Chapter 6: Fat and Cholesterol Are Not Your Enemy Flashcards
1
Q
What is Cholesterol?
A
Cholesterol is a yellow, waxy molecule comprised of lipid (fat).
2
Q
What are lipoproteins composed of?
A
Lipoproteins are comprised of cholesterol, triglyceride, phospholipid (another type of fat), and protein.
3
Q
Where is cholesterol manufactured?
A
In the liver
4
Q
True or False
Cholesterol and other fats in the bloodstream are packaged together with lipoproteins to ease their movement through the bloodstream.
A
True
5
Q
True or False
The liver provides for the body’s cholesterol needs regardless of how much you eat.
A
True
The liver varies its production level in accordance with dietary intake. The less cholesterol you ingest, the more the liver will make.
6
Q
Why must cholesterol be packaged together with lipoproteins in the blood?
A
Cholesterol is oil-based and the bloodstream is water-based.
7
Q
True or False
Most cells in the body can manufacture the cholesterol they need because the LDL particles in the blood will direct the production of more cholesterol.
A
False
Protein molecules in the cell will direct the production of more cholesterol (or pulling in more LDL particles circulating in the bloodstream) if insufficient levels are detected in the cell.
8
Q
Name the types of lipoproteins from largest to smallest.
A
- Chylomicrons,
- VLDLs (Very Low Density Lipoprotein)
- IDLs,
- LDLs, (Low Density Lipoprotein) and
- HDLs (High-Density Lipoprotein)
as well as subfractions of each).
9
Q
True or False
The three most prominent lipoproteins relative to the heart disease discussion are HDLs, LDLs and IDLs.
A
False
The three that are the most prominent in the heart disease saga are VLDLs, LDLs, and HDLs (very low-density, low-density, and high-density lipoproteins, respectively).
10
Q
Why are HDLs known as “nature’s garbage trucks?”
A
HDLs are known as the “good cholesterol” or “nature’s garbage trucks” for their ability to cleanse the arteries and bloodstream of oxidized cholesterol, thereby reducing the risk of heart disease.
HDLs (High-density lipoproteins): HDLs take oxidized cholesterol from the bloodstream back to the liver for excretion or recycling into useful service.
11
Q
Where do HDLs take oxidized cholesterol after removing it from the bloodstream?
A
To the liver for excretion or recycling.
12
Q
True or False
About 30 percent of the total cholesterol in a healthy body is composed of HDL.
A
True
13
Q
True or False
Cholesterol is contained in the membrane of every cell in the body except blood plasma.
A
False
Cholesterol is contained in the membrane of every cell in the body, as well as in blood plasma.
14
Q
What roles do cholesterol play in the body?
A
Building and maintaining cell membranes, metabolizing fat-soluble vitamins, producing bile to help digest fat, and synthesizing many hormones, including sex hormones.
15
Q
True or False
High levels of HDL decrease the risk of heart disease.
A
True
16
Q
What does VLDL stand for?
A
Very Low-Density Lipoproteins
17
Q
Where are VLDLs manufactured?
A
In the liver
18
Q
What is the primary function of VLDL?
A
VLDL transports triglyceride and cholesterol to target fat or muscle cells.
19
Q
True or False
Prior to delivering their payload to the cells, VLDLs are composed of about 80 percent cholesterol and 20 percent triglyceride.
A
False
Initially, VLDLs are composed of about 80 percent triglyceride. After VLDLs deliver their cargo to various target cells in the body, they contain mostly cholesterol and minimal triglyceride.
20
Q
What takes place after VLDLs deliver their contents to the cells?
A
They shrink substantially in size and transform into either large, fluffy LDLs or small, dense LDLs.
21
Q
What is another name for large, fluffy LDL?
A
Buoyant LDL
22
Q
How is large, fluffy LDL formed?
A
This type of cholesterol is formed from VLDL when blood levels of triglycerides and insulin are low.
23
Q
True or False
In all cases, the presence of high concentrations of large, fluffy LDL is a prominent indicator of heart disease risk.
A
False
These molecules are generally harmless except in the presence of other risk factors (high insulin-producing diet, systemic inflammation, abdominal obesity, family history, smoking, etc.).
24
Q
What factors can contribute to large, fluffy LDL becoming oxidized?
A
Adverse lifestyle practices, low HDL values, poor thyroid function.
25
How can the thyroid contribute to oxidation of large, fluffy LDL?
Poor thyroid function down-regulates LDL receptors and causes LDL to circulate for longer periods in the bloodstream with insufficient antioxidant protection.
