Hdl Quotes

[from an entry by her daughter Camille] ...research published fifteen years ago in the New England Journal of Medicine: eggs from chickens that ranged freely on grass have about half the cholesterol of factory-farmed eggs, and it's mostly HDL, the cholesterol that's good for you. They also have more vitamin E, beta-carotene and omega-3 fatty acids than their cooped-up counterparts.

For women, the higher their cholesterol is, the longer their life; there’s a direct relationship between the two. Your cholesterol cannot be too high if you are a woman, but it can certainly be too low.

Values of TG/HDL-C over 3.5 indicate that you probably have pattern B with a predominance of small LDL particles, and a ratio this high indicates there’s a good chance you may also have insulin resistance[55].

A study published in the Proceedings of the National Academy of Sciences found that restricting calories by 30 percent significantly increased life span in monkeys.27 The experimental diet, while still providing adequate nourishment, slowed monkeys’ metabolism and reduced their body temperatures, changes similar to those in the long-lived thin mice. Decreased levels of triglycerides and increased HDL (the good) cholesterol were also observed. Studies over the years, on many different species of animals, have confirmed that those animals that were fed less lived longest. In fact, allowing an animal to eat as much food as it desires can reduce its life span by as much as one-half.

The “concerns” about low-carbohydrate diets still revolve around the imagined risk of cardiovascular disease from fat in the diet despite the continued failure to show any risk. Carbohydrate restriction, however, improves the usual markers, notably HDL (“good cholesterol”) and triglycerides.

Scientists generally agree that the more HDL you have, the lower your risk for heart disease. As you might have imagined, people with Metabolic Syndrome and type 2 diabetes also typically have low levels of beneficial HDL. Exercise is one of the cheapest, easiest, and most effective ways to raise HDL. Consuming saturated fat is another!

Today we call this cluster of problems “metabolic syndrome” (or MetSyn), and it is defined in terms of the following five criteria: high blood pressure (>130/85) high triglycerides (>150 mg/dL) low HDL cholesterol (<40 mg/dL in men or <50 mg/dL in women) central adiposity (waist circumference >40 inches in men or >35 in women) elevated fasting glucose (>110 mg/dL)

Niacin. This supplement, also called vitamin B3, has earned a reputation as a natural cholesterol-lowering agent that often rivals prescription drugs in mild to moderate cases. Unlike most prescription cholesterol-lowering medications, which simply lower levels of LDL cholesterol and the bad fats found in triglycerides, niacin also raises levels of HDL cholesterol. As a result, this vitamin may prove more potent than conventional medicines in ultimately reducing the risk of a heart attack.

in life you’ll surround yourself with good company sometimes, however, the best company will be yourself. we might as well learn to accept the quiet, acknowledge the stillness, shake hands with the discomfort and declare it safe. because truth be told, if we aren’t safe alone with ourselves, we probably won't be with anyone else.

Simple markers can show us “check engine” alerts. A most basic and accessible way to see if you have a reasonable level of metabolic health is by checking five markers that are almost always tested and tracked at your annual checkup: blood sugar, triglycerides, high-density lipoprotein (HDL) cholesterol, blood pressure, and waist circumference. When these markers fall into an optimal range, in the absence of medication—see Chapter 4 for exact specifications—you can deduce that your cellular energy production is doing OK. Typically, you will feel vibrant, healthy, and pain-free. These feelings, too, should tell you that your body has Good Energy, the foundation of general good health.

Triglyceride-to-HDL Ratio After assessing each of these five biomarkers, there is one more step: calculate your triglyceride-to-HDL ratio to better understand insulin sensitivity. Simply divide your triglycerides by your HDL. Interestingly, studies have shown that this value correlates well with underlying insulin resistance. So even if you are unable to access a fasting insulin test, the triglyceride-to-HDL ratio can give you a general sense of where you’re at. According to Dr. Mark Hyman, “the triglyceride-to-HDL ratio is the best way to check for insulin resistance other than the insulin response test. According to a paper published in Circulation, the most powerful test to predict your risk of a heart attack is the ratio of your triglycerides to HDL. If the ratio is high, your risk for a heart attack increases sixteen-fold—or 1,600 percent! This is because triglycerides go up and HDL (or ‘good cholesterol’) goes down with diabesity.” Dr. Robert Lustig agrees: “The triglyceride-to-HDL ratio is the best biomarker of cardiovascular disease and the best surrogate marker of insulin resistance and metabolic syndrome.” In children, higher triglyceride-to-HDL is significantly correlated with mean insulin, waist circumferences, and insulin resistance. In adults, the ratio has shown a positive association with insulin resistance across normal weight and overweight people and significantly tracks with insulin levels, insulin sensitivity, and prediabetes. Perplexingly, the triglyceride-to-HDL ratio is not a metric used in standard clinical practice. If you remember one thing from this chapter, remember this: you need to know your insulin sensitivity. It can give you lifesaving clues about early dysfunction and Bad Energy brewing in your body, and is best assessed by a fasting insulin test, discussed below. Right now, this is not a standard test offered to you at your annual physical. I implore you to find a way to get a fasting insulin test or to calculate your triglyceride-to-HDL ratio every year. Do this for your children, as well. And take the steps outlined in the following chapters to ensure it does not start creeping up. RANGES: Range considered “normal” by standard criteria: none specified in standard criteria Optimal range: Anything above a ratio of 3 is strongly suggestive of insulin resistance. You want to shoot for less than 1.5, although lower is better. I recommend aiming for less than 1.

For our purposes, the most important thing to note is that this whole kerfuffle serves as a perfect example of how a failure to consider the functional, social benefits of alcohol can seriously skew public debate on the topic. There is no need to quibble around the margins about HDL levels. The most important thing that neo-Prohibitionists and health authorities alike fail to consider in coming down on the side of total abstinence is that the obvious physiological and psychological costs of alcohol must be weighed against their venerable role as an aid to creativity, contentment, and social solidarity. Once we recognize the functional benefits of intoxication—its role in helping humans to adapt to our extreme ecological niche—the argument that we should strive for a completely dry world is difficult to sustain. We saw in Chapter Three how alcohol and

Most people now have the ‘LDL-C is bad and HDL-C is good’ concept down pat. But there is more to the story. It is well established that not all LDL particles are created equal. Moreover, certain types of LDL have been shown to correlate with abnormal lipid profiles and promote atherosclerosis. As noted previously, the larger more buoyant LDL particles are less harmful than smaller ones. Small LDL particles reside in the circulation longer, have greater susceptibility to oxidative damage by free radicals, and more easily penetrate the arterial wall, contributing to atherosclerosis. No matter what your total LDL-C concentration, if you have relatively more small particles (referred to as Pattern B) it puts you at a several-fold higher risk for heart disease compared to people with larger LDL particles (Pattern A)[49]. And once again, this is independent of your LDL-C concentration.

The best test for measuring LDL particles is the NMR Lipoprofile test from Liposcience in Raleigh, North Carolina. NMR is the acronym for “nuclear magnetic resonance” and it is the best commercial lab test using this state-of-the-art technology to determine the nature of your LDL particles—whether they are mostly the large, fluffy Pattern A kind (the good ones) or the small, dense Pattern B type (the bad ones). Your LDL-P number is far more relevant to heart health than your LDL-C will ever be.

