Submitted by resmonde on Saturday, May 21, 2022 - 19:31

When I was a kid, I occasionally saw Arthur Ashe playing tennis on the TV or 'telly' as it was to us Irish kids in the 70's/80's.  He was fantastic.  When he died in 1985, I was shocked.  One of my heroes had fallen.  Several decades later, I found out he died from AIDs contracted from a blood transfusion for heart surgery in 1983.  Why was this amazing athlete having heart surgery in the first place?  It turns out, he had elevated Lipoprotein(a) which necessitated having blocked arteries addressed with surgery.

Lipoprotein(a) or Lp(a) as it is often abbreviated to, is a form of LDL (low density lipoprotein) cholesterol in our blood.  Most of us have some Lp(a).  One in five people have elevated levels of it and some (very few) have no Lp(a).  High Lp(a) is hereditary unfortunately.  It is thought that it arose within our evolution to help speed up tissue repair.  I have elevated Lp(a) - possibly why I've always healed pretty quickly from cuts and scrapes.

Sit tight, ... this will wander into many health issues/realms. 

Cholesterol

Our bodies need cholesterol to form and sustain cells.  We also need it to nourish our brains, to generate sex hormones, manufacture vitamin D, to tackle inflammation, ...etc.  However, it cannot travel naked in the blood stream because of its fat content.  It's not soluble, it would simply glob together and go nowhere.  It needs to get to target sites throughout our body each day to keep us healthy.  So, the body packages it inside little protein sacks.  These then travel throughout the body in the bloodstream to sites of inflammation and basically wherever they are needed to continue to nourish and maintain the body's cells.  These protein containers are what the medical world refers to as LDL.  HDL(high density lipoprotein) is another kind of protein sack which the body uses to collect the cholesterol from the sites in the body where it was needed or where it has built up.  It shuttles it back to the liver and then its removed.  In this light, you can appreciate why people refer to LDL as 'bad cholesterol' and HDL as the 'good.'  But as you can see, that's over simplifying things and frankly, misrepresenting LDL and its good deeds.  All cholesterol is good and required by the body - up to a point. 

Cholesterol comes in several varieties(Chylomicron, VLDL, IDL, LDL[LDL-c, Lp(a)], HDL).  The much maligned LDL has its own sub-varieties, one of which is Lp(a).  Generally speaking, LDL only becomes a health problem if we ingest a lot of bad food in our diet.  But this is where things can become vague and hard to grasp.

Which LDL is potentially the most harmful?

Beyond Lp(a); small VLDL, IDL and LDL-c might be construed as harmful in the context of entering the walls of ones arteries where they can build up and cause harm.  This usually starts  when it penetrates the inner most layer of the artery (the endothelial layer) and then gets inside the next layer, the Intima.  Large VLDL which I've heard described as large fluffy LDL does not enter the intima owing to its girth.

Glucose

When we consume sugar, it is converted into glucose in our bodies.  Our cells need this to respire (make energy).  However, consuming too much sugar causes problems.  Most foods spike our glucose levels to some extent.  Sugar and carbohydrates especially.  Consumption of too much glucose leads to adverse health outcomes.  The hard part to conceive is that things like (but not limited to); white bread, wheat bread, spaghetti, rice, potatoes and just about anything containing wholemeal flour or worse; refined white flour are huge glucose spiking villains.  So it's not just cakes, candies, chocolate and ice creams which cause problems.  Glucose needs reigning in.  Enter Insulin.

Insulin

Insulin is a hormone manufactured in our pancreas.  It controls the amount of sugar in our blood.  As intimated above, foods which are high in refined carbohydrates ultimately cause us problems over the long term.  If we eat a lot of things like pasta, pizza and other starchy foods we are forcing our pancreas to constantly secrete insulin.  Insulin tells the body how to cope with all this glucose;  'Bring it here, we need more energy there, store it as fat here, send it here for removal, ..etc.'  We aren't usually cognizant of all this internal messaging and activity so we keep eating a heavy carbohydrate diet (because its yummy) and eventually our insulin secretions become ineffective and we are said to be insulin resistant or 'pre-diabetic'. 