26
What is familial hypercholesterolemia?
A genetic condition in which LDL values are extremely high, and almost entirely of the large, fluffy variety.
27
What is VLDL?
Small, dense LDL
28
How is VLDL created?
VLDL converts to small, dense LDL when triglyceride and insulin levels are elevated in the bloodstream.
29
What is the endothelial cell layer (ECL)?
The cells that line the walls of your arteries.
30
What happens when VLDL gets lodged in the ECL?
Since oxygen is constantly flowing through arteries, the small, dense LDL that end up trapped in the ECL sustain oxidative damage and trigger an immune response that can progress toward an eventual heart attack.
31
Other than high-carb eating, what is another pathway to the accumulation of small, dense LDL?
Some who convert to Primal/paleo eating develop sluggish thyroid function which triggers an elevation in small, dense LDL because LDL is being cleared from the blood slower than usual. Often this unique population of thyroid sufferers can tweak their eating habits (e.g., adding back more high-nutrient value carbs), and regain optimal thyroid function and clearance of oxidized cholesterol.
32
True or False
| Having a relatively low total LDL reading does not guarantee a person won't have a heart attack.
True
Heart attacks can and do occur in individuals who have a relatively low total, and seemingly safe, LDL reading if a high percentage of the total LDL is small, dense LDL, and if systemic inflammation and oxidative damage are present due to adverse diet and lifestyle practices.
33
True or False
The total LDL reading on a blood test indicates both the total cholesterol amount carried by your LDL particles as well as the size of the particles.
False
| Total LDL readings do not reveal what size the particles are.
34
What is LDL-C?
LDL-C is the term for total amount of cholesterol someone is carrying.
35
What is LDL-P?
LDL-P is the number of LDL particles in the blood.
36
Why is LDL-C not always a reliable measure of the amount of LDL someone's blood contains?
Although LDL-C is often used to estimate the amount of LDL someone's blood contains (with the logic that having more "passengers" to transport will usually mean there are more "vehicles" zooming to and fro), it can be misleading when we take particle size into account.
37
```
True or False
Eating Primally (a diet high in natural saturated fats) can result in an increase in the number of LDL particles in the bloodstream.
```
False
Eating Primally might increase the total amount of cholesterol in the bloodstream, but typically in the form of large, fluffy LDL (buses).
38
True or False
Dr. Ronesh Sinha recommends that, due to evidence which shows that an ideal LDL level of 100 is not fully protective against heart attacks, LDL targets should be set even lower.
False
Dr. Ronesh Sinha references a UCLA meta-study (analysis of many independent studies) showing that 75 percent of patients hospitalized for a heart attack had an LDL of less than 130 mg/dl (widely accepted as "safe"), and that half of the victims had an LDL under 100, widely considered "ideal." Unfortunately, as Dr. Sinha explains, instead of seeing the big picture of how all risk factors interplay, "many physicians and drug companies are [mis]-interpreting the results of the UCLA meta-study to mean we should set our LDL targets even lower."
39
Summarize the heart disease process.
Small, dense LDL cholesterol molecules hang out in the bloodstream for far too long, and are oxidized due to the constant flow of hemoglobin and exposure to free radicals and other oxidants. These oxidized LDL molecules then lodge onto damaged (and thus more receptive) ECL, only to become oxidized even further. Inflammation is caused by the immune response of the macrophages turning into foam cells. Coagulation (clot formation) eventually causes a significant obstruction—a fat-filled tumor known commonly as "plaque"—on the ECL.
40
True or False
In a healthy body, cholesterol molecules can serve as a temporary band-aid to cover lesions in the ECL, and are then recycled back to the liver by HDL when the inflammation subsides.
True
41
True or False
Atherosclerosis is characterized by plaques that are formed in arteries when small, dense LDL molecules become lodged in the ECL and cause inflammation when they become oxidized by the constant flow of oxygenated blood passing by.
True
42
What are macrophages?
Scavenging white blood cells designed to engulf and digest cellular debris that rush to the scene and attempt to gobble up oxidized small, dense LDL.
43
What are foam cells?
When macrophages become overwhelmed by the effort to gobble up oxidized small, dense LDL, they expand in size to become what are known as foam cells.
44
How do foam cells lead to additional inflammation and oxidation?
Foam cells produce a chemical called myeloperoxidase, which further oxidizes LDL particles. Foam cells also release chemicals called cytokines into the bloodstream, which attract more macrophages to the area to cause further inflammatory damage.
45
How do plaques cause stroke or heart attack?