Below are recommended optimal ranges for key metabolic blood tests. Falling outside of these ranges is an indicator that you could have brewing dysfunction. The remainder of Part 2 and the plan in Part 3 will give specific steps to increase Good Energy and improve these biomarkers: Triglycerides: Less than 80 mg/dL HDL: 50 to 90 mg/dL Fasting Glucose: 70 to 85 mg/dL Blood Pressure: Less than 120 systolic and less than 80 diastolic mmHg Waist Circumference: <80 cm (31.5 inches) for women and <90 cm (35 inches) for men (South Asian, Chinese, Japanese, and South and Central Americans) <80 cm (31.5 inches) for women and <94 cm (37 inches) for men (European, Sub-Saharan African, Middle Eastern, and Eastern Mediterranean) Triglyceride-to-HDL Ratio: Below 1.5. Above 3 is a clear sign of metabolic dysfunction. Fasting Insulin: From 2 to 5 mIU/L. Above 10 mIU/L is concerning and above 15 mIU/L is significantly elevated. HOMA-IR: Less than 2.0 High-Sensitivity CRP (hsCRP): Less than 0.3 mg/dL Hemoglobin A1c: From 5.0 to 5.4 percent Uric Acid: Less than 5 mg/dL for men, and from 2 to 4 mg/dL for women

REPROGRAMMING MY BIOCHEMISTRY A common attitude is that taking substances other than food, such as supplements and medications, should be a last resort, something one takes only to address overt problems. Terry and I believe strongly that this is a bad strategy, particularly as one approaches middle age and beyond. Our philosophy is to embrace the unique opportunity we have at this time and place to expand our longevity and human potential. In keeping with this health philosophy, I am very active in reprogramming my biochemistry. Overall, I am quite satisfied with the dozens of blood levels I routinely test. My biochemical profile has steadily improved during the years that I have done this. For boosting antioxidant levels and for general health, I take a comprehensive vitamin-and-mineral combination, alpha lipoic acid, coenzyme Q10, grapeseed extract, resveratrol, bilberry extract, lycopene, silymarin (milk thistle), conjugated linoleic acid, lecithin, evening primrose oil (omega-6 essential fatty acids), n-acetyl-cysteine, ginger, garlic, l-carnitine, pyridoxal-5-phosphate, and echinacea. I also take Chinese herbs prescribed by Dr. Glenn Rothfeld. For reducing insulin resistance and overcoming my type 2 diabetes, I take chromium, metformin (a powerful anti-aging medication that decreases insulin resistance and which we recommend everyone over 50 consider taking), and gymnema sylvestra. To improve LDL and HDL cholesterol levels, I take policosanol, gugulipid, plant sterols, niacin, oat bran, grapefruit powder, psyllium, lecithin, and Lipitor. To improve blood vessel health, I take arginine, trimethylglycine, and choline. To decrease blood viscosity, I take a daily baby aspirin and lumbrokinase, a natural anti-fibrinolytic agent. Although my CRP (the screening test for inflammation in the body) is very low, I reduce inflammation by taking EPA/DHA (omega-3 essential fatty acids) and curcumin. I have dramatically reduced my homocysteine level by taking folic acid, B6, and trimethylglycine (TMG), and intrinsic factor to improve methylation. I have a B12 shot once a week and take a daily B12 sublingual. Several of my intravenous therapies improve my body’s detoxification: weekly EDTA (for chelating heavy metals, a major source of aging) and monthly DMPS (to chelate mercury). I also take n-acetyl-l-carnitine orally. I take weekly intravenous vitamins and alpha lipoic acid to boost antioxidants. I do a weekly glutathione IV to boost liver health. Perhaps the most important intravenous therapy I do is a weekly phosphatidylcholine (PtC) IV, which rejuvenates all of the body’s tissues by restoring youthful cell membranes. I also take PtC orally each day, and I supplement my hormone levels with DHEA and testosterone. I take I-3-C (indole-3-carbinol), chrysin, nettle, ginger, and herbs to reduce conversion of testosterone into estrogen. I take a saw palmetto complex for prostate health. For stress management, I take l-theonine (the calming substance in green tea), beta sitosterol, phosphatidylserine, and green tea supplements, in addition to drinking 8 to 10 cups of green tea itself. At bedtime, to aid with sleep, I take GABA (a gentle, calming neuro-transmitter) and sublingual melatonin. For brain health, I take acetyl-l-carnitine, vinpocetine, phosphatidylserine, ginkgo biloba, glycerylphosphorylcholine, nextrutine, and quercetin. For eye health, I take lutein and bilberry extract. For skin health, I use an antioxidant skin cream on my face, neck, and hands each day. For digestive health, I take betaine HCL, pepsin, gentian root, peppermint, acidophilus bifodobacter, fructooligosaccharides, fish proteins, l-glutamine, and n-acetyl-d-glucosamine. To inhibit the creation of advanced glycosylated end products (AGEs), a key aging process, I take n-acetyl-carnitine, carnosine, alpha lipoic acid, and quercetin. MAINTAINING A POSITIVE “HEALTH SLOPE” Most important,

Let me describe a typical person with wheat deficiency: slender, flat tummy, low triglycerides, high HDL (“good”) cholesterol, normal blood sugar, normal blood pressure, high energy, good sleep, normal bowel function.

Fasting insulin between 3 and 6 µu/dl A1C less than 5% Triglycerides below 100 mg/dl HDL greater than 65 mg/dl (male) or 75 (female) Cortisol below 12 µg/dl

For men, score an “A” if your IGF-1 is in the range 150 ng/ml ± 20 (higher is dangerous), total testosterone is above 500 ng/dl, and HDL is above 65 mg/dl. Score a “B” if your IGF-1 is above 125 ng/ml and HDL is above 45 mg/dl. Otherwise a “C.

Part One—The Lipid Panel. Used to evaluate heart health, this panel comprises of four biological markers representing the four types of fat found in the blood—triglycerides, total cholesterol, high-density lipoprotein (HDL), and low-density lipoprotein (LDL). Two additional measures of cardiovascular health, homocysteine and c-reactive protein (CRP), may also be measured as part of a more comprehensive profile. These two labs are discussed in Part Six, “Optional Tests” (see page 8). •  Part Two—The Basic Metabolic Panel. The labs used to evaluate metabolism measure blood sugar regulation, electrolyte and fluid balance, and kidney function. Biomarkers included in this panel are glucose, calcium, sodium, potassium, blood urea nitrogen (BUN), and creatinine. •  Part Three—The Hepatic Function Panel. This panel determines how well your liver is functioning by measuring levels of different proteins produced and processed by the liver, like albumin and globulin, as well as liver enzymes. •  Part Four—The Complete Blood Count (CBC) Panel. The lab values measured in the complete blood count (CBC) panel include red blood cells, white blood cells, platelets, and hemoglobin. Maintaining healthy levels of these biomarkers affect your vitality and energy, immune system, and cardiovascular health. •  Part Five—Hormones. Although they are not always included in a routine blood test, hormones should be periodically tested, especially in aging adults. Hormones such as estrogen, testosterone, progesterone, DHEA, and prostate specific antigen (PSA) play an integral role in reproductive wellness and affect other aspects of health. Maintaining balanced levels can slow down the aging process, for instance. Hormones involved in metabolism, like the thyroid hormones and the stress hormone cortisol, are also discussed in this section. •  Part Six—Optional Tests. This final part of the book highlights four tests—homocysteine, c-reactive protein (CRP), vitamin D, and magnesium—that are not typically measured unless requested, or if a standard blood test shows an abnormality that requires a more in-depth analysis. These tests can provide a more complete picture of heart health, immunity, calcium absorption, blood sugar regulation, and a number of other vital processes.

Dietary cholesterol, for instance, has an insignificant effect on blood cholesterol. It might elevate cholesterol levels in a small percentage of highly sensitive individuals, but for most of us, it’s clinically meaningless.” At the same time, a diet high in carbohydrates is strongly associated with high triglycerides, low HDL, and the damaging particles of LDL, which is the killer profile.

These fully grown particles are the “really good” cholesterol we mentioned earlier, and are also known as HDL2b, mature cholesterol, or very large HDL particles.