Side note; One sign of this as we age can be the formation of skin tags. 

If we continue to consume a high (refined)carb diet and have a sweet tooth, then our bodies start to ignore the sugar in the blood and it runs amok to some extent because the body is overwhelmed by the constant flood of "glucose incoming" messages it is trying to keep up with and respond to.  It stores as much as it can as fat but the rest begins to become a menace.  As this process continues, instead of being controlled and removed or stored as fat it's now running through our blood stream. 

Glycation

If the rampage of too much glucose continues, it sticks to the protein chains that surround LDL molecules.  When it does so, a process called 'Glycation' occurs.  In layman's terms, think of it like rust.  What was a perfectly good and healthy LDL molecule has now become oxidized by a dirty great big glucose molecule.  When this occurs the body's internal 'clean up' mechanism no longer recognizes these molecules as cholesterol so it can't shuttle them back to the liver in little HDL containers.  Instead it tries a second form of defense. 

Macrophages 

We have cells called Macrophages which our bodies use to combat infection.  They view oxidized LDL molecules as intruders and grab onto them.  If a carb high diet is maintained , we get a lot of macrophage action happening and the 'glycated' or oxidized LDL molecules can begin to build up in our vascular system.  This can then cause narrowing of the arteries by itself or add to it. 

Artery Hardening

At this point, it's important to note that as our hearts pump blood around the body, over time the inner walls of our arteries harden.  This is natural.  Even the arteries of the healthiest people on the earth gradually harden.  Consider that if you kept pounding your right fist into your left palm, the skin on the left palm would begin to harden.  As arteries harden they become more susceptible to internal damage to the endothelial (inner) layer of the artery wall.  If this happens, more cholesterol and macrophages are sent to the sites on the vascular system where that damage has occurred. 

Adverse Health Outcomes

In a worse case scenario you can have a tear in the endothelial wall which gets infected by oxidized LDL and often as far as the intima (next layer inside artery). Now the body sends more LDL and macrophages to the site to help heal it up.  This can lead to a build up of what is termed 'plaque' under the wall which can grow outward thereby obstructing the flow of blood through a vessel.  To get the blood passed this obstacle one's blood has to pulse harder.  Over time, 'plaquing' gets worse.  If we exert ourselves and are unaware of the health of our arteries like most of us are, one or more of these plaque obtrusions can rupture.  The plaque inside is besieged by more macrophages and white blood cells and now a clot is flowing through one's vascular system.  This can cause a stroke if it blocks oxygenated blood from reaching the brain or a heart attack if it blocks the hearts own arteries.  Some of the most easily affected arteries are the ones supplying oxygenated blood to the heart muscle itself.  Why?  Because they are some of the closest arteries to the initial pressure of the pumping engine(heart muscle).  The pressure is strongest there.  The pressure lessens as the blood moves further from the heart.

Side note: This is why our arteries have little valves in them - to prevent back flow under low pressure or when we are physically in different positions...like upside down for instance.

Lp(a) buildup - Image courtesy of athero.org.au
Lp(a) buildup - Image courtesy of athero.org.au

Prevention

So what does all this mean?  It means in addition to more exercise and a less sedentary life style, we need to adopt a healthier diet to avoid this gradual aging of our internal vascular system and limit the oxidation of LDL molecules.  Additionally, we need to keep our blood pressure down and try to limit our intake of carbs to healthy ones.  What is meant by a healthy carbohydrate?  Organic ones (organic fruits and veggies).  Ones which are not refined.

In a nutshell then; diminish artery hardening through exercise and diet, reduce insulin resistance through diet, prevent glycation through diet, reduce artery narrowing through diet and exercise.  Net result: live longer or atleast enjoy a much healthier quality of life.

