How to avoid hidden sources of gluten

Congratulations, you’ve gone gluten free to improve your health! Perhaps you have celiac disease, or non-celiac gluten sensitivity, both of which require avoidance of gluten for optimal health. You know to avoid wheat, barley, rye, triticale, einkorn, farro, kamut, spelt, farina, emmer, durum, and semolina, plus most oats because they are commonly cross-contaminated with gluten grains in the field or factory. That pretty much sums it up, right?

Well, not quite. Gluten can actually reside as a hidden component in many common food ingredients, which can make food shopping, restaurants, travel, and potlucks a risky business. In this article, we’ll offer some guidelines for successfully navigating this tricky terrain.

Navigating Food Labels

Manufacturers are not presently required to identify gluten as an ingredient on labels. Just because a product doesn’t list a gluten grain, doesn’t mean it’s gluten-free.

Your greatest tool in determining what is safe to eat is to read food labels, and become familiar with stealthy ingredients that may include gluten. Have you ever seen an ingredient that you can’t identify? If so, it’s best to avoid it. Here is a (non-exhaustive) list of some common ingredients that can contain gluten:

• Malt, and barley malt
• Food starch and modified starch
• Dextrin and maltodextrin -- sourced from corn or wheat
• HPP = Hydrolyzed Plant Protein
• HVP = Hydrolyzed Vegetable Protein
• TVP = Texturized Vegetable Protein
• “Natural flavor”
• “Spices”
• “Artificial flavor”
• Brewer’s yeast
• Gelatinized and pregelatinized starch
• Brown rice syrup

Pre-packaged foods can add a challenge as well. Below are some common foods that may have gluten in them. Look for a certified GF label if you aren’t sure; otherwise, pass it up.

• Soy sauce (a good replacement is coconut aminos, or wheat-free tamari -- 100% soy)
• Many salad dressings use gluten thickener
• Gravies, sauces, marinades
• Fish sauce (common in Thai restaurants)
• Canned and boxed soups
• Soup mix
• Bouillon
• Licorice candy
• Instant coffee
• Coffee substitutes
• Condiments
• Puddings and pie fillings
• Processed meats (gluten is used as a binder in cold cuts, hot dogs, sausages, and some specialty/reformed meats)
• Many reduced-fat and ready-made foods have binder starches sourced from wheat
• Ice cream –- look out for added gluten (cookie dough, anyone?) and beware of scoop cross - contamination where ice cream is served
• Mashed potatoes
• Imitation crab
• Some wasabi
• Vegan meat substitutes
• Chips (factory cross-contamination)
• Beer
• White sauce (made from a wheat flour roux)
• Worcestershire
• Communion wafer (ask your church about bringing your own GF version)
• All Chinese condiments contain wheat, including soy, oyster, hoisin, and bean sauces
• Some spice companies use glutenous fillers; use only pure, high-quality herbs and spices with no fillers

The Restaurant Dilemma

Restaurants can pose their own challenges. Here are some things to look out for:

• Fried food; those delectable fries may have been cooked in the same oil that fried the onion rings doused in wheat batter
• Vegetables may have been par-boiled in the pasta water
• At Asian restaurants, you may ask for GF but the busy chef may not be looking at the ingredients on the hoisin or fish sauce; ask for no sauce if uncertain.
• GF foods may be prepared on the same surfaces or with the same utensils that glutenous foods touch.

If you are uncertain at a restaurant, talk to the chef directly. If you aren’t happy with the answer, don’t eat there. Many restaurants are becoming aware of the need for truly GF foods, but it’s always good to make sure they are careful about food prep. Ask friends, and ask local online GF groups about recommended eateries.

Gluten Free Shopping: When In Doubt, Go Without!

When you are new to eating GF, restaurants and grocery shopping can be daunting, but the more you do it, the better you’ll get at determining what goes in your belly. If you aren’t sure, don’t eat it. Ask questions, read ingredient labels; just because those noodles say, “Rice” on the front, that doesn’t mean they don’t have a gluten grain added in. “Wheat-free” doesn’t necessarily mean gluten free. Lastly, always check product labels for warnings that state a food is produced in a factory that also makes gluten-based products; if it is, cross-contamination could be an issue.

