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  • LDL and vascular damage theory question

    Hey guys,

    I wanted to ask a somewhat generic question about a topic that has been discussed before, but I am still unclear.

    So the prevailing theory among the Paleo/Primal folks is that cholesterol is a symptom not a cause. Often times the cause is vascular damage (internal inflammation). OK. I can buy that. Furthermore LDL serum levels indicate that cholesterol is being delivered to the damage sites and thus we can sort of tell by proxy that high LDL levels suggest something may be "wrong". Not necessarily, but possibly.

    So then here is my question.

    Why is it, that such an overwhelming amount of Paleo folks, including myself recently, see their LDL levels spike? After all, we remove the supposed primary agents of vascular inflammation (sugar, omega-6s imbalance, refined grains) etc? I read here and there that high LDL may be caused by other factors that emerge. Thyroid, copper deficiency, etc. Sure, ok, but the amount of times a Paleo practioner sites high LDL cannot be explained. Does everyone have a thyroid condition around here? Can't be...

    On the flip side, my vegetarian friends who supposedly are doing precisely the wrong things by eating pastries, sugar, pasta, etc have LDLs under 100 - consistently!

    So what gives? If its vascular damage, then why are we the ones showing symptoms of the damage when it is supposed to be exactly the opposite. Mind you I do eat my share of conventional poultry, but I only eat grass-fed meat, pastured butter and basically consume zero added sugar. Yet my LDL is 140.

    Just interested in the science.

  • #2
    I recommend this: The straight dope on cholesterol
    This is from Dr. Peter Attia and is part 1 (of 9) on cholesterol. You can also search him for videos on the topic, he gives excellent presentations.
    It is a lengthy series, but well worth the effort to pound through if you are interested in the science on cholesterol.
    The Buck stops here. I am responsible for my past and my future. So for today: I choose to be happy. I will seek wisdom. I will be a servant to others. I will greet this day with a forgiving spirit.

    Comment


    • #3
      I like this question... I would love to hear opnions/evidence on this too!!

      Comment


      • #4
        Here's a guess

        LDL delivers cholesterol to where it's needed.

        HDL returns cholesterol to the liver from where it is no longer needed.

        Both are required.

        If you're male and want/need testosterone then you need LDL to deliver cholesterol to make testosterone.

        If you lift heavy and want/need to repair and build muscle the LDL will deliver cholesterol to the muscles.

        Lifting heavy also means bones, ligaments, tendons, joints, need to be strengthened and built up - LDL will deliver cholesterol to help do that.

        Note also bile salts ( used to break down dietary fats) made by the liver and stored in the gallbladder is made from cholesterol - not sure of the role of LDL in this though.

        Maybe your non-inflamed arteries don't need repairing LDL cholesterol delivery but other parts need it to grow and strengthen.

        Cholesterol has a lot of good uses in the body and LDL gets it from the liver to where it's needed.

        May be if you're a low fat eating vegetarian that doesn't lift or need much testosterone or bile salts, then MAYBE LDL is not needed to be high as it's not used much.

        Maybe their HDL is low too - possibly their trigs are high..

        Mostly guesses though - I don't really know.

        Comment


        • #5
          The short of it is:

          Cholesterol is not a fat. It is a liver steroid (chole= liver, sterol = steroid). It's primary role is to move these building blocks to wherever they need to be, to and from the muscles and liver. The density of this transport can vary widely, however, which is what we track.

          About 70% of one's serum cholesterol is not influenced by diet, but by the body itself with a large genetic component. The take home is that the actual TOTAL cholesterol is next to meaningless; some people will naturally be having more transport, more cars on the highway so to speak, but that is how the system is meant to function. For instance, people with chronically low cholesterol, sometimes through pathological processes, generally age much faster than normal people....because every cell in your body requires cholesterol in its cell walls.

          The problem comes when the vessels themselves are damaged, via various basement membrane diseases such as diabetes or atherosclerosis. These sort of cause big potholes in the road, and otherwise let it deteriorate. Then, and only then, do the cars and what they are composed of start to cause problems. It's not that there is cholesterol. It's that there is now a degraded vessel for it to travel in.

          In metabolic syndrome, the ratio of LDL to HDL is thrown off due to the feedback mechanisms between the pancreas and liver. These same changes run in concert with the basement membrane degradation, so a diseased liver declines along with the vessel quality....and over time, people that eat a lot of processed garbage, or other non-fibrous foods which hit the liver the hardest, will see their lipid ratios move with them....but even this is the cart before the horse. The liver and pancreas are no longer synergistic, causing the ratios to move at the same time that the vessels are lost. They are the SAME mechanism, not a cause and effect.