Lp(a)

That was a lot to digest but back to Lp(a); At a structural level, this specific LDL molecule has an an extra protein chain wrapped around it.  This extra protein chain makes it stickier than regular LDL-c so as it glides through our vascular system, it is even more prone to sticking onto rampant glucose, oxidizing and getting stuck to sites along our artery walls which are damaged.  Now the macrophages have even more work to do in trying to contain all this glycated Lp(a) and that in turn means there is an increased likelihood of this oxidized LDL contributing to degradation of one's arteries.

LDL-c_vs_Lp(a) courtesy of Amgen.com
LDL-c vs Lp(a) (image courtesy of Amgen.com)

 

What about taking a Statin?

Statins can do nothing for elevated Lp(a) at this time (May 2022) but even if they could, I personally would not want to take one owing to their side effects in the long run.  That's a topic for another day.

I am not a doctor, if you're on a statin, keep taking it unless otherwise prescribed by your healthcare professional.

How do I know if I have elevated Lp(a)?

You have to get your blood checked.  It's a non-standard part of healthcare in the USA and likely elsewhere in Europe so, you'd need to ask your doctor for the Lp(a) level test explicitly when you are getting your blood profile analyzed.

What can I do to limit the likelihood of a bad outcome health-wise from elevated Lp(a)?

Again, I am not a doctor.  Just another citizen scientist so, I am merely relaying what I do based on what I have researched.  Please do your own research and speak with as many qualified and respected scientists and doctors as you can on this subject matter.  Even if you do not agree with all that they might impart, get as many qualified opinions as possible before making your own informed decision.  It's your health, take charge of it.  As with any change to your diet or health regime, talk with a healthcare professional before you make any radical changes.  Here is what I try to do:

  • Keep weight down with regular exercise.  This can be as simple as walking.
  • Start adjusting diet.  Start simple.  Build slowly or you will not maintain beneficial dietary changes: For example; no more sugar in coffee?  Too harsh?  Halve the amount and work toward none.
    • Replace fries/potato/rice with veggies, reduce dairy intake?  Remember; baby steps are best but don't let yourself fall back into the bad habits.
  • Take up QiGong/Tai Chi.  It works, just do it!  Read this and view Chris's videos on YouTube
  • Take up Chi Nei Tsang.  Remarkable practice.  What is that and how do I get started?
  • Meditate.  15mins a day is all it takes.  Start even smaller with Lee Holden's inner smile guided meditation.
  • Practice some additional breathing exercises each day.  4-7-8 breathing is a good place to start.  Big deep belly breaths.
  • Fast.  Begin some intermittent fasting.  Limit how often you eat and occasionally do not eat at all.  Read up on this before hand.  Prepare the day before by consuming high protein (think grassfed beef, wild salmon or broccoli and tofu)  and rich organic fats (think avocados, not ice cream).  Start by cutting out snacking between meals.  Again, start small.
  • Consume additional Vitamin C
  • Take a daily 81mg supplement of aspirin (makes one's blood 'slippier')
  • Consider taking a B3 (Niacin) supplement once in a  while
  • The body produces its own CoQ10 (a type of enzyme) but we can take more CoQ10 to help keep the inner walls of the arteries a little more elastic as we age.

Moderation

We have all heard the old adage; 'Everything in moderation'.  It's true.  If you can stick rigidly to a new healthier diet for the rest of your life then I applaud you.  I can't.  I still eat pasta and consume sugar but very little compared to what I used.  For example; I might have pasta every few months.  If I eat bread, I make sure its a mixed grain.  I might have crispy delicious french bread made with white flour every few months but I know it will lead to inflammation which I can feel in my joints - I know I am damned when I do.  It's a once in a while treat.  Depending on one's health prognosis, you'll know if you can afford the occasional indulgence or whether you need to completely abstain.

If you can adopt a Ketogenic diet, give it a try.  I haven't because I don't eat meat from cows or sheep or pigs and without those sources of protein with fat, it gets a little tricky.  I eat fish, chicken very occasionally and lots of veggies, nuts and fruit so Keto while not impossible for me becomes a little challenging.

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