The more you do it, the more natural it becomes, and soon you will be navigating your gluten-free life with ease.

Gluten cross-reactivity with non-gluten foods

Non-gluten grain options include: rice, corn, amaranth, millet, quinoa, sorghum, teff, and buckwheat (not actually in the wheat family). However, these grains can cross-react with gluten in some people. This means their body recognizes them as gluten and responds with a reaction. An elimination/provocation diet or food sensitivity test  can let you know which grains are safe to eat. Dairy is another food that commonly cross-reacts with gluten, as is coffee. If your gluten-free diet is not helping you feel better you may need to consider cross-reactive foods.

Diet soda, artificially-sweetened foods

Though it does not actually contain gluten, the artificial sweetener aspartame is recognized as a serious offender for many with gluten intolerance or celiac disease. Since aspartame often triggers similar allergic symptoms, including severe stomach pain and bloating, avoiding it can spare you the pain and suffering.

Manage diabetes with functional medicine

Anyone with diabetes knows it’s important to manage insulin levels. Functional medicine offers unique tools to manage insulin and blood sugar -- including diet, exercise, stress management, detoxification, and maximizing essential nutrients. To understand how all these tools apply, it’s helpful to know how insulin works.

Insulin and Blood Sugar: A Balancing Act

Insulin helps keep glucose (sugar) levels in the bloodstream within normal range. When you eat, carbohydrates are broken down into glucose, our primary energy source. When glucose enters the bloodstream, the pancreas responds by producing insulin, which enables glucose to enter the body’s tissues. Excess glucose is stored in the liver; when needed to sustain blood sugar between meals, the liver releases sugar and the pancreas responds with more insulin to help it enter cells. This balancing act keeps the amount of sugar in the bloodstream stable.

When the pancreas secretes little or no insulin (type I diabetes), when your body doesn’t produce enough insulin, or when your cells are resistant to insulin (insulin resistance, common in type II diabetes), sugar levels in the bloodstream can get too high. Chronic high blood sugar can lead to complications such as blindness, nerve damage, and kidney damage.

Managing Insulin with a Multi-Faceted Approach

Certain environmental and lifestyle factors increase the need for insulin, which is a problem when the body can’t produce enough.

Diet

What you eat directly affects your blood sugar and insulin levels.

• Not eating regularly, and eating larger meals causes drops and spikes in blood sugar and insulin, driving insulin resistance  If blood sugar is a problem, better to eat smaller, more frequent meals to keep blood sugar and insulin levels stable.
• Processed and fast foods drive inflammation, which causes insulin resistance and other disease processes. It also increases cortisol levels, which can increase blood sugar levels.
• Food sensitivities cause immune and inflammatory responses, which causes insulin resistance. Many people have food sensitivities they don’t know about.
• Pay attention to Glycemic Index and Glycemic Load. Glycemic index measures the insulin response your body has after eating a food. The higher the number, the more insulin your pancreas needs to secrete. Glycemic load is the amount of that food eaten.

Exercise

Fat cells have insulin receptors. Exercise burns calories and fat; fewer cells mean less need for insulin. And, when you exercise, your muscles need more energy to fire and insulin receptor sites become more receptive. Even a short walk can reduce blood sugar levels and insulin demands dramatically.

Stress

Up to 90 percent of doctor visits are related to chronic stress. Stress has big impact on insulin by:

• decreasing insulin receptor sensitivity, which means the body must make more insulin to have the same response to blood sugar.
• elevating cortisol, which can raise blood sugar levels.
• causing the liver to raise blood sugar (the body’s way of increasing energy to handle stressful situations). Raised blood sugar means more need for insulin.

Toxins

Toxins are found throughout our environment -- in body products, food, air, and water. The body gets overworked trying to deal with them, causing inflammation and increasing insulin resistance. Inflammation shuts down receptor sites, requiring the body to make more insulin.

