Cholesterol and Triglycerides Basics

Keep in mind that 50% of the people that have a heart attack or stroke, have normal or below normal cholesterol levels.

Cholesterol and triglycerides are two forms of lipid, or fat, that circulate in your bloodstream. They are both necessary for life itself. Cholesterol is necessary for building and maintaining key parts of your cells (such as your cell membranes), and for making several essential hormones. Triglycerides, which are chains of high-energy fatty acids, provide much of the energy needed for your tissues to function. So you can't live without them.

But when blood levels of cholesterol and triglycerides become too high, your risk of developing cardiovascular disease is significantly increased. And this is why you need to be concerned about your lipid profile levels.

Where Do Cholesterol and Triglycerides Come From?
There are two (2) sources for cholesterol and triglycerides: dietary sources, and "endogenous" sources (that is, manufactured within the body).

Dietary cholesterol mainly come from:

Meat and Poultry

Meat and poultry are major sources of cholesterol, with a single serving containing as much as 70mg of cholesterol.

Dairy Products
Dairy products, including cheese, ice cream,and milk, are one of the primary sources of saturated fat and cholesterol in the U.S. diet, according to Harvard School of Public Health.

These dietary lipids are absorbed through your gut,and then are delivered through the bloodstream to your liver, where they are processed.

Food is one source of triglycerides. Your liver also produces them. When you eat extra calories—especially carbohydrates—your liver increases the production of triglycerides. Triglycerides come mainly from dietary carbohydrates.

When you consume—or your body creates—excess triglycerides, they’re stored in fat cells for later use. When they’re needed, your body releases them as fatty acids, which fuel body movement, create heat and provide energy for body processes.

For good health, your triglyceride level should be less than 150 mg/dL, according to the National Heart, Lung and Blood Institute. Border-line high levels are 150 to 199 mg/dL; high is 200 to 499 mg/dL; and very high is 500 mg/dL and greater.

One of the main jobs of the liver is to make sure all the tissues of your body receive the cholesterol and triglycerides they need to function. Generally, for about 8 hours after a meal, your liver takes up dietary cholesterol and triglycerides from the bloodstream. During times when dietary lipids are not available, your liver produces cholesterol and triglycerides itself. About 75% of the cholesterol in your body is manufactured by the liver.

Your liver then places the cholesterol and triglycerides, along with special proteins, into tiny sphere-shaped packages called lipoproteins, which are released into the circulation. Cholesterol and triglycerides are removed from the lipoproteins and incorporated into your body's cells, wherever they are needed.

Types of Cholesterol

What Are LDL and HDL?
LDL stands for "low density lipoprotein," and HDL for "high density lipoprotein." In the bloodstream, "bad" cholesterol is carried in LDL, and "good" cholesterol is carried in HDL. In most people, the majority of the cholesterol in the blood is packaged as LDL, and only a relatively small proportion is from HDL cholesterol.

Why Are High LDL Cholesterol Levels Bad?
Elevated levels of LDL cholesterol have been strongly associated with an increased risk of heart attack and stroke. It appears that when LDL cholesterol levels are too high, the LDL lipoprotein tends to stick the lining of the blood vessels, which helps to stimulate atherosclerosis. So, an elevated LDL cholesterol level is a major risk factor for heart disease and stroke. This is why LDL cholesterol has been called "bad" cholesterol.

What is VLDL (Very Low Density Lipoproteins) Cholesterol?
VLDL Cholesterol (very low density lipoprotein) is a lipoprotein subclass assembled in the liver from cholesterol and apolipoproteins. It is then converted in the bloodstream to low density lipoprotein (LDL). VLDL is prone to accelerate atherosclerosis, and is elevated in a number of diseases and metabolic states. It is composed mostly of cholesterol, with little protein. VLDL (and LDL) is often called "bad cholesterol" because it deposits cholesterol on your artery walls. VLDL transports endogenous triglycerides, phospholipids, cholesterol and cholesteryl esters. It functions as the body's internal transport mechanism for lipids.

So VLDL cholesterol is usually estimated as a percentage of your triglyceride value.

Triglycerides / 5 = VLDL

Normal VLDL cholesterol level is between 5 and 40 milligrams per deciliter.

Why Is HDL Cholesterol Called "Good" Cholesterol?
A lot of evidence now suggests that higher HDL cholesterol levels are associated with a lower risk of heart disease, and conversely, that low HDL cholesterol levels are associated with an increased risk. Because the higher your HDL cholesterol the better, HDL cholesterol is called "good" cholesterol.

