Thursday, February 3, 2011

Bigger is Better!!

Cholesterol: Bigger is Better

One of the advantages to having a doctor that is about your same age is that they are worried about the same types of health issues that you are.  For example, after Dan took a heart scan and started working on preventing heart disease, his primary care doctor started off with the standard prescription of statins. He also put him on Co-enzyme Q10 to counter the statin depletion of this enzyme that is critical to your heart health.  Many of Dan’s friends that have seen cardiologists are also on statins but are not on CoQ10, go figure.  Then he had Dan take a Berkley Heart Lab blood test ( and measured his vitamin D.Low vitamin D levels have been shown to correlate to significantly higher risk of heart disease.  The Berkley is a comprehensive test that measures the particle size distribution of your LDL and HDL along with arterial inflammation as well as a number of gene typing tests.  Particle size is critical because, while most of the generic info is focused on just getting your LDL down, more recent research is showing that the real killers in heart disease are the small dense LDL particles ( This risk is compounded when your HDL particles are also small. So, when it comes to cholesterol, Bigger is definitely better. A standard lipid profile doesn’t distinguish between small LDL and the larger benign LDL particles. It also doesn’t distinguish between the really big HDL, the heart healthy type, and the smaller HDL particles.  Statins only tend to reduce the overall number of LDL particles but don’t change their distribution. They also don’t do much to improve your HDL profile.  On the other hand, nicotinic acid otherwise known as niacin and sold as Niaspan (prescription) or Slo-Niacin (non-prescription) will not only reduce LDL, increase HDL but also move both the LDL and HDL particle size distribution to the big side. While nicotinic acid helps all aspects of the lipid profile, it is not without its side effects, so it is important to consult your doctor before starting on this supplement. While this was surprising enough, one of the most interesting gene tests that Dan took was the Apo E. This test measures how diet will affect your cholesterol profile.  While a low fat diet helps reduce overall LDL in all gene types it only reduces these deadly small dense particles in 25% of the population.  Shockingly, it actually increases these small dense particles in the other 75% of people (check out the chart on page 9 in this white paper – Additionally, while alcohol consumption, in moderation, can improve the lipid profile for 75% of the population it makes it worse for 25% of the population, here again, depending on your gene type. For years, both Dan and I were eating a diet that was close to what the American Heart Association would recommend. This included 6-8 servings of grains and not much meat, very low fat, getting enough veggies was an issue, (who can eat two heads of cauliflower a day?).  Dan’s cholesterol profile was pretty good for not being on drugs, yet it was heavily biased to the small size. When looking at his gene type he would fall into the 75% that would see an increase in small dense particles when on a low fat diet. Who knew that whole wheat bread we ate was so bad?  We are now working on a diet that increases protein and veggies while reducing the amount of grain and potatoes. All of the grains, rice and potatoes, yes even the whole grain type, tend to have a relatively high glycemic index.  These foods will increases triglycerides in your system and in turn triglycerides tend to create those deadly small dense LDL particles in 75% of the population. As a double whammy on high glycemic foods, a recently published study demonstrated that eating a meal such as corn flakes with milk very quickly produces arterial stress in otherwise normal, healthy adults, potentially leading to the inflammation at the root of cardiovascular disease (see this link  While the recommended low fat diet, including lots of whole grains, may be great for 25 percent of the population it could be killing the other 75 percent. The bottom line is that when it comes to controlling heart disease – One Size does NOT fit all. If you or a loved one are serious about improving your heart health-have your particle distribution tested (there are several tests for this including Berkley, VAP and NMR lipoprofile) and know your gene type!   
I urge you to talk to your doctor or holistic practitioner before making any changes to your current medications.  Your Doctor may be able to suggest the appropriate dosage of niacin for your particular situation and be able to monitor your progress as well as watch for any possible side effects.

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