Essential Nutrients

Essential nutrients are necessary for healthy bodily function. Key nutrients commonly lacking in patients with blood sugar issues are:

• Alpha-Lipoic Acid -- Alpha-lipoic acid is one of the main nutrients responsible for making sugar into energy. Anti-inflammatory and anti-oxidant, it helps reduce insulin resistance.
• Magnesium -- Diabetics tend to utilize magnesium faster than non-diabetics. Magnesium is responsible for making energy, helps muscles and nerves fire, and is responsible for over 300 processes in the body. Low magnesium can contribute to constipation, depression, and high blood pressure.
• Zinc -- Excess inflammation causes you to use more zinc than normal. Because diabetes is rooted in inflammation, a lot of diabetics are low in zinc. An important nutrient to the pancreas, it plays a role in almost 300 reactions in the body.
• B-Vitamins -- The b-vitamins play a role in almost every cellular process. Diabetic medications can deplete b-vitamins.
• Chromium -- Chromium helps make insulin receptor sites receptive to insulin, helping lower blood sugar levels.

A Multi-Faceted Approach is Key

For proper diabetes management, we must provide adequate exercise, proper nutrition, and manageable stress levels. As a functional health provider, I understand that you have unique needs and am prepared to help you develop a customized action plan to manage your blood sugar and insulin levels.

Grow "thin" gut bacteria by eating more veggies

We’ve all heard that a high-fiber diet is good for health because it keeps the digestive system moving. As it turns out, fiber also plays a more important role than we suspected. To understand why, we need to take a look at the gut microbiome -- the community of microorganisms that live in the digestive tract.

Trillions of bacteria live in the human gut –- they account for ten times more cells than in the human body -- and they play vital roles in our metabolism and health. It’s a mutually beneficial relationship; the bacteria happily feed on dietary fiber while they perform a variety of duties, including helping to make vitamins B and K, repressing growth of harmful microorganisms, and breaking down and fermenting dietary fiber. This breakdown of fiber results in a release of beneficial, anti-inflammatory short chain fatty acids that are a vital energy source for our bodies.

In recent research, the firmicutes and bacteroidetes classes of gut bacteria have received a lot of attention. Multiple studies show that obese people have a higher concentration of firmicutes than bacteroidetes, while in lean people the bacteroidetes predominate (to help keep it straight, think of fermicutes as “fat” and bacteroidetes as “bony”). Moreover, when the diet is high in fat, the obesity-friendly firmicutes increase (the exception being a ketogenic diet), yet a high-fiber diet helps bacteroidetes increase. In addition, researchers observed that overgrowth of firmicutes led to chronic systemic inflammation, which is known to contribute to common health problems such as metabolic syndrome, diabetes and heart disease. The message: Though they both have jobs to do, you want your bacteroidetes to be stronger than your firmicutes.

Feeding The Magnificent Microbes

One might wish to rid the body of the firmicutes microbes, yet this can actually open the pathway to overgrowth of candida albicans, or a yeast infection, which leads to problems of its own. Instead, supporting a healthy population of bacteroidetes is the key, and this is done by supplying ample prebiotics in the diet. Prebiotics are non-digestible carbohydrates –- in the form of dietary fiber –- that serve as food for the bacteria in your gut.

To keep a healthy balance of bacteria in the gut, an ample supply of fiber-rich plant foods is necessary. These foods should be part of a diet that includes plenty of good fats, vitamins and micronutrients, and avoids bad fats, excess refined sugars, processed/junk foods, and excess alcohol. Good forms of dietary fiber include: All vegetables but especially artichokes, peas, broccoli, and Brussels sprouts; fruits; and beans. Your mother was right, even if she didn’t know the whole truth: Veggies are good for you!

In addition to a diet strong in prebiotic fiber, you can help support a healthy gut environment by using supplemental probiotics: Live, "friendly” bacteria that bolster your gut's population of healthy microbes. For probiotics to work, there must be a sufficient number of live bacteria present in the product (read your labels!) to survive the acidic environment of the stomach, and reach the large intestine. Your dietary fiber (prebiotics) acts as food to nourish these friendly probiotic bacteria, and ensures their growth and colonization. This combination of pre- and probiotic support can be vital for insuring a healthy gut.