As oxidation and inflammation continue, plaques becomes stiff and calcified and more susceptible to rupture. Once a rupture occurs, it can block the artery on the spot, or more commonly detach from the wall, drift into circulation and eventually cause a stroke, or a heart attack (aka myocardial infarction—blockage of a coronary artery).
46
What is a stroke?
blockage of an artery heading to the brain
47
What is a myocardial infarction?
aka "heart attack, Myocardial infarction is the blockage of a coronary artery (feeding the heart itself)
48
What is hyperinsulinemia?
Chronically elevated insulin levels leads to a condition known as hyperinsulinemia, which promotes systemic inflammation in the body.
49
How does hyperinsulinemia lead to high blood pressure?
It causes damage to the ECL by reducing bioavailability of nitric oxide (a compound that keeps the ECL relaxed) and promoting platelet adhesiveness (sticky platelets that clot more readily). These conditions increase the sheer force of blood flowing against the ECL (high blood pressure).
50
How do elevated insulin levels affect triglycerides?
Chronically elevated insulin levels prevent triglyceride from being mobilized into free fatty acids for use as energy. Instead, you are stuck in a fat storage pattern instead of a balance between energy mobilization (burning of fatty acids) and energy storage (storing ingested fats or ingested carbs converted into fats).
51
What effect do elevated levels of trigyceride in the bloodstream have on VLDL?
Elevated levels of triglyceride in the bloodstream drive VLDL conversion into small, dense LDL instead of large, fluffy LDL.
52
What factors can contribute to elevated cortisol levels?
Poor eating habits, chronic exercise habits, insufficient sleep, and other forms of life stress that overstimulate the fight-or-flight response can result in chronic, or systemic, inflammation.
53
What is cortisol?
Stress hormone
54
True or False
| Insufficient levels of HDL can significantly increase heart disease risk.
True
55
List elements of the Standard American Diet that can elevate disease risk.
Excess carb intake and insulin production;
Excess consumption of PUFA oils (which are inherently prone to oxidation and become incorporated into LDL particles);
Any consumption of chemically altered trans or partially hydrogenated fats (which impair blood flow);
Insufficient intake of antioxidants (which can help prevent oxidation in the first place);
Insufficient intake of saturated fat (eating saturated fat helps elevate HDL and makes LDL particles more resistant to oxidation);
Poor LDL clearance (with diet likely contributing to poor thyroid function that inhibits LDL clearance).
56
True or False
| Statins reduce risk of heart disease by targeting and reducing the levels of the most troublesome lipoproteins.
False
| Statins reduce levels of all types of cholesterol, including HDL.
57
According to Dr. Cate Shanahan, what is the most important blood metric to assess?
Triglyceride-to-HDL ratio. A ratio of 3.5:1 or below is desirable, while a ratio of 1:1 is considered superior.
58
What factors lead to excessive triglycerides?
Excess carbohydrate intake, excess insulin production, and the conversion of excess ingested carbohydrates into triglycerides in the liver.
59
What is the significance of high triglyceride levels?
High triglycerides indicate the body's cholesterol processing system is overwhelmed.
60
True or False
| Elevating HDL and reducing triglycerides is the most worthwhile tandem goal to reduce heart disease risks.
True
61
True or False
| High blood pressure is not a particularly reliable indicator of unhealthy dietary, exercise and lifestyle habits.
False
62
What is considered a safe blood pressure threshold?
A systolic/diastolic reading of 120/80 or lower (for each value).
63
True or False
| For those who are sun-challenged, supplementing can be extremely effective.
True
64
True or False
Govermenment recommendations for dietary Vitamin D intake and sun exposure are comparable to those dispensed by Vitamin D experts.
False
Long-standing government recommendations for both dietary vitamin D intake (600 I.U. per day) and sun exposure are very low and in sharp contrast to the recommendations dispensed by vitamin D experts.
65
What is the preferred Vitamin D blood test?
25(OH)D
66
True or False
| Vitamin D advocates recommend an optimal blood value range of 50-70 ng/mL when treating heart disease or cancer.
False
Vitamin D advocates agree on an optimal blood value range of 50-70 ng/mL, and a range of 70-100 ng/mL when treating heart disease or cancer.
67
What level do Vitamin D experts consider to be deficient?
Any value below 50 ng/mL is categorized as deficient.
68
What vitamin and/or mineral deficiencies could lead to excessive Vitamin D levels?
Vitamin A, vitamin K, and potassium
69
True or False
| Vegetarian sun worshippers would do well to supplement with cod liver oil.
True
| Heavy sun exposure can deplete vitamin A, and cod liver oil boosts vitamin A levels.
