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  • Free Markets are Destroyed by Congress, Not Created January 30, 2015
    By Jane M. Orient, M.D. When people clamor for Congress to pass a “free-market health plan,” they are forgetting two things: Congress only does laws, which restrict freedom. We need fewer laws, not more. And the free market is by …
  • Ralph Weber Talks MediCrats with FreedomWorks – Part 3 January 26, 2015
    MediBid is the free market answer to rising healthcare costs. Employer-sponsored plans, as well as self-insured individuals, make up most of MediBid’s customers. On MediBid, a patient makes a procedure request which gets sent out to physicians and facilities around …
  • Medical Debt Still a Problem for Those With Health Insurance January 23, 2015
    by Adrienne Snavely Medical debt can affect anyone of any age in any state in any income bracket. Medical debts account for more than half of debt collections on credit reports. One in three Americans struggle to pay medical bills, …
  • Q&A with Direct Pay Physicians January 22, 2015
    Direct pay physicians answer colleagues’ questions about third-party-free medical practice. From January 9, 2015, New Orleans AAPS workshop.
  • Ralph Weber Talks MediCrats with FreedomWorks – Part 2 January 21, 2015
    The pitfalls of Obamacare are that it makes healthcare affordable to the employee, yet unaffordable to dependents. Some plans cover children, but not spouses. This means less options for families. The independent physicians are being bought out by hospitals and …
  • Cash and out-of-network: good for medicine as free agency is for sports January 21, 2015
    Andrew Schlafly, J.D., General Counsel, AAPS, opens the 21st Thrive, Not Just Survive workshop held Jan. 9, 2015 in New Orleans, LA.
  • Opting Out of Medicare January 20, 2015
    Lawrence Huntoon, MD, PhD, presents via Skype at the AAPS 21st Thrive Not Just Survive Workshop on Third Party Free Practice, January 9, 2015
  • Say Goodbye to 3rd Party Medical Payments January 19, 2015
    Obamacare is increasing costs, restricting access to care, and putting Medicrats in charge. Out of this adversity comes innovative physicians who are changing the world of medical care. Doctors know what is best for their patients, so they must be …
  • My Direct Pay Practice January 19, 2015
    Brenda Arnett, MD http://arnettmd.com, talks about why and how she launched a third-party-free internal medicine practice. From January 9, 2015.
  • AtlasMD: Direct Pay Primary Care better for patients and physicians January 18, 2015
    Dr. Josh Umbehr, founder of http://atlas.md speaks at AAPS XXI Thrive Not Just Survive Workshop, January 9, 2015 in New Orleans, LA.
  • Epiphany Health, Affordable, high-quality direct primary care January 17, 2015
    Lee Gross, MD, Founder, Epiphany Health http://www.epiphanyhealth.net & President, Docs 4 Patient Care Foundation http://www.d4pcfoundation.org addresses the AAPS Thrive Not Just Survive XXI conference, January 9, 2015, in New Orleans, Louisiana.
  • Ralph Weber Talks MediCrats with FreedomWorks – Part 1 January 16, 2015
    Wayne Brough of FreedomWorks interviews MediBid’s CEO, Ralph Weber, about Obamacare and Weber’s book MediCrats. Weber has found innovative ways to bring the free market to healthcare. MediCrats, by definition, are medical bureaucrats who add administrative burdens and increase costs. …
  • Third Party Free Specialty Practice January 16, 2015
    Gerard J. Gianoli, M.D., F.A.C.S. of The Ear and Balance Institute, Covington, Louisiana, http://EarAndBalance.net speaks at the AAPS Thrive, Not Just Survive workshop held January 9, 2015 in New Orleans.
  • Stop the Interstate Licensing Compact January 15, 2015
    Dr. Ken Christman explains how the FSMB’s proposed compact is a backdoor for MOC and MOL. January 9, 2015, New Orleans, LA.
  • Update on AAPS Legal Initiatives in War on Doctors and Patients January 15, 2015
    Andrew Schlafly wraps up Thrive XXI with a look at ongoing and future AAPS legal initiatives to protect patients and their physicians.
  • The Answer to American Medicine is NOT Coming from DC January 15, 2015
    … it is coming from physicians who are kicking ObamaCare and insurance OUT and working directly with their patients, explains AAPS Executive Director, Jane M. Orient, MD. From AAPS Thrive, Not Just Survive XXI, Jan. 9, 2015, New Orleans, LA.
  • The End of the 10-Minute Doctor’s Appointment January 14, 2015
    The patient-physician relationship should be balanced, not one-sided with physicians skimping on visit time and not allowing patients to ask enough questions or explain their symptoms well. Eighteen seconds is the average time a patient is allowed to talk before …
  • The Physicians Declaration of Independence in 2015 January 14, 2015
    We need a critical mass of truly independent doctors and core who will pass along the art of medicine to the next generation, explains AAPS President Richard Amerling, MD on January 9, 2015 at talk to colleagues in New Orleans, …
  • Physicians & Patients: Take Your Power Back January 14, 2015
    Dr. Elaina George explains that it is crucial for patients and physicians to work together outside of ObamaCare and insurance-dominated system. She discusses alternatives to ObamaCare such as health care sharing programs like Liberty HealthShare: http://LibertyOnCall.com
  • Self-Funded Awareness & The Movie “Dune” January 7, 2015
    by G. Keith Smith, MD “The sleeper has awakened.” Anyone who has seen the movie “Dune” knows the scene where Paul Atreides proclaims his new awareness. Having recently attended the annual meeting of the Self-Insurance Institute of America I was …

