How many working brain cells do researchers have? Part n+1

Once upon a time, I took the mickey out of some eejit researchers in How many working brain cells do researchers have? Guess what? I'm doing it again. A Facebook friend sent me a link to a worrying "new" study Omega-3 Supplements Linked To Prostate Cancer. Oh, dear. Things are looking bad for oily fish & fish oil supplements. Just a moment!

I did some digging on PubMed for the author and found this:- n-3 Fatty acids and prostate cancer risk. The main feature of wild oily fish & fish oil supplements is their high ratio of EPA & DHA (long-chain omega-3 fatty acids) to LA (a shorter-chain omega-6 fatty acid). It would therefore be logical to assess oily fish consumption and/or fish oil supplement intake by measuring the ratio of serum EPA:LA and/or DHA:LA and/or (EPA+DHA):LA.

What did Brasky TM, Crowe FL & Kristal AR actually do? According to the abstract, they measured only serum EPA, DHA & (EPA+DHA). They didn't measure serum LA. Therefore, if the subjects in the EPIC study ate a diet with a high omega-6 (n-6):omega-3 (n-3) ratio (i.e a Standard English Diet), subjects with a high serum n-3 level would have a very high serum n-6 level. As excessive levels of serum n-6 pufas are carcinogenic (see Completing the trine: Which are the safest fats?), it's not surprising that the study produced the results that it did.

There only one thing to do, in cases like this...

Because one palm just isn't enough!

EDIT: Here's a better analysis:- Fish Oil and your Prostate. It looks as though n-6 was measured, which makes my analysis wrong, but I'm keeping the double face-palm, as the full study is hidden behind a £30 pay-wall. Here's another good analysis:- Omega-3 Fats and Cancer.

Rigid diets & taking loadsa supplements to compensate for them.

I do not believe you want to be doing that!

This post was inspired by a recently-published study by Alan Aragon & Brad Schoenfeld, as bodybuilders are a group of people who often eat a rigid diet (some eat skinless chicken breasts, broccoli & brown rice for several meals each day).

See Nutrient timing revisited: is there a post-exercise anabolic window?
"Collectively, these data indicate an increased potential for dietary flexibility while maintaining the pursuit of optimal timing."

This post is also aimed at people who eat severely restricted diets in the (often mistaken) belief that something's making them ill.

People with type 1 diabetes who struggle to keep their blood glucose within reasonable limits (3 to 8mmol/L, or 24 to 144mg/dL) benefit from restricting their intake of high-GL carbohydrates, so this post is not aimed at them. See The problem with Diabetes.

People with type 2 diabetes who severely restrict their intake of carbohydrates must be in caloric deficit, otherwise the physiological insulin resistance caused by high serum NEFAs will mess up just about everything in their body if they are in caloric balance or caloric excess. I've read (so it could be false) that a certain non-skinny blogger who I'm in conflict with (who has type 2 diabetes and who eats a VLC diet) has heart problems and is taking medication(s) for high blood pressure. Hmmm.

People who suffer from gastrointestinal problems after eating gluten-containing foods, or mucus after eating casein-containing foods may have impaired gut integrity. See Gluten - more than just a pain in the guts?

Supplements that I consider of positive value are:-

Fish oils: If the diet is low in oily fish (tinned tuna is not an oily fish), there may be insufficient EPA & DHA (especially in men, children & post-menopausal women). Women of reproductive age can get away with taking flaxseed oil.

Magnesium: If the diet is low in veg/high in dairy, there may be too much Calcium relative to Magnesium.

Vitamin D3: If the lifestyle results in sun-avoidance, insufficiency in Vitamin D is highly likely.

Vitamin K2: If the diet is low in animal fats and/or fermented foods, insufficiency in Vitamin K2 is highly likely.

Supplements that I consider of negative value are:-

Vitamin A: If there's an insufficiency in Vitamin D, supplementing with Vitamin A/β-carotene may exacerbate it. As Vitamin D + Calcium may reduce cancer risk, supplementing with Vitamin A absent Vitamin D3 may increase cancer risk.