Lp(a). People with high concentrations of Lp(a), an LDL variant, are at increased risk of heart problem and should focus on heart-healthy practices (exercise, low carbs). APO-E4. Apolipoproteins are a family of proteins that coat LDL, HDL, and chylomicron particles in order to make them water soluble. The APO-E4 subtype is a strong risk factor for Alzheimer’s and heart disease. Again, the best way to fight it, indeed, the only way, is through heart-healthy practices. Celiac Disease. This is caused by a reaction to gluten, which is found primarily in wheat. It can be quite serious if undiagnosed. Some cannot digest wheat. The solution is simple, though: no wheat or other glutens. LDL particle size. A predominance of small LDL particles causes heart disease. The size is determined by diet and exercise, but also genetically. Again heart-healthy practices can counteract this. Homeostatic weight. If you are on a low-carb diet and exercise, your body will regulate to the weight that your hypothalamus thinks is your healthiest. Further weight loss is difficult. The specific level is largely genetic. MTHFR. A deficiency of this could result in high homocysteine. Homocysteine is a toxic breakdown product of the essential amino acid methionine. Stress

Lp(a). Already mentioned, Lp(a) is a lipoprotein (cholesterol) variant that increases heart risk. About 10% of the population is at risk. See the “Is Your Lp(a) High?” section in chapter 9 for details. APO-E4. Apolipoproteins are a family of proteins that coat LDL, HDL, and chylomicron particles in order to make them water soluble. The APO-E4 subtype is a strong risk factor for Alzheimer’s. See “Do You Have the APO-E4 Variant?” in chapter 9 for details. Again, the best way to fight it, indeed, the only way, is through heart-healthy practices, and knowledge of its presence provides strong motivation. Normally this test is ordered after it is too late. Caught early, the risk can be substantially reduced. TTG and Gliadin Antibodies - Gluten Intolerance. Gluten intolerance is a severe reaction to gluten, found primarily in wheat. In the extreme, it is called celiac disease. Some cannot digest wheat at all. The solution is simple though: cut out wheat and other glutens. See “Are You Gluten Intolerant?” in chapter 9 for details.

Lipids (fats) of interest here are HDL, triglycerides, and Lp(a). Lp(a) need be measured only once. HDL and triglycerides are measured quarterly.

APOLIPOPROTEIN A1 (Apo A1) Apo A1 is the major protein of HDL (good) cholesterol. Low levels of Apo A1 is associated with increased risk of early cardiovascular disease, and may be seen more often in patients with a high-fat diet, inactivity, and central obesity.

Ultra-Sensitive C-Reactive Protein Blood (HS-CRP) C-reactive protein measures an inflammatory response in the body and has been shown to play a role in atherosclerosis and blood clot formation.  Patients should ask their doctor specifically about HS-CRP, as this test helps determine heart disease risk. Elevated HS-CRP is related to increased risk for heart attack, restenosis of coronary arteries after angioplasty, stroke, and peripheral vascular disease (PVD). While elevated cholesterol, LDL, and triglycerides plus low HDL are independent risk factors for heart disease and cholesterol build-up, HS-CRP provides added information about inflammation in the arteries. This cannot be determined by lipid testing alone. Results Less than 1.0 mg/L = Low Risk for Cardio Vascular Disease (CVD) 1.0 – 2.9 mg/L = Intermediate Risk for CVD Greater than 3.0 mg/L High Risk for CVD

Results about disease risk that largely agree among different studies include those for CHD [Coronary Heart Disease] and perhaps diabetes and colon cancer. In addition, data on other risk factors for chronic diseases, such as overweight, blood lipids, and blood pressure, fit this criterion. Mortality and incidence rates of coronary disease events are indeed clearly lower in vegetarians. This is true in the 2 previous cohorts of Adventists (16, 22) and in the older cohorts of British and German vegetarians (23–25). A combined analysis of those cohorts (26) confirmed this result with a 32% higher CHD mortality rate in the nonvegetarians. This is not surprising because there is convincing evidence that several important risk factors for CHD have more optimal values in vegetarians. Regular, moderate nut (16, 27) and wholegrain (11, 16) consumption are associated with lower risk of CHD. These are foods often preferred by vegetarians. Several other studies of nonvegetarians have strongly suggested that dietary patterns emphasizing fruit, vegetables, and less meat are associated with much lower risk of CHD (10, 28) consistent with the CHD mortality data in studies of vegetarians. Animal fats (largely saturated) raise LDL cholesterol (29) and increase risk; these obviously come from foods eaten less or not at all by vegetarians. Total or LDL cholesterol is typically lower in vegetarians (30, 31). HDL cholesterol is not consistently different (30, 32), although it does tend to be a little lower in Adventists (33), perhaps because of the lack of alcohol consumption. Vegetarians are consistently thinner, or at least less overweight, than are nonvegetarians within the same studies (34, 32). It is also probable that vegetarians have lower blood pressures than others (32, 35, 36), although the reasons are still controversial, and effects are sometimes small as in British vegetarians (37).

Moreover, staying physically fit has numerous other benefits, including improving cardiovascular health, moderating your blood pressure, boosting your HDL (“good”) cholesterol, and lowering your triglycerides. Both aerobic exercise and weight-bearing exercise also improve your balance (so you are less likely to injure yourself in a fall), lift your mood and alleviate stress, up your energy level, and enhance the quality of your sleep. And that’s just for starters.

the case of arteries, oxidization of LDLs causes an inflammation in the cells that make up the arterial wall, which then triggers white blood cells to come and clean up the mess. Unfortunately, the white blood cells trigger a positive feedback loop because part of their response is to create a foam that traps more small LDLs, which then also get oxidized. Eventually, this foamy mixture coagulates into a stiffened accumulation of crud on the artery wall, known as a plaque. Your body fights plaques primarily with HDLs, which scavenge cholesterol from the plaque and return it to the liver. Plaques thus develop not just when LDL levels (again, mostly the small ones) are high but also when HDL levels are low. If

The most important and most easily measured would be waist circumference. But other factors include small, dense LDL (or a high apoB or LDL particle number), high triglycerides, low HDL cholesterol, high blood pressure, and high fasting glucose. If your triglycerides are elevated and your HDL is low, that’s a very good sign you have metabolic syndrome and should address it by restricting the carbohydrates and particularly the sugars in the diet. 12.

Reversing Atherosclerosis - Exercise, HDL, and HDL2b The other side of the equation consists of increasing the amount of HDL and maximizing the percentage of “mature” cholesterol, also called HDL2b.

Overall HDL level is controlled by the hypothalamus, and if the exercise is concentric and explosive, the HDL level will be increased, along with numerous other healing and repair functions.

