NS
CHD deaths 1 0.98 1.03 0.86 0.72 0.93 (0.83 to 1.04) NS 1 1.17 2.12 1.61 0.76 0.99 (0.81 to 1.21) NS
All deaths 1 1.09 1.00 0.87 0.85 0.95 (0.88 to 1.02) NS 1 0.98 0.79 1.03 0.72 0.95 (0.86 to 1.04) NS

You can take a look at a neater version here (apologies for messy presentation above)

http://www.bmj.com/highwire/markup/608368/expansion?width=1000&height=500&iframe=true&postprocessors=highwire_figures%2Chighwire_math

or the full report where you can click on the last pop table to get the Vit C data at

http://www.bmj.com/content/315/7110/722

The figures from left to right show hazard ratios for different levels of intake of Vitamin C among the study subjects. The more Vitamin C taken the lower the hazard for Cardio Vascular Disease and CVD death. The 3 stars *** mean that the data for Vit C is highly statistically significant. There are 3 stars next to Vit C and men and incidence of CVD meaning the less men took the more likely they were to suffer from CVD.

My policy is to take a pink grapefruit with my breakfast every day and a Vit C supplement. Doing this has resulted in my own lowest reading of Lp(a), a well documented risk factor for heart disease.

The confusing aspect of the study is that Total cholesterol levels were also shown to be an increasing hazard as levels increased and were also statistically significant.

Gut Microbiome

Eat lots of veggies, fruits and whole foods. Avoid processed foods, grains and sugar. All seems like good advice but why are veggies better for us. What is the mechanism behind the digestion of these foods that eventually results in better heart health ?.

Dr Rhonda Patrick gives a pretty good explanation here about how a compromised gut microbiome might be the underlying cause of heart disease.

RCT’s and 2005

Reading the book ‘Fat and Cholesterol don’t cause heart attacks’ found here

https://wordpress.com/read/feeds/2090682/posts/1167174164

It becomes clear that 2005 is a pretty important date in the debate about heart disease and in particular Statins. Most doctors will swear that Statins are beneficial in primary and secondary care (meaning you have not had a heart attack and you have had a heart attack). Of the remaining doctors most will swear that they are beneficial in secondary care. Even Doctor Kendrick has raised his hand to this question. A few will be brave enough to doubt that they are of use to anybody. This latter small group may well be correct when we look at the data from a different viewpoint.

In 2005 the regulations regarding randomised control trials, that’s the kind of trials that doctors like to label as ‘gold standard’ and the kind of trials they bring up when trashing epidemiological studies (studying populations without controls in place). It seems that there was plenty to get worried about pre 2005 when it came to the quality of RCT’s, and there’s me thinking that all RCT’s run by big pharma were clean and above board :). The FDA decided that the way trials were run needed tightening up, I cannot quite remember which medical disaster took place that forced their hand but it must have been compelling to get the FDA to squeeze Pharma. The net result is that when you are told that Statins are good for secondary prevention it is invariably based on meta analysis done on numerous studies both pre and post 2005. In some cases its just pre 2005. If on the other hand you focus on just post 2005 when RCT’s presumably became more reliable the benefits of Statins disappear for secondary prevention. The section in the book on this also highlights some of the dodgy practices that go on with trials and big pharma. For example they usually run numerous identical trials in different locations so that they can bin the ones that do not turn out as they would like and simply quote the one that does. This has been tightened up post 2005. There has even been an example where a trial going well for Pharma was pulled early which is quite puzzling, only to find on deeper examination that the incidence of diabetes amongst Statin users was becoming a thorn in the side of Pharma at the time and they probably pulled the study while the results looked OK for the reason that to take it to completion would have meant running the risk of uncovering type II diabetes rates increasing amongst the users of Statins in the trial.

I can strongly recommend the book, its a little more technical in parts than your average book on Cholesterol but do not let that put you off. There are plenty of excellent readable chapters.

Coffee Heart Friendly ?