Vitamin E: If there's an insufficiency in γ-tocopherol, supplementing with α-tocopherol may exacerbate it. As γ-tocopherol may reduce CHD mortality risk, supplementing with α-tocopherol absent γ-tocopherol may increase CHD mortality risk. Most Vitamin E supplements contain α-tocopherol only. Some Vitamin E supplements contain mixed tocopherols and these are O.K.

Quality >> Quantity.

Mum passed away peacefully in the middle of the night. I'm waiting for paperwork to be done.

"And the best you can hope for is to die in your sleep."

On the internet, I read that Dementia with Lewy bodies has a mean survival time of 6 years from the onset of symptoms. Mum first became confused in mid-July 2007, so it's been just under 6 years. Does this mean that all of the supplements I gave her were worthless. Hell, no!

As mentioned in Look after your brain., mum's MMSE score increased from 14 to 26 out of 30 after taking medication and supplements. The medication gave a 3 point increase in MMSE score on average, so the rest of the increase in MMSE score was probably due to the supplements, which had no undesirable side-effects.

On Christmas day 2008, mum was capable of preparing Brussels sprouts for cooking, though she got the knives, forks & spoons mixed up when she tried to lay the table. Here's her final Christmas at home. Roast duck with all of the trimmings. Om, nom, nom!

Mum's last Christmas at home.

In conclusion, I believe that quality of life trumps quantity of life, so supplementation for the win.

Do not exceed the recommended intake/dosage.

The above warning is on mum's fish oil and on all supplements. The recommended daily intake (RDI) for Seven Seas fish oil for adults & children over 12 is 10ml/day, or 1 capsule/day if in capsules.
1 capsule contains 360mg of EPA+DHA.

Seven Seas fish oil must be dangerous stuff!

Here's some perspective. A small can (213g) of wild Alaskan red salmon contains 14g of fish oil and 1.9g of EPA+DHA. That's 533% the amount you get in one capsule of Seven Seas fish oil. There are no warnings on small cans of wild Alaskan red salmon to not eat more than a fifth of a can a day. I usually eat a whole can at a time. My brain really likes this. See Guess who didn't look after his brain?

For breakfast, I sometimes eat ten Brazil nuts and ten prunes washed down with a milky coffee. Ten Brazil nuts contain ~4,000ug of selenium. That's about 1,000% the RDI for selenium. However, I'm not showing any symptoms of selenium toxicity.

EDIT: I may be showing one symptom. Somebody told me that I smelled slightly of garlic. I had eaten a lot of raw onion on liver pate earlier that day and I was giving off a smell of onion. This has happened before.

Moral of the story: Get nutrients from foods wherever possible.

Move More: You are NOT going to believe this! Part 2.

At mum's care home on Wednesday, the activities ladies held a tai-chi session for the residents, as movement is good for their muscles and well-being. They roped me in as well. Mum was reading a Henley-on-Thames leaflet so she didn't join-in.

Tai-chi is harder than it looks! Mum noticed that I was waving my arms about in a graceful manner and stopped reading the leaflet. She looked slightly bemused (as would you if you saw what I was doing) and started smiling.

It was also somebody's birthday, so we all sang "Happy birthday to you" to him and gave him three "hip-hip hoorays" followed by a round of applause.

To the astonishment of the activities ladies, mum started to clap her hands. 5,000iu/day of Vitamin D3 + me being chatty, For The Win!

The nurse on duty also had a chat with me about the best way to give mum 10ml/day of fish oil and 2.5ml/day of Epsom Salts. She later told me that mum swallowed the fish oil without any problems (mum loves smoked salmon) and swallowed the Epsom Salts dissolved in a cup of juice without any problems either.

In other news, I now have a Blackberry 8900. This blog looks rather different when displayed on a tiny screen.

EDIT: I now ache all over!

Get in! Parts 2 & 3.

In Get in!, I described how I persuaded mum's GP to let mum have Vitamin D3 5,000iu/day.

