Cholesterol… Hero or Villain? Rita C. Stanley, M.D. Board Certified, Internal Medicine Natural Grocers Topeka, KS January 17, 2014

What is Cholesterol? ● a wax-like steroid molecule that plays a critical role in metabolism ● major component of cellular membranes

NECESSARY “HERO” Precursor to the steroid hormones.. ● Sex hormones (testosterone, estrogens) ● Mineral-corticoids…control balance of water & minerals in the kidney ● Glucocorticoids…..control protein and carbohydrate metabolism, immune suppression, and inflammation ● Also the precursor to vitamin D

ESSENTIAL TO LIFE!

STANDARD LIPID PROFILE ● TOTAL CHOLESTEROL ● LDL “BAD” CHOLESTEROL ● HDL “GOOD” CHOLESTEROL ● TRIGLYCERIDES TAKE AWAY! Standard testing provides limited insight into multiple factors underlying CVD Identifies only 40% of people at risk for CAD Calculated values…not measured

LDL “BAD” CHOLESTEROL ● LOW DENSITY LIPOPROTEIN: Combination fat/protein ● Lipoprotein is a carrier for cholesterol and fats ● Has 3 particle sizes ● DANGER: Small,dense particles vulnerable to oxidation ● Oxidized LDL penetrates lining of artery ● Contributes to development of atherosclerosis

ENDOTHELIAL DYSFUNCTION

HDL “good” Cholesterol ● Removes LDL cholesterol from vessel walls ● Carries it to the liver for disposal ● “Reverse cholesterol transport” ● Higher the HDL, less risk for CVD ● CVD events reduced 11% for every 5 mg/dl increase in HDL ● More than LDL, better predictor of future heart attack ( Framingham Study ) ● Large HDL (HDL 2b) most active in removing cholesterol

ADVANCED CHOLESTEROL TESTING ● Directly measures LDL (Bad Cholesterol) and ● Provides measurements for 15 lipid components. ● VAP (vertical auto profile), NMR, CardioIQ

PREVENTION TAKE AWAY!  VAP DETECTS CARDIOVASCULAR RISK LONG BEFORE SYMPTOMS MANIFEST  DATA ALLOWS PERSONAIZED PREVENTION AND TREATMENT STRATEGY VAP tests for all present and emerging risk factors in NCEP ATP III cholesterol guidelines

Coenzyme Q10 An enzyme produced in all tissues Called a “coenzyme” because of its unique ability to participate in chemical reactions but remain at steady-state levels in the cell, ANTIOXIDANT: NEUTRALIZES FREE-RADICALS INHIBITS LIPID PEROXIDATION (OXIDATION OF LDL) MITOCHONDRIAL ATP SYNTHESIS: Plays integral role in suppying energy to chemical reactions in the body

ESSENTIAL FATTY ACIDS ● Essential fatty acids or EFAs,. ● Fatty acids required for biological processes ● Not produced in our body…must be ingested ● Essential components of all cell membranes ● Three most nutritionally important omega-3 fatty acids are ● alpha-linolenic acid (ALA) ● eicosapentaenoic acid (EPA) and ● docosahexaenoic acid (DHA)

OMEGA-3 OILS

Best oils for the kitchen.. ● Coconut oil (organic virgin) ● Butter – Ghee (clarified butter) GRASS FED COWS ● EVOO Olive Oil ● Lard, Tallow, Bacon Drippings PASTURE RAISED, GRASS FED ANIMALS

AVOID! ● Soybean Oil ● Corn Oil ● Cottonseed Oil ● Canola Oil ● Rapeseed Oil ● Sunflower Oil ● Sesame Oil ● Grapeseed Oil ● Safflower Oil ● Rice Brain Oil ● Highly processed, refined products that are way too rich in Omega-6 fatty acids ● New data links these oils with many serious diseases, including heart disease and cancer (21, 22, 23)

Fatty Acid Breakdown: Saturated: 92%. Monounsaturated: 6%. Polyunsaturated: 1.6%.

COENZYME Q 10 ● Inhibits oxidation of LDL cholesterol ● Attaches to LDL particles ● Lowers Lp(a), a powerful predictor of cardiac health ● Food sources: ORGAN MEATS (liver, kidney, beef, sardines, mackerel, peanuts) ● 50x more antioxidant power than Vitamin E

POLICOSANOL

Policosanol ● Protects LDL cholesterol from oxidation ● Derived from sugar cane ● Inhibits proliferation of vascular cells, platelet aggregation ● INCREASES HDL CHOLESTEROL ● Comparable to many cholesterol lowering drugs (Prat et al. 1999)

GUGULIPID Extract from mukul myrrh tree Used for centuries in India Human clinical trials showed 14-27% drop in total cholesterol levels 22-30% reduction in triglycerides HDL increased in 60% of cases Plaque formation regression Non-toxic