13 Reasons to include Curry Leaves to your Diet Sambar. Upma. Dal. Poha. What do they all have in common? A tempering rich in curry leaves. But curry leaves – or Curry leaves, as they are commonly known in India – do more good than simply seasoning your food. Curry power benefits include weight loss and a drop in cholesterol levels. But there’s lots more that the Curry leaves can do. Here are 13 reasons to chew on those curry leaves that pop up on your plate. To keep anaemia away The humble Curry leaves is a rich source of iron and folic acid. Anaemia crops up when your body is unable to absorb iron and use it. “Folic acid is responsible for iron absorption and as Curry leaves is a rich source of both compounds, it’s the perfect choice if you’re looking to amp up your iron levels,” says Alpa Momaya, a Diet & Wellness consultant with Sunrise nutrition hub. To protect your liver If you are a heavy drinker, eating curry leaves can help quell liver damage. A study published in Asian Journal of Pharmaceutical and Clinical Research has revealed that curry leaves contain kaempferol, a potent antioxidant, and can protect the liver from oxidative stress and harmful toxins. To maintain blood sugar levels A study published in the Journal of Plant food for Nutrition has revealed that curry leaves can lower blood sugar levels by affecting the insulin activity. To keep your heart healthy A study published in the Journal of Chinese Medicine showed that “curry leaves can help increase the amount of good cholesterol (HDL) and protect you from heart disease and atherosclerosis,” Momaya says. To aid in digestion Curry leaves have a carminative nature, meaning that they prevent the formation of gas in the gastrointestinal tract and facilitate the expulsion of gas if formed. Ayurveda also suggests that Curry leaves has mild laxative properties and can balance the pitta levels in the body. Momaya’s advice: “A juice of curry leaves with a bit of lime juice or added to buttermilk can be consumed for indigestion.” To control diarrhoea Even though curry leaves have mild laxative properties, research has shown that the carbazole alkaloids in curry leaves can help control diarrhoea. To reduce congestion Curry leaves has long been a home remedy when it comes to dealing with a wet cough, sinusitis or chest congestion. Curry leaves, packed with vitamin C and A and rich in kaempferol, can help loosen up congested mucous. To help you lose weight Curry leaves is known to improve digestion by altering the way your body absorbs fat. This quality is particularly helpful to the obese. To combat the side effects of chemotherapy Curry leaves are said to protect the body from the side effects of chemotherapy and radiotherapy. They also help protect the bone marrow and halt the production of free radicals in the body. To improve your vision Curry leaves is high in vitamin A, which contains carotenoids that can protect the cornea. Eating a diet rich in curry leaves can help improve your vision over time. To prevent skin infections Curry leaves combines potent antioxidant properties with powerful anti-bacterial, anti-fungal and antiprotozoal properties. It is a common home remedy for common skin infections such as acne and fungal infections of the nail. To get better hair Curry leaves has long been used to prevent greying of the hair by our grandmothers. It also helps treat damaged hair, tackle hair fall and dandruff and add bounce to limp hair. To take care of skin Curry leaves can also be used to heal damaged skin. Apply a paste on burns, cuts, bruises, skin irritations and insect bites to ensure quick recovery and clean healing. Add more Curry leaves to your diet and enjoy the benefits of curry leaves.

Individuals with a ratio of total to HDL cholesterol higher than 4 are considered to have an exceptionally high risk of developing heart disease. So, the higher your HDL cholesterol, the better. However, people with exceptionally low LDL cholesterol do not have to worry about their HDL level. You don’t need the garbage collectors when there is no garbage.

As a guide, your HDL level should be equal to or higher than your triglyceride level, which basically signifies that you’re recycling more fat than is being stored. But during our current 365-day growth cycle, the vast majority of people have the exact opposite ratio.

Low HDL cholesterol (aka the “good cholesterol”) is also a risk factor for heart disease. Those of us with low HDL cholesterol are at far greater risk of having a heart attack than those of us with high total or LDL cholesterol. For women, HDL levels are so good at predicting future heart disease that they are, effectively, the only predictors of risk that matter. (When researchers look for genes that predispose individuals to living an exceedingly lengthy life—more than ninety-five or a hundred years—one of the few genes that stand out is a gene for a naturally high HDL cholesterol level.) When you replace fat in your diet, even saturated fat, with carbohydrates, you lower your HDL, which means you make it more likely that you’ll have a heart attack, at least by this predictor of risk. Once again, if you give up scrambled eggs and bacon for breakfast and replace them with cornflakes, skim milk, and bananas, your HDL cholesterol, your “good” cholesterol, will go down, and your heart-attack risk will go up. If you’re currently eating cereal, skim milk, and bananas and switch instead to eggs and bacon, your HDL cholesterol will go up, and your heart-attack risk will go down. This has been known since the 1970s.

Take lard, for example, which has long been considered the archetypal example of a killer fat. It was lard that bakeries and fast-food restaurants used in large quantities before they were pressured to replace it with the artificial trans fats that nutritionists have now decided might be a cause of heart disease after all. You can find the fat composition of lard easily enough, as you can for most foods, by going to a U.S. Department of Agriculture website called the National Nutrient Database for Standard Reference. You’ll find that nearly half the fat in lard (47 percent) is monounsaturated, which is almost universally considered a “good” fat. Monounsaturated fat raises HDL cholesterol and lowers LDL cholesterol (both good things, according to our doctors). Ninety percent of that monounsaturated fat is the same oleic acid that’s in the olive oil so highly touted by champions of the Mediterranean diet. Slightly more than 40 percent of the fat in lard is indeed saturated, but a third of that is the same stearic acid that’s in chocolate and is now also considered a “good fat,” because it will raise our HDL levels but have no effect on LDL (a good thing and a neutral thing). The remaining fat (about 12 percent of the total) is polyunsaturated, which actually lowers LDL cholesterol but has no effect on HDL (also a good thing and a neutral thing).

Durante todo el estudio, los que seguían la Dieta mediterránea tuvieron un menor riesgo de enfermedad cardiaca que los que estaban en la dieta baja en grasa. Comparado con el grupo bajo en grasa, los que hicieron la dieta mediterránea mantuvieron triglicéridos más bajos, más colesterol “bueno” HDL, menos colesterol “malo” LDL, menos proteína C reactiva (un indicador de inflamación crónica) y menos insulina (un marcador de la diabetes); también perdieron más peso, cinco kilos en promedio, comparado con 3.5 kilos para el grupo bajo en grasa. La Dieta mediterránea por tanto se veía mejor que la dieta baja en grasa en todas las formas posibles. “Así que mi conclusión conservadora es128 no comenzar con una dieta baja en grasa”, dijo Stampfer, un pronunciamiento que habría sido impensable una década antes, a principios del año 2000, cuando se concibió el estudio. Definitivamente, éstos son resultados positivos para la amada Dieta mediterránea. Pero, ¿sugieren que la dieta es mejor? Stampfer insiste en el hecho de que la gente en esta dieta no tuvo ningún problema para adherirse a ella, lo que es importante. Pero eso puede deberse al hecho de que, como eran israelíes, era su gastronomía local. De hecho, lo que a Stampfer no le gusta pregonar, y lo que el informe del estudio mismo no enfatiza, fue el notable éxito del tercer brazo del estudio. Éste era el grupo que comía una dieta baja en carbohidratos, relativamente alta en grasa. Los participantes de esta dieta, resulta, eran los más sanos de todos. Perdieron incluso más peso (6 kilos) y sus biomarcadores para enfermedad cardiaca se veían mejor: los triglicéridos estaban más bajos y su colesterol HDL mucho más alto que el de los otros dos grupos. Sólo el colesterol LDL se veía mejor para las personas de la Dieta mediterránea, pero este biomarcador ha demostrado ser menos confiable de lo que se pensaba antes. Por tanto, aunque el hallazgo no ha recibió ninguna atención, realmente no hay duda de que la dieta baja en carbohidratos fue mejor que la baja en grasa y la mediterránea.

