This blog is the second part of two blogs during February, “Heart Month,” dealing with heart disease. The topic for this blog is hyperlipidemia. So, what does hyperlipidemia mean and what is its connection to heart and vascular disease? And what can someone do if they have hyperlipidemia?
The prefix “hyper” means above or excessive. Lipids are fats. The word hyperlipidemia means an excessive amount of fats in the blood. These fats are known as cholesterol and triglycerides.
Cholesterol is made naturally by the liver and is also ingested via certain foods – mainly animal products. It is essential for the production of cell membranes and is the precursor chemical for adrenal (think cortisol) and sex steroid hormones (think estrogen, progesterone, testosterone). The body makes enough cholesterol to provide what it needs, so the cholesterol taken in by food is extra. Triglycerides are a combination of three different fatty acids with a glycerol molecule; think fat plus sugar, i.e., pastries and other sweets. Triglycerides can come from the fats you eat or can be made from ingested carbohydrates. Triglycerides are the storage mechanism for unused calories throughout the body, especially from excess calorie intake, alcohol, and sugar.
Cholesterol and triglycerides are packaged in the body as LDL (low-density lipoproteins), HDL (high-density lipoproteins), and VLDL (very low-density lipoproteins). LDL is the “bad” cholesterol (or, as I think of it, the “lousy” cholesterol). It is the vehicle by which cholesterol is deposited in the arteries, which builds up and forms what is called plaque (see the previous blog on hypertension and the diagram of the plaque formation). HDL is the “good” cholesterol (I like to think of it as the “happy” cholesterol). It brings cholesterol to the liver, which then gets rid of it. I sometimes think of it as Drano for the blood vessels, cleaning them out of excessive cholesterol. In terms of amounts, the lower the LDL can be the better it is for your body. Generally, the higher HDL, the better – it can clear out excessive cholesterol from the blood vessels. The VLDL is the packaged form of triglycerides, which add to plaque and the development of atherosclerosis (hardening of the arteries from a lot of plaque deposition).
Remember the process of plaque formation. First, there is damage to the innermost lining of the blood vessel, called the endothelium, which is just one cell layer thick. It becomes less responsive to nitric oxide, the chemical that causes blood vessels to relax. This leads to inflammation in the area endothelial damage. Then, lipids are able build up in the innermost portion of the endothelium. This occurs through cells called macrophages (scavenger cells in the body) which engulf the lipids and become “foam cells.” These “foam cells” ultimately cause necrosis (death) of the underlying tissue, and then smooth muscle cells cover the area of foam cells and debris, producing plaque. The firm covering of plaque keeps the lipids from being destroyed and causes atherosclerosis or hardening of the arteries. Paques can rupture, sending blood clots to the heart (causing a heart attack), the brain (a stroke), and so forth.
Lipids are evaluated by a blood test called a Lipid Panel. The blood is usually drawn after an overnight fast. The following are the generally recommended normal levels, although you will find some variations in recommendations depending upon which group is doing the recommending (like Centers for Disease Control and Prevention, National Institutes of Health, American Heart Association etc.):
- Total cholesterol – less than 200 mg/dl
- LDL – best less than 100 mg/dl
- HDL- greater than 40 mg/dl in men, greater than 50 mg/dl in women, some sources recommend a level of at least 60 mg/dl
- Triglycerides – less than 150 mg/dl
There are many risk factors for hyperlipidemia: family history/genetics, obesity, sedentary lifestyle, eating the standard American diet (which is heavy in cholesterol-laden animal products), diabetes, smoking, drinking too much alcohol, hypothyroidism, stress. The negative impacts on health are an increased risk of heart attack and sudden cardiac death, stroke, peripheral artery disease (atherosclerosis in the blood vessels feeding oxygenated blood to the legs), dementia, to name a few. Family history/genetics cannot be changed, but most of the other risk factors can be modified. So, when a person is told that his or her lipids are elevated, the most important place to start in terms of management is lifestyle modification. Diet is one of the first places to start because the extra cholesterol ingested is from our food and the triglycerides come from the intake of excessive calories and refined carbohydrates. To help reduce cholesterol:
- Increase the amount of fiber in your diet by increasing your intake of fruits, vegetables, beans, and whole-grain products. It is recommended that you have 6 to 8 servings of fruits and vegetables a day. That is a lot, so you have to plan for eating that much, starting with your morning meal. Foods that come in their own packages (bananas-the peel, apples-the skin, peas-the pod, etc.) are the healthiest for you.
- Stop smoking. There are many resources available to help. I think of smoking cessation as a journey, starting with getting ready to quit. You would not go on a trip to London or Paris without planning what you would like to do when you get there. It is the same with smoking cessation; planning for the times when the urge to smoke comes over you or when something personally stressful happens will help you to ultimately be successful. Medication can also be used, which you can discuss with your health care provider.
- Lose weight. There are some fairly simple changes that can help you on your way. Transition to a plant-based diet. For example, make a wonderful bean soup, have a nice salad with lots of veggies. Discontinue consumption of cow milk products and cheese. Use unsweetened nut milks or soy milk instead. Try the easiest form of intermittent fasting, which is to compress your eating into 6 to 10 hours a day, resting your gastrointestinal tract for 14 to 18 hours. One way is to eat only during daylight hours. Don’t snack. Try to avoid eating in restaurants. Sit down to eat and enjoy your food, even if you are eating alone. Sometimes it helps to keep a food diary for a couple of days to figure out how many calories you have consumed. For women, maintenance calorie consumption might be as low as 1400-1600 calories per day. If someone eats as little as 100 calories a day over their baseline, that person could gain one pound every 5 weeks, which would add up to be 10.4 pounds per year!
- Decrease alcohol intake if you tend to over-consume. For women, no more than 1 drink per day, for men no more than 2 drinks per day, according to the “Dietary Guidelines for Americans 2020-2015”, Department of Health and Human Resources and the U.S. Department of Agriculture
- Start moving around. Decrease TV and device watching. Do things you like – walking, gardening, bird watching, swimming, dancing, etc. Try to connect with nature.
- Learn techniques to deal with stress – this might include meditation, yoga, perhaps counseling, or psychotherapy.
- Work with your health care provider if you have hypothyroidism or diabetes. You might need medication to help lower your lipids.
- Avoid sugar and refined carbohydrates like white flour. Use whole wheat products instead. Avoid processed meats, animal products, and junk food.
By making lifestyle changes, you can lower your lipid levels. Each time I have a nice salad with lots of vegetables, a hearty vegetable-filled soup, or just a delicious plant-based meal, I imagine my HDL washing away all those lipids in my bloodstream! My wish for you is that this information has been understandable and that it will help you bring about changes in your life that will result in better health and vitality.