I am mainly a green tea and hibiscus tea drinker these days but I have to admit I love the taste of coffee. Despite the fact that service in modern coffee bars has reduced to almost handing you a kettle and asking you to make your own I still like an occasional Americano. I am not tempted by the virtual desert menu of alternative coffee’s so that’s a good thing but is coffee heart friendly ?. Latest research says yes and no. It seems that coffee can increase your chance of a heart attack if you are a slow metabolizer of caffeine. If on the other hand you are a swift metabolizer then it is heart protective. Details of this discovery here

https://www.ncbi.nlm.nih.gov/pubmed/16522833

The determining factor with regard to the am I fast or slow is the CYP1A2 gene. If the rs762551 variant of this gene happens to be AA then you are a fast metabolizer (coffee is ok for you). If you are AC or the even slower CC then you are a slow metabolizer and should avoid coffee. You can get a breakdown of this gene and a whole host of others at 23andme.

I appear to be AA which means drinking coffee should not increase my heart attack risk but could help with lowering Alzheimers risk which is good news because I have one APOE e3 and one APOE e4 gene which means a higher risk of Alzheimers. This does not mean I am about to start packing the coffee in but its good to know that the occasional cup is probably fine. By the way there is research that shows that coffee increases LDL whilst green tea lowers it. I have found this to be true so if you are not a cholesterol sceptic and want to lower your LDL then perhaps coffee should be avoided.

Latest Tests

Whilst out in Portugal I had my blood tests done at the considerably cheaper rate than is available in the UK. The test came in at 180 euros which at today’s miserable post Brexit rate still comes in at around £165 and a £450 to £500 saving on what they would cost in the UK.
I included a couple of new tests and dropped the test for Vit D levels which in my case seem to be consistently good. In fact I have dropped my Vit D + K2 tablet down to 1,000mg rather than the original 5,000.
The test results were as follows.

Fibrigonen This came in at 290 mg/dl. Fibrigonen produced by the liver can increase Platelet aggregation and blood viscosity making it an increase risk for clotting. My reading was well under the levels shown in trials to increase risk and you really want it to be below 300mg/dl. Maybe my Fruitflow supplement is doing the trick here. There is a good account of Fibrigonen at
http://www.lifeextension.com/magazine/2006/5/awsi/page-01

Apo A1 135 mg/dl
Apo B 89 mg/dl

The number to look at here is the Apo B to Apo A1 ratio. In other words ApoB divided by Apo A1. In my case its 0.66 which is way below the suggested 0.9 for men. In more than one trial this ratio has been shown to be a better predictor of Cardio disease than LDL counts, HDL counts or even Total Cholesterol to HDL ratio. Many people have pressed for this to be included within the standard lipid panel you get from your GP for this very reason. Of course it would muddy the waters and probably reduce the number of people needing Statins (does anyone need Statin ?), so don’t expect this to happen anytime soon. The Quebec Cardio Study makes a strong case for this ratio, read more about it at http://www.scielo.br/scielo.php?pid=s0066-782×2007000600014&script=sci_arttext&tlng=en

Lp(a) I have covered this on previous blog entries. Considered by many to be a substitute for Vit C and only produced by those species who cannot manufacture their own Vit C like us humans. In my case my Vit C intake seems to be keeping it down at 18.3 mg/dl (ideal is below 30)

MPO (Myeloperoxidase) This newcomer to me is a test of an enzyme made by white blood cells within the artery wall and is a good indicator of inflamation levels and hence vulnerable plaque. That’s vulnerable in the sense that its likely to burst and spill its gunge into your blood stream which with the help of your systems natural defences, will turn into a thrombus. Mine came in way below the reference of less than 3.5 KUA/L at somewhere less than 0.2. Don’t you just wish all these various test currency units were in just one currency like Euro’s?. Thinking about it maybe not Euro’s, perhaps Bitcoins.
A link here for MPO readers
http://www.bostonheartdiagnostics.com/science_portfolio_testing.php
Also some evidence supporting veggies have lower levels of MPO
https://www.ncbi.nlm.nih.gov/pubmed/27496081

Homocyteine This one came in slightly higher than the reference range of 0.5 to 1.88 mg/L at 1.93. This was a bit of a surprise as my previous two readings were 1.27 and 1.18. There are two possible explanations for this. First of all for the past 2 or 3 months I have leaning far more in the direction of Vegananism simply because I have cut down on fish a tad. I still eat fish but not as often. The second explanation is that I now take a Vit B12 lozenger instead of the multi vit B with Folate pill that I originally took. Homecysteine is lowered in the blood stream via 3 pathways.