To explore how physical activity helps but doesn’t entirely prevent cardiovascular diseases, let’s return to the trinity of intertwined factors that are the root causes of the problem: high cholesterol, high blood pressure, and inflammation. Cholesterol. A cholesterol test usually measures the levels of three molecules in your blood. The first is low-density lipoprotein (LDL), often termed bad cholesterol. Your liver produces these balloon-like molecules to transport fats and cholesterol throughout your bloodstream, but some LDLs have a harmful tendency to burrow into the walls of arteries, especially when blood pressure is high. These intrusions cause an inflammatory reaction that generates plaques. The second type of cholesterol is high-density lipoprotein (HDL), sometimes called good cholesterol, because these molecules scavenge and return LDLs back to the liver. The third type are triglycerides, fat molecules that are floating freely in the bloodstream and a signpost for metabolic syndrome. To make a long story short, diets rich in sugar and saturated fats contribute to cardiovascular disease because they promote high levels of plaque-forming LDLs. Conversely, physical activity helps prevent cardiovascular disease by lowering triglycerides, raising HDL levels, and to a lesser degree lowering LDL. Blood pressure. A blood pressure test gives you two readings: the higher (systolic) number is the pressure your heart’s main chamber overcomes when it squeezes blood throughout your body; the lower (diastolic) number is the pressure your heart experiences as its main chamber fills with blood. By convention high blood pressure is a reading greater than 130/90 or 140/90. Blood pressures above these values are concerning because, unabated, they damage the walls of arteries, making them vulnerable to invasion by plaque-inducing LDLs. As we already saw, once plaques start to form, blood pressure can rise, potentially stimulating yet more plaques. Chronically high blood pressure also strains the heart, causing it to thicken abnormally and weaken. By forcing more blood to flow more rapidly through arteries, physical activity stimulates the generation of new arteries throughout the body and helps keep existing arteries supple, protecting against high blood pressure. Inflammation. Plaques don’t form out of the blue but instead occur when white blood cells in the bloodstream react to the inflammation caused by LDLs and high blood pressure. Chronic inflammation also increases one’s likelihood of developing plaques from high cholesterol and blood pressure.40 And, as we have previously seen, while inflammation is caused by factors such as obesity, junky diets, excess alcohol, and smoking, it is substantially lowered by physical activity.

Fasting glucose of 100 mg/dL or higher A waistline of more than 35 inches for women and 40 inches for men HDL cholesterol less than 40 mg/dL for men and 50 mg/dL for women Triglycerides of 150 mg/dL or higher Blood pressure of 130/85 mmHg or higher

As is well understood, there is “bad” cholesterol, also known as low-density lipoprotein-associated cholesterol (LDL) and “good” cholesterol (high-density lipoprotein-associated cholesterol, HDL). LDL-cholesterol is the type that gets added to an atherosclerotic plaque, whereas HDL-cholesterol is cholesterol that has been removed from plaques and is on its way to be degraded in the liver. As a result

Make a list of some of the things that can go wrong from the last two chapters: elevated insulin levels in the blood. Elevated glucose levels. Elevated systolic and diastolic blood pressure. Insulin resistance. Too much LDL-cholesterol. Too little HDL. Too much fat or cholesterol in the blood. Suffer from a subset of these, and you’ve got Metabolic syndrome (the formal diagnosis involves “one or more” from a list of some of these problems, and “two or more” from a list of the others).

high blood pressure (>130/85) high triglycerides (>150 mg/dL) low HDL cholesterol (<40 mg/dL in men or <50 mg/dL in women) central adiposity (waist circumference >40 inches in men or >35 in women) elevated fasting glucose (>110 mg/dL)

The Sufi path is marked by a number of different stages or stations (maqdm/maqdmdt) which the Sufi traveller (sdlik) passes through as he advances on the path. On his way the Sufi also experiences various psychological and emotional states (hdl/ahwdf). [...] The Sufi’s progress along the path is hindered by the machinations of the self (nafs), that is, the ego-self or what is called in the Qur’an the self that incites or exhorts to evil {al-tiafs al-ammdrah bi-al-su). In order to maintain his progress along the path to God the Sufi must be able to control the ego-self by disciplining it, and by continually blaming and abasing it.

The criteria for metabolic health involves five metrics: blood sugar, blood pressure, HDL choles- terol, triglycerides, and waist circumference all being at healthy levels without the need for prescription medications. This tells us that “sick” is the new normal. So be aware that it might not be a good thing when your doctor tells you that everything looks “nor- mal.” You need to discover the truth for yourself. Our health care system is set up to treat sick people, not to prevent illness or disease. Until you’re at the point that you need to be prescribed medication or undergo a procedure, there is nothing they can do.

syndrome. Metabolic syndrome means cells are struggling to get their jobs done because of problems in their energy production system. Metabolic syndrome is clinically defined as having three or more of the following traits: Fasting glucose of 100 mg/dL or higher A waistline of more than 35 inches for women and 40 inches for men HDL cholesterol less than 40 mg/dL for men and 50 mg/dL for women Triglycerides of 150 mg/dL or higher Blood pressure of 130/85 mmHg or higher The reason you want to know whether your markers have tipped into suboptimal states is that it gives you a surefire clue that the Bad Energy processes are happening inside the cells.

The association between high triglycerides and heart disease is very well established. Even the National Lipid Association, from which this study and statement originate, acknowledges an independent association with triglycerides: “…triglycerides are the third component of the lipid profile and are an independent and compounding risk factor for heart disease, the leading cause of death in the U.S. Studies have shown that the risk of developing heart disease doubles when triglyceride levels are above 200 mg/dL. When triglycerides are above 200 mg/dL and HDL cholesterol is below 40 mg/dL, a person is at four times the risk of developing heart disease.

The most important and most easily measured would be waist circumference. But other factors include small, dense LDL (or a high apoB or LDL particle number), high triglycerides, low HDL cholesterol, high blood pressure, and high fasting glucose. If your triglycerides are elevated and your HDL is low, that’s a very good sign you have metabolic syndrome and should address it by restricting the carbohydrates and particularly the sugars in the diet.

Some of these results were predictable, but others took me totally by surprise. Here’s what happened to various blood markers prior to and immediately after my fast:           PRE-FAST      POST-FAST      Total cholesterol      295      195      LDL-C      216      131      HDL-C      61      50      Triglycerides      90      68      LDL-P      2889      1664      Small LDL-P      1446      587      Lp(a)      441      143      Fasting insulin      13.9      10.0      hsCRP      1.6      .94   Most of those numbers are related to cardiovascular health, including advanced cholesterol tests.

Of those that appeared to play obvious roles in heart disease, three in particular stood out even in the early 1950s. Two of these are familiar today: the low-density lipoproteins, known as LDL, the bad cholesterol, and the high-density variety, known as HDL, the good cholesterol. (This is an oversimplification, as I will explain shortly.) The third class is known as VLDL, which stands for “very low-density lipoproteins,” and these play a critical role in heart disease. Most of the triglycerides in the blood are carried in VLDL; much of the cholesterol is found in LDL. That LDL and HDL are the two species of lipoproteins that physicians now measure when we get a checkup is a result of the oversimplification of the science, not the physiological importance of the particles themselves. In

Eating saturated fats elevates LDL levels, but it has long been known and repeatedly shown that low levels of HDL are much more strongly associated with heart disease than high levels of LDL.

Drug companies had made quite a few attempts to find a drug that raised HDL-cholesterol, but those efforts had all failed. Lowering LDL-cholesterol, however, was something they could do—very

Here is all of the above information in one location. It includes the biomarker and recommended amounts or ranges, but remember, many of these items have a complex story associated with them. Cholesterol total: 120–140 mg/dl HDL cholesterol >50 mg/dl LDL cholesterol 40–70 mg/dl Triglycerides 50–80 mg/dl C-reactive protein <1.0 mg/dl Hb1Ac <5

Results like Knopp’s were revealing that the gold-standard diet of the day, low in fat and saturated fat, could improve LDL-cholesterol but would invariably worsen HDL-cholesterol. This was an extremely awkward discovery because it meant that the chosen diet might actually be worsening the risk for heart disease.

Nutrition experts also ignored the research showing that what raised HDL-cholesterol more effectively than anything else was not red wine or exercise, as we commonly think, but saturated fat.

The study leaders reported that in both men and women from ages 40 to 90, “of all the lipoproteins and lipids measured, HDL-cholesterol had the largest impact on risk.” People with low HDL-cholesterol levels (below 35 mg/dL) had an eight times higher rate of heart attacks than did people with high HDL-cholesterol levels (65 mg/dL or above).

The choice to favor LDL-cholesterol over HDL-cholesterol was also probably fueled by the megabillion-dollar pharmaceutical industry, which heavily favored LDL-cholesterol as a target for therapy.