Well...

Today, I persuaded mum's GP to let mum have Epsom Salts 2.5g/day (provided by me) dissolved in fruit juice and Seven Seas Fish Oil 10ml/day (provided by me). There's only one possible reaction:-


P.S. The doctor didn't even ask for supporting evidence. He just said "Yeah, other relatives do that. No problem. He just wanted to check for contraindications, which is fine by me. I have plans to ask him to allow mum to have one more supplement that may help her bones & brain. Any ideas as to what that might be, O.K.?

P.P.S. Another lady that's been at the care home since day one died Wednesday night/Thursday morning. She died from terminal cancer, but she had been physically crippled by Parkinson's Disease. R.I.P.

The usual suspects.

On Facebook, on message boards and face to face, I keep seeing and hearing:-

1) I'm down in the Winter/I keep getting infections/I have allergies/I have aches & pains.

2) I'm up & down a lot.

3) I'm down/anxious/I can't sleep/I get restless legs/cramps/menstrual cramps/muscle spasms/migraines.

4) I've got inflamed or painful joints/skin/guts/lungs/whatever.

5) Ooh! It makes me so mad!

1) Vitamin D insufficiency/deficiency is widespread by the end of Winter (~90% of people have serum 25(OH)D less than 75nmol/L or 30ng/mL) due to insufficient sun exposure during the Summer. A safe & effective dose is 50iu of Vitamin D3/kg body weight/day. See Vitamin D.

2) Modern diets are lacking in long-chain omega-3 fatty acids (EPA & DHA), as many people don't eat any/enough oily fish. Tinned tuna is not an oily fish! See Omega-3 fatty acids and major depression: A primer for the mental health professional. Women of reproductive age can take flaxseed oil, if they can't/won't eat oily fish or take fish oil capsules. Women not of reproductive age & men need to supplement with vegan DHA in addition to flaxseed oil, if they can't/won't eat oily fish or take fish oil capsules.

3) Diets low in greens are low in magnesium. Magnesium deficiency can cause all of the above symptoms. Epsom Salts are a very cheap source of Magnesium. 4g/day of Epsom Salts provides 400mg/day of Magnesium. See Magnesium and the Brain: The Original Chill Pill and Magnesium: Just as important as Calcium.

4) Vitamin D is anti-inflammatory. Fish oil is anti-inflammatory.

5) Vitamin D raises your mood. Fish oil keeps it stable. Magnesium chills you out.


Here's a picture to go with the title.


And finally...
I am so glad that I don't work with David Thorne.

Inflammation: Is omega-6 really to blame?

Take a look at the following diagram from Tripping Lightly Down the Prostaglandin Pathways showing the omega-6 and omega-3 pathways.


Omega-6 pufas result in the production of Series 1 prostaglandins (anti-inflammatory) and Series 2 prostaglandins (inflammatory). Omega-3 pufas result in the production of Series 3 prostaglandins (anti-inflammatory).

Now, see Are diets high in omega-6 polyunsaturated fatty acids unhealthy?

"Insulin sensitivity might be the common factor relating disease to fatty acid metabolism — both within and between the fatty acid pathways. A high linoleate to arachidonate concentration occurs in insulin resistance, in diabetic complications and also in some tumours."

"Current epidemiological and clinical evidence supports the regular consumption of cold-water fish as part of a balanced diet, in which attention to lifestyle and the quantities eaten (to prevent obesity and the insulin resistance syndrome) may be more critical than the nature of the fatty acids consumed."

Do you see where I'm going with this? If you have insulin resistance, don't change your diet (low in carbs & avoiding omega-6) to suit the insulin resistance. Tackle the insulin resistance!

This isn't an open invitation to start guzzling high-pufa oils. Stick to oils that have been squeezed out of things that grow in hot climates. I include Extra-Virgin Olive Oil in this category. Check the label, as the pufa contents of different EVOOs vary. Solesta from Aldi contains only 6.6% pufas.