Cholesterol and Triglyceride: What’s it all about?

by Kristine L. Soly, MD, FACC

Cholesterol and triglyceride have such a bad reputation that the very words conjure up an image of blobs of fat (like those congealed on cold soup) lurking in the blood stream ready to attack the first available artery.  It’s so bad that people feel guilty or ashamed if their levels are elevated.  Articles regularly appear about cholesterol and triglyceride, as if it were something we all really understood.  But nothing could be further from the truth.

Not even physicians or scientists understand all we need to know about this complex issue.  New data is constantly emerging, resulting in changes in recommendations.  Hence the confusing (and often conflicting) advice from the medical community over the past decade that has left patients uncertain about what to do.

Cholesterol and triglycerides are not bad substances.  They are natural and normal substances in the body and are essential components.  We could not survive without them.

Cholesterol is not a fat.  It is a white, waxy substance, which is soluble in fat (but not in water).  Each cell can synthesize its own cholesterol, which is used to regulate the rigidity of every cell membrane.  In addition, the liver manufactures about 3000 mg. of cholesterol every day, which is used to produce the sex hormones (estrogen, progesterone, and testosterone) and adrenal hormones (aldosterone and cortisone), to make vitamin D and bile, to constantly assure proper cell repair throughout the body, and to serve as an antioxidant when vitamin and mineral stores are low.

Triglyceride is fat, and it also is not soluble in water.  Triglycerides are our main source of energy, and a layer of triglycerides make up the cell membranes of all of our cells, which enable them to function normally.

Cholesterol and triglyceride are called lipids.  Though they are not necessarily bad for us, they get their bad reputation because of their association with saturated animal fats.  After consuming meat or dairy, lipids (triglyceride and cholesterol) are absorbed by the intestines and enter the blood stream.  From here they go to the liver and to the rest of the body.

Since the blood is essentially water, and since triglyceride and cholesterol are not water soluble, they must be transported in the blood in carriers that can dissolve in water.  These carriers are called lipoproteins, which are made by the liver.  As their name suggests, lipoproteins are composed of lipids and proteins.  The lipids making up lipoproteins are mostly cholesterol and some triglyceride.  Hence, all lipoproteins contain cholesterol and triglyceride, even if they are not transporting them.  When your total cholesterol or triglyceride is measured, that number includes all that is contained in the lipoproteins–that which is part of the carrier as well as that which is being transported.

