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Lipid Disorders

Conditions

High lipid levels are only one of many factors of cardiovascular disease. Other factors, such as levels of antioxidants, which are necessary in preventing the oxidation of cholesterol to form plaques, might be a more important factor. Low levels of lipids are also detrimental to patients because cholesterol is required for steroid synthesis and membranes of cells.

• Elevated Total Cholesterol over 200 mg/dl
  
• Elevated LDL Cholesterol over 150 mg/dl
  
• Reduced HDL Cholesterol under 35 mg/dl
  
• Elevated Apolipoprotein B (ApoB) over 110 mg/dl
  
• Reduced Apolipoprotein A1 (ApoA1) under 140 mg/dl
  
• Elevated Triglycerides over 190 mg/dl
  

  Associated Syndromes and Etiologies

• Low Thyroid, Liver Disease, and Diabetes: Other considerations in treating dyslipidemia include screening for low thyroid function, liver disease, and diabetes, all of which can contribute to the condition.
• CVD: The main concern with dyslipidemia is the increased risk of cardiovascular disease. However, other independent risk factors also should be considered in an individual patient, such as blood homocysteine, C-Reactive protein, fibrinogen, RBC magnesium, and CoQ10 levels.
  

  Signs and Symptoms

• Typically, asymptomatic unless early onset familial dyslipidemia is present.
  

  Medical History

• Family or personal history of diabetes, insulinemia, heart disease, stroke, transient ischemic attacks, intermittent claudication, angina pectoris, pancreatitis, hypertension, dyslipidemia, gallbladder disease, cigarette smoking, overweight or obesity.
  

  Physical Examination

• Blood pressure, heart rate and rhythm, exercise stress test, earlobe crease, arcus senilis, or the presence of xanthomas should be investigated.
  

  Laboratory Tests

• Fasting Blood Lipids Test
  A fasting blood lipids test should be taken as baseline and evaluated as follows:
• Is total cholesterol high considering other risk factors (cardiovascular history, diabetes etc.)?
• Is there a high ratio of triglycerides to HDL?
• Is the HDL:Total Cholesterol ratio adequate for CVD protection?
• Is LDL high?
• If triglycerides:HDL ratio is high (typically 4:1 or higher), then metabolic Syndrome X (hyperinsulinemia) should be considered. This patient may have truncal obesity, borderline or normal blood glucose, a history of inactivity, and a high rate of carbohydrate consumption, especially those with high glycemic index. Often there is a family history of DM Type II.

  Normal Distribution for Plasma Lipids and Lipoprotein Cholesterol

Therapeutics

Lipid Diet
Patients should be placed on a carbohydrate restricted diet, such as suggested by Gerald Reaven (45% fat, 15% to 20% protein, 35% to 40% carbohydrates). Patients who are put on a strict lipid diet can normally expect about a 5% to 20% decrease in cholesterol within a few months.

• Restrict Carbohydrates: All simple carbohydrates, starchy vegetables, and, for the more extreme cases, complex carbohydrates should be restricted.
• Limit Total Dietary Fat: Total dietary fat has been clearly linked with total serum cholesterol levels.
• Decrease Cholesterol: Each 1 mg/1000 Kcal results in approximately a 0.1 mg/dl increase in serum cholesterol.
• Limit Hydrogenated Vegetable Oils: Hydrogenated vegetable fat appears to be just as bad as animal fats in epidemiological studies.
• Consume Good Fats: Omega 3, 6, 9 versus saturated animal fats.
• Avoid Oxidation of Fats: Heating of fats, such as in frying, has shown to increase the degeneration of smooth muscle cells in arterial tissue.
• Select Protein: Protein should be obtained from fish, skinless chicken, and nuts and seeds. Protein powder shakes are also acceptable.
• Increase Fiber: Water-soluble forms of fiber (oat bran, guar gum, pectin) seem to be much more effective than water insoluble forms of fiber, such as wheat and cellulose. Regardless of the type, fiber does seem to have a minor to moderate effect in lowering cholesterol levels.
• Eat Vegetarian: Not only does a vegetarian diet exclude cholesterol from the diet, but also it inhibits cholesterol absorption by competing for cholesterol binding sites. May be difficult with Syndrome X though, so low fat proteins are encouraged.
• Limit Coffee: In a study of 1,130 male medical students, the relative risk for cardiovascular disease was 2.49 times greater for those who drank 5 cups of coffee as opposed to those who did not, even while taking smoking, hypertension status, and serum cholesterol into consideration. Coffee increases homocysteine and decreases magnesium.
• Drink Alcoholic Beverages in Moderation: In every epidemiological study, it was found that moderate drinkers had a lower cardiovascular risk than either low or high intake groups. Best choices are red wine and dark beer because of the antioxidant content.

  Liver and Digestive Support
  For high levels of LDL, the liver (which produces and metabolizes cholesterol) and the digestive tract (which excretes cholesterol in bile) need to be supported.

• Supporting healthy digestion and preventing dysbiosis with probiotics, such as Lactobacillus Acidophilus, has been shown to improve blood lipids.
• Also necessary is the support of liver function with lipotrophic agents (methionine, inositol, choline), botanical medicines , and a healthy diet.
• Diet should focus on restriction of saturated fat and inclusion of unsaturated fat in the diet. In other words, animal fats should be avoided, and fats from nuts, seeds, and fish should be encouraged.

  Exercise
  Exercising for at least 20 minutes three times per week at 50% to 80% of maximum heart rate is crucial to this healthy approach to lowering LDL. Exercise should be started under supervision of a physician.