The solution may be to return to stable, solid animal fats, like lard and butter, which don’t contain any mystery isomers or clog up cell membranes, as trans fats do, and don’t oxidize, as do liquid oils. Saturated fats, which also raise HDL-cholesterol, start to look like a rather good alternative from this perspective.

The “fragmentary information on what maneuvers will lead to an increase in HDL cholesterol levels,” Gordon and his collaborators wrote, “suggests that physical activity, weight loss and a low carbohydrate intake may be beneficial” (my italics).

carbohydrates might be responsible for causing or exacerbating either metabolic syndrome or the combination of low HDL, high triglycerides, and small, dense LDL, which is described as occurring “commonly in persons with premature [coronary heart disease].

Finally, the results of a randomized clinical trial of more than 1,000 patients, published in the June 2012 issue of Archives of Internal Medicine, found that women experienced a disproportionate level of extreme fatigue and decreased energy levels after taking statin medications to lower their cholesterol. So if you are a mother or a career woman taking statins, don’t assume it’s your busy life that’s zapped you of energy; it might be those cholesterol pills prescribed to supposedly make you healthier. At the very least, all these studies make it clear that it’s not only worth taking a closer look at the evidence, it’s worth asking if women should be lowering their cholesterol at all.

Dr. Bowden: Let’s go back in time. If you went to a health fair around 1950, you’d see people sitting there with little pin pricks on their fingers that were used test your blood for cholesterol. The nurse would say, "Oh, Mr. Jones, your cholesterol is 175." She would give you just one number. In the early 1960’s, researchers realized that cholesterol travelled in the body in two distinct packages. One of them is called HDL or high density lipoprotein. The other one is called LDL or low density lipoprotein. They discovered that LDL and HDL functioned and behaved somewhat differently in the body, and we began to nickname HDL "good cholesterol" and LDL "bad cholesterol."  

Studies on high-fat diets have almost always been done in conjunction with a high-carb diet. We are now beginning to see that the mixture of high fat and high carbohydrate foods is a recipe for disaster, leading to an almost inevitable and rapid decline in health. Many researchers and health experts have made the mistake of targeting fat when it comes to heart disease. But what if, as evidence is beginning to show, carbohydrates are doing most, if not all, of the real damage?

Yüksek insülin hormonu ayrıca karaciğerden fazla kolesterol yapılmasını da artırır, HDL denilen faydalı kan kolesterolünü düşürür ve kanı yoğunlaştırarak, kanın pıhtılaşmasını kolaylaştırır.

Insulin resistance and the diabesity associated with it are often accompanied by increasing belly fat, fatigue after meals, sugar cravings, blood sugar swings or hypoglycemia, high triglycerides, low HDL, high blood pressure, low sex drive, problems with blood clotting, and increased inflammation. These clues can often be picked up long before you ever get diabetes, and may help you prevent diabetes entirely. If you have a family history of obesity (especially around the belly), diabetes, early heart disease, or even dementia or cancer, you are even more prone to this problem.

According to the American Heart Association, optimal levels are as follows (note: those levels have been converted from US mg/dL measures): Total cholesterol (3.7–5.1 mmol/L, below 3.7 has been associated with depression) High-density lipoprotein (HDL) (>= 1.5 mmol/L) Low-density lipoprotein (LDL) (<2.6 mmol/L) Triglycerides (<1.1 mmol/L).

According to the American Heart Association, optimal levels are as follows (note: those levels have been converted from US mg/dL measures): Total cholesterol (3.7–5.1 mmol/L, below 3.7 has been associated with depression) High-density lipoprotein (HDL) (>= 1.5 mmol/L) Low-density lipoprotein (LDL) (<2.6 mmol/L) Triglycerides (<1.1 mmol/L). If your lipids are off, make sure to get your diet under control, as well as taking fish oil and exercising regularly. Of course you should see your physician. Also, knowing the particle size of LDL cholesterol is important. Large particles are less toxic than smaller particles.

Estriol—Estriol is the weakest of the three estrogens and has a protective role in breast tissue. It is believed to protect vaginal tissue too. Estriol helps to reduce hot flashes in women, protects the urinary tract, and plays a role in retention of bone density. It can help increase “good” HDL and decrease “bad” LDL cholesterol. One compelling study showed that taking estriol can reverse brain lesions in women with multiple sclerosis. Estrogen is particularly needed in women to make serotonin function at its best in the brain. Serotonin is one of the brain’s feel-good hormones. With no estrogen, your mood can change to anxious and depressed. Cognitive functions, such as critical thinking and short-term memory, are also eroded with the loss of estrogen production. Below is a list of symptoms related to low and high estrogen levels:

S.P. is a 68-year-old retired painter who is experiencing right leg calf pain. The pain began approximately 2 years ago but has become significantly worse in the past 4 months. The pain is precipitated by exercise and is relieved with rest. Two years ago, S.P. could walk two city blocks before having to stop because of leg pain. Today, he can barely walk across the yard. S.P. has smoked two to three packs of cigarettes per day (PPD) for the past 45 years. He has a history of coronary artery disease (CAD), hypertension (HTN), peripheral vascular disease (PVD), and osteoarthritis. Surgical history includes quadruple coronary artery bypass graft (CABG × 4) 3 years ago. He has had no further symptoms of cardiopulmonary disease since that time, even though he has not been compliant with the exercise regimen his cardiologist prescribed, he continues to eat anything he wants, and continues to smoke two to three PPD. Other surgical history includes open reduction internal fixation of the right femoral fracture 20 years ago. S.P. is in the clinic today for a routine semiannual follow-up appointment with his primary care provider. As you take his vital signs, he tells you that, besides the calf pain, he is experiencing right hip pain that gets worse with exercise, the pain doesn't go away promptly with rest, some days are worse than others, and his condition is not affected by a resting position. � Chart View General Assessment Weight 261 lb Height 5 ft, 10 in. Blood pressure 163/91 mm Hg Pulse 82 beats/min Respiratory rate 16 breaths/min Temperature 98.4° F (36.9° C) Laboratory Testing (Fasting) Cholesterol 239 mg/dL Triglycerides 150 mg/dL HDL 28 mg/dL LDL 181 mg/dL Current Medications Lisinopril (Zestril) 20 mg/day Metoprolol (Lopressor) 25 mg twice a day Aspirin 325 mg/day Simvastatin (Zocor) 20 mg/day Case Study 4 Name Class/Group Date ____________________ Group Members INSTRUCTIONS All questions apply to this case study. Your responses should be brief and to the point. When asked to provide several

Several serious medical studies and entire referenced books show that lowering cholesterol with medications did NOT reduce the number of deaths by stroke nor the amount of sickness, including heart attacks and (Atkins, Herbert, TW, Suurbula, Ravnskov, Smith). In addition, some commonly prescribed cholesterol-lowering drugs actually lowered the good HDL cholesterol as well (Johansson), putting you at higher risk of an early heart attack.

