For a very long time, doctors have mistakenly told patients that higher HDL cholesterol levels are a marker for better health, and that the ratio of HDL to LDL was an important metric to monitor. Many doctors have furthermore insisted that lower HDL levels are markers of poor health. None of this is true. Lower LDL AND HDL cholesterol levels should be the goal, and higher HDL levels are not only not protective, but are a risk factor for coronary artery disease and other health issues.
Some Basics
A primary role of HDL cholesterol is reverse transport, the mechanism by which the body takes excess cholesterol from the peripheral tissues and bloodstream and delivers it to the liver for removal by the gall bladder. Generally, HDL levels can be expected to rise in response to higher plasma LDL levels. With few exceptions, higher plasma LDL levels result from consuming a diet high in saturated fat and cholesterol, both of which are concentrated in animal foods. The more LDL and saturated fat consumed, the more cholesterol produced by the liver. Another way of looking at this is that there would be no need for higher HDL levels if a person were not consuming so much food containing LDL cholesterol and saturated fat.
Quality is Better Than Quantity
The measurement of plasma cholesterol that is most related to the prevention of atherosclerosis and coronary events is HDL efflux capacity – the ability of HDL to remove bad, or LDL cholesterol from macrophages.[1] Macrophages are immune cells that become pro-inflammatory foam cells when they engulf LDL cholesterol. This explains why some people with high plasma HDL cholesterol develop coronary artery disease, while others with lower plasma HDL do not.
To illustrate this point, HDL efflux capacity was measured in almost 1000 subjects;
442 of them had been diagnosed with coronary artery disease, 351 had not been diagnosed coronary artery disease, and 203 healthy volunteers.
The researchers reported that:
· Subjects with high HDL efflux capacity had lower levels of atherosclerosis and obstructive coronary artery disease, while those with low HDL efflux capacity had higher levels of atherosclerosis and obstructive coronary artery disease.· Statins were not effective for raising HDL efflux capacity.· There was no relationship between blood levels of HDL and efflux capacity.· Habits influenced efflux capacity: smokers had low HDL efflux capacity even if they had higher plasma HDL levels, for example.· There was a significant relationship between HDL efflux capacity and carotid artery thickening (a marker for atherosclerosis), and this relationship persisted regardless of plasma levels. In other words, higher plasma cholesterol was not protective, while lower plasma levels with higher efflux capacity was.· The proportion of patients with coronary artery disease decreased consistently with increases in HDL efflux capacity.[2]
The bottom line:
Measuring plasma levels of HDL to determine health status is futile. Additionally, attempts to increase HDL levels using drugs and supplements has been shown to increase the risk of cardiovascular events and death.[3] [4]
Furthermore, higher HDL levels are indicators for risk of macular degeneration,[5] fractures,[6] and dementia. Data from a longitudinal study that included 18,668 healthy participants showed that those with HDL levels of 80 mg/dLor higher had a 27% higher risk of dementia than subjects with HDL levels of lower of 60 mg/dL.[7] The diet that protects the cardiovascular system also protects the brain.
Conclusions:
A plant-centered diet that is low in saturated fat and cholesterol is the best diet for humans. The incidence of coronary artery disease is very low in cultures that consistently consume a plant-based diet. These include the Tarahumara Indians[8], The Papua New Guinea highlanders[9], and rural Chinese.[10] In some rural areas of China, hundreds of thousands of people go for years without a single myocardial infarction.