70
True or False
| Toxicity is a danger to anyone who supplements with Vitamin D, gets too much sun exposure or eats a high Vitamin D diet.
False
Vitamin D toxicity is most likely to happen in unique, sensitive individuals when they take too many supplements over a long period of time. It’s impossible to become vitamin D toxic from sun exposure, since the body automatically regulates vitamin D production by tanning the skin (and consequently shutting down further vitamin D production) when you’ve had enough.
71
True or False
| Native Americans can likely thrive on lower ranges of Vitamin D than Caucasians.
True
There is believed to be some variation in optimal vitamin D levels based on ethnicity, with those of non-White ancestry able to thrive in lower ranges than light-skinned folks.
72
Describe the significance of the relationship between Vitamin D levels and PTH (parathyroid hormone).
Vitamin D levels on the low end of normal are not problematic if you also have low levels of parathyroid hormone (PTH). PTH regulates the conversion of 25(OH)D into a more active form of vitamin D in the body. If PTH is high, above 30 pg/mL according to Dr. Masterjohn, and vitamin D is low, that suggests that there is not enough vitamin D available in the body. On the other hand, if vitamin D is borderline low (25 to 30 ng/mL), but PTH is also low, that probably reflects a functioning vitamin D regulatory system and is not cause for concern.
73
True or False
| Chronic overproduction of insulin can be detected on a fasting blood insulin test.
True
74
True or False
| HbA1C measures how much hemoglobin is attached to a glucose molecule.
False
HbA1C: Known as the "estimated average glucose" test, HbA1C measures how much glucose is attached to a hemoglobin molecule, a reliable marker for a state of elevated blood glucose levels over an extended time period.
75
What does a triglyceride reading over 150 suggest?
An excess of oxidized LDL and thus elevated disease risk.
76
What is considered to be an ideal level of trigylcerides?
Under 100 is optimal.
77
What can be determined from a High Sensitivity C-Reactive Protein (hs-CRP) test?
In the absence of other acute infections, a high level of hs-CRP in your blood is a reliable sign of inflammation in the blood vessels. Elevated C-reactive protein is associated with an increased risk of heart attack, stroke, and sudden cardiac death.
78
What is CRP?
C-Reactive Protein is C-reactive protein (CRP) is a protein that increases in the blood with inflammation and infection as well as following a heart attack, surgery, or trauma.
79
True or False
Marathon runners often reveal permanently high levels of CRP as a consequence of the trauma sustained from running 26 miles.
False
| These levels will typically return to normal in 72 hours.
80
How might you determine whether someone has an elevated level of CRP without a blood test?
Excess belly fat is often an indicator of elevated C-reactive protein and systemic inflammation.
81
What is considered an ideal level of CRP over the long term?
Under normal circumstances or over the long-term, ideal CRP levels are well under 1 mg/L.
82
What types of cells secrete Interleukin-6?
T cells (a type of white blood cell that plays a huge role in the immune response) and macrophages (cells that engulf and digest—also known as phagocytosing—stray tissue and pathogens) both secrete IL-6 as part of the inflammatory response
83
True or False
| Homocysteine is an amino acid that can become elevated due to vitamin and mineral deficiencies.
True
84
True or False
| Elevated levels of the enzyme CPK could indicate damaged tissues from surgery.
True
85
What is Lipoprotein(a)?
Lipoprotein(a) promotes coagulation (clotting), making it a heart disease risk marker. Elevated values are strongly associated with early and aggressive forms of heart disease.
86
What is LpA2?
LpA2 is an enzyme that promotes oxidation of lipoproteins, making it a heart disease risk marker.
87
True or False
| Apolipoprotein B can fluctuate from day to day and should be retested at regular intervals.
True
88
What is Apolipoprotein B?
A protein residing in all LDL particles. High levels indicate elevated LDL particle number and elevated heart disease risk.
89
What do tests such as the Berkeley Heart Lab test, VAP test and NMR test measure?
LDL particle size/advanced lipid profile testing: Provides values for large, fluffy LDL (also known as "Type A LDL") and small, dense LDL (aka, "Type B LDL").
90
What is the significance of high trigylceride levels vis a vis Type B LDL?
High triglyceride levels suggest that Type B values may be elevated, because blood triglyceride levels determine whether VLDL converts into large, fluffy or small, dense molecules after delivering cargo to target organs and cells.
91
What does Coronary calcium testing measure?
Calcium buildup in the arteries via CT scan, a strong indicator of atherosclerosis.