My own story is instructive. More than twenty years ago I was diagnosed with type 2 diabetes. The conventional treatment made my condition worse, so I approached this health challenge from my perspective as an inventor. I immersed myself in the scientific literature and came up with a unique program that successfully reversed my diabetes. In 1993 I wrote a health book (The 10% Solution for a Healthy Life) about this experience, and I continue today to be free of any indication or complication of this disease.13 In addition, when I was twenty-two, my father died of heart disease at the age of fifty-eight, and I have inherited his genes predisposing me to this illness. Twenty years ago, despite following the public guidelines of the American Heart Association, my cholesterol was in the high 200s (it should be well below 180), my HDL (high-density lipoprotein, the “good” cholesterol) below 30 (it should be above 50), and my homocysteine (a measure of the health of a biochemical process called methylation) was an unhealthy 11 (it should be below 7.5). By following a longevity program that Grossman and I developed, my current cholesterol level is 130, my HDL is 55, my homocysteine is 6.2, my C-reactive protein (a measure of inflammation in the body) is a very healthy 0.01, and all of my other indexes (for heart disease, diabetes, and other conditions) are at ideal levels.14

The yolk of an egg is incredibly nutritious. It contains 100 percent of the carotenoids; essential fatty acids; fat-soluble vitamins A, E, D, and K that our body requires; and more than 90 percent of the calcium, iron, phosphorus, zinc, thiamine, folate, B12, pantothenic acid, as well as the majority of the copper, manganese, and selenium our body requires. They are also excellent sources of lutein and zeaxanthin, which evidence has shown are highly protective against developing macular degeneration—the major cause of blindness in the elderly. Since most people don’t eat liver, egg yolks are the only major source of choline, which helps to protect against fatty liver disease, which afflicts about one-third of Americans. Additionally, animal studies indicate that when you get three times more than the recommended amount of choline early in life, you can have lifelong protection against senility and dementia, along with major boosts in memory and mental performance throughout your life. Eggs yolks are primarily feared by people because of their cholesterol content, but they are jam-packed with really important nutrients, some of which are very difficult to get anywhere else in your diet.” –Dr. Chris Masterjohn

Animal fats (largely saturated) raise LDL cholesterol (29) and increase risk; these obviously come from foods eaten less or not at all by vegetarians. Total or LDL cholesterol is typically lower in vegetarians (30, 31). HDL cholesterol is not consistently different (30, 32), although it does tend to be a little lower in Adventists (33), perhaps because of the lack of alcohol consumption. Vegetarians are consistently thinner, or at least less overweight, than are nonvegetarians within the same studies (34, 32). It is also probable that vegetarians have lower blood pressures than others (32, 35, 36), although the reasons are still controversial, and effects are sometimes small as in British vegetarians (37).

1. Hipertensión arterial (>130/85). 2. Concentración alta de triglicéridos (>150 mg/dl). 3. Concentración baja de colesterol HDL (High Density Lipoproteins, o lipoproteínas de alta densidad) (<40 mg/dl en los hombres o

Here’s the list of the tests you need to make sure your doctor orders: lipid profile (LDL-C, HDL-C, TG), homocysteine (Hcy) level, alanine aminotransferase and aspartate aminotransferase (ALT and AST), uric acid, fasting insulin, fasting glucose, and hemoglobin A1c.

tests to evaluate your lipoprotein profile—better than HDL and LDL.

According to Dr. Mark Hyman, “the triglyceride-to-HDL ratio is the best way to check for insulin resistance other than the insulin response test. According to a paper published in Circulation, the most powerful test to predict your risk of a heart attack is the ratio of your triglycerides to HDL. If the ratio is high, your risk for a heart attack increases sixteen-fold—or 1,600 percent! This is because triglycerides go up and HDL (or ‘good cholesterol’) goes down with diabesity.

Metabolic syndrome is clinically defined as having three or more of the following traits: Fasting glucose of 100 mg/dL or higher A waistline of more than 35 inches for women and 40 inches for men HDL cholesterol less than 40 mg/dL for men and 50 mg/dL for women Triglycerides of 150 mg/dL or higher Blood pressure of 130/85 mmHg or higher

HDL is often referred to as “good” because it helps remove cholesterol from the blood vessels and carries it back to the liver for processing and elimination from the body. This process of reverse cholesterol transport can help prevent the buildup of plaque in the arteries and reduce the risk of heart disease and stroke. Therefore, high levels of HDL in the bloodstream are considered beneficial for cardiovascular health. Meanwhile, LDL (low-density lipoprotein) is often referred to as “bad” cholesterol because it can deposit cholesterol in the walls of the arteries, leading to the formation of plaque. This process, known as atherosclerosis, can narrow the arteries and increase the risk of heart disease and stroke.

GOOD ENERGY BIOMARKERS AND MOVEMENT When you’re striving to be part of the 6.8 percent of metabolically healthy Americans, regular movement will help you get there. Research shows that exercise improves all five of the following basic biomarkers of metabolism: Glucose Levels Above 100 mg/dL: Twelve-week exercise programs of either high-intensity running (40 minutes per week) or low-intensity running (150 minutes per week) both brought participants’ blood sugar from the prediabetic range (100 mg/dL or greater) to the nondiabetic range (<100 mg/dL). HDL Cholesterol Less Than 40 mg/dL: A 2019 review of the literature showed that exercise increased HDL cholesterol, “with exercise volume, rather than intensity, having a greater influence.” Meanwhile, “raising HDL levels pharmacologically has not shown convincing clinical benefits.” Triglycerides Above 150 mg/dL: Numerous studies have demonstrated that physical activity effectively lowers triglyceride levels. In a 2019 study, an eight-week moderate aerobic exercise program significantly reduced triglyceride levels in participants. Furthermore, even a single session of intense aerobic exercise has been found to decrease triglyceride levels the following day. This positive effect could be due to the increased activity of hepatic lipase in the liver, an enzyme that facilitates the absorption of triglyceride from the bloodstream. Blood Pressure of 130/85 mmHg or Higher: Research has shown the effects of exercise among populations with high blood pressure were similar to the effects of commonly used medications. A Waistline of More Than 35 Inches for Women and 40 Inches for Men: Not surprisingly, regular exercise can help decrease obesity by increasing energy expenditure and promoting weight loss. Research shows a clear inverse relationship between the amount of movement people do each week and the size of their waistline: more movement, smaller waist circumference. What’s more, lower activity (fewer than 5,100 steps per day) yields a 2.5 times higher risk of central obesity than higher activity (more than 8,985 steps per day).

Good Cholesterol, Bad Cholesterol You’ve probably heard the terms “good cholesterol” and “bad cholesterol.” These terms refer to two subtypes of lipoproteins, those tiny amphibious vehicles that carry fats throughout our circulatory system. One subtype, called low-density lipoprotein (LDL), is said to be the “bad” cholesterol. Another subtype, high-density lipoprotein (HDL), is said to be the “good” cholesterol. These terms are imprecise, at best, since there is only one molecule called cholesterol, and that molecule is the same in all our lipoproteins. Where did they come from? Way back in 1958, a doctor at Cleveland Clinic named Angelo M. Scanu coined the term “good cholesterol” when he observed that people with high HDL tended to have lower heart attack risk.3 He hypothesized that HDL might clean up the cholesterol that LDL seemed to deposit in our arteries. At some point, people started calling LDL “bad cholesterol” based on these ideas. But by the 1990s, accumulating evidence suggested that LDL does not, in fact, deposit cholesterol in our arteries—unless it’s oxidized.4 What’s more, we’ve also discovered that HDL can harm our arteries, too, when it’s oxidized.5 It seems time to abandon these imprecise, outdated terms and focus on the real “bad player”: oxidation.

Once You’re in Keto, How Can You Keep It Going Without Fasting? The short answer is: Eat a boatload of fat (~1.5 to 2.5 g per kilogram of body weight), next-to-no carbs, and moderate protein (1 to 1.5 g per kilogram of body weight) each day. We’ll look at Dom’s typical meals and day in a minute, but a few critical notes first: High protein and low fat doesn’t work. Your liver will convert excess amino acids into glucose and shut down ketogenesis. Fat as 70 to 85% of calories is required. This doesn’t mean you always have to eat rib eye steaks. A chicken breast by itself will kick you out of ketosis, but a chicken breast cut up into a green leafy salad with a lot of olive oil, feta cheese, and some Bulletproof Coffee (for example) can keep you in ketosis. One of the challenges of keto is the amount of fat one needs to consume to maintain it. Roughly 70 to 80% of your total calories need to come from fat. Rather than trying to incorporate fat bombs into all meals (one does get tired of fatty steak, eggs, and cheese over and over again), Dom will both drink fat between meals (e.g., coconut milk—not water—in coffee) and add in supplemental “ice cream,” detailed on page 29. Dom noticed that dairy can cause lipid profile issues (e.g., can spike LDL) and has started to minimize things like cream and cheese. I experienced the same. It’s easy to eat a disgusting amount of cheese to stay in keto. Consider coconut milk (Aroy-D Pure Coconut Milk) instead. Dom doesn’t worry about elevated LDL as long as other blood markers aren’t out of whack (high CRP, low HDL, etc.). From Dom: “The thing that I focus on most is triglycerides. If your triglycerides are elevated, that means your body is just not adapting to the ketogenic diet. Some people’s triglycerides are elevated even when their calories are restricted. That’s a sign that the ketogenic diet is not for you. . . . It’s not a one-size-fits-all diet.