          LDL will spike in anyone that is consuming more fatty foods, as anyone eating paleo will in order to transport their end products. This said, the ratio generally improves drastically. So there are more cars on the road, but real food does not cause the liver/BM vessel damage that processed does, so the system functions normally.

          This all explains the finding that yes, a lot of people that have AMIs have high cholesterol....but at the same time, there are also a large number that have them with completely normal numbers. So if AMIs are caused by plaque buildup s/t high cholesterol, then how can someone with it being normal have them in such numbers? Inflammation....all AMIs have inflammation as their common denominator; which makes sense, because at root these chronic diseases are all basement membrane pathologies. In other words, pay attention to the health of the roads and stop counting cars.

          Hope this helps.
          "The soul that does not attempt flight; does not notice its chains."

          Comment


          • #6
            OK, let me attempt to rephrase the question based on certain assumptions that this community accepts as facts.

            1) LDL serum levels are useless in determining anything whatsoever
            2) Just because you have a lot of transport activity going on does not mean anything. Perhaps cholesterol is being delivered for repair/build reasons due to normal growth or because there is some kind of damage evoking the response.
            3) No such thing as bad cholesterol. Labeling LDL bad is lazy, ineffective and grossly simplifies the issue at hand.

            Again, I want to simply understand why is it that the vegetarian community/vegan people have such low LDL markers while also acknowledging that it DOES NOT mean they are a lower risk group for heart attack. In fact plenty of studies suggest low total numbers are correlated with depression, mortality, etc. While the Paleo community is running high.

            What is happening within our bodies that obviously and clearly produces such varying markers.

            Also guys, remember that in our low information society most folks are still conditioned to believe low cholesterol numbers are good. So this is an attempt to frame the topic in a different light, that low numbers not only are meaningless but potentially dangerous. I just don't know how to do that because I don't understand the difference myself.

            Could it be that high LDL numbers actually indicate health?

            "LDL will spike in anyone that is consuming more fatty foods, as anyone eating paleo will in order to transport their end products."

            Why?

            "About 70% of one's serum cholesterol is not influenced by diet,"

            I want to focus on this. We are talking serum levels in blood, right? SO someone feasting on vegetable oils, sugars and flour all their life may have low serum levels but tons of plaque - ya? IN that sense cholesterol *is* influenced by diet, but in an indirect causal way not the correlated dietary way most nutritionists preach.
            Last edited by rkd80; 03-13-2015, 01:13 PM.

            Comment


            • #7
              According to Peter, our vascular damage argument is way too simplistic. Taking aside for why there is significant LDL population in the blood, the real issue of inflammation occurs when the LDL penetrates the internal arterial wall, which then causes inflammation (vascular damage). Would appear that the premise that high LDL is *because* we have arterial damage is both incorrect and entirely moot.

              The straight dope on cholesterol

              Which again brings me to the original question. Why do most Paleo people have higher serum LDL and why do vegans, etc have low serum LDLs. Again, belaboring the point, that this says nothing of what is happening within the endothelium.

              Comment


              • #8
                Originally posted by rkd80 View Post
                Which again brings me to the original question. Why do most Paleo people have higher serum LDL and why do vegans, etc have low serum LDLs. Again, belaboring the point, that this says nothing of what is happening within the endothelium.
                I don't know that most paleo eaters have higher serum LDL. Higher than what? Vegans? Most paleo persons panels that I have seen are pretty stellar, and certainly exhibit a trend of improvement vs prior to eating paleo. There is a small subset that tend to be hyperresponders but thats about it.

                What I consistently see in "most paleo eaters" is a trend of higher HDL, lower trigs, and stable LDL.

                I think the problem is that you are trying to examine LDL in a vacuum and its not gonna work.
                Last edited by Neckhammer; 03-13-2015, 02:44 PM.

                Comment


                • #9
                  Originally posted by rkd80 View Post
                  According to Peter, our vascular damage argument is way too simplistic. Taking aside for why there is significant LDL population in the blood, the real issue of inflammation occurs when the LDL penetrates the internal arterial wall, which then causes inflammation (vascular damage). Would appear that the premise that high LDL is *because* we have arterial damage is both incorrect and entirely moot.

                  The straight dope on cholesterol

                  Which again brings me to the original question. Why do most Paleo people have higher serum LDL and why do vegans, etc have low serum LDLs. Again, belaboring the point, that this says nothing of what is happening within the endothelium.
                  This is your second post where you assert vegans have lower serum LDL than most Paleo's. What evidence do you have other than the very limited anecdotal "data" you presented in your first post. BTW, Attia's ideas have been refuted by many with credentials as good or better than his. Even Attia has admitted he is not as confident now as he was when he wrote the series, especially his ideas about the importance of LDL-P.