92
True or False
Prescribing statins to lower overall cholesterol levels is a medically sound course of action whenever total LDL is found to be high.
False
Evaluating the big picture of heart disease risk factors—as discussed with triglycerides, LDL particle sizes, HDL, systemic inflammation markers, and other advanced blood tests—is a more effective approach than the current trend of prescribing statins to millions of patients based on total cholesterol readings or total LDL cholesterol readings.
93
What are the side effects of statins?
1. Statins suppress the production of cholesterol in the liver, producing lower blood values of all forms of lipoproteins, including beneficial HDL.
2. Suppressing cholesterol production through pharmaceutical means can interfere with healthy serotonin balance (less energy and alertness; potential mood consequences too);
3. Hampered vitamin D synthesis
4. Disturbances in regulating blood sugar,
5. Disturbances in controlling inflammation, and d
6. Disturbances in an assortment of critical hormonal processes.
7. Causes inflammation in the liver
8. Can deplete cells of CoQ-10
94
What is the function of CoQ-10?
CoQ10 helps mitochondria produce energy in cells.
95
What symptoms can deficiency of CoQ-10 cause?
Fatigue, muscle pain, and other indicators of muscle dysfunction. Furthermore, CoQ10 depletion can hamper the ability of all cells to fight free radicals and moderate inflammation, plus cause elevated oxidative damage in cells whose normal energy production mechanisms are compromised.
96
True or False
| Statins to not affect trigylceride levels or LDL particle size.
True
97
True or False
Statins have never been shown to decrease risk of death in any women, in men under 65 or in men over 65 who have not had a heart attack.
False
| In men OVER 65, or in men under 65 who have not had a heart attack.
98
Name some of the incidental benefits, or pleiotropic effects, of statins.
Anti-inflammatory effect, a blood thinning effect (helping reduce plaque formation in those susceptible), and a plaque-stabilizing effect (reducing the risk of rupture in those susceptible).
99
True or False
According to Dr. Sinha, only those patients who demonstrate an inability to carry out minimum levels of recommended lifestyle changes should be prescribed statins.
True
100
With regard to the diet-heart hypothesis, what has been shown by major epidemiological studies such as Women's Health Initiative, Health Professional's Study, Nurses Health Study and Framingham Heart Study?
No correlation between dietary fat intake or cholesterol intake and heart disease.
101
What are the three main reasons that dietary fat has been maligned as unhealthy?
Flawed science, propaganda, and manipulative marketing and advertising.
102
As it relates to fat, what is the problem with the original USDA food pyramid in 1992?
Failure to distinguish between healthy and unhealthy fats: it is one of the most egregious examples of a blanket condemnation of dietary fat without regard to the type of fat consumed. It not only indicates to consume all forms of fat "sparingly," but also lumps fats and oils in with sweets!
103
What are some important functions of saturated fat in our bodies?
Saturated fat comprises about half of our cell membranes, contributes to a variety of healthy metabolic and hormonal processes in the body, is an abundant source of important vitamins like K2, A and D, and is easily burned as free fatty acids in the bloodstream.
104
True or False
The fact that saturated fat and cholesterol are the agents that clog your arteries is proof that their dietary intake can be problematic.
False
Conventional wisdom makes an inaccurate association between saturated fat consumption and heart disease. While saturated fat and cholesterol are indeed the agents that clog your arteries and cause heart attacks and strokes, the process by which saturated fat and cholesterol turn dangerous is completely independent of their intake in the diet.
105
True or False
| Consuming calorically dense fatty foods rarely leads to weight gain even in the context of a high-carb diet.
False
Consuming calorically dense fatty foods can indeed lead to weight gain thanks to the high insulin production (from a grain-based diet) that drives ingested calories into fat storage.
106
True or False
| TV ownership correlates more tightly with heart diesease than saturated fat consumption.
True
107
True or False
| MyPlate rectified the long-standing bias against dietary fats in official government recommendations.
False
| The importance of high quality dietary fats is completely absent.
108
True or False
| Any diet that de-emphasizes the Standard American Diet is a step in the right direction.
True
109
What are the three main challenges to adhering to strict low-fat or vegan/vegetarian diets?
First, these diets exclude many rich and satisfying foods, making satiety difficult to achieve.
Second, their emphasis on carbohydrates promotes energy, appetite, and mood swings due to excess insulin production.
Third, their emphasis on grains, even whole grains, delivers less nutrient density per calorie than a Primal Blueprint type eating pattern featuring liberal intake of nutrient-dense meats, fish, fowl, eggs, vegetables, fruits, nuts, and seeds.
