What are LDL and HDL and how do they affect my health?

Low-Density Lipoprotein (LDL) and High-Density Lipoprotein (HDL) are two types of lipoproteins (particles made of protein and fats/lipids) that transport cholesterol in the bloodstream.

LDL is often referred to as the "bad" cholesterol because it carries cholesterol from the liver to the cells and can build up in the blood vessels, increasing the risk of heart disease. However, this happens primarily to OXIDIZED LDL. LDL is oxidized by accumulating oxidative stress from toxin exposure.

HDL is considered the "good" cholesterol as it picks up excess cholesterol from the artery walls and takes it back to the liver to be removed from the body. But larger HDL is primarily responsible for this beneficial activity.

Maintaining a healthy balance of LDL and HDL cholesterol is important for overall health as high levels of LDL and low levels of HDL can increase the risk of heart disease and stroke, while high levels of HDL and low levels of LDL can help protect against heart disease. Regular exercise, a healthy diet, and avoiding smoking and excessive alcohol consumption can help maintain a healthy balance of LDL and HDL cholesterol levels.

However, there is more to LDL and HDL than a single reading. Small and large LDL and HDL affect cardiovascular health.

Large LDL is less risky and is commonly referred to as “buoyant” because it stays in circulation. This makes it less likely to penetrate the artery protective inner layer, literally bouncing off the wall like a beach ball. A preponderance of Large LDL is called a Pattern A.

Small LDL is considered higher risk. It is more “dense,” penetrating, and prone to get stuck in the wall to become fuel for inflammation which creates atherosclerotic plaque. A preponderance of Small LDL is called a Pattern B. It is associated with insulin resistance, the most common driver of arterial inflammation.

Large HDL removes cholesterol from the artery more efficiently than small HDL, transporting it to the liver for processing and removal. 

To summarize, larger LDL and HDL particles reduce risk of arterial disease and events, while smaller LDL and HDL particles increase risk.

Image Source: Berkley Heart Lab

What causes smaller LDL and HDL in the body?

Smaller LDL and HDL particle size is commonly associated with insulin resistance (prediabetes, metabolic syndrome, Type 2 Diabetes), diets high in sugar and processed foods, smoking, and a sedentary lifestyle.

How can I increase the size of LDL and HDL in my body?

Lose fat (especially visceral fat), consume less sugar, starch and processed foods, including a significant amount of vegetables and fasting. Exercise (especially resistance training and increased muscle mass) is also a key driver of larger LDL and HDL production. Individuals with diabetes and prediabetes, should also work to improve control of these conditions, as they are also a factor in LDL and HDL size.

Why is oral health important to my overall health?

Oral health has a bigger impact on your overall health than you likely suspect. Inflammation and disease in the mouth can have a negative impact throughout your whole body and lead to some very serious conditions. Bacterial, viral and fungal pathogens contribute to arterial disease (50% of heart attacks and strokes!) metabolic disease (insulin resistance, prediabetes, Type 2 Diabetes), cancer, dementia, high risk pregnancy, and inflammatory arthritis.

One of the key players in this oral systemic connection are the bacteria that live in your mouth. There are both good and bad bacteria that inhabit the mouth, the “oral microbiome.” The goal is to maintain barriers to invasion locally (gingivitis and periodontitis) and systemically (arterial injury) reduce the population of the bad bacteria and create an environment to promote good bacteria.

While colonization may be difficult or impossible to eliminate, prevention of infection of gums and systemic invasion are the primary goals of an optimal oral hygiene routine. Brushing and flossing are the foundation of good oral hygiene, but may not be enough if bad bacteria have taken hold.

How are bad bacteria detected?

Visual inspection alone will not pick up the presence of high risk bacteria. Even if your gum tissues appear healthy, these bacteria may invade subtle pockets of inflammation or be opportunistic for a lapse in hygiene or the barrier to invasion associated with healthy gums. This can turn colonization into infection and inflammation in the gums, arteries and elsewhere.

More and more dentists and hygienists are highlighting the connection between the mouth and the rest of the body. If your dental care providers are on board with this focus, you are fortunate. If your dentist is unaware or uninterested in this connection, The CureCenter can recommend oral health providers who are on board for at least a second opinion and perhaps a transfer of care.

We use saliva testing to measure the amount of bad or pathogenic bacteria in the mouth. The results will motivate a plan (provided by a dental professional) to address the concern. The key is to reduce the level of bad bacteria that contribute to chronic disease and preserve barriers to invasiveness locally and systemically. For more detail, click SimplyPerio. In general, I classify Fn as “bad, Td and Tf as “worse” and Pg and Aa as “the worst” bacteria to be present in the mouth.

For more details go to https://simplytest.solutions/testing/saliva-perio-testing/

What should my dentist be looking for?

Dentists who are on the leading edge of oral care use cone beam/3D CT scans to look for presymptomatic abscesses and other issues that may be missed by routine examination and standard x-rays. These conditions don't always cause symptoms that would cause concern. This can be dangerous because the first noticeable symptom could be a heart attack or stroke. High risk oral pathogens can also contribute to poor control of diabetes and prediabetes.

We recommend cone beam CT, especially for our patients who have had prior events or elevated myeloperoxidase (MPO). Traditional x-rays will routinely miss abscesses that could be driving arterial inflammation and increase the likelihood of heart attack or stroke. For example, old root canals can be sites of chronic inflammation but detection may not be possible without use of the cone beam CT. 