EDIT: In addition, your brain depends on omega-3 to function properly. Too much omega-6 can "fry" it. See Mental Health and Omega 3/6 Ratio, A New Review.

Vitamin D is anti-inflammatory. Fish oils are also anti-inflammatory.


I just spotted this on Anthony Colpo's Blog: The Adventures of Chris “Razzi” Razwell and Other Assorted Internet Psychos. Oh, my!


And finally: I made mum a CD of "Dare" by The Human League (I bought it in vinyl years ago) and played it on the CD/Record player in the lounge at the nursing home. She loved it and was moving her arms in time with the music. This is her favourite track from that album.

Look after your brain.

"One in three people over 65 will die with dementia..." said Dr Susanne Sorensen, head of research at the Alzheimer's Society. I read this in a recent BBC News article Vitamin D 'is mental health aid' which referred to the study Serum 25-Hydroxyvitamin D Concentration and Cognitive Impairment.
The article contained the usual phrase "...more work was needed..."

The above article also led to Parkinson's linked to vitamin D which referred to the study Prevalence of vitamin d insufficiency in patients with Parkinson disease and Alzheimer disease. "However, the Emory University researchers do not yet know if the vitamin deficiency is a cause or the result of having Parkinson's". "Further research is required...." yet again.

It's like someone standing by their broken-down car wondering whether it's the empty fuel tank that's made the car stop or whether it's the car stopping that's made the fuel tank empty. Does it matter? Just put some fuel in the tank and see what happens! See also Higher serum vitamin D3 levels are associated with better cognitive test performance in patients with Alzheimer's disease.

Severe Mental Impairment blights the lives of many old people and their loved ones. My mum developed Parkinson's Disease a few years ago. I didn't know anything about the condition at the time, but it's caused by the formation of Lewy Bodies (blobs of abnormally-folded alpha-synuclein protein) in the substantia nigra part of the brain, which controls movement. This part of the brain has high levels of the Vitamin D receptor. Why does the brain contain Vitamin D receptors?

As Lewy Bodies form in other parts of the brain, mental faculties decline. The hippocampus is involved with short-term memory. The neocortex is involved with concious thought.

Mum started showing obvious signs of mental impairment in August 2007. She was assessed by a Community Psychiatric Nurse (CPN) in January 2008 when she scored 14/30 in a MMSE. She was unable to remember 3 words or follow 2 simple instructions in a row (e.g. fold this piece of paper in half and put it on the floor). I started her on 5,000iu/day of Vitamin D3 as it was having a positive effect on my mental function. She was prescribed Aricept, starting at 5mg/day for a month then increasing to 10mg/day. In May 2008 she was re-assessed and scored 26/30 in a MMSE. EDIT: In 2010, Mum's consultant told me that Aricept increases MMSE score by 3 points on average.

Unfortunately, Aricept has side-effects including severe diarrhoea and worsening of the symptoms of Parkinson's Disease which she complained about, so her Aricept dose was reduced back to 5mg/day.

Unsurprisingly, this resulted in a slight decline in mum's mental faculties. In November 2008, I increased her intake of smoked salmon to about 400g/week, as the consumption of long-chain pufas have benefits. See
Low Plasma N-3 Fatty Acids and Dementia in Older Persons: The InCHIANTI Study and
Disruption of glial (oligodendrocyte and astrocyte) cellular function leads to carnosine (b-alanyl-L-histidine) synthesis failure, and nutrient and protective factor deficiency in neurons with secondary development of oxidative stress and amyloid toxicity, with subsequent neuronal dysfunction and development of dementia which stated "Measures which reduce toxicity to vascular endothelium and glia, such as fish oil, may have potential for reducing the likelihood of development of the disease..."