Fermented foods such as sauerkraut, kimchee, kombucha, and yogurt contain live microbes, and can also help boost the probiotic content of your digestive tract. One caution; not all fermented foods have live cultures, and it’s the live ones you want. Again, read your labels!

Medications, hygiene, age, health status, and stress can also influence your gut microbe balance. Eating a fiber-strong, gut-friendly diet and supplementing with probiotics and fermented foods is one of your best strategies for supporting gut health.

What causes a hangover

It’s no secret that drinking too much alcohol can cause a hangover. Have you ever wondered what goes on inside your body that could cause so much suffering? The facts are intriguing, and may even change how much you drink.

The formal term for hangover is veisalgia, from kveis, the Norwegian word for “uneasiness following debauchery,” and algia, the Greek word for pain. Generally, the more drinks consumed, the worse the hangover. Some common symptoms of hangover include:

• General malaise
• Headache
• Nausea
• Fatigue
• Dehydration
• Anxiety
• Difficulty Sleeping

While we don’t know why all the symptoms of hangover occur, scientists have uncovered some unique facts behind the physiology of the common symptoms.

Vasopressin Inhibition: Enter Dehydration

Alcohol consumption blocks the production of vasopressin, a hormone that promotes water absorption in the body. Without enough vasopressin, the body sends water directly to the kidneys for elimination. Ever notice how much you run to the restroom when you’re out for drinks? Studies have shown that drinking about 250ml of an alcoholic beverage causes the body to expel 800 to 1000ml of water; a four-to-one loss!

This diuretic effect helps create the fatigue and dry mouth. And that headache? During dehydration, the body’s organs compensate by stealing water from the brain, causing it to reduce in size and pull on the membranes connecting it to the skull. Ouch!

Frequent urination also depletes the body of magnesium and potassium, critical for proper muscle and nerve function, a lack of which can lead to headaches, fatigue and nausea.

Glycogen Breakdown

Alcohol breaks down the body’s store of glycogen, a key energy source, turning it into glucose that gets expelled in the urine. The resulting lack of glycogen is partly responsible for the weakness, fatigue, and lack of coordination you feel the next day.

The amount of alcohol consumed isn’t the only factor; what kind of alcohol you drink affects you, too. Alcohol contains congeners, toxic byproducts of fermentation. The greatest amounts are found in red wine and dark liquors such as bourbon, brandy, and whiskey, while less is found in clear liquors such as vodka and gin. White wine has the least. Combining different kinds of alcohol compounds the toxic effect. Finally, the carbonation in beer speeds up alcohol absorption; following beer with liquor puts extra strain on the liver to deal with the added toxins, hence the phrase, “Beer before liquor; never sicker.”

Glutathione: Your Hangover Prevention Ally

A product of alcohol that is more toxic than alcohol itself, acetaldehyde, is created when liver breaks down alcohol. The body attacks it with a powerful antioxidant called glutathione. When we drink in moderation, the levels of glutathione in the liver can keep up with the need for detoxification; we feel fine the next day. When we drink too much, the liver’s store of glutathione depletes quickly, allowing toxic acetaldehyde to build.

Glutathione is our body’s most powerful antioxidant; this enzyme is integral for regulating the immune system, and is on the front line of fighting destruction from oxidative stress in the body. You need it to function well. When glutathione is depleted, it sets the stage for destructive inflammatory processes; in fact, studies show a direct correlation between a breakdown in the glutathione system and autoimmune disease.

Glutamine Rebound

The fatigue, stomach irritation, and general malaise that hangovers deliver have been tracked to glutamine rebound. While you drink, alcohol inhibits glutamine, one of the body’s natural stimulants. When you stop drinking, the body responds by producing more than it needs. The increased glutamine stimulates the brain, preventing deep, refreshing levels of sleep, which results in fatigue the next day. Severe glutamine rebound may also be responsible for hangover tremors, anxiety, restlessness, and increased blood pressure.

Alcohol Contributes to Leaky Gut

Alcohol can contribute in a variety ways to leaky gut, a condition where the lining of the intestinal tract becomes over-permeable, allowing foreign particles into the bloodstream and promoting inflammation throughout the body.

