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Atherosclerosis

Posted: Tue Dec 20, 2011 9:06 pm
by Paperclip
From what I've gathered, the mechanism of atherosclerosis is apparently quite clear but there may be more than what have been known and I hope that you could fill me in.

First, I'd like to check if my knowledge about the mechanism is correct. There are 5 types of fat-transporting lipoproteins, namely (from the smallest to the biggest) HDL, LDL, IDL, VLDL, and chyclomicrons. The last three are thought to be big enough so the particle cannot lodge into the arterial wall, oxidized, and cause inflammation which is how atheroclerosis first initiated. When this happens, a macrophage comes and try to "eat" the oxidized stuck particle but it can't metabolize the thing so the macrophage becomes a foam cell and stays there. It will experience necrosis and there will be other macrophages to clean up the mess, but somehow, all those macrophages are stuck in one place an slowly building up with time so you have an atheroma. A part of this atheroma can disengage, travels, and blocks an artery or it can rupture and creates a thrombus/blood clot which could block the artery wall where it happens.

Now back to the lipoproteins. The major culprit of atherosclerosis is thought (I don't know if they indeed found LDL in atheromas) to be type B LDL (the smaller more dense one as opposed to type A LDL) because it's always present, small enough, and by its job, travels from the liver to the tissues (to deliver cholesterol) so at one time it must try to pass the arterial wall to reach the target tissue. Now there are theories/studies/etc. which say that eating cholesterol combined with saturated fat can have post-prandial (post eating) effect of increasing the activity and the number of LDL particles, although the LDL could return to basal level later. Some others say that chyclomicrons (the biggest lipoprotein) can lodge into the arterial wall and also say that actually most atheromas are initiated by stuck chyclomicons. As you now chyclomicrons exist around the time when you eat (to transfer the fat and cholesterol from the intestines to other parts of the body) so again it accentuates the post-prandial effect of consuming fat and cholesterol.

I'm interested about what you think, mainly on the last part. Basically they say that basal (fasting) measurement of blood lipids is just one side of the story.

Re: Atherosclerosis

Posted: Wed Dec 21, 2011 1:35 am
by Oscar_Actuary
did I stumble into some bio chemistry forum?
szorry, I may have had too mncuh Pinot

Re: Atherosclerosis

Posted: Wed Dec 21, 2011 5:19 am
by Paperclip
I'm trying to understand the correlation of diet, cholesterol, and fat with coronary heart disease (my father got an angina once) and apparently it boils down to atherosclerosis.

BTW I just checked my blood lipids (basal) and the result is:

total cholesterol: 202 (<200)
LDL: 165 (<130)
HDL: 31 (31-63)
triglycerides: 32 (<150)

Next time I'm gonna take the direct LDL measurement to know the composition of my LDL.

Re: Atherosclerosis

Posted: Wed Dec 21, 2011 8:02 am
by stuward
There are alternative views in the role of cholesterol in heart disease. First, the causal relationship has not been proven. It also appears protective of other diseases like cancer and depression.

Looking at your numbers, the only thing I would be concerned with is the low HDL. You're at the bottom of the normal range but it could improve. Increasing Omega 3 and saturated fats will help. Coconut oil would probbaly work well. I know you already exercise,which is the other important step.

Your LDLs are very probably pattern A which is a good thing. It is extremely unlikely to see trigs as low as yours with pattern B.

Re: Atherosclerosis

Posted: Wed Dec 21, 2011 8:19 am
by Paperclip
stuward wrote: Your LDLs are very probably pattern A. It is extremely unlikely to see trigs as low as yours with pattern B.
This is interesting, stu, and I hope that you're right. BTW what does low trig number signify? That I have good fat metabolism for example?

I already take fish oil (300mg EPA and 200mg DHA per one 1000mg cap) on average 5 caps a day. Should I take more fish oil to improve my HDL number? How about fried foods (do they have any correlation)? I consume "coconut oil" from the coconut milk used in cooking here in the tropics.

