Cholesterol

   This past weekend, I went to a BBQ and we had hamburgers, chicken and of course all kinds of bread products to complement the meats. I saw several of my friends avoiding the hamburgers like the plague and going for the chicken and heap of bread. A friend told me that his doctor told him to avoid red meat at all cost because it would raise his cholesterol. I simply walked away with a loaded plate of hamburgers and a piece of chicken. The ugly word cholesterol shows up everywhere; folks are trying to keep their cholesterol down. Gary Taubes in his book, Good Calories Bad Calories talks about the Eisenhower paradox. I thought the story was really interesting and relevant to our cholesterol discussion, here is the gist of it.  President Dwight Eisenhower suffered his first heart attack at the age of sixty four in September 1955. Eisenhower's heart attack brought the coronary heart disease to the forefront of American radar. The Monday after the heart attack, Dr. Paul White, a cardiologist flown in from Harvard to consult on President's situation gave a very descriptive press conference describing the heart disease and an update on President's health. For the six subsequent weeks, two press conferences were held daily to update the American public on President's situation. By the time President returned back to his presidential duties, the middle-aged Americans were well versed in the evils of cholesterol and high fat diet. The cholesterol haters were born and that bandwagon was rolling. However, President Eisenhower saga was not done yet, it was only starting. Prior to the heart attack, President was very active, had quit smoking years ago, maintained his weight, had occasional high blood pressure, and had normal cholesterol level (165mg/dl). Then why did the President suffer a heart attack? After his illness, the President fanatically started to watch his food intake, and still continued to exercise. He was measuring his cholesterol ten times per year, had his food cooked in soy bean oil, watched his cholesterol intake by reducing fats in his diet, he ate newly developed healthy polyunsaturated margarine, but the more he dieted the worst his situation became. Once his weight crept up to 176 pounds, he gave up breakfast of oatmeals and skim milk, and switched to melba toast and fruit. When his weight refused to come down then he gave up breakfast altogether. Few years later after receiving some information about the benefits of corn oil, the President gave up cream, lard, butter, and margarine for corn oil. Despite all the precautionary measurements his cholesterol had reached up to 223 mg/dl and his doctors were lying and were telling him a smaller number (217mg/dl). Eisenhower, had practically renounced all types of fatty foods, and was living on few pieces of cheese, skim milk, cold cuts, fruit, and sanka. His last day in office, January 19, 1961, his measured cholesterol was 259 mg/dl, but he was told a lower number by the staff doctors. President Eisenhower, died in 1969 just 14 years after suffering his first heart attack. During the 14 years span he suffered 6 more heart attacks, while he remained fanatically obsessed with reducing his cholesterol and did everything in his power to reduce his fat and cholesterol intake. The experience of Eisenhower is shared by many others who take all necessary precautions to lower their cholesterol. These days the doctors play the statin game, and experiment with different dosage of statins to lower a patient's cholesterol. The doctors routinely advise their patients to reduce the fat and cholesterol intake, eat whole grains, and exercise more. The patients dutifully follow their doctors' advice, yet the sale of lipitor has reached a staggering $125 billion since 1996. Despite all the good intentions and numerous efforts, the heart disease still continues to climb and is the number one cause of death in the country and in most countries around the globe. When I speak with friends, a general phobia of fats and cholesterol is expressed. People have varying understanding of what fats and cholesterol do for our bodies, but no one seem to have the complete picture. I think it is only fair that if we are going to conquer this beast, let us at least understand and learn some of its behavior, and besides no paleo blog will be complete without some discussion of cholesterol.

                    Lipids_____Triglycerides (Fats and oils)
                             |                                          |___fatty acids
                             |                                                                |___Saturated
                             |                                                                |___Monounsaturated (MUFA)
                             |                                                                |___Polyunsaturated (PUFA)
                             |                                                                                       |____Omega 3
                             |                                                                                       |____Omega 6
                             |_____ Phospholipids
                             |                                |___Lecithin
                             |_____ Sterols
                                                   |____Cholesterol