                  Comment


                  • #10
                    Originally posted by TheyCallMeLazarus View Post
                    The short of it is:

                    Cholesterol is not a fat. It is a liver steroid (chole= liver, sterol = steroid). It's primary role is to move these building blocks to wherever they need to be, to and from the muscles and liver. The density of this transport can vary widely, however, which is what we track.

                    About 70% of one's serum cholesterol is not influenced by diet, but by the body itself with a large genetic component. The take home is that the actual TOTAL cholesterol is next to meaningless; some people will naturally be having more transport, more cars on the highway so to speak, but that is how the system is meant to function. For instance, people with chronically low cholesterol, sometimes through pathological processes, generally age much faster than normal people....because every cell in your body requires cholesterol in its cell walls.

                    The problem comes when the vessels themselves are damaged, via various basement membrane diseases such as diabetes or atherosclerosis. These sort of cause big potholes in the road, and otherwise let it deteriorate. Then, and only then, do the cars and what they are composed of start to cause problems. It's not that there is cholesterol. It's that there is now a degraded vessel for it to travel in.

                    In metabolic syndrome, the ratio of LDL to HDL is thrown off due to the feedback mechanisms between the pancreas and liver. These same changes run in concert with the basement membrane degradation, so a diseased liver declines along with the vessel quality....and over time, people that eat a lot of processed garbage, or other non-fibrous foods which hit the liver the hardest, will see their lipid ratios move with them....but even this is the cart before the horse. The liver and pancreas are no longer synergistic, causing the ratios to move at the same time that the vessels are lost. They are the SAME mechanism, not a cause and effect.

                    LDL will spike in anyone that is consuming more fatty foods, as anyone eating paleo will in order to transport their end products. This said, the ratio generally improves drastically. So there are more cars on the road, but real food does not cause the liver/BM vessel damage that processed does, so the system functions normally.

                    This all explains the finding that yes, a lot of people that have AMIs have high cholesterol....but at the same time, there are also a large number that have them with completely normal numbers. So if AMIs are caused by plaque buildup s/t high cholesterol, then how can someone with it being normal have them in such numbers? Inflammation....all AMIs have inflammation as their common denominator; which makes sense, because at root these chronic diseases are all basement membrane pathologies. In other words, pay attention to the health of the roads and stop counting cars.

                    Hope this helps.
                    Dr. Laz, I thoroughly enjoy your posts and find you very credible. You are so confident in your analysis as though all of your ideas are self-evident based on the research. I would appreciate knowing your explanation of why the current CW in the medical community continues to link SF >>> elevated LDL-C >>> CVD. I do not get the sense that statins are falling out of favor as the go-to treatment for high LDL-C and every CW medical site, eg Mayo clinic, advises a very low SF/high complex carb/high PUFA seed oil diet to prevent CVD.
                    Last edited by Artbuc; 03-13-2015, 02:52 PM.

                    Comment


                    • #11
                      LDL and vascular damage theory question

                      He said 70% is not - so by that it leaves 30% that IS effected by diet.

                      So I guess if you're eating a low fat veg diet and your TC is 200, then eat high fat paleo and TC goes to 285. The baseline of 200 is about 70% of the high fat paleo diet of 285. Maybe this is what is meant of the 70% - you're going to make a baseline number by just being alive (maybe only just) and YOUR (individual) baseline number is mostly genetic.

                      Maybe the 200 is close to the absolute minimum allowed by YOUR body/genetics (much lower and you're in real trouble ) - maybe your friends/relative's genetic minimum number is 170.

                      So maybe the veg people with low numbers have dragged their numbers down to CLOSE to the absolute minimum their body can produce ( that number being due to their genetics) - perhaps this this a major stressor to the body to have to force the minimum set point ( body fighting to maintain a minimum - with no help from the diet) - maybe if it's forced even lower than the individual's genetic minimum by extreme diet or extreme exercise it becomes an ER event.

                      May be having a comfortably higher number (with help of diet) than that of your own absolute rock bottom genetic limit (call an ambulance type numbers) is a healthy margin, a low stressor to the body, plenty of LDL and HDL to transport cholesterol to where it's needed muscles etc and stored back to liver for reuse later.

                      All just guesses - I'd like to know too.
                      Last edited by EatMoveSleep; 03-13-2015, 03:39 PM.

                      Comment


                      • #12
                        OK, I would like to clarify a few things, and then reask the number.

                        I was under the impression that many people on these forums and paleohacks report of rising LDL. Perhaps that is not as common as I thought. I was also under the impression that many who switch to a low veg diet see lower LDL.

                        But I can kick that aside and just look at mine.

                        On SAD I was about 90 LDL and am now 134. So why did mine go up?