After about four weeks, this had a noticeable (by myself and mum's friend) positive effect on her mental faculties so, inspired by Dr Art Ayers, I started her on Turmeric (curcumin) extract and Goldenseal (berberine) extract. See
Curcumin inhibits aggregation of alpha-synuclein
Neuroprotective effects of curcumin
Alpha-synuclein assembly as a therapeutic target of Parkinson's disease and related disorders
Curcumin labels amyloid pathology in vivo, disrupts existing plaques, and partially restores distorted neurites in an Alzheimer mouse model
Influence of piperine on the pharmacokinetics of curcumin in animals and human volunteers
Research on the mechanism of neuronal apoptosis in Alzheimer's disease and the effects of tetrohydroberberine on the apoptosis... and
Berberine chloride can ameliorate the spatial memory impairment and increase the expression of interleukin-1beta and inducible nitric oxide synthase in the rat model of Alzheimer's disease.

On January 12th 2009, mum was re-assessed and scored 26/30 in a MMSE. I thought that this was impressive considering that a) she was taking half the dose of Aricept compared to when she previously got that score, b) she had no adverse effects from taking any of the supplements and c) she was 8 months older and degenerative brain diseases worsen with time.

I mentioned to the CPN who did the MMSE that I was starting mum on 15mg/week Vitamin K2 as there were benefits. See
Menaquinone-4 concentration is correlated with sphingolipid concentrations in rat brain ,
Vitamin K status influences brain sulfatide metabolism in young mice and rats ,
Vitamin K and sphingolipid metabolism: evidence to date ,
Substantial sulfatide deficiency and ceramide elevation in very early Alzheimer's disease: potential role in disease pathogenesis and
The possible role of vitamin K deficiency in the pathogenesis of Alzheimer's disease and in augmenting brain damage associated with cardiovascular disease
I don't know what sphingolipids are (I know who probably does) but sulfatides are good and ceramides are bad.

Around the time that mum collapsed, I received a copy of a letter from the CPN to mum's GP which stated "I have informed him (i.e. me) that I am unaware of any robust evidence that these substances are of any benefit." However, there is no evidence that these substances are of any harm.

And finally......
What started the cascade of confusion and collapse leading to hospitalisation and discharge to a nursing home was a simple Urinary Tract Infection (UTI) of e. coli. I don't know why UTIs cause so much confusion in elderly people, but elderly females are at a high risk of developing UTIs because a) elderly people don't drink enough so they don't pass enough urine, b) females have insufficient spacing between anus & urethra and c) elderly females who have any urinary/faecal leakage wear a Tena disposable "nappy/diaper", which increases the likelihood of faeces entering the urethra.

To reduce the risk of further UTIs, I have supplied the nursing home with a pot of D-mannose Plus, which contains d-mannose and cranberry extract, with instructions to add a heaped teaspoonful to a glass of juice once a week. See Intervening with urinary tract infections using anti-adhesives based on the crystal structure of the FimH-oligomannose-3 complex and
Natural approaches to prevention and treatment of infections of the lower urinary tract

EDIT: Thanks to Galina L for bringing the following study to my attention.
Magnesium supplementation in the treatment of dementia patients.
It's probably of no help to Lewy Body Dementia sufferers, as they already have high Mg levels in their CSF. See CSF Mg and Ca as diagnostic markers for dementia with Lewy bodies.

Continued on Look after your brain, Part 2.

The Protein-Sparing Modified Fast (PSMF)

As promised, I shall discuss the PSMF (I was going to have a whinge about the sudden loss of ability to watch "Neighbours" on Demand Five using Firefox, but I'll save that for another time if Demand Five Support don't fix the problem).

What's a PSMF?

A standard PSMF is ~1g of protein for every kg bodyweight a day plus lots of green leafy vegetables plus six to ten fish oil capsules a day plus vitamin & mineral supplements plus unlimited water AND NOTHING ELSE. You may find this quite literally hard to swallow! PSMF may also stand for Protein Strictly , Mother-F***er! A 100kg person (e.g. me) may get to eat ~400kcals from protein + ~100kcals from incidental carbohydrates & fats = ~500kcals a day. Hear that rumbling noise? It's my tummy! A well-known PSMF is Lyle McDonald's Rapid Fat Loss Handbook.