Why is HDL cholesterol protective?
It appears that the HDL lipoprotein "scours" the walls of blood vessels and removes excess cholesterol. So the cholesterol present in HDL is (to a large extent) excess cholesterol that has just been removed from cells and blood vessel walls, and is being transported back to the liver for processing. The higher the HDL cholesterol levels, presumably, the more cholesterol is being removed from where it might otherwise cause damage.

How Important Are Triglycerides?
In recent years several studies have established that people with elevated levels of triglycerides are indeed at increased risk.

What Causes High Cholesterol?
Elevated cholesterol levels can be caused by several factors, including heredity, poor diet, obesity, sedentary lifestyle, age, smoking, and gender (pre-menopausal women have lower cholesterol levels than men). Several medical conditions, including diabetes, hypothyroidism (low thyroid,) liver disease, and chronic renal (kidney) failure, can also increase cholesterol levels. Some drugs, especially steroids and progesterone, can do the same.

Testing For Cholesterol and Triglyceride Levels
Beginning at age 20, testing for cholesterol and triglycerides is recommended every five years. And if your lipid levels are found to be elevated, repeat testing should be done yearly.

VAP Test

VAP stands for vertical auto profile, and it tests cholesterol measurements more specifically than previous cholesterol tests.

The VAP cholesterol test provides accurate, detailed results, identifying people at risk for cardiovascular disease—with a detection rate that is more that of routine cholesterol panels. Compared to conventional lipid panels, the sophisticated VAP test enables physicians to more accurately assess their patients’ risks for cardiovascular disease, and thus to better manage their treatment. As we learn more about emerging risk factors for heart disease, advanced lipid testing will become even more crucial in helping to arrest the progression of what remains America’s leading cause of premature death.

Previous blood cholesterol tests examined the levels of high density lipoproteins (HDL), also called “good cholesterol.” These tests also examined and counted the presence of low density lipoproteins (LDL), or “bad cholesterol.” These earlier tests were roughly 40% accurate in predicting risk for heart attack.

What scientists discovered while developing the VAP test is that HDL and LDL could be broken down further into subtypes by reclassifying density. These subtypes could further define cholesterol levels and risk of heart attack. High levels of LDL are considered to increase risk for heart attack and necessitate treatment. The VAP test expands on this knowledge. It examines a subtype of LDL called Lp(a), which, when it is the predominant form of LDL, can increase the risk of heart attack up to 25 times.

The expanded information from the VAP test includes:

• More accurate, direct measurement of LDL.
• Measurement of LDL pattern density. This is important because small, dense LDL (“Pattern B”) triples the likelihood of developing coronary plaque and suffering a heart attack.
• Measurement of lipoprotein subclasses, which include HDL2 and HDL3, intermediate-density lipoprotein (IDL), very-low-density lipoproteins (VLDL1, VLDL2, VLDL3), and lipoprotein(a) [Lp(a)], a particularly dangerous lipoprotein that can lead to heart attacks and strokes.
• LPa (verbalized as LP little a) is a serious contributor to heart and vascular disease when the value is over 30.
• If you have a high LPa you should also have a homocystiene, hsCRP, plasminogen activator inhibitor I (PAI-1) test.

Specifically, the VAP test measures:

• Total VLDL: Elevated VLDL levels correspond to an increased risk of heart disease and diabetes.
• Sum Total Cholesterol: The sum of HDL, LDL and VLDL levels.
• Total non-HDL: The sum of only LDL and VLDL levels; a higher value indicates a greater risk for developing heart disease.
• Total apoB100: Apolipoprotein B100 helps create, carry and deliver "bad cholesterol" to cells; measuring apoB100 levels aids in determining the type and/or cause of high cholesterol.
• Lp(a) cholesterol: Research suggests that Lp(a), which is similar to LDL, is an inherited risk factor for atherosclerosis.
• IDL: A lipoprotein of intermediate density; according to Atherotech, this number is elevated among individuals with a family history of diabetes.
• LDL-RC: LDL that is bound to C-reactive protein; this type of LDL is found at the site of atherosclerotic plaques in the body, which are one of the key features of artery disease and -- when they rupture -- the primary initiator of heart attacks.
• Sum Total LDL-C: The sum of Lp(a), IDL and LDL.
• LDL Size Pattern: Reported as one of three categories -- A, A/B or B. In pattern A, the LDL molecules are larger and less dense, making them easier for the body to remove. In pattern A/B, there is a combination of light and dense molecules. In pattern B, smaller, high-density molecules predominate. According to Atherotech, patients with small, dense LDL particles (pattern B) have a four-fold greater risk of developing heart disease than patients with LDL size pattern A.
• HDL-2: A subclass of "good cholesterol" that is particularly protective against heart disease. A low number here could mean an increased risk of coronary artery disease, even in those with otherwise normal cholesterol levels.
• HDL-3: Another subclass of HDL, which does not protect against coronary artery disease to the same degree as HDL-2.
• VLDL-3: A triglyceride-rich very low-density lipoprotein; some studies suggest a potential correlation between higher VLDL-3 numbers and the development of diabetes.

