What are the roles of lipoproteins and cholesterol in the body? Consider the interplay of insulin and cholesterol. How does a client’s insulin level impact his/her level of cholesterol? What is the current standard of care for someone who presents with elevated cholesterol? In what ways does this current standard of care affect insulin levels? Outline a nutritional protocol to help your client address his/her concerns of high cholesterol. Include labs might you request from your client’s primary care provider to assist you in designing this protocol. (600 words)
Lipids are hydrophobic: they are non-polar and insoluble in water. This means that they cannot dissolve in blood and rely on special particles for transport. These particles are called lipoproteins. Lipoproteins are a group of proteins synthesized in the small intestine and liver that transport hydrophobic lipids throughout the body. Lipoproteins are made up of lipids and proteins. The hydrophobic lipid portion of lipoproteins is placed in the core, while the hydrophilic protein portion is placed in the periphery of the particle. This particular structure is what allows lipoproteins to travel in the blood and transport lipids through the body.
Find Out What The Different Types of Lipoproteins and Their Names
There are different types of lipoproteins, and they are named according to the density of their content: chylomicron, chylomicron remnant, very low density lipoprotein (VLDL), intermediate density lipoprotein (IDL), low density lipoprotein (LDL), and high density lipoprotein (HDL). Chylomicrons are the least dense while HDL are the densest.
The lipids present in lipoproteins are triglycerides, phospholipids, free cholesterol, and cholesterol ester. Cholesterol is a high-molecular-weight alcohol, and it comes from two sources: exogenous (dietary cholesterol contained only in food from animals) and endogenous (manufactured by the liver). Cholesterol has several vital functions within the body. It gives our cells stability and stiffness. It is a precursor for the synthesis of steroid hormones, vitamin D, and bile, and it acts as an antioxidant. Cholesterol is needed for serotonin function, and low levels of cholesterol have been linked to aggressive behavior, violence, depression, and suicidal tendencies. Breast milk is rich in cholesterol, and infants and children need cholesterol-rich foods for proper development of the brain and nervous system. Cholesterol is also considered the “duct tape” of the body, used to repair damaged tissues.
Cholesterol and Heat Exposure
Cholesterol can become damaged upon exposure to heat and oxygen. Oxidized cholesterol is found in foods like fast foods, fried foods, margarines, baked goods, and foods that are deep fried in rancid vegetable oils.
Several studies reveal that prolonged exposure to insulin is linked to higher levels of lipid peroxidation markers in LDL. For this reason, we need to be aware that clients suffering from hyperinsulinemia will present higher levels of LDL compared to clients with normal blood sugar metabolism. The cholesterol guidelines from the American College of Cardiology and American Heart Association are as follows: patients with arterial plaques and otherwise healthy patients with LDL-C levels greater than or equal to 190 mg/dl are advised to drastically reduced intake of dietary cholesterol and are prescribed high-intensity statin therapy (or maximum tolerated statin therapy). Diabetic patients between the ages of 40 and 75 with LDL-C levels greater than or equal to 70 mg/ dl are prescribed moderate-intensity statin. It is disheartening to see such guidelines in place and to read that many expert physicians consider them not aggressive enough. Statins are dangerous medications linked to a host of side effects including memory loss and confusion, liver damage, muscle pain and damage. Statins also activate an immune response that prevents insulin from working correctly, causing an increase in blood sugar and, therefore, a higher incidence of diabetes. While as a nutritionist I cannot recommend against doctor’s orders, it is my duty to provide my clients with the latest research and information necessary to make informed decisions.
What Is High Cholesterol and How To Bring The Levels Down
When working with clients who are concerned about high cholesterol levels, some of the tests that I find helpful are the advanced lipid tests LDL particle number (LDL-P) and apolipoprotein B (apoB) as well as serum insulin test and c-reactive protein. These tests all measure biomarkers that can accurately predict risk of cardiovascular disease.
The nutritional protocol for such clients focuses on an anti-inflammatory diet that supplies high quality proteins, fats, and carbohydrates from low-glycemic vegetables and fruits. The diet removes added sugars, processed foods, fried foods, and vegetable oils. I also help them with stress management techniques and sleep hygiene. Supplements are an important part of nutritional therapy and, while there is no typical protocol, nutrients that are helpful in cases presenting high cholesterol are: chromium: 200-400 mcg with each meal; vitamin E: 200-600 IU d-alpha and d-gamma tocopherol; l-arginine: 700 mg two to three times a day with meals; magnesium orotate: starting with 400 mg and dosed to bowel tolerance; and curcumin: 15-60 mg three times a day. A formulation that I have used with success is Lipid-Sirt from Biotics Research.
