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.

Ketogenic diets - when they're not ketogenic, Part 2.

If I said that Eskimos eating their traditional diet were eating some processed carbs, what would you think?

Structure of the chitin molecule, showing two of the N-acetylglucosamine units that repeat to form long chains in β-1,4 linkage.

Eskimos eat marine mammals & oily fish, also any edible vegetation that they can find. Marine mammals eat oily fish which in turn eat crustaceans. Crustaceans have an exoskeleton made of Chitin. Chitin has a structure similar to cellulose and a function similar to keratin (hair & fingernails/claws). Humans cannot digest chitin unless it's first powdered and hydrolysed. Certain fish and bacteria are able to digest it using chitinases.

If Eskimos consume the stomach contents of the animals that they kill for food (they usually consume the whole animal, sometimes after leaving it for a long time to auto-digest), there is likely to be a significant amount of pre-digested chitin in their diets. Therefore, Eskimos eating their traditional diet are eating some processed carbohydrates. This would reduce ketogenesis somewhat.

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.

PPP - another bijou rant-ette.

Blame it on the hot weather and screaming kids! :-D

PPP stands for Piss Poor Parenting.

Why, oh why, oh why do parents allow children to dictate their own diets? As if children know what's good for them! At an event I attended recently, "Johnny*" was given a plate of chicken drummers (mechanically-recovered chicken formed into the approximate shape of chicken drumsticks and coated with breadcrumbs) and oven chips. I asked Johnny if he would like a beefburger, sausage or pork steak. He replied. "I don't like them". He only wanted manufactured shite. Seriously, WTF?

When I was a lad, I was given the same food as my parents. If I didn't eat it, I went without. I ate it!
Nowadays, "children's menus" in restaurants (I'm being quite generous in the use of the word restaurant) consist of lots of manufactured shite that children like. Unlike veggies & fruit, this shite contains very little fibre/fiber or magnesium.

Is it any wonder that childhood constipation is a problem? Why are children being given PEG or even Lactulose, when there's a much better solution - Epsom Salts (which contains magnesium). The gut needs magnesium to function properly. See You're free, and a testimonial.

The brain needs magnesium to remain cool, calm and collected i.e. function properly. The brain also needs DHA and Vitamin D3 to function properly. Many kids don't like oily fish so they won't/don't eat it. It's not rocket science to purée some wild red salmon with some Bolognese/Sweet chilli/w.h.y. sauce so that they won't notice it. Many kids play indoors or are smothered in sunblock when they do go outdoors. Is it any wonder that childhood ADD/ADHD is much more common? Medication and psychotherapy? Seriously, WTF?

When I was a lad, there were a couple of show-offs in my class at school, but nobody behaved like "Jimmy*" (physically and mentally hyperactive with bad behaviour, screaming and shouting). Johnny was also badly behaved, but not as bad as Jimmy. The parents at the event seemed content that, every day, their children had to be given "uppers" (e.g. Ritalin) to help them concentrate during the day and "downers" to help them sleep at night. Seriously, WTF?

I will now take a deep breath and count to twenty. There, that's better!

*Names changed.

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.

Guess who didn't look after his brain?

Due to the sudden deterioration in my mum's physical & mental health and also due to struggling to come to terms with her having to spend the rest of her life in a nursing home (not the happiest of places), my diet went completely to pot.

I "went off" salmon, sardines & powdered linseeds and started to eat carbohydrate/fat-based comfort foods. A black cloud slowly descended over me. I lost the motivation to do anything, including updating this blog. I also slept a lot. This continued for several months.

Then, for no apparent reason, a few weeks ago I got an urge to eat smoked salmon. I added 200g of smoked salmon twice a week back into my diet and after a few weeks, the black cloud started to lift.

Before I started supplementing with Vitamin D3, I used to eat lots of oily fish but did not function correctly mentally. This time, my Vitamin D3 status was good (I never stopped taking supplements even when I had the black cloud over me) but my EPA (Eicosapentaenoic Acid) and DHA (Docosahexaenoic Acid) intakes were near zero.

In conclusion, it would appear that my brain needs adequate Vitamin D3 and EPA and DHA (and magnesium) to function correctly.

I won't be blogging as much as I have been previously, as I've now dumped the vast majority of the nutritional knowledge within my brain into this blog. If I come across anything new, I'll post it here.

Finally, I've found the cheapest source yet of 5,000iu Vitamin D3 gelcaps.

I was just thinking......

On a messageboard in a galaxy far far away, someone suggested that as many as one in three people in the UK could have impaired carbohydrate metabolism. This set me thinking.

London is 51degrees North of the Equator, so the sun has to pass through ~45% more atmosphere to reach us, compared to the Equator.

According to Elina Hyppönen & Chris Power, (edited) "The prevalence of hypovitaminosis D was highest during the winter and spring, when 25(OH)D concentrations less than 75nmol/L were found in 87.1% of participants, respectively; the proportion was 60.9%, respectively, during the summer and autumn."