1. Vitamin B6
2. Choline
3. Vitamin B12 and Folate

For Vegans B6 and Choline is not usually a problem but B12 in particular is as the main source is meat. Given that it works in conjunction with Folate it could be that I need at least to have a B12 and Folate supplement or to revert back to the multi Vit B tablet even if it does turn your piss green.

Footnote – 1 week back on the Jarrow B Right supp’s and my Homocystein dropped to 1.74 which suggests that with a few more weeks it will be back at the 1.27 range. I am however going to switch to a B12 and Folate supp’. As I stated earlier I want to avoid Niacin which is in the multi B supp as there is some evidence that Niacin can increase Lp-PLAC2. I will retest in January after a good spell on B12 plus Folate.

Update – It is now January and I can report that on the B12 and Folate from Life Extension my Homocysteine is back down to 1.42 mg/L that’s 10.5 um/ol. Not quite as low as when I was on the Jarrow tab’s originally but I am pretty happy with that.

The Blind Spot

okiamandmeA concert held by a friend of mine recently involved an interesting experiment. For one song we were all asked to listen blindfolded while Okiem played piano accompanied by a 10 piece orchestra. This was an interesting experience although at the time I did not realize that the blindfold handed out and stored in my pocket would prompt me to try another experiment later on that week.
I have just finished an excellent book called Tripping Over The Truth. A history of the flawed approach to tackling Cancer and how a perhaps more promising metabolic path first mentioned by Otto Warburg has for too long been ignored. One paragraph that really caught my eye was that blind people suffer less with all known cancers. One theory being that they are more in tune with their Circadian rythmns. In other words they are not effected by night time light and as a result sleep better and produce more or at least adequate Melatonin.
Now I am sure you can see (no pun intended) where this is going. There is plenty of research linking poor quality of sleep and the production of stress hormones such as Cortisol. There is also a growing line of thinking that stress may be the strongest factor in promoting heart disease. Certainly countries suffering large mass traumatic stress see big spikes in heart attacks. Now I have long been a believer that if you can for one minute just imagine how you feel on those odd days when you sleep uninterrupted like the proverbial baby for 8 hours the night before. Now imagine every day was like that. Where do you think your health would be ?. For that matter where would your life be?. I am sure you would be more successful in all departments as you utilize that fantastic feeling of well being that comes on those days.
Needless to say prompted by all this I have been experimenting with wearing a face mask during the night time. After the initial hi ho silver jokes I can report that I do seem to be sleeping deeper. If I can couple this up with my theory on fiber (check pea consumption in my case) and the elimination of night time bathroom visits then who knows I may even consider buying a white horse.

Carbs and Saturated Fat

Mounting evidence suggests that a low carb high fat diet is healthy and part of our trouble has been the last 40 years or so of high carb low fat recommendations. Sat fat is not the devil unless it ends up being stored in your blood stream but consuming it does not guarantee this will happen. Simple carb’s seem to be the accomplice that promote saturated fat into the blood stream. As the speaker in this excellent presentation suggests, a marbled steak with lots of potatoes and rice can be a killer but with just vegetables its a different proposition.

Fibrinogen and Heart Disease

Fibrinogen, a protein produced by the liver, plays a role in the development of atherosclerotic plaque. Fibrinogen can also cause acute blood clot formation that may block a coronary artery (causing a heart attack) or a cerebral artery (causing an ischemic stroke). I must admit I had not paid too much attention to this measure as when I last had it tested it came in at 309 mgdl which was well inside the OK range on the blood report I got back. This reference range tends to be 150 to 400 but some authorities are stating that there is evidence to support keeping it below 300. It is one of those factors that is not easily manipulated, the biggest effect coming from quiting smoking which in my case does not apply. Exposure to cold increases fibrinogen levels by 23 percent according to one study, perhaps adding weight to the fact that the further away from the equator you are the more likely to suffer from HD. Another study however has shown that Turmeric can have a significant effect on lowering Fibrinogen. I have already mentioned that a simple and easy way to up your Turmeric consumption is to add a little to your daily porridge. here is the link to the study that suggested Turmeric can help.

Turmeric Reverses Fibrinogen