In addition, the VAP test provides individuals with a better idea of their vulnerability to the metabolic syndrome, a combination of factors that significantly elevate the risk an individual will develop diabetes or cardiovascular disease.

Get a VAP test on your client www.directlabs.com

Treating High Cholesterol and Triglyceride Levels

Deciding on whether you ought to be treated for high cholesterol or high triglyceride levels, whether that treatment ought to include drug therapy, and which drugs ought to be used, is not always entirely straightforward. Still, if your cardiovascular risk is elevated, the right treatment aimed at your lipid levels can substantially reduce your chances of having a heart attack, or even of dying prematurely. So when it comes to treating cholesterol and triglycerides, it is important to get it right.

Treatment

Exercise

If you are otherwise in good health, one of the best ways to lower triglycerides is with reg

ular exercise. Choose an activity that gets your heart beating faster. Aim for at least 30 minutes of exercise on most days.

Nutrition

Making the following adjustments to your diet also may help:

• Consume less/more total fat in your diet. Limit fat calories to less than 30 percent of your total caloric intake.
• Consume less simple carbohydrates, such as table sugar and syrup. Limit your intake of baked goods made with white flour and sugar. Instead, choose complex carbohydrates, such as found in whole wheat flour, brown rice and vegetables.
• Eat foods high in omega-3 fatty acids. These fats, found in fish, play a role in helping keep triglycerides down. Salmon, albacore tuna, sardines, and herring all have a lot of omega-3s.
• Get 25 to 30 grams of fiber a day. Fruits, vegetables and whole grains, such as whole-wheat bread and brown rice, are great sources.
• Cut back on alcohol. For some people, drinking even a little bit can have a big effect on triglycerides.

In addition to limiting or eliminating certain foods from the diet, doctors often encourage patients with higher levels of VLDL cholesterol to consume more green vegetables, fresh fruits and whole grains. This can help to increase the amount of fiber in the diet, which will also help to lower cholesterol levels in the bloodstream.

How much Omega 3 do you need to add?

This is under debate and more research is being done. Right now the range experts recommend is from 500-2000 mg/day. Here are the current American Heart Association (AHA) recommendations.

The AHA recommends that individuals without heart disease eat a variety of fish twice a week.

For individuals with heart disease, the AHA recommends 1 g of EPA (eicosapentanoic acid) + DHA (docosahexaenoic acid) daily, preferably from fatty fish.

The AHA recommends 2 to 4 g of EPA + DHA daily for individuals that need to lower triglycerides. High doses, > 3 grams/day, can result in excessive bleeding. Talk to your MD before supplementing greater than 3 grams.

Calamari Oil from Standard Process: Calamari oil (squid), natural flavor, and mixed tocopherols (soy).

Serving size: 1 teaspoon (5 mls)

• Calories 36
• Calories from Fat 32
• Total Fat 3.5 g 5%*
• Saturated Fat 0.7 g 4%*
• Polyunsaturated Fat 1.5 g
• Monounsaturated Fat 0.8 g
• DHA 800 mg
• EPA 400 mg

Omega 3 Content of Different Foods

• Wild Salmon, 4 oz. 1700 mg (DHA 700 mg, EPA 400 mg)
• Tuna canned in water 4 oz. 300 mg (DHA 200 mg, EPA 50 mg)

• Cod, 4 oz. 600 mg (DHA 160 mg, EPA 50 mg)

• Walnuts, 1 oz. 2570 mg (ALA 2570 mg)

• Pecans, 1 oz. 280 mg (ALA 280 mg)

• Wheat germ, ¼ cup 210 mg (ALA 210 mg)

• Olive oil, 1 Tbsp 100 mg (ALA 100 mg)

There's a reason I included details on amounts of DHA, EPA, and ALA for each omega 3 source. Right now, DHA and EPA have a greater link with lower cholesterol levels, lower triglycerides, and higher HDL levels than ALA. The body is able to convert ALA to EPA and DHA, but the conversion rate is low; therefore, it is best to include high DHA and EPA sources in your eating plan.

Niacin

If you have low HDL (good) cholesterol, niacin is an option. Niacin alone lowers LDL by 10-20%, triglycerides even more, and boosts HDL by as much as 15-35%. Dosages vary from 1-4 grams. Recommended taking it in the form of niacinamide to reduce the side effect of itching.