Naviglio D. Bad Cholesterol or “Bad” Science? Med chem [Internet]. 2016 [cited 2020 Oct 15];6(1). Available from: https://www.omicsonline.org/open-access/bad-cholesterol-or-bad-science-2161-0444-1000321.php?aid=66755
Shane Ellison — Life Saving Cholesterol Facts [Internet]. [cited 2020 Oct 15]. Available from: https://newswithviews.com/Ellison/shane13.htm
Kendrick M. The great cholesterol con: the truth about what really causes heart disease and how to avoid it. London: John Blake; 2008. 270 p.
Ross AC, editor. Modern nutrition in health and disease. 11th ed. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins; 2014. 1616 p.
Shils ME, Shike M, editors. Modern nutrition in health and disease. 10th ed. Philadelphia: Lippincott Williams & Wilkins; 2006. 2069 p.
Smith LL. Another cholesterol hypothesis: cholesterol as antioxidant. Free Radic Biol Med. 1991;11(1):47–61.
Mei S, Gu H, Yang X, Guo H, Liu Z, Cao W. Prolonged Exposure to Insulin Induces Mitochondrion-Derived Oxidative Stress through Increasing Mitochondrial Cholesterol Content in Hepatocytes. Endocrinology. 2012 May 1;153(5):2120–9.
Colas R, Pruneta-Deloche V, Guichardant M, Luquain-Costaz C, Cugnet-Anceau C, Moret M, et al. Increased lipid peroxidation in LDL from type-2 diabetic patients. Lipids. 2010 Aug;45(8):723–31.
Grundy Scott M., Stone Neil J., Bailey Alison L., Beam Craig, Birtcher Kim K., Blumenthal Roger S., et al. 2018
Grundy SM, Stone NJ, Bailey AL, Beam C, Birtcher KK, Blumenthal RS, et al. 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA Guideline on the Management of Blood Cholesterol: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation [Internet]. 2019 Jun 18 [cited 2020 Oct 16];139(25). Available from: https://www.ahajournals.org/doi/10.1161/CIR.0000000000000625
Master SR, Rader DJ. Beyond LDL Cholesterol in Assessing Cardiovascular Risk: apo B or LDL-P? Clin Chem. 2013 May 1;59(5):723–5
Echinacea and elderberry are herbs used to treat upper respiratory tract infections.
There are three main types of Echinacea used as herbal remedies: Echinacea angustifolia, E. purpura and E. pallida. Historically, Echinacea has been used by the Native Americans. The Eclectics used predominantly Echinacea angustifolia, while German herbalists used predominantly E. purpurea because it is the easiest to grow of all the species and the whole plant can be used in herbal remedies. Echinacea enhances innate immunity and resistance to infections; it supports the immune system as it fights allergies as well as autoimmune conditions. Echinacea has also anti-inflammatory properties and it is helps the body recover from chemotherapy. Clinical trials have supported the use of Echinacea in treating upper respiratory tract infections and enhancing immune function (Bone & Mills, 2013). In-vitro studies have shown that Echinacea has some effect upon the influenza virus. A new Czech research published on Current Therapeutic Research shows that the combination of Echinacea and elderberry (Sambucus nigra), is more effective than Tamiflu in the early treatment of influenza.
Elderberry (Sambucus nigra) is an anticatarrhal herb that exerts antiviral properties against flu viruses. According to Torabian et al. (2019) during the early stages of an infection, elderberry’s action blocks the flu viral proteins that are responsible for entry and attachment of viruses. If supplementation is started at the onset of the first symptoms, the viral infection can be inhibited almost completely. Even when the infection has already spread, elderberry can inhibit replication of the viral cells. it also stimulates cells to release cytokines which coordinates the responses to invading pathogens.
Ginseng (Panax ginseng) is commonly referred to as Korean ginseng or Asian ginseng. Originally used in Chinese tradition medicine, it is now widely used in the Western world. According to the Chinese, ginseng has the ability to replenish the body’s energy and fluids and to promote good health and longevity. The main and lateral roots are traditionally used as medicinal ginseng; the smaller root hairs that are utilized in the West are of lower quality. Commercial ginseng is available as two different preparations: red ginseng and white ginseng. For red ginseng, the root is steamed unpeeled before drying, while the white form is peeled dried normally. In Chinese medicine, ginseng is used to treat severe respiratory illness and anxiety issues. In the west, ginseng is used to treat stomach and digestive issues, anorexia, and sexual disorders. The main and lateral roots contain saponins called ginsenosides as well as polysaccharides, essential oils, diacetylines, peptides, lipids, and arginine (Bone & Mills, 2013).