But since your blood is drawn 10-12 hours after your last meal, all the cholesterol and most the triglyceride you ate have been delivered to cells and are no longer in circulation.  But, the lipoprotein carriers are still in the blood stream, so the cholesterol and triglyceride that make up the lipoproteins are what is measured.

Problems arise when there are too many of some (but not all) lipoproteins in the blood stream. Certain lipoprotein carriers in the blood stream get into the arterial wall when the inner lining of the blood vessel (the endothelium) is damaged.  The body perceives these as foreign invaders and sends in white blood cells (macrophages) to gobble them up.  The macrophages with engulfed lipoproteins (called foam cells) cause plaque to develop (atherosclerosis), which subsequently causes heart attacks, strokes, and other problems with arteries.  Only those lipoproteins that become part of a foam cell are problematic.  Hence, lipid disorders are really disorders of the lipoproteins that are involved in foam cells.

There are a number of lipoproteins in the body.  Chylomicrons transport cholesterol and triglyceride from the intestines, but only exist for a few minutes after eating so are usually not measured.  Very low-density lipoproteins (VLDL) transport cholesterol and triglyceride, breaking down into cholesterol-laden LDL after delivering the triglyceride to cells.  Low-density lipoproteins (LDL) transport cholesterol to cells.  High-density lipoproteins (HDL) transport LDL from the blood stream back to the liver.  After all the cholesterol and triglyceride have been delivered, the primary lipoproteins left in the blood stream are LDL and HDL.

LDL cholesterol is called the “bad” cholesterol because some forms of it can oxidize and become involved in the formation of foam cells that cause plaque in the arteries.  HDL cholesterol is called the “good” cholesterol because one of its subgroups (HDL 2b) takes LDL out of circulation and protects from the development of plaque.

We also know that there is something called Lipoprotein(a), also called Lp(a), which is an LDL with an extra adhesive protein wrapped around it.  This is a “really bad” form of LDL that has a strong correlation with the formation of foam cells and plaque.  Unfortunately, this lipoprotein is largely acquired by heredity, though lifestyle definitely plays a role.

To further complicate matters, we now know that LDL (the “bad” cholesterol) comes in more than one size (LDL Pattern).  There are large fluffy LDL’s (called Pattern A) that are thought to be benign.  Then there are the small dense LDL’s (called Pattern B) which have a strong association with atherosclerosis.  So, not all LDL cholesterol is bad!  This might explain how someone might have high LDL without atherosclerosis (Pattern A) and someone else might have low LDL with very aggressive atherosclerosis (Pattern B).  Both heredity and lifestyle determine the LDL pattern.

Simply knowing your total cholesterol level does not provide enough information to decide whether you’re at risk for atherosclerosis.  Nor does just knowing your LDL and HDL levels.  You need to know your Lp(a) level, how much of both LDL pattern A and LDL pattern B you have, and how much HDL 2b you have.

Additionally, it’s not just the cholesterol levels that you need to know–elevated triglyceride is a problem for atherosclerosis also.  Triglycerides that are transported in your body by a form of very-low-density lipoprotein (VLDL 3) and by an intermediate lipoprotein (IDL) are strong stimulants of foam cell formation, and hence plaque.  VLDL3 and IDL are known collectively as Remnant Lipoproteins (RLP).

It is desirable to have low levels of both cholesterol and triglyceride.  However, with cholesterol, it is best to have low levels of only the LDL-cholesterol and high levels of the HDL-cholesterol.  With LDL-cholesterol, it is best to have low levels of Pattern B and Lp(a).  For HDL, it is best to have high levels of HDL 2b.  And, with regard to triglycerides, it’s best to have low levels of RLP (VLDL3 and IDL).

Dr. Soly is board certified in Cardiology, Internal Medicine, and Holistic Medicine, and is a Fellow of the American College of Cardiology.  She practices Holistic Cardiology and is director of the Holistic Cardiology Learning Center at 220 Andrews Lane, Crossville, TN.



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