For more information, see http://forums.lylemcdonald.com/forumdisplay.php?f=7 and Is Rapid Fat Loss Right For You?

To make a PSMF easier to manage (but have a slower rate of weight loss), here are some modifications:-

1) Instead of six to ten fish oil capsules a day, stir ~25g of powdered linseeds into a large glass of drink and swallow the lot. Do this at breakfast-time. 25g of linseeds contains ~10g of fat (of which ~6g is Alpha-Linolenic Acid, an omega-3 fatty acid) which does the following:-

a) It stimulates the gall-bladder to empty, thus reducing the risk of gallstones.
b) It usually results in a bowel movement some time later. The ~10g of soluble fibre/fiber in the linseeds + accompanying fluid guarantees regularity.
c) It provides women (but not men) with all of the omega-3 fat they need each day.

Men need to eat either half a 213g tin of wild red salmon a day or six to ten fish oil capsules a day as their bodies don't produce enough DHA from Alpha-Linolenic Acid. See Extremely Limited Synthesis of Long Chain Polyunsaturates in Adults: Implications for their Dietary Essentiality and use as Supplements

2) Eat about 100g of protein a day. As meat, poultry & fish contains 20-25% protein, this means that you can eat ~1lb of meat, poultry & fish a day. 100g of protein a day is well within the capabilities of your liver and kidneys.

3) Eat about 44g of fat a day. This allows you to choose less lean cuts of meat & poultry and you can even eat the skin on chicken as long as you factor it into your total fat allowance. It also allows you to use vinaigrette salad dressings or a knob of butter or a dollop of real mayonnaise to make your vegetables taste nicer.

4) Eat about 50g of carbohydrate a day. This allows you to eat shed-loads of leafy green vegetables and also an onion. It also allows you to eat a portion of fruit e.g. an apple or a bowl of berries/cherries with Splenda & a dollop of whipped cream each day.

5) If you do any intense exercise (e.g. HIIT or resistance training with weights), eat an extra 50g of slow-release carbohydrates a couple of hours beforehand to fuel it.

6) Supplement with 5,000iu/day of Vitamin D3. Nowadays, many of us spend our lives mostly indoors and this causes many of us to become deficient in Vitamin D. Please read Vitamin D.

In conclusion:

100g of protein provides 400kcals, 44g of fat provides 400kcals and 50g of carbohydrate provides 200kcals, making a grand total of 1,000kcals a day. Hopefully, this will be enough to stop your tummy from rumbling. If you weigh over 100lbs but aren't losing weight on 1,000kcals a day, see your GP as you may have a thyroid problem.

I believe that the above diet tackles the problems of gallstones, constipation, dry skin, dry hair, depression and dietary deficiencies. You get to eat real food and quite a lot of it too, for a fairly rapid fat loss diet.

Cholesterol And Coronary Heart Disease

Cholesterol & coronary heart disease are mentioned a lot in the media. Unfortunately, most of what you see & hear is either completely wrong, or dumbed-down so much that it's inaccurate.

Fat & cholesterol don't stick to the insides of artery walls like grease on the inside of a drainpipe. This article explains what cholesterol is, how arteries get blocked and how to minimise the risk of having a heart attack or ischaemic stroke.

What is cholesterol?
Cholesterol is a large, waxy molecule (C₂₇H₄₅OH) consisting of a hydrocarbon (fat-soluble) tail, a middle section consisting of four carbon rings (the steroid bit) and an alcohol (water-soluble) group on the end. Cholesterol is a powerful anti-oxidant and is what bile acids, mineralcorticoids, glucocorticoids and sex hormones are made from.

Cholesterol is "chauffeured" around the body in lipoprotein "limousines". Lipoproteins are lipo (fat-soluble) at one end, protein (water-soluble) at the other end and they form a spherical shell around their contents with the lipo end pointing inwards and the protein end pointing outwards. The shell is like the body of the limousine. In the shell, there are apo(lipo)proteins which are like the chauffeur, as they determine where the particles are taken up. HDL has apo A in its shell which makes it get taken up by receptors in the liver. LDL has apo B in its shell which makes it get taken up by receptors in cells, artery walls etc. The passengers are cholesterol, cholesteryl esters, phospholipids and triglycerides. These limousines have different types, like chylomicrons, VLDL, LDL, IDL & HDL, the difference being the type & amount of apo(lipo)protein and the relative proportions of cholesterol & the other passengers. There are also sub-groups of each type.

