One of our viewers, David Ivers, asked, “What is the process by which LDL is pulled out from between the media and intima layers of the artery wall?” A brief answer that I gave had to do with 3 different mechanisms.
One, inflammation, which is not a good way. Two, autophagy, which is helpful in cellular processes. Three, HDL.
Autophagy
What is autophagy?
Breaking down the term, “auto” means self, and “phagy” means eating. It’s your cell eating pieces of itself—trash that have proteins and lipids, things that have been used in the past but are no longer necessary.
Autophagy is a wonderful process. It has to do with the obesity epidemic. It has to do with fasting. If you never go through fasting stages, and if you are continually eating and gaining weight, then your cells never get to go through this healthy process of autophagy.
Inflammation
Inflammation, as I mentioned earlier, is not a pleasant way to deal with plaques in your artery walls.
Your immune system says that plaque shouldn’t be there. LDL should not be between the intima and the media layers of the artery walls. If that happens, it will send in white cells, monocytes, and leukocytes, and attack those plaques.
The leading drivers of inflammation are insulin resistance, diabetes, and carbohydrate metabolism problems.
If you’re thinking, “Well, that’s diabetes, I don’t have to worry about that,” think about this: If you’re an adult in the state of California, UCLA says you have 55% chance that you have a problem.
In other words, you’re burning your arteries right now with CV (cardiovascular) inflammation due to insulin resistance or prediabetes. The risk of prediabetes increases with age, with risk for 60 and older being significantly over 50%.
What’s interesting about this UCLA study is that it is based only on fasting blood glucose and hemoglobin A1c. It doesn’t deal with the far more sensitive tests of oral glucose tolerance and/or insulin surveys. The reality is it’s far greater if you haven’t had those tests.
If you’re not inflaming your arteries, but you still have plaque, then what is the most common and the most important way of getting plaque out of those artery walls?
This brings up a good point for me to talk about the importance of HDL.
HDL (High-density lipoprotein)
What is HDL? Why is it important?
Here’s an image. LDL will drop and deposit cholesterol in the arteries. HDL is high-density lipoprotein, while LDL is low-density lipoprotein. When you go to the doctor, most of us have heard that HDL is called the “good cholesterol” while LDL is called “bad cholesterol.”
Lipoprotein
The final L in LDL and HDL stands for lipoprotein. “Lipo” means fat or oil, and “protein” is protein made to transport fat or oil.
We know that oil and water don’t mix. We eat oil, we use oil. For example, there is fat in hamburgers if you eat them. If you’re a healthy person, and you eat a lot of olive oil, even olive oil does not mix with blood because blood is over 95% water.
If you don’t have something in your body to keep this oil from coalescing, you’d have what’s called a fat embolus.
Fat emboli do occur, like in car wrecks where major bones are broken. Our bone marrow has fat in it. When that fat is released into the bloodstream from trauma, it can cause a heart attack as you got this fat floating around in your blood. That means there’s a big blob of fat that’s going to cut off the blood supply.
When you digest fat, things like HDL, LDL, and apolipoprotein keep those fat particles in a tiny microscopic area so you don’t get these large emboli.
HDL vs. LDL
What is the most important way of getting fat out of the area between the intima and the media?
It’s HDL. This underlines its importance. What I learned from numerous patients is that HDL is far more protective than LDL. HDL is like an empty dump truck and an empty wheelbarrow taking fat back out of the artery so it can be metabolized again.
Let’s compare these two bars from the Framingham Heart Study. Here is the risk associated with a heart attack and stroke.
The point here is that someone with an HDL of 65 has a lower heart attack and stroke risk even if they have an LDL of 220 than a person with an LDL of 100 if their HDL is only 25.
Let me repeat that: HDL at 25 is very low, LDL at 100 is very low. The person is safe.
The other person has an LDL of 220 (very high) but their risk is far lower. Why? Because their HDL is 65 (which is high).
The bottom line here is that HDL is incredibly important. It’s far more protective than LDL, which is destructive.
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