                        Can anyone provide resources/links on the thinking behind LDL-C and LDL-P? Right now, I am getting the following:

                        - The total amount of cholesterol carried within the LDL particle is misleading, however that is what the standard lipid panel shows (LDL-C)
                        - The total number of particles matters, because somehow they magically bump into each other and penetrate the endothelium (LDL-P).

                        Further still, breaking down the Framingham study it would suggest that high LDL-C is not a precursor of anything, with higher LDL-C and lower LDL-P appearing to be the best precursor of health.

                        How much of this is theory? how much of this probably true? If this is all true, then in my case, why the rise in LDL-C? Why is my HDL is so low? I am happy that my TG is low-ish, but could be lower considering I eat no sugar.
                        Last edited by rkd80; 03-14-2015, 03:22 PM.

                        Comment


                        • #13
                          How often did/do you get your lips panels done? The panel is simply a snapshot in time and may vary by as much as 20 points from week to week depending on a number of factors.

                          Did you lose weight between what you seem to be viewing add your before & after panels?

                          Was your LDL actually measured or just calculated? If your trigs are under 100 and your LDL was calculated target than measured then it's most likely reported as higher than it actually is.

                          http://homepages.slingshot.co.nz/~geoff36/LDL_mg.htm
                          How did your HDL and Trig results change will you LDL increased?

                          What are were/are the actual numbers for your total, hdl, ldl and trigs?
                          If you're interested in my (very) occasional updates on how I'm working out and what I'm eating click here.

                          Originally posted by tfarny
                          If you are new to the PB - please ignore ALL of this stuff, until you've read the book, or at least http://www.marksdailyapple.com/primal-blueprint-101/

                          Comment


                          • #14
                            Originally posted by rkd80 View Post
                            OK, I would like to clarify a few things, and then reask the number.

                            I was under the impression that many people on these forums and paleohacks report of rising LDL. Perhaps that is not as common as I thought. I was also under the impression that many who switch to a low veg diet see lower LDL.

                            But I can kick that aside and just look at mine.

                            On SAD I was about 90 LDL and am now 134. So why did mine go up?

                            No way to know for certain without every single one of your other blood tests and a valid history of changes made in lifestyle. Measurements in different seasons, stress levels, sleep patterns, exercise type and frequency, or the fact that from day to day LDL can vary by at least 20 points with zero changes to anything.


                            Can anyone provide resources/links on the thinking behind LDL-C and LDL-P? Right now, I am getting the following:

                            - The total amount of cholesterol carried within the LDL particle is misleading, however that is what the standard lipid panel shows (LDL-C)
                            - The total number of particles matters, because somehow they magically bump into each other and penetrate the endothelium (LDL-P).

                            LDL on its own is a useless number. LDL-p is simply better correlated to risk of cardiovascular event. While LDL-c tells you next to nothing about anything.

                            Further still, breaking down the Framingham study it would suggest that high LDL-C is not a precursor of anything, with higher LDL-C and lower LDL-P appearing to be the best precursor of health.

                            How much of this is theory? how much of this probably true? If this is all true, then in my case, why the rise in LDL-C? Why is my HDL is so low.
                            lol. It's ALL theory dude. All of biology is but theory and clinical health management is simply the application of that theory based on current best evidence. This absolutely will change with presentation of new data. We know far less than we don't know. Currently I would say that a singular reading of cholesterol assessing your risk is about as good as asking a magical eight ball if you are at risk. Now, when you take that LDL reading and get ratios with trigs and hdl along with some values of inflammatory markers....now we have a bit more validity for our predictions. But it's still just theory.

                            Comment


                            • #15
                              That is just as snap shot that the test was done ( maybe it always fluctuates but you haven't had a test everyday to see it).

                              If it is really now ALWAYS higher (everyday - but you don't test everyday) and before everyday it was lower ( again you didn't test every day) then is probably due to your change to paleo diet/lifestyle.

                              To compare : my LDL went up more much than yours. My HDL went up heaps too. My trigs dropped heaps.

                              IF my LDL is CONSISTENTLY higher than before ( I don't know for sure - but at a GUESS I accept it probably is), then I would directly 'blame' eating/living close to what is prescribed as paleo.

                              I also 'blame' my version of a paleo lifestyle (including plenty of fats) for much better physical/mental health, more strength, more muscle, recovery from chronic back injury I carried for half my life, less body fat, not getting sick in years, better gut health, healthier skin/hair etc - damn paleo for raising my LDL!

                              So in short paleo probably raised your LDL - maybe you need it to heal and grow.

                              I personally won't drop healthy fat consumption to get lower number/s that suits an arbitrary maximum number quoted by a lab - doing so will certainly reduce my quality of life and I believe reduce my lifespan.

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