   Cholesterol is a sterol and part of a nutrient class called lipids. Above is cholesterol's family tree. Sterols are found in many foods, but cholesterol can only be obtained from animal products: meats, eggs, dairy, fish, and poultry. Liver makes 800-1500 milligrams of cholesterol per day contributing much more to the body's total cholesterol than diet.  If cholesterol was such an evil thing as we have made it out to be, then why would nature produce it in large quantities on the daily basis. The fact is that cholesterol is really useful for our well being; cholesterol made by the liver is used for making bile acids, vitamin D, and various hormones like testosterone and cortisol. Cholesterol is responsible for creating the cell membranes, hence 90% of body's cholesterol is contained in the cells. If our cell membranes were not elastic enough, we would crumble like objects made out of sand, and if cholesterol did not act like a barrier, our cells will never take shape and would lose all their internal fluids. Brains of an animal contains a large amount of cholesterol. The myelin sheath around the nerves is basically made out of cholesterol and fats. Myelin sheath acts like an insulating outer wall of an electric wire. In the future if someone calls you a fat head, do't be offended, your head is actually made out of fat and cholesterol. A 4 oz. serving of beef brains contains about 2254 mg of cholesterol. An amount that will put a big frown on the faces of most cardiologists and the creators of the famous food pyramid.

   So, if cholesterol is useful, then how did it become evil? The answer lies with few of the proteins our bodies makes to transport cholesterol and other lipids around the body. Cholesterol must first enter the lymphatic system before it can be absorbed by the cells. The body makes four types of proteins to transport most of the fats and cholesterol around the body. Collectively, these proteins are called lipoproteins. Lipoproteins basically solve the problem of transporting fats through the watery blood stream. Below is the function of each lipoprotein described in detail:

   Chylomicrons are the first type of lipoproteins responsible for carrying triglycerides and mostly diet derived lipids to cells around the body. As chylomicrons move about the body, various cells remove fats, so in about 10-14 hours the chylomicrons get smaller and smaller and little is left of them other than protein remnants. Special protein receptors on the liver cells sense the depleted chylomicrons and remove them from the blood circulation. The liver cells dismantle the chylomicrons to make new triglycerides.

   VLDL (Very-Low-Density Lipoproteins). While chylomicrons are busy delivering fats to cells in the body, the liver is busy making cholesterol from other chylomicrons remnants, carbohydrates, proteins, and alcohol. The excessive carbs in combination with high fats are a sure recipe for disaster. If the body is not able to expend the excessive dietary carbs, then it ends up converting them to fats for future use. The caveat is that it requires a lot more energy to convert carbs into fat for storage then to convert fats into triglycerides for storage. A diet high in fat is an optimal diet for the reason that body has to do less work in converting the fatty acids to triglycerides for storage and energy usage. Most cells prefer to use fats as their energy source and little fat ends up going a long way because of the high amount of calories available in fats. It boils down to less work for the liver, an optimal diet is high in fats, moderate in proteins, and moderate in carbohydrates; other words, paleo diet. The cholesterol and triglycerides created in liver are packaged with VLDLs and shipped throughout the body for delivery to the cells. As VLDLs move through the body, the cells remove triglycerides and cholesterol causing VLDL to get progressively smaller. Since fat molecules are removed, the VLDL protein package gets more dense.

   The VLDL eventually becomes LDL (Low-Density Lipoproteins) and continues to circulate the body making cholesterol available to cell membranes and tissues. The cholesterol rich LDL is rushing towards the cells to provide a bandage for abrasions and tears in the cell lining. After all the cell membranes are made out of cholesterol. This is where cholesterol gets its bad name. LDL rich in cholesterol and low in triglycerides and due to systemic inflammation caused by most grains, the LDL gets stuck in the arteries and causes plaque that eventually leads to coronary disease. When cardiologists open up a heart patient, they consistently find deposits of LDL stuck in arteries, so naturally the blame goes to the cholesterol responsible for the heart attack. Of course all the blame goes to the dietary cholesterol obtained from eggs, red meats, and saturated fats. No one even mentions the systemic inflammation caused by the grains, that caused the arteries to constrict in the first place. Instead of calling LDL the bad cholesterol, the doctors and nutritionists should really be pointing out the inflamed arteries to the patients.

  On different occasions, the fat cells release their fatty acids and glycerol molecules back in the blood stream, the liver makes another type of lipoprotein called HDL (High-Density Lipoproteins). HDL is responsible for carrying the cholesterol and other lipids from cells to the liver for recycling and disposal. HDL is called a good cholesterol, because it is responsible for removing excessive cholesterol from the blood stream. Here is a graphic depiction of each lipoprotein:

   As you can see from the above table that LDL contains the most amount of cholesterol and this is the cholesterol that ends up getting stuck in the arteries and ultimately causes heart disease. As I mentioned earlier, that the reason why cholesterol gets stuck is due to the inflammation of the arteries. The inflammation is caused by the proteins in the grains. In a normal healthy body the cholesterol has no reason to get stuck. The lipoproteins carrying cholesterol and fats are designed to move about the lymphatic system freely to deliver energy and repair/rebuild cell membranes. If you have a splinter in your hand, the body responds by inflaming the area to fight the foreign object. This inflammation is good and this is how a healthy immune system works. Now if you poked the infected area constantly, the inflammation will never go down. This is exactly what bad proteins in grains do to our bodies. The lectins end up escaping into the body and the immune system launches an attack by inflaming the area. Since grain products containing lectins and glutens are consumed frequently, the inflammation never goes down. It is like poking the inflamed area over and over again. The cholesterol rushes to various parts of the body to repair the cell tissues and build cell membranes, but due to systemic inflammation, ends up getting stuck in the constricted arteries causing build up of plaque. Yes, a high cholesterol and fat diet with grains is really bad and will eventually give you a coronary. But if you eliminate the grains and eat fats, proteins, and carbs from vegetables and fruits, then the systemic inflammation goes away. The constricted arteries return to their normal state and the cholesterol and fats run through the lymphatic system without ever getting stuck. If you are on paleo and your cholesterol goes up, there is no need for panic; most likely your HDL will go up as well. The ratio to watch for is triglycerides to HDL. If this ratio is less than 2 then you have good foamy LDL that will not get stuck in the arteries. It may take few months or up to a year for the  body to repair the damages caused by prolonged grains consumption. Eventually the body will recover and will return to its normal state. There are no guarantees that eating melba toast and skim milk will lower your cholesterol, as President Eisenhower learned the hard way. 

   To lower your cholesterol, a diet must be formulated with at least 50% fats, 30% proteins, and 20% carbs (from vegetables, fruits, nuts, and seeds). The grains, soy, legumes, sugars, and dairy must be eliminated from the diet. These types of foods only became available when we adopted the agrarian life style and our health has been declining since then. The modern processing makes these foods even more dangerous; that is why there is an obesity epidemic out there. If grains are such a good source of energy then why do they have to be fortified. The fats, meats, and healthy carbs make an optimal diet. If you want to beat the heart disease then check out this article from one of the paleo experts, Chris Kresser.

Vitamins

   Several national surveys indicate that more than half of the U.S. population takes some form of vitamin and mineral supplement. Most malls across the country have some vitamin or GNC store that manages to keep its lights on all year long. The Third National Health and Nutrition Examination Survey (NHANES III) indicated that among adults, the dietary supplement usage was more prevalent in women than men. This is certainly the case in my house, my wife is always offering me a vitamin pill and of course, taking one herself on the daily basis. Before my paleo days, I simply accepted my daily dose of "Centrum for Men One a day" pill from my wife. Lovingly, the pill was always there with my breakfast Cheerios or Corn Flakes. The pill always made me sick, but I simply could not turn down the kind gesture of love. Who was I to argue, vitamins are good for you and they make you healthy, was the extent of my vitamin knowledge any ways. Little that I knew that every food you ate contained vitamins and minerals. The higher the education and income level the more dietary supplements you consumed, was another interesting fact revealed by the NHANES III survey. Once again, in my small sampling this fact was confirmed by conducting several secret interviews of my friends. Since adopting a paleo lifestyle, I have not consumed a single vitamin, asprin, tylenol, or any other type of over the counter pill. My recent blood works was clean and showed absolutly no vitamin or mineral deficiency. so what is all this fuss with the vitamins? why do folks continue to spend in the neighborhood of 70 billion dollars per year on dietary supplements and minerals? Why do we take vitamins? Why are women obsessed with vitamins? Lookout, because I did some reading and now I am full of vitamin information that I will gladly share with you at no charge..:-)

What are Vitamins?
 
   Vitamins are non-energy producing nutrients; like their counterparts, carbohydrates, fats, and proteins, vitamins offer no calories. So if vitamins offer no calories, then how are they important in the functioning of a healthy body? The roles of vitamins is to help release energy from energy yielding nutrients and make it available to the body. For example, when I move my fingers to write these sentences, certain vitamins help release the energy from glucose which eventually gives electrical signals, that twitch my fingers and create motion. Without vitamin B the energy will not be fully released and will not produce motion. There are certain vitamins who assist in the production of various proteins and DNA molecules. Yes, vitamins are very important to our well being, that is why nature has cleverly packed them in foods that we consume. No need to consume a dietary supplement pill. The vitamins are classified by their solubility. The water soluble vitamins are B and C. The fat soluble vitamins are A, D, E, and K.