For instance, alcohol reduces the body’s production of prostaglandins, substances that help control inflammation. Suppression of prostaglandins allows systemic inflammation to increase, which can trigger or contribute to leaky gut.

Heavy alcohol consumption also damages the lining of the gastrointestinal tract, reducing the body’s ability to extract nutrients from food. This can lead to micronutrient deficiencies that help drive various chronic disease states.

As you can see, excessive alcohol consumption has some pretty serious effects on the body; our casual cultural mindset about the consequences –- a hangover –- gloss over the ugly truth of what happens inside the body when we over-consume alcohol.

Ask my office for hangover prevention and remedy ideas from the world of functional medicine.

New study pegs sugar as main culprit in diabetes

For years, medicine has pegged obesity as the number one cause of diabetes. However, results of a recent large epidemiological study suggest it’s sugar that plays a pivotal role in diabetes. The study also illustrates that how many calories you eat isn't as important as what makes up those calories -- the study found calories from sugar is more damaging than calories from other foods.

Researchers looked at the correlation between sugar availability and diabetes in 175 countries during the last ten years and controlled for such factors as obesity, calories consumed, diet, economic development, activity level, urbanization, tobacco and alcohol use, and aging.

They found the more sugar a population ate the higher the incidence of diabetes, independent of obesity rates. According to Sanjay Basu, MD, PhD, the study’s lead author, “We’re not diminishing the importance of obesity at all, but these data suggest…additional factors contribute to diabetes risk besides obesity and total calorie intake, and that sugar appears to play a prominent role.” The study provides the first large-scale, population-based evidence for the idea that perhaps it’s not just calories, but the type of calories, that matter when looking at diabetes risk.

All calories are not created equal

One thing is clear from the study – although by definition all calories give off the same amount of energy when burned, sugar is uniquely damaging to the body.

The study showed an additional 150 calories from any food source caused a 0.1 percent increase in the population’s diabetes rate whereas an additional 150 calories of sugar caused it to raise a full 1 percent. That’s a ten-fold increase. To put it into perspective, a can of soda contains roughly 150 calories of sugar. Consider the average American consumes 22 teaspoons of added sugar a day, or about 350 calories’ worth, and it’s clear why diabetes is the fastest growing disease in history.

The study also showed the longer a population was exposed to excess sugar, the higher the diabetes rates were. The clincher: Diabetes rates dropped when sugar availability dropped, independent of changes in calorie intake, physical activity, or obesity rates.

Does sugar cause diabetes?

Does sugar cause diabetes? It’s too early to say definitively, but this study clearly shows a correlation and spotlights the need for more research. Dr. Basu suggested sugar affects the liver and pancreas in ways that need more exploration.

What can you do to prevent or manage diabetes?

While there are various forms of diabetes, Type II diabetes, which is caused by diet and lifestyle, accounts for 90 percent of all cases of diabetes.

What can you do to minimize your risk for diabetes? Reducing your sugar intake is a great place to start. In functional medicine we understand that every body is unique. We start with a careful evaluation of your health history, lifestyle, heredity, nutritional status, and environmental risk factors. We help you customize a program that includes diet, exercise, stress management, nutritional support, detoxification, gut health support, and dampening of inflammation -- all of which can dramatically affect your insulin and blood sugar levels and hence your risk of diabetes. This can reverse the path to diabetes and sometimes even the disease itself.

Ask my office for more information on support with blood sugar imbalances and diabetes.

How alkaline and acidic diets affect your health

You may have heard of the importance of an alkaline diet. It can help reduce acidity in the body and prevent bone demineralization, kidney stones, back pain, muscle wasting, hypertension, stroke, cancer, asthma and exercise-induced asthma. The foods you eat profoundly affect how acidic or alkaline you are, and thus your health.

Let’s begin with some chemistry… pH is a measure of how acidic or alkaline something is. On a scale of 0 to 14, a pH of 0 is totally acidic, 14 is totally alkaline, and 7 is neutral. Blood is slightly alkaline at between 7.35 and 7.45. The kidneys and respiratory system tightly control blood pH with little room for variation. Your stomach is very acidic at 3.5 or below. This acidity is necessary to break down food and protect you from harmful bacteria and other organisms. Your urine pH changes depending on what you eat.