At the CureCenter, we will work with your current dentist to gather this type of information if they show an interest. If not, we can recommend a dentist who we know is on board with this process.

What can I do to avoid oral health issues?

Choose a dental professional who understands concerns beyond your teeth. You can find this out by learning if your dentist has participated in continuing education about the oral systemic connection. Regularly visit this dental professional and make sure they provide an ongoing treatment plan for any issues. Follow their plan.

Get saliva testing at least once to discover any bad bacteria that may be present. We have seen patients that have no obvious issues or new cavities that have had significant levels of dangerous bacteria in spite of their current dental plan. Don’t let colonization with these bacteria become invasive infection in your gums or arteries.

Associations between high risk (red complex) oral bacteria and serious medical conditions and complications.

Follow a daily routine to maintain proper oral care and prevent bad bacteria from growing in your mouth. Daily brushing and flossing can be augmented with use of a waterpik and dental picks. Use a pH neutral mouth rinse twice daily to help promote healthy bacteria that protect teeth and gums. Brush your entire mouth, not just the teeth and gums, and always go to bed with a clean mouth.

During the day, choose 100% xylitol gum or mints and eat tooth protecting foods (low carb/high protein) at the end of meals or snacks.

Get regular cleanings and follow the advice of your dental professional. They are your best resource for learning to avoid oral systemic disease.

Ask your dentist about PerioProtect, a system that delivers an antibacterial solution to the areas below the gumline where brushing and mouthwashes/rinses won’t reach. If your current dentist does not offer Perioprotect, we are happy to suggest one who will.

What is visceral fat and how do I reduce it?

There are two types of fat that our body stores: subcutaneous fat and visceral fat.

Subcutaneous fat is stored just under the skin. We can feel it in our arms, legs, and hips. Think of it as the fat that you are able to pinch with your fingers.

Visceral fat, or visceral adipose tissue, is the fat that is stored inside the body cavity and wraps itself around and infiltrates our internal organs, such as the heart, liver, or intestines. This fat is metabolically active and functions as if you had another organ in your body which produces negative hormonal effects. We call it “angry” or “inflammatory” fat.

Why is visceral fat dangerous?

Visceral fat is also referred to as “active” or “inflammatory” fat because it produces substances that contribute to insulin resistance, leading to Type 2 Diabetes. Insulin resistance is the prediabetic state where your body is losing its ability to properly balance insulin and regulate blood glucose. 

Visceral fat secretes a protein called retinol-binding protein 4 (RBP4) that increases insulin resistance in the body. It also releases inflammatory substances called cytokines, which leads to chronic inflammation.

High levels of visceral fat are associated with increased risk for:

• Type 2 Diabetes

• Heart disease

• Breast cancer

• Colorectal cancer

• Alzheimer’s disease

• Nonalcoholic fatty liver disease (NAFLD)

It is very difficult to be healthy with high amounts of visceral fat. Lowering visceral fat eliminates a major driver of chronic diseases.

What are the sources of visceral fat?

The root causes of visceral fat are refined carbohydrates, processed foods, and artificial sweeteners ingested without periods of fasting. This type of diet is typical in Western cultures. In order to eliminate visceral fat, the secret is to minimize the five S’s: Sweets, Starch, Snacks, Seed oils, and Sitting.

How do you test for visceral fat?

There are many ways to estimate your visceral fat. MRI, DEXA, and CT scans are accurate but costly and inconvenient. A cheaper way to estimate visceral fat is to measure your waistline. A healthy waistline in women is typically 35” or lower, and 40” or lower for men. However, these measurements are prone to variability. They are inexpensive, but not precise.

At the CureCenter, we have a simple, non-invasive, and cost-effective way to measure and monitor visceral fat. We use the InBody 570 analyzer to obtain accurate body composition data on our patients repeatedly over time. This data allows us to monitor not only visceral fat, but percent body fat, skeletal muscle mass, and hydration levels. This information is crucial in monitoring the benefit of our treatment and demonstrating optimal results. The InBody data goes far beyond the scale and helps us provide motivation for ongoing lifestyle improvements.

Body composition tests using the InBody 570 only take a few minutes and are completely painless and non-invasive. The process is similar to stepping on a scale - only this machine measures much more than your average at-home device. If you have a pacemaker or defibrillator, or you are pregnant, we don’t use the InBody, even though the risk is not high.

How do I eliminate visceral fat?

• Reduce your sugar intake, especially sugary drinks, refined white carbohydrates, and processed foods.

• Avoid artificial sweeteners. They raise insulin in the same way as sugar, even though they are lower in calories. They also perpetuate cravings for real sugar by feeding your sweet tooth, like a “gateway” drug.

• Restrict eating to a window of time (ideally 6-8 hours) and devote time every day to fasting (drinking only water or non-sugary drinks). At least 16 hours of fasting, including sleep, is a goal we promote to our patients. We call it “window feeding.”

• Exercise as much as you can most days.

• Eat a low-glycemic diet. Low-glycemic foods consist of green vegetables, whole fruits (in moderation), beans, and lentils. 

• Get a good night’s sleep. Too little sleep or too much sleep on a regular basis can lead to more visceral fat storage.

• Manage stress. Mindfulness practices like prayer, meditation, or yoga can help manage your body’s stress response and lower cortisol levels.

• Limit alcohol. When your liver is processing alcohol, it is not processing fat.

• Quit smoking. Tobacco use can negatively affect your ability to deal with glucose and increase insulin resistance.

• Targeted supplements and medications can improve insulin sensitivity for some individuals with stubborn visceral fat.