Wahlberg et al. studied the effects of nicotinic acid (which is the same thing as niacin) on patients with type IIa, IIb or type IV hyperlipidemia, all of which are marked by raised LDL and/or VLDL levels. They found that 4 grams of niacin daily decreased triglycerides, LDL and VLDL, while HDL and HDL2 increased by 37% and 135%, respectively.

Seed et al. report similar effects. When patients with type II hyperlipidemia were given 1 gram of niacin, total cholesterol dropped by 16.3%, triglycerides dropped by 25.5%, and LDL by 23.7%. HDL increased by 37.3%.

Elam et al. looked at patients with peripheral arterial disease, some of whom also had diabetes. Mean HDL in patients with and without diabetes was 39 mg/dL and 42 mg/dL, respectively. When given 3,000 mg niacin per day, HDL increased in both groups by 29%. Triglycerides decreased by 23% and 28%, respectively, in patients with and without diabetes. LDL decreased by 8% and 9%.

Standard Process Niacinamide B6

• Niacinamide 50 mg
• Vitamin B6 9 mg

Proprietary Blend: 416 mg Bovine liver, porcine stomach, calcium lactate, soy (bean), bovine spleen, ovine spleen, defatted wheat (germ), para-aminobenzoate, porcine brain, and ascorbic acid.

Niacin can be found in the following foods:

• Dairy products
• Lean meats
• Poultry
• Fish
• Nuts
• Eggs

The main objection to niacin is:

Therapeutic (pharmacologic) doses (100mg to 1,000 mg) cause an elevation in homocysteine levels. 75 mg or more can cause side effects.

"Niacin Treatment Increases Plasma Homocyst(e)ine Levels"

http://www.medscape.com/viewarticle/417292_print

Conclusion
Niacin is effective in correcting unhealthy cholesterol levels. In patients with high LDL, niacin decreases LDL, VLDL and triglycerides while raising HDL. The VLDL-lowering effect seems to result from niacin's ability to increase the size of LDL particles.

In patients with low HDL, niacin with or without cholesterol-lowering drugs increases HDL and decreases triglycerides. Doses in these studies were high, ranging from 1 gram per day to 4 grams per day, which resulted in the unpleasant itching sensation known as the "niacin flush" in many patients.

Sources:

Bioletto, Silvana, Alain Golay, Robert Munger, Barbara Kalix and Richard W. James. "Acute Hyperinsulinemia and Very-Low-Density and Low-Density

Lipoprotein Subfractions in Obese Subjects." American Journal of Clinical Nutrition 71(2000): 443-449.

Mayo Clinic Staff. "Cholesterol Test: Sorting out the Lipids." MayoClinic.com. 1 Feb. 2007. The Mayo Clinic. 11 Mar 2008 .

Crider, Kristin. "Unique Lipoprotein Phenotype and Genotype." CDC.gov. 2 Nov. 2007. Centers for Disease Control. 11 Mar 2008 

http://www.cdc.gov/genomics/hugenet/ejournal/lipoprotein.htm

"Fact Sheet: The VAP Cholesterol Test." The Most Comprehensive Cholesterol Test - VAP. 2008. Atherotech, Inc.. 20 Mar 2008 http://www.atherotech.com/aboutus/presskit.asp?presskititem=vapcholesteroltestfacts.

Kulkarni, KR, DW Garber, SM Marcovina and JP Segrest. "Quantification of Cholesterol in all Lipoprotein Classes by the VAP-II Method." Journal of Lipid Research. 35(1994) 159-168. 20 MAR 08 http://www.jlr.org/cgi/content/abstract/35/1/159?ijkey=d20e388ec3061eb7fd0df98e17f01fe91121e17b&keytype2=tf_ipsecsha

"Metabolic Syndrome." Metabolic Syndrome. 2008. American Heart Association. 20 Mar 2008 http://www.americanheart.org/presenter.jhtml?identifier=4756

Singh, SK, MV Suresh, B Voleti and A Agrawal. "The Connection Between C-reactive Protein and Atherosclerosis." Annals of Medicine. 40.2. 16 NOV 2007 110-120. 20 MAR 08 http://www.ncbi.nlm.nih.gov/pubmed/18293141?ordinalpos=2&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pu.

Ziajka, Paul. "Using VAP Expanded Lipid Testing from Atherotech to Develop Optimal Patient Treatment Plans." 2008. Atherotech. 20 Mar 2008 www.atherotech.com/HealthcareProfessionals/pdfs/ziajkamonograph_thirded.pdf.

LifeWire, a part of The New York Times Company, provides original and syndicated online lifestyle content. Betsy Lee is an independent journalist living in Kansas City, Mo.