[1] Khera AV, Cuchel M, de la Llera-Moya M et al. “Cholesterol efflux capacity, high-density lipoprotein function, and atherosclerosis.” NEJM 2011 Jan;364(2):127-135
[2] IBID
[3] Keene D, Price C, Shun-Shin MJ, Francis DP. "Effect on cardiovascular risk of high-density lipoprotein targeted treatments niacin, fibrates, and CETP inhibitors: meta-analysis of randomized, controlled trials including 117 411 patients." BMJ 2014; 349:g4379
[4] Michael O'Riordon "No Clinical Benefit to Raising HDL With Existing Therapies, Meta-Analysis Shows" July 23, 2014 www.heartwire.com
[5] Colijm JAM, den Hollander AI, Demirkan A et al. “Increased High-Density Lipoprotein Levels Associated with Age-Related Macular Degeneration: Evidence from the EYE_RISK and European Eye Epidemiology Consortia.” Ophthalmology 2019 Mar;126(3):393-406
[6] Hussain SM, Ebeling PR, Barker A, Neilin LJ, Tonkin AM, McNeil JJ. “Association of Plasma High-Density Lipoprotein Cholesterol Level With Risk of Fractures in Healthy Older Adults.” JAMA Cardiol 2023 Mar;8(3):268-272
[7] Hussain SM, Robb C, Tonkin AM et al. “Association of plasma high-density lipoprotein cholesterol level with risk of incident dementia: a cohort study of healthy older adults.” Lancet Regional Health 2023 Nov: https://doi.org/10.1016/j.lanwpc.2023.100963
[8] Connor WE, Cerqueira MT, Connor RW, et al. “The plasma lipids, lipoproteins, and diet of the Tarahumara Indians of Mexico.” Am J Clin Nutr 1978 Jul;31(7):1131-42
[9] Sinnett PF, Whyte HM. “Epidemiological studies in a total highland population, Tukisenta, New Guinea. Cardiovascular disease and relevant clinical, electrocardiographic, radiological and biochemical findings.” J Chron Diseases 1973 May; 26(5):265-290
[10] Campbell TC, Parpia B, Chen J. “Diet, lifestyle, and the etiology of coronary artery disease: The Cornell China Study.” Am J Card 1998 Nov;82(10B):18T-21T.
Dr. Pam Popper, President, Wellness Forum Health
Your Wellness Lifestyle Starts Here
Some of the worst dietary advice is given to athletes of all ages. The misinformation starts in middle and high school, when well-meaning but misinformed coaches often instruct student athletes to eat more protein, use sports drinks for hydration, and consume dairy products for strong bones. Supplements are almost always recommended by trainers for body builders and other adult athletes with the promise that they contribute to more rapid muscle development and better performance. Diet and supplement recommendations are delivered with the implication that results are virtually assured and usually without any explanation of the potential risks. Furthermore, other dietary patterns, such as more plant-based diets are almost never discussed, except to dismiss them as not adequate for helping athletes to train and perform.
Supplements, in particular, are a concern, and the results of a new study should encourage even more people to avoid them. This study included 356 men between the ages of 18 and 55 who had had testicular cancer and 513 controls. Researchers looked at many factors, including exercise, smoking, drinking, family history, and the use of supplements for building muscle. The researchers concluded that muscle-building supplements, particularly those that contained both creatine (which is a hot topic right now) and protein, and those with testosterone-boosting androstenedione, significantly increased the risk of testicular germ cell cancer. Lead researcher Tongzhang Zheng said, “The observed relationship was strong. If you used them at an earlier age, you had a higher risk. If you used them longer, you had a higher risk. If you used multiple types, you had a higher risk.”
The researchers also noted that many supplements contain unknown ingredients that can increase the risk of cancer, citing a study that showed that 15% of supplements that did not include hormones on the labels contained anabolic androgenic steroids which have been associated with testicular cancer in animal studies.
The incidence of testicular germ cell cancer is rising in both the U.S. and Europe, and is the most common malignancy in men between the ages of 15-39 years of age. While many other factors are most certainly contributors, including poor diet, supplements to boost sports performance increase the risk even more, and should be avoided.
Athletes should be informed that optimal performance can be achieved without high-protein diets and supplements; in fact more and more athletes are finding that sports performance is enhanced by eating a more plant-based diet. Athletes do not need to choose between optimal performance or optimal diet. In fact optimal diet leads to optimal performance.