The nutrients in food have either an acidic or alkaline effect on the blood. Fish, meat, cheese, eggs, legumes and grains are considered acid forming, while fruits, vegetables, and mineral soda waters are considered alkalinizing. All junk foods, sodas, and processed foods are considered acid forming, and should be avoided. Note that just because a food is acidic itself doesn't mean that it will be acid forming in the body and vice versa with more alkaline foods. For instance, although lemon and raw apple cider vinegar are acidic they are alkalinizing in the body.

Acid and alkaline imbalances

When the body’s pH gets out of balance, health issues can arise:

Acidosis (too acidic)

In acidosis, the enzyme systems of the body run on high speed, forcing the adrenal glands into overdrive. Symptoms include:

• Agitation
• Feeling fast and racy
• Being physically tired but mentally wired
• Cancer
• Candida

Alkalosis (too alkaline)

While acidosis is more talked about, one can become too alkaline. In alkalosis, the enzyme systems of the body run below par, reducing blood pressure and pulse, contributing to:

• Low thyroid activity
• Low stomach acid (digestive issues)
• Allergies
• Wheezing
• Diarrhea
• Fatigue
• Sluggishness and slowness
• Fertility issues

So, what’s for dinner when you want to reduce acidity?

There is little question that the mainstream western diet imposes a high acidic load on the body. You might think the fix would be to eliminate all acidic foods. Instead, increasing the ratio of alkaline foods to acidic foods is what makes the most sense. It's all about balance. An added benefit; this reduces the total number of calories consumed.

When you consider that many classically acid forming foods have important vitamins, fats, minerals, and other nutrients, it makes sense to find a reasonable place for them in the diet. Remember, the acidic foods you consume should be nutrient-dense, quality foods, not a binge in the chip aisle! Instead, focus on a plant-based diet that is made up primarily of vegetables, fruits in moderation, and enough protein and healthy fat to keep your blood sugar and energy levels stable.

Increased fruits and vegetables in an alkaline diet improve the sodium/potassium ratio, which can benefit bone health, reduce muscle wasting, as well as mitigate other chronic diseases such as hypertension, strokes and cancer. On the other hand, an overly acidic diet (such as too much meat and not enough veggies) can reduce bone density. In fact, in a recent study of 136 trials that examined the effects of dietary calcium (mainly from dairy) on fracture risk in osteoporosis, two-thirds of the trials showed that a high calcium intake does not reduce the number of fractures. Meanwhile, it was found that eating fruits and vegetables improved bone density in an amazing 85 percent of studies that looked at the effects of such foods.

A more alkaline diet can also increase growth hormone, which may improve cardiovascular health and memory and cognition.

Based on the alkaline/acidic nature of foods, scientists have created a way to rate foods called the Potential Renal Acid Load (PRAL) score. But take note: becoming too concerned with pH and doing constant measuring of urine pH (the most accessible form of testing) will likely cause more stress than good; it’s balancing the big picture that matters!

The acid-alkaline diet is about balance

Food isn't the only thing that affects pH in the body; stress also plays a big part. Stress causes us to breathe shallowly, creating a buildup of highly acidic carbon dioxide, which is acidifying. Therefore, it's important to utilize positive stress reduction methods to help manage your body’s acidic load.

Alkalinizing lifestyle tips

• Engage in regular, weight-bearing exercise.
• Eat a diet strong in alkalizing vegetables and fruits.
• Use positive stress management techniques such as yoga, meditation, laughter, qigong, and walking.
• Deep breathing reduces stress and increases the rate at which carbon dioxide is released from the body, reducing acidity.
• Go Organic: pesticides are acid-forming.
• Make the change gradually: If you think a quick switch will be stressful or set you up for failure bingeing, make the transition slowly over a matter of weeks.
• Adequate dietary Vitamin D levels may help with absorption of calcium, magnesium and phosphate, which can help with acid/alkaline balance. Most populations in northern climates are deficient in vitamin D, so getting tested may be a good idea for you.

Remember, the big picture is what matters; balancing diet, exercise, and lifestyle will provide you with the best tools for maintaining a healthy pH balance in your body.