Note that 75nmol/L was insufficient to give me normal Insulin Sensitivity. See Chiu, Chu, Go & Saad. However, greater than 160nmol/L was sufficient, but that was only obtained after I supplemented with 5,000iu/day of Vitamin D3 (25 x RDA).

A deficiency of omega-3 EFAs can cause Insulin Resistance (poor Insulin Sensitivity). See Ghafoorunissa, Ahamed Ibrahim, Laxmi Rajkumar & Vani Acharya, Storlien LH, Kraegen EW, Chisholm DJ, Ford GL, Bruce DG & Pascoe WS and Yam D, Bott-Kanner G, Friedman J, Genin I, Klainman E & Shinitzky M.The typical omega-6:omega-3 ratio in the British diet is ~15:1. This is partly due to the fact that animal produce from grain-fed animals contains a lot more omega-6 and a lot less omega-3 than it used to. See Is food less nutritious than it used to be? Andre Purvis investigates. In addition, people eat grains, nuts, seeds, oils & spreads high in omega-6 and don't eat much oily fish, powdered Flax-seeds (a.k.a. Linseeds) or Purslane (a plant that's relatively high in omega-3).

With all of these problems, I wonder what percentage of the UK population actually do have some degree of impaired carbohydrate metabolism? It might be more than one in three.

According to The eatwell plate, one third of our total Calories are supposed to come from bread, rice, potatoes, pasta and other starchy foods. All of these foods raise blood glucose. Impaired carbohydrate metabolism makes for roller-coaster blood glucose levels which encourages over-eating, leading to obesity (see my Blog post on Blood Glucose, Insulin & Diabetes.)

I think that that's enough thinking for now.

Fats: Spawn of Satan or Dogs' Doodads?

Fats get a lot of bad press in the media. There are so many adverts with "X% fat-free" or "only 1g of fat per Jaffa Cake" as if that's going to stop you from getting fat when you "om nom nom" your way through a whole box of the things!

Saturated fats are usually described as "bad" and polyunsaturates are usually described as "good". This is simplistic. Everything is bad in excess, even polyunsaturates. The thing about fats is that there are four basic types (saturates, monounsaturates, omega-6 polyunsaturates and omega-3 polyunsaturates) and they need to be consumed in roughly the right proportions for optimum health. Suffice it to say, the majority of people in the West do not eat them in anywhere near the right proportions. So, what exactly are fats?

Fats

Fats are an ester of glycerol and three fatty acids and are also known as triglycerides or triacylglycerols.

1 molecule of glycerol + 3 molecules of fatty acid = 1 molecule of triglyceride + 3 molecules of water.

It's the fatty acids that determine whether a fat is sat, mono etc. The four different types of fatty acid all have a CH3 at one end and a COOH at the other. The difference is in the middle section.

Saturated fatty acids have a middle section consisting of all CH2's. Here's a diagram for Stearic acid (the predominant fatty acid in beef):-

__H H H H H H H H H H H H H H H H H OH-C-C-C-C-C-C-C-C-C-C-C-C-C-C-C-C-C-C-O-H__H H H H H H H H H H H H H H H H HMonounsaturated fatty acids have one C=C bond in the middle, which is usually (but not always) 9 from the left-hand end resulting in monounsaturates usually being referred to as omega-9's, as omega is the letter at the end of the Greek alphabet. Here's a diagram for Oleic acid (the predominant fatty acid in olive oil):-

__H H H H H H H H_____H H H H H H H OH-C-C-C-C-C-C-C-C-C=C-C-C-C-C-C-C-C-C-O-H__H H H H H H H H H H H H H H H H H

Omega-6 polyunsaturated fatty acids have two or more C=C bonds in the middle with the last one always being 6 from the left-hand end. Here's a diagram for Linoleic acid (the predominant fatty acid in sunflower oil):-

__H H H H H_____H_____H H H H H H H OH-C-C-C-C-C-C=C-C-C=C-C-C-C-C-C-C-C-C-O-H
__H H H H H H H H H H H H H H H H H

Omega-3 polyunsaturated fatty acids have three or more C=C bonds in the middle with the last one always being 3 from the left-hand end. Here's a diagram for Alpha-linolenic acid (the predominant fatty acid in flax-seed oil):-

__H H_____H_____H_____H H H H H H H OH-C-C-C=C-C-C=C-C-C=C-C-C-C-C-C-C-C-C-O-H__H H H H H H H H H H H H H H H H H

These diagrams are slightly misleading. Where there is a C=C bond, there are two H's on the "underside" only of the molecule. This asymmetry causes the H's to repel each other and bend the molecule into a V-shape at each C=C bond. C=C bonds with H's on the same side are known as "cis" bonds. The above molecule is really cis, cis, cis (c,c,c) Alpha-linolenic acid. The other type of C=C bond is known as "trans" and looks like the following diagram:-

__H H H___H H___H H___H H H H H H H OH-C-C-C=C-C-C=C-C-C=C-C-C-C-C-C-C-C-C-O-H
__H H___H H___H H___H H H H H H H H

This is a diagram of trans, trans, trans (t,t,t) Alpha-linolenic acid. As the H's are on opposite sides of the molecule, they do not repel each other and the molecule is straight as shown above. Note that saturated fatty acid molecules are naturally straight. Therein lies the problem with trans-fatty acids. They're straight, like saturated fatty acids but have unsaturated bonds which are prone to oxidation. See http://www.cyberlipid.org/perox/oxid0002.htm WARNING! Heavy-duty organic chemistry!