Water Soluble vitamins
 
   There are two major vitamins in this class; B and C. The water soluble vitmins are absorbed directly into the blood stream and help with many metabolic functions. The water soluble vitamins travel freely in water-filled parts of the body. Usually kidneys detect their excess and remove it via urine. Because of frequent disposition the water soluble vitamins need to be consumed more frequently. The amount of vitamin C consumed by us is mind boggling. We consume way more than what we need and end up excreting most of it via urine. The joke is that each time you urinate you are excreting few dollars worth of water soluble vitamins. Americans probably have the most expensive urine in the world..few billion dollars worth. The family of B vitamins contains 8 vitamins; they have collectively been labeled B complex vitamins. Below is an extremely over simplified function of each vitamin in B complex family:

• Vitamin B1 Thiamin is responsible for converting carbohydrates into energy. Thiamin is also responsible for the well being of the nervous system. Thiamin deficiency is rare and usually occurs in alcoholics, who tend to obtain most of their energy from empty calories and forget to eat real meals.
• Vitamin B2 Riboflavin is another coenzyme involved in many metabolic reactions. Another important vitamin in releasing energy from the carbohydrates. Riboflavin is responsible for processing the oxygen and ensuring adequate oxygen supply is provided to the internal organs.
• Vitamin B3 Niacin plays a major role in creating various hormones in addition to the metabolism of glucose in your body. Pellagra is the disease caused by the deficiency of niacin. In patients Pellagra causes severe diarrhea, skin rashes, and dementia. 
• Vitamin B5 Pantothenic Acid is very important in the synthesis of lipids, neurotransmitters, steroid hormones, and hemoglobin. 
• Vitamin B6 is another important vitamin helping the breakdown of proteins, fats, and carbohydrates. Vitamin B6 also assists in the synthesis of genetic materials. 
• Vitamin B7 Biotin is important in metabolism of fatty acids and amino acids to produce glucose. In prolong period of starvation, biotin assist in the process of gluconeogenesis to produce glucose from non carbohydrate sources such as amino acids. Another way for nature in preserving and prolonging life. The bacteria in the GI tract can also produce biotin and make up the dietary gap.
• Folate is also known as folic acid. Folic acid works closely with vitamin B12 in the synthesis of DNA in growing cells. Hence, folic acid is an essential part of the prenatal kit and is commonly consumed by pregnant women to assist the growing baby. 
• Vitamin B12 and folate work closely in the synthesis of amino acids. Vitamin B12 in addition to helping release energy from carbohydrates, also plays a major role in keeping the red blood cells healthy. Vitamin B12 can only be obtained from animal products. 

Vitamin C
 
   Vitamin C is the second water soluble vitamin. Vitamin C has a dual personality. In some settings, vitamin C acts as coenzyme helping an enzyme complete its job of releasing energy from nutrients, and in some settings vitamin C acts as an antioxidant, because of its unique ability to quickly lose electrons. In the antioxidant role, vitamin C is able to bind to the free radicals and remove them from the body. The free radicals are molecules that are missing electrons and are not complete. These free radicals are looking for other molecules and cells to bind to and complete their existence. Most often free radicals end up binding to iron, magnesium, and calcium and prevent these important minerals from being absorbed in the body. Vitamin C sacrifices its own life to protect the hundreds of water soluble substances from free radicals. Vitamin C also helps form the fibrous structural protein tissues called collagen. Collagen is the building block for forming bones and teeth. Collagen also helps when a person is wounded by creating a scar and sealing up the wounded area. Collagen is also responsible for holding cells together, especially the arterial walls that  must withstand a constant pressure from heart pumping blood. The popular belief that common colds are cured by vitamin C is not true. Once again media plays a major role in spreading this myth. To this date there is no scientific evidence that vitamin C cures common colds. Vitamin C is probably the most consumed vitamin in the world. Folks consume it in almost toxic quantities. The toxic effects of vitamin C are abdominal cramps, nausea, and diarrhea. Common sense advice, no need to spend your hard earned money on vitamin C supplements, most fruits and vegetables contain ample amount of vitamin C. Paleo folks are covered by eating variety of vegetables and seasonal fruits.

Vitamin Name	Food Source
B1 Thiamin	Lean meats, spinach, green peas, squash, acorn
B2 Riboflavin	Organ meats, lean meats, eggs, broccoli, and spinach
B3 Niacin	Organ meats