Cholesterol often wrong target in heart disease risk

Everyone has heard that high cholesterol is bad for heart health. But as it turns out, the association between cholesterol and cardiovascular disease has been somewhat misrepresented. Doctors are starting to accept that cholesterol levels do not necessarily predict risk for heart disease as much as we thought. Consider the following:

• 75 percent of people who have heart attacks have normal cholesterol.
• Older patients with lower cholesterol have a higher risk of death than those with higher cholesterol.
• Countries with higher average cholesterol than Americans such as the Swiss or Spanish have less heart disease.
• Recent evidence shows that it is likely statins’ ability to lower inflammation that accounts for the benefits of statins, not their ability to lower cholesterol.

We need cholesterol!

Cholesterol is a fat-like substance found in every cell in the human body. The liver makes 75 percent of cholesterol. Cholesterol helps produce cell membranes, vitamin D, and vital hormones, and is needed for neurological function. Put bluntly, we would die without it.

The cholesterol players

When we measure cholesterol levels, we are actually measuring the lipoproteins LDL and HDL. We refer to them as cholesterol, but they are actually small packages of fat and protein that help move cholesterol throughout the body.

High-density lipoprotein -- HDL

This is considered “good” cholesterol. It helps keep cholesterol away from your arteries and removes excess arterial plaque.

Low-density lipoprotein -- LDL

This is considered “bad” cholesterol. It can build up in the arteries, forming plaque that narrows the arteries and makes them less flexible (atherosclerosis).

Also important are:

Triglycerides

Elevated levels of this dangerous fat have been linked to heart disease and diabetes. Levels rise from eating too many sugars and grains, smoking, being physically inactive, excessive drinking and being overweight.

Lipoprotein (a) or Lp(a)

Lp(a) is made up of an LDL part plus a protein (apoprotein a). Elevated Lp(a) levels are a very strong risk for heart disease.

When testing cholesterol, total cholesterol is not as important as:

• Levels of HDL “good” cholesterol versus LDL “bad” cholesterol
• Triglyceride levels
• The ratio of triglycerides to HDL
• The ratio of total cholesterol to HDL

In order for cholesterol to cause disease, it has to damage the arterial walls. There are small and large particles of LDL, HDL, and triglycerides. Large particles are practically harmless, while small, dense particles are the dangerous ones, lodging in the arterial walls, causing damage and inflammation. The resulting “scar” is called plaque. Repeated trauma causes a buildup of plaque and chronic inflammation while your risk of high blood pressure and heart attack increases.

The biggest culprits in high cholesterol? Sugar and bad fats!

Although we’ve been taught that a high-fat diet causes problems with cholesterol, the type of fat you eat is more important than the quantity. Trans fats, or hydrogenated and saturated fats, promote abnormal cholesterol, while omega-3 fats and monounsaturated fats actually improve the type of cholesterol in our bodies. Eat your good fats, your body needs them!

The surprise: the biggest source of abnormal cholesterol isn’t dietary fat, but sugar. Sugar (and refined carbs, including processed white foods), drives good cholesterol down and triglycerides up. It causes those small particles, encouraging dangerous plaque buildup, and can lead to heart disease and metabolic syndrome or “pre-diabetes.” Doctors are starting to admit that sugar, not dietary fat, is the bigger cause of most heart attacks.

So, the real concern isn't really the amount of total cholesterol you have, but the type of fats, sugar, and refined carbohydrates in your diet that lead to abnormal cholesterol production.

Inflammation promotes heart disease

Systemic inflammation plays a key role in heart disease and, in fact, most all chronic illnesses. Systemic inflammation can arise from poor diet, a sedentary lifestyle, stress, allergies, and more. Research at Harvard has shown that people with high levels of systemic inflammation (measured by a test called C-reactive protein, or CRP) had higher risk for heart disease than those with high cholesterol, while normal cholesterol was not protective to those with high CRP.

Clearly, multiple factors come together to determine your risk for heart disease, including diet, lifestyle, and environment. If you are concerned about your heart health, contact my office for a comprehensive evaluation to help reveal the factors that may increase your risk for heart disease.