The different variants are affected by serum triglycerides. High serum triglycerides (caused by a chronic over-consumption of sugary & starchy carbohydrates for activity level) result in cholesterol-depleted, triglyceride-rich particles and low serum triglycerides result in cholesterol-rich, triglyceride-depleted particles. As cholesterol is a powerful antioxidant, small cholesterol-depleted particles (Type B) oxidise faster than large cholesterol-rich ones (Type A).

Oxidised LDL particles are "bad cholesterol" and are swallowed by scavenger macrophages. These expand into foam cells, which become embedded in the intima of artery walls. Other processes occur which cause cholesterol & calcium to accumulate as a plaque inside the media of artery walls. To see a cross-section through an artery wall, click HERE and scroll down to the bottom of the page. Unoxidised LDL particles are not swallowed by scavenger macrophages, so unoxidised LDL particles are not "bad cholesterol". In young people, plaques of cholesterol with no calcium can accumulate, making Coronary Artery Calcium (CAC) scans ineffective. See Stenosis Can Still Exist in Absence of Coronary Calcium.

Plaques force the inner artery wall inwards, making the artery narrower, impeding the flow of blood through it. This can cause angina pectoris (pain in the chest) as the heart is starved of oxygen, or vascular dementia as the brain is starved of blood. Eventually, the cap covering the plaque can rupture, causing chunks of plaque to circulate and block coronary arteries (causing a heart attack), or cerebral arteries (causing an ischaemic stroke).

It's possible to reduce serum triglycerides significantly by eating lots of long-chain omega-3 fats from oily fish. These inhibit the conversion of glucose into triglycerides. Inhibiting the conversion of glucose into triglycerides can result in increased blood glucose levels (not good - see below) if sugary/starchy carbohydrate intake is too high. Solution? Reduce sugary/starchy carbohydrate intake to suit activity level.

Why do foam cells embed themselves into the intima of artery walls?
Arteries are elastic, muscular tubes which stretch a bit each time the heart pumps and contract again between beats. They also relax & constrict to control the flow of blood through them. When you get cold, they constrict to reduce the flow of blood to the skin to prevent excessive heat loss. When you get hot, they open to increase the flow of blood to the skin to increase heat loss.

Foam cells don't go just anywhere. They embed themselves into damaged areas of artery walls. This is a good thing otherwise damaged artery walls could rupture, causing a haemorrhage.

What damages artery walls?
Chronically-high blood pressure.
Chronically-high blood glucose.
Chronically-high blood free radicals.
Chronically-high blood homocysteine.
Chronically-low blood antioxidants.
Chronically-high blood pro-oxidants.
Chronically-low blood anti-inflammatories.
Chronically-low Vitamin K2.
Chronically-high LDL due to hypothyroidism or other factors.

How can I reduce damage to artery walls?
1) Have blood pressure (BP) tested regularly. There's one problem with having your BP taken in a GP's surgery and that is 'white-coat hypertension' where the stress of having your arm squeezed by the cuff sends your BP up! If you buy your own BP monitor (Lloyds pharmacy sell a fully automatic BP monitor with standard cuff for £9.99), you can become accustomed to using it and overcome white-coat hypertension. 5,000iu/day of Vitamin D3 can reduce BP by making artery walls more elastic. 4g/day of Epsom Salts provides 400mg/day of magnesium, which acts as a smooth muscle relaxant, reducing BP & cardiac arrhythmias.

2) Have blood glucose (BG) tested regularly. If you're lucky, you may be able to get a HbA1c test. This shows accumulated damage to red blood cells by blood glucose.