Re: Atherosclerosis

Posted: Wed Dec 21, 2011 8:33 am
by stuward
Coconut oil is extracted from the meat of the coconut. You probably have easy access to whole coconuts so, go ahead and add that to your regular diet. Fish oil is OK if you don't eat much fish. Fish is a better source than the oil as it seems to be better absorbed. That tells me that there is more to it than simply the omega 3. Most cold water fish is higher in omega 3 than tropical fish but when in doubt, the food your own ancestors have been living on for generations is probably a good bet.

Re: Atherosclerosis

Posted: Wed Dec 21, 2011 8:39 am
by stuward
Paperclip wrote:
stuward wrote: Your LDLs are very probably pattern A. It is extremely unlikely to see trigs as low as yours with pattern B.
... BTW what does low trig number signify? That I have good fat metabolism for example?
...
Triglyceride are simply the amount of fat in your blood stream. The lower numbers mean that your fat metabolism is working well. Low carbs are the best way of reducing triglycerides. Yours are very low and that is very healthy. You don't need to worry about your levels.

Re: Atherosclerosis

Posted: Wed Dec 21, 2011 2:29 pm
by Travis
coincidentally, Marks Daily Apple today "How to interpret Cholesterol Test Results"
http://www.marksdailyapple.com/how-to-i ... z1gzOCfJhh" onclick="window.open(this.href);return false;

Re: Atherosclerosis

Posted: Fri Dec 23, 2011 6:07 pm
by jml
Food for thought
(Conclusion) - Small LDL confounded the association of large LDL with
IMT because of its strong inverse correlation with large LDL,
which may underlie the widespread belief that large LDL
confers less cardiovascular risk than small LDL. Contrary to
current opinion, both small and large LDL were signi´Čücantly
associated with subclinical atherosclerosis independent of
each other, traditional lipids, and established risk factors, with
no association between LDL size and atherosclerosis after
accounting for the concentrations of the two subclasses.
https://docs.google.com/viewer?a=v&q=ca ... FJzG6JhVRg

Re: Atherosclerosis

Posted: Fri Dec 30, 2011 1:32 am
by jml
Travis wrote:coincidentally, Marks Daily Apple today "How to interpret Cholesterol Test Results"
http://www.marksdailyapple.com/how-to-i ... z1gzOCfJhh" onclick="window.open(this.href);return false;
Did anyone notice this graph he used?
http://perfecthealthdiet.com/wp/wp-cont ... sterol.jpg
I really don't see how this helps his point of "total cholesterol doesn't matter" re: mortality

Re: Atherosclerosis

Posted: Fri Dec 30, 2011 9:01 am
by stuward
jml wrote:
Travis wrote:coincidentally, Marks Daily Apple today "How to interpret Cholesterol Test Results"
http://www.marksdailyapple.com/how-to-i ... z1gzOCfJhh" onclick="window.open(this.href);return false;
Did anyone notice this graph he used?
http://perfecthealthdiet.com/wp/wp-cont ... sterol.jpg
I really don't see how this helps his point of "total cholesterol doesn't matter" re: mortality
That's an important chart, and although it doesn't say that cholesterol amounts don't matter, it still shows that we're being lied to. The drug companies consider 220 to be high and even suggesting that people take statins if it's as low as 200. The blue line on the chart should that optimum health is at 220, and 200 is just as bad as 240. Even with non communicable diseases 210 is best.

The bottom line as I see it is that cholesterol is more complicated than a single number and simply basing an assessment of someones health on TC is ridiculous.

Re: Atherosclerosis

Posted: Fri Dec 30, 2011 3:11 pm
by jml
I believe that what you say cannot be drawn from this chart.

Look at the countries on the left of the graph with relatively low cholesterol. Here are a few of them: Chad, Mali, Niger, Burkina Faso, Gabon, Sudan...
Now in the middle. At the bottom are Japan, Switzerland, Sweden, Canada...; at the top are Haiti, Cambodia, Laos, Turkmenistan, Ukraine...

Here is my point: It is clear from this chart that having modern medical interventions brings down all-cause mortality and cardiovascular mortality despite higher cholesterol levels. One cannot conclude based on this chart that 200-240 (or whatever) is the ideal range for cholesterol levels.