Li N, Hauser R, Holford T et al. “Muscle-building supplement use and increased risk of testicular germ cell cancer in men from Connecticut and Massachusetts.” British J Cancer March 31 2015;112:1247-1250
Niamh Michall “Muscle-building supplements linked to testicular cancer risk.”
Nutraingredients-usa.com April 14 2015
Wellness Forum Health
Stress Paralyzes Immune Cells
A research team in Australia led by immunologist Scott Mueller injected a stress hormone, norepinephrine, into the bloodstreams of mice. The purpose was to see how immune cells responded to stress hormones. Within just a few minutes, T-cells stopped moving. To make sure it was the stress hormone and the injection itself, the researchers performed the same experiment using dopamine, which had no effect on immune function.
To further research the issue, researchers infected the mice with herpes simplex virus (HSV). After two days the mice were treated with a molecule called Iso that mimics the action of adrenaline, a stress hormone. This also stopped the action of T-cells and dendritic cells for over two hours. When another substance called salmeterol, which acts on the same receptors, was injected two times per day for three days, there were fewer virus-specific T-cells at the sites of infection. Additional experiments with mice injected with melanoma cells or malaria parasites showed the same result – stress hormones and substances that mimic them suppress immune function.
There are other mechanisms at work too:
- In response to intense fear or stress, messages from the brain are sent to the endocrine system
- The adrenal glands release adrenaline and noradrenaline
- The body gets ready for fight or flight
- The heart beats faster, and blood pressure rises to send more blood to the arms and legs
- Extra glucose and fat are released for energy
This cascade of events works well for short-term situations in which people must act quickly to survive but does not work well when lower-level stress and anxiety becomes a chronic condition.
Stress also activates responses like inflammation, which helps to repair damaged or infected tissues. Inflammation causes white blood cells to flood an area where an injury has occurred, and release cytokines and recruit macrophages to clean out debris and dead cells. Inflammation is helpful for healing injury; not so much when stuck in the “on” position due to being in a continuous state of fight or flight.
Remaining constantly stressed about viruses makes you more likely to get sick from viruses. Here are some recommendations to reduce your stress:
- choose sources of information that do not result in increased stress
- carefully choose the people you hang around with – some have become toxic sources of stress and panic
- focus on strategies like eating well, exercising, getting out in the sunlight, drinking water – you will feel less stressed about health if you are healthy
- practice gratitude – thinking about what is good in life shifts the focus from the things that are not as good.
Devi S, Alexandre YO, Loi JK et al. “Adrenergic regulation of the vasculature impairs leukocyte interstitial migration and suppresses immune responses.” Immunity 2021 Jun;54(6):1219-1250
Building a Muscular Body for Health and Longevity
Did you know that as we age, we "disintegrate"? Nursing homes are full of folks who did not age well.
Building muscle strength is protective for our health. Frailty is destructive to our health.
Muscle is a functional metabolic organ and poor muscle strength is an independent predictor of poor health outcomes for the elderly who do not engage in proper strength training.
Skeletal muscle is the largest organ in the body by mass-30% to 50% of total body mass-depending on fitness level. Muscle is considered an endocrine organ contributing to metabolic function, hormone regulation and disease prevention. Muscle plays a part in preventing Type 2 diabetes because it plays a role in glucose metabolism. Muscle controls glucose and lipid levels, which results in reduced risk of diabetes. Muscle loss results in reduced glucose clearance, which then increases the risk of Type 2 diabetes. Energy expenditure, or calorie burn, is related to how muscular you are as well, with exercise playing a more minor role.
Most people in westernized countries lose muscle as they age. This is referred to as sarcopenia. The average muscle mass of a young healthy person ranges from 77 to 110 lbs. Contrast that to an elderly woman that has not engaged in strength training with only around 29 lbs. of muscle mass.