3) Don't smoke! Apart from lung cancer, chronic obstructive pulmonary disease & emphysema, smoking speeds the oxidation of LDL.

4) Take a B-complex containing B6, B12 & folic acid, which lowers serum homocysteine levels.

5) Eat a diet rich in anti-oxidants from coloured veggies (beta-carotene), fruits (Vitamin C + bioflavonoids), tomatoes (lycopene), nuts & seeds (gamma-tocopherol & copper), Brazil nuts (selenium), beer/wine in moderation (muscle relaxant), green tea (polyphenols), cocoa/dark chocolate (polyphenols & copper), onions/garlic (quercetin) etc. See Antioxidant state and mortality from coronary heart disease in Lithuanian and Swedish men: concomitant cross sectional study of men aged 50.

6) In men and non-menstruating women, too much iron in the blood relative to copper is pro-oxidant, so don't supplement with iron. Menstruating women have the opposite problem. See The unusual suspects.

7) Take about 2g/day of long-chain omega-3 fats from oily fish, or about 20g/day of flaxseed oil if male, or about 10g/day of flaxseed oil if female. Please note that tinned tuna contains virtually zero omega-3 fats. See Clinical nutrition: 4. Omega-3 fatty acids in cardiovascular care.

8) Eat a diet rich in Vitamin K2, to make calcium go into bones & teeth, instead of arteries, kidneys & brain. For good sources of Vitamin K2, see HERE. Note: Warfarin/Coumadin works by depleting Vitamin K, so lots of Vitamin K2 makes Warfarin/Coumadin ineffective.

9) If you're feeling tired and are gaining weight for no obvious reason, get serum thyroid hormone levels tested (TSH, FT4 & FT3 preferably), as low thyroid hormones down-regulate LDL receptors, resulting in LDL particles lingering in the blood for longer than usual. This increases the oxidation of these particles.

What about Benecol & Flora Pro-Activ?
These yoghurts & spreads contain plant sterols/stanols, which reduce total serum cholesterol by up to 15%. However, LDL quality is more important than LDL quantity (up to a point) and there is no evidence that these foods save lives.

What about statins?
Statins (HydroxyMethylGlutarate Coenzyme-A Reductase inhibitors) reduce serum cholesterol. They also have anti-inflammatory & anti-clotting effects by reducing levels of the non-sterol derivative mevalonate and subsequent products. Click HERE to see the cholesterol synthesis pathway. Statins save lives in people who have had a heart attack and in men between the ages of 30 and 60. However, younger & older men and women do not get a significant reduction in deaths, (though heart-attack deaths may be reduced) and there can be undesirable side-effects (muscle pains, memory loss etc). I strongly recommend that anyone taking statins should supplement with at least 100mg/day of Co-Q10, as the synthesis of this vital substance is reduced. Note that fish oils have anti-inflammatory, anti-clotting and anti-arrhythmia actions, but don't suppress the production of Co-Q10.

What about dietary cholesterol?
When cholesterol is eaten, the liver produces less cholesterol. An average egg contains about 250mg of cholesterol. The vast majority of people (who don't have genes for familial hypercholesterolaemia) can eat two eggs a day without significantly affecting their serum cholesterol & triglyceride levels. See Effect of dietary egg on human serum cholesterol and triglycerides, and Eat Whole Eggs All Day and Throw Your Statins Away? 375x Increased Dietary Cholesterol Intake From Eggs Reduces Visceral Fat & Promotes Healthy Cholesterol Metabolism. People with ApoE4/E4 are more sensitive to dietary cholesterol raising serum LDL, and cannot eat cholesterol willy-nilly.

There are a couple of sites that have CVD risk calculators, JBS2 and QRISK®2-2013. The National Institute for Clinical Excellence (NICE) no longer recommends the use of JBS2, as it's overly-pessimistic. Note that CVD mortality isn't the same thing as overall mortality. Higher than "normal" total cholesterol level is associated with lower overall mortality, according to Research finds ‘raised’ cholesterol to be associated with a reduced risk of death.