Interestingly, however, we can use two of those numbers as a highly accurate indicator of LDL size—a “poor man’s” method, if you will. By dividing the level of triglycerides (in mg/dL) by HDL (in mg/dL; TG/HDL), we get a ratio that is surprisingly accurate in predicting LDL size. The lower the ratio (e.g., ~<2.0), the more prevalent the larger, buoyant LDL particles; that is to say, LDL A predominates. But as the ratio climbs (~>2.0), the small, dense LDL B particles are more common.

we didn’t know that HDL, triglycerides, and the size of your LDL (bad cholesterol) mattered more than total cholesterol.

But after two years, the participants in the ketogenic group began to gain their weight back as they struggled to stay consistent. Those who ate according to their genotype not only lost significantly more weight but also reduced total cholesterol, increased the beneficial HDL cholesterol, and improved fasting blood glucose levels.

Garlic has three very important cardiovascular effects: One, it lowers blood pressure and is a key component in any natural approach to treating hypertension. Two, it lowers cholesterol and fats (triglycerides) in the blood, raising the protective (HDL) fraction of total cholesterol while reducing the susceptibility of the harmful (LDL) fraction to oxidation and thereby diminishing its potential to damage artery walls. Three, garlic inhibits blood clotting by reducing the tendency of platelets to clump together.

I monitor several biomarkers related to metabolism, keeping a watchful eye for things like elevated uric acid, elevated homocysteine, chronic inflammation, and even mildly elevated ALT liver enzymes. Lipoproteins, which we will discuss in detail in the next chapter, are also important, especially triglycerides; I watch the ratio of triglycerides to HDL cholesterol (it should be less than 2:1 or better yet, less than 1:1), as well as levels of VLDL, a lipoprotein that carries triglycerides—all of which may show up many years before a patient would meet the textbook definition of metabolic syndrome. These biomarkers help give us a clearer picture of a patient’s overall metabolic health than HbA1c, which is not very specific by itself.

Because cholesterol belongs to the lipid family (that is, fats), it is not water soluble and thus cannot dissolve in our plasma like glucose or sodium and travel freely through our circulation. So it must be carted around in tiny spherical particles called lipoproteins—the final “L” in LDL and HDL—which act like little cargo submarines. As their name suggests, these lipoproteins are part lipid (inside) and part protein (outside); the protein is essentially the vessel that allows them to travel in our plasma while carrying their water-insoluble cargo of lipids, including cholesterol, triglycerides, and phospholipids, plus vitamins and other proteins that need to be distributed to our distant tissues.

The reason they’re called high- and low-density lipoproteins (HDL and LDL, respectively) has to do with the amount of fat relative to protein that each one carries. LDLs carry more lipids, while HDLs carry more protein in relation to fat, and are therefore more dense.

it’s not the cholesterol per se that causes problems but the nature of the particle in which it’s transported. Each lipoprotein particle is enwrapped by one or more large molecules, called apolipoproteins, that provide structure, stability, and, most importantly solubility to the particle. HDL particles are wrapped in a type of molecule called apolipoprotein A (or apoA), while LDL is encased in apolipoprotein B (or apoB). This distinction may seem trivial, but it goes to the very root cause of atherosclerotic disease: every single lipoprotein that contributes to atherosclerosis—not only LDL but several others[*1]—carries this apoB protein signature.

garden-variety LDL particle is fused with another, rarer type of protein called apolipoprotein(a), or apo(a) for short (not to be confused with apolipoprotein A or apoA, the protein that marks HDL particles). The apo(a) wraps loosely around the LDL particle, with multiple looping amino acid segments called “kringles,” so named because their structure resembles the ring-shaped Danish pastry by that name. The kringles are what make Lp(a) so dangerous: as the LDL particle passes through the bloodstream, they scoop up bits of oxidized lipid molecules and carry them along. As my lipid guru Tom Dayspring points out, this isn’t entirely bad. There is some evidence that Lp(a) may act as a sort

keeping a watchful eye for things like elevated uric acid, elevated homocysteine, chronic inflammation, and even mildly elevated ALT liver enzymes. Lipoproteins, which we will discuss in detail in the next chapter, are also important, especially triglycerides; I watch the ratio of triglycerides to HDL cholesterol (it should be less than 2:1 or better yet, less than 1:1), as well as levels of VLDL, a lipoprotein that carries triglycerides

By dividing the level of triglycerides (in mg/dL) by HDL (in mg/dL; TG/HDL), we get a ratio that is surprisingly accurate in predicting LDL size. The lower the ratio (e.g., ~<2.0), the more prevalent the larger, buoyant LDL particles; that is to say, LDL A predominates. But as the ratio climbs (~>2.0), the small, dense LDL B particles are more common.

I monitor several biomarkers related to metabolism, keeping a watchful eye for things like elevated uric acid, elevated homocysteine, chronic inflammation, and even mildly elevated ALT liver enzymes. Lipoproteins, which we will discuss in detail in the next chapter, are also important, especially triglycerides; I watch the ratio of triglycerides to HDL cholesterol (it should be less than 2:1 or better yet, less than 1:1), as well as levels of VLDL, a lipoprotein that carries triglycerides—all of which may show up many years before a patient would meet the textbook definition of metabolic syndrome. These biomarkers help give us a clearer picture of a patient’s overall metabolic health than HbA1c, which is not

HDL levels also got worse after one month of abandoning regular slow jogging. Establishing your exercise routine is a great first step, but only sticking to it guarantees lifelong results!

In the first year after a heart attack, women are over 50 percent more likely to die than men are. Within the following five years, 47 percent of the women will die, develop heart failure, or suffer from a stroke, compared with 36 percent of the men. Why is that? One theory is that before menopause, estrogen keeps the harmful LDL cholesterol low while improving the good HDL cholesterol, therefore protecting women’s arteries from the buildup of plaque that contributes to heart attack and stroke. The menopausal drop in estrogen levels and the increase in LDL cholesterol are among the key players in a woman’s increased risk of heart disease, although more research is needed to explore the mechanisms involved.

I watch the ratio of triglycerides to HDL cholesterol (it should be less than 2:1 or better yet, less than 1:1), as well as levels of VLDL, a lipoprotein that carries triglycerides—all of which may show up many years before a patient would meet the textbook definition of metabolic syndrome. These biomarkers help give us a clearer picture of a patient’s overall metabolic health than HbA1c, which is not very specific by itself. But the first thing I look for, the canary in the coal mine of metabolic disorder, is elevated insulin. As we’ve seen, the body’s first response to incipient insulin resistance is to produce more insulin.

The observation that monounsaturated fats both lower LDL cholesterol and raise HDL also came with an ironic twist: the principal fat in red meat, eggs, and bacon is not saturated fat, but the very same monounsaturated fat as in olive oil.

Both analyses confirmed that the higher the HDL cholesterol the lower the triglycerides and the risk of heart disease. The inverse relationship between HDL and heart disease held true for every age group from forty-year-olds to octogenarians, in both men and women, and in every ethnic group from Framingham, Massachusetts, to Honolulu.