Our bodies take trans-fatty acids and incorporate them into cell membranes as if they were saturated fatty acids. This results in atherogenicity (artery-clogging), damage to the immune system and other health problems. Trans-fatty acids are found in partially-hydrogenated vegetable oils and so any processed foods or cooking/spreading fats which has the word "hydrogenated" high-up in the ingredients list should be avoided. These truly are bad fats. There are also naturally-occurring trans-fatty acids made by bacteria in the stomachs of ruminant animals, like Conjugated Linoleic Acid (CLA). This looks a bit like the diagram below:-

__H H H H H_____H___H H H H H H H H O
H-C-C-C-C-C-C=C-C=C-C-C-C-C-C-C-C-C-C-O-H
__H H H H H H H___H H H H H H H H H

This has one of the C=C bonds shifted to the left and also has one cis bond and one trans bond, so the molecule is always bent. CLA has possibly beneficial properties but medical studies show mixed results. It's certainly not artery-clogging, so don't let anyone put you off eating butter from grass-fed cows (e.g. New Zealand butter) by saying that it has trans-fats in it. CLA is a harmless trans-fat.

Anyway, back to diet. Saturated fat consumption should be about 10% of total calories. This is because, even though sat fats are not essential (our bodies can manufacture them), this guarantees adequate levels of sex hormones in the body. Total polyunsaturate consumption should be about 5% of total calories, with a ratio of omega-6 (O6) to omega-3 (O3) of between 1:2 and 4:1. As O3's are only found in greater quantities than O6's in flax-seeds (a.k.a. linseeds) and oily fish, and many people eat way too little or no oily fish (and who, other than body-builders and some vegetarians/vegans, eats flax-seeds?), the O6:O3 ratio in the West is about 20:1. This is due to the widespread consumption of meats, eggs & milk from grain-fed animals, grains, nuts and seeds. So, it’s not surprising that there are high rates of heart disease and other inflammatory diseases in the West, as O6's end up in series 1 & 2 prostaglandins and series 2 prostaglandins are pro-inflammatory. O3 fats end up in series 3 prostaglandins, which are anti-inflammatory.

So eat up yer oily fish if you're not vegetarian or vegan. Otherwise, eat up yer ground-up flax-seeds!

Monounsaturates can make up 15% to 35% of total calories, depending on activity levels. Remember from the histogram in the Blog post Everyone is Different, sedentary people on average burn twice as much energy from fats as from carbs. So, if energy from protein is 25% say, 25% of energy can come from carbs and 50% can come from fats i.e. a 2:1 ratio of fats:carbs. The cyclists at the left-hand end of the histogram in Chapter 1 would do best on 25% protein, 5% carbs, 70% fat when sedentary, whereas the cyclist at the right-hand end of the histogram would do best on 25% protein, 60% carbs, 15% fat when sedentary. When active, more carbs are needed by everyone.

Which fats contain which fatty acids? See http://homepage.ntlworld.com/nigel.kinbrum/comparison-of-fats.gif for a Comparison of Dietary Fats chart. Click http://www.apag.org/oleo/fatsoils.pdf for tables of Properties & Composition of Vegetable & Special Oils and Properties & Composition of Animal & Marine Fats & Oils.

For high-temperature cooking, saturates are the least likely to oxidise (when they're on fire, they're oxidising!), followed by monos, then omega-6's with omega-3's being the least stable. An oil doesn't have to be smoking to be oxidising. Alpha-linolenic acid oxidises at room temperature, which is why linseed oil is used to varnish cricket bats and soften putty. The best non-animal fat for high-temperature cooking is Coconut Oil, followed by Palm Oil and then Olive Oil. Extra-Virgin Olive Oil (EVOO) has a lower smoking temperature than refined Olive Oil (due to higher levels of free fatty acids), but has higher levels of polyphenol antioxidants, which makes it pretty heart-healthy.

Oils high in polyunsaturates shouldn't be heated above 100°C, as polyunsaturates can change from the cis configuration to the trans configuration at temperatures as low as 102°C. See http://www.harricksci.com/sites/default/files/pdf/application_notes/FatIR_App-Notes_ATR_Oil-Analysis.pdf

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.