Similar to Asian ginseng, American ginseng (Panax quinquefolis) also turns red after steaming. While it does not have the same chemical makeup, American ginseng also contains ginsenosides. Both American and Asian ginseng are affected by the steaming process; some levels of ginsenosides are reduced after steaming. The saponins in American ginseng contribute to its antiproliferative effect which is greater than that of Asian ginseng (Wang et al, 2007).
Studies show that both Asian and American ginseng are helpful in the management of type 2 diabetes. They have also both been found to improve energy levels and overall quality of life in cancer patients. Other similarities concern immune-enhancing properties: both types of ginseng improve cold and flu symptoms. Both types are used to improve memory and cognition (Chen & Hui, 2012). American and Asian ginseng are also used for their antioxidant properties. A small in vivo study showed that consumption of American ginseng tea has immediate antioxidant effect on cellular DNA, protecting it from oxidative stress (Szeto et al., 2015). A study conducted on the use of red Asian ginseng (the unpeeled, steamed kind) has shown antioxidant and chemoprotective properties (Dong et al., 2013).
As far as difference are concerned, American ginseng is more calming. It is utilized for the treatment of insomnia and for stress management. Asian ginseng has stimulating properties, and it is used for energy and even erectile disfunction (Chen et al., 2008).
Chen, C. F., Chiou, W. F., & Zhang, J. T. (2008). Comparison of the pharmacological effects of Panax ginseng and Panax quinquefolium. Acta pharmacologica Sinica, 29(9), 1103–1108. https://doi.org/10.1111/j.1745-7254.2008.00868.x
Chen, E. Y., & Hui, C. L. (2012). HT1001, a proprietary North American ginseng extract, improves working memory in schizophrenia: a double-blind, placebo-controlled study. Phytotherapy research : PTR, 26(8), 1166–1172. https://doi.org/10.1002/ptr.3700
Dong, G. Z., Jang, E. J., Kang, S. H., Cho, I. J., Park, S. D., Kim, S. C., & Kim, Y. W. (2013). Red ginseng abrogates oxidative stress via mitochondria protection mediated by LKB1-AMPK pathway. BMC complementary and alternative medicine, 13, 64. https://doi.org/10.1186/1472-6882-13-64
Szeto, Y. T., Sin, Y. S., Pak, S. C., & Kalle, W. (2015). American ginseng tea protects cellular DNA within 2 h from consumption: results of a pilot study in healthy human volunteers. International journal of food sciences and nutrition, 66(7), 815–818. https://doi.org/10.3109/09637486.2015.1088937
Wang, C. Z., Aung, H. H., Ni, M., Wu, J. A., Tong, R., Wicks, S., He, T. C., & Yuan, C. S. (2007). Red American ginseng: Ginsenoside constituents and antiproliferative activities of heat-processed Panax quinquefolius roots. Planta Medica, 73(7), 669–674. https://doi.org/10.1055/s-2007-981524
Nothing says “holidays” more than a hot cup of cocoa. The smell reminds me of home, winter, and childhood. I love hot cocoa, but I can’t stand the sugar-laden process stuff. If I am going to indulge, I want the real thing!
In the past few days, I have craved home and family time, and with it comes my craving for hot cocoa, my comfort Christmas beverage.
I have experimented with a few recipes, trying to marry Martha Stewart and primal living, and I think that no one out there will be dissatisfied with the recipe I came up with!
Makes 2 servings
2 tablespoons and 2 teaspoons unsweetened cocoa powder
*I buy Organic Pastures milk and cream. If you are intolerant or allergic to dairy or following a strict paleo diet, substitute for full-fat coconut milk.
Combine the cocoa, maple sugar and pinch of salt in a saucepan. Blend in the boiling water. Bring this mixture to an easy boil while you stir. Simmer and stir for about 2 minutes. Stir the milk and heat until hot, but do not bring to a boil. Remove from heat and add vanilla extract. Divide between 2 mugs. Whip the cream and maple syrup. Add the cream to the mugs of cocoa, with a dash cinnamon, enjoy and don’t burn your mouth!
Dandelion greens sauteed in extra-virgin olive oil and garlic.
Tomato-avocado-olives salad with extra-virgin olive oil, balsamic vinegar and celtic sea salt.
Rack of lamb grilled medium rare.
There you go, a delicious, healthy meal in 20 minutes…
I feel so refreshed after a trip around the Farmer’s Market, where I am surrounded by the smells and colors of perfectly unperfect food. How strange, really, to walk into a supermarket and see rows and rows of identical tomatoes. I am already anticipating how juicy, sweet and unique each of my “unperfect” tomatoes will taste.
I can’t wait for Sunday’s Hillcrest Farmer’s Market. I need some more eggs.