Muscle burns more calories than fat. A young person loses around 0.5% muscle mass per year. By the time we are in our 50s-60s, it accelerates to 3% per year. It is an imperceptible change which leads to that moment in life when we wake up one day and say, "how did I get so overweight and out of shape?!" Sarcopenia has been happening!
Early signs include not being able to climb stairs like we used to, not being able to lift something heavy that never gave us trouble in the past, and falls, to name a few. This all leads to a loss of independence.
Life spans are shorter for people who are not muscular and recovery from diseases can take longer due to complications that develop in older and frail people. During illness, the body depends on nutrients stored in muscle to promote better immune response and tissue repair. People with limited muscle reserves therefore have a harder time recovering from illness, including cancer.
The only solution to this is strength training. Eating a high protein diet does not help. Muscle mass also contributes to lower levels of inflammation and muscle releases myokines like interleukin 6 that lowers inflammation. Inflammation is a major influence in promoting all of the diseases that we don't want to get, like cardiovascular disease, arthritis, cancer.
Aerobic exercise helps, but strength training helps more! Another benefit of strength training is that it directly stimulates mitochondrial biogenesis and improves mitochondrial function, which impacts energy production and improves the function leading to increased endurance and lower risk of disease and lower risk of early death.
Strength training is key to preventing osteoporosis and improving bone mass if you have already lost some bone mass.
Just walking is not enough because strength training impacts bones that walking does not, like hips and spine. 10,000 steps a day does not build strength, or even aerobic capacity. You are just "marking time".
Be willing to do what needs to be done for your long-term health. It's fun to be a strong person.
Did you know that you can rebuild your brain with exercise?
In a previous blog, I wrote about the brain's capacity to rewire itself based on repeated thoughts and experiences. This is called "neuroplasticity". If you are a scripture reader, the apostle Paul points to neuroplasticity when he says, "be transformed by the renewing of your mind." (Romans 12:2) The more you do or think something, the more neural pathways you create. Our goal should be to create strong pathways by setting our minds and actions on positive thoughts and habits, reinforcing them daily. Whatever "rut" you think you are stuck in, well, you are not if you don't want to be. We have the ability to change, to transform.
When we exercise, we are also creating new neural pathways. People who exercise have physically different brains.
- The hippocampus, which is key for memory, is stimulated by exercise that increases heart rate. Out of shape people grew new blood vessels in the hippocampus after just 12 weeks of exercise. Aerobic exercise that is good for the heart is good for the brain. Higher levels of aerobic fitness is associated with increased hippocampus volume.
- Exercise has been shown to reverse age-related shrinkage of the brain. Klotho, which is a hormone associated with longevity and protection against cognitive decline, show increased levels after only 20 minutes of intensive aerobic exercise.
Alzheimer's is almost always a diet and lifestyle induced disease, and exercise plays a key role in prevention as well as a diet rich in fruit and vegetables, high in fiber and low in fat. Physical activity
affects the brain’s immune cells, which results in lowered inflammation in the brain.
Microglia are immune cells in the brain which clear away debris and dying cells that result from injury or infection. Microglia also stimulate production of new neurons, which communicate with other cells, a process called neurogenesis that is involved in learning and memory. Microglia shift from a resting state to an activated state in order to do their jobs. When signals from pathogens or damaged cells activate the microglia, they produce pro-inflammatory molecules which are needed to repair damage to resolve infection or injury. The bottom line is that if we eat well for our health, we will be eating well for our brain!
Are you ready to transform your mind? Is it still in a rut? Are you believing the negative spin that you tell yourself? Once you buy into the lies you tell yourself, you risk that it will certainly play itself out.
We remain committed to making learning about health interesting and fun. You CAN take control of your health and make better and more informed decisions about what you eat, how you exercise, and other optimal lifestyle changes.
Liz Fattore
Certified Food Over Medicine Instructor
Diet & Lifestyle Intervention
