Question: If your cholesterol is high, how do you avoid having a large burden of oxidized LDL?

First, normalize your cholesterol.

And no, I'm not saying that high cholesterol is the cause of heart disease. It's not, but oxidized LDL is, and the number one cause of both high cholesterol and oxidized LDL is not clearing LDL particles from the blood. So, I would never skip over the question of what I can do to get cholesterol in the normal range.

I think the boundaries of the normal range are a little exaggerated.

If you look at traditional cultures that eat a traditional diet, live a traditional lifestyle — they're not modernized, and they don't have heart disease — you do see cholesterol levels that go higher than ours.

So, for a man, maybe going up to 220 mg/dL in total cholesterol is pretty normal. For a woman in her 40s and 50s, up to 250 maybe.

I'm not looking to change those numbers if lifestyle and diet are ancestral. If everything else about the data make it look like that person's very healthy — especially if direct measures of plaque development like carotid IMT, intima-media thickness, and coronary calcium score are normal. I wouldn't be thinking about fixing the cholesterol at that point.

But, for someone whose cholesterol is like 300 mg/dL, you don't even see that in Tokelau, where the saturated fat content and the traditional cholesterol levels are the highest ever recorded in an ancestral population. So, when they're that high, you have to fix it as your first line of defense.

That means improving LDL receptor activity.

The big things to look at are body composition, inflammation, fiber intake (higher fiber is generally better), and thyroid.

Let's say you haven't brought the cholesterol down, what do you do to protect it?

Well, that largely comes down to a few things. Imagine the lipoprotein leaves the liver, some as LDL, some as VLDL, both of which wind up being LDL at some point. It leaves the liver packaged with antioxidants. Those include vitamin E and coenzyme Q10, but it isn't limited to those two. They are just the most important in this situation.

When LDL is circulating in the blood, it gets behind the arterial wall, and that's the main site of oxidation. So, the question is, how oxidizing of an environment is that? Also, it gets stuck behind the arterial wall, so the question is, how sticky of an environment it is?

Because if it gets stuck in the oxidizing environment behind the arterial wall, then that's the very powerful regulator of whether it's going to oxidize.

So, the stickiness. Probably the dietary approach that best regulates the stickiness is manganese. Manganese is found mostly in plant foods and vegetarians have the highest intakes. People with plant-rich diets that also eat animal foods are in the middle. And people who eat a lot of animal foods and no plants are at the bottom. So, eat a lot of plant foods is one thing. There are some animal experiments specifically with blueberries as a source of manganese showing in animals that it makes the arterial wall less sticky, so there's that.

Then there's the oxidizing environment. A big part of that is systemic inflammation because if inflammation causes oxidative stress. You should have been looking at inflammation for high cholesterol in the first place. Assume you have that covered. And then antioxidants in general.

You're looking at protein, selenium, zinc, copper, iron, manganese, vitamin C, vitamin E, glycine… you're looking at so many things in there, so you really got to figure out what the weakest link is in that person and focus on that weakest link. There may be many.

This Q&A can also be found as part of a much longer episode, here:https://chrismasterjohnphd.com/podcast/2019/02/09/ask-anything-nutrition-feb-1-2019/

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Chris Masterjohn, PhD, is the Founder and Scientific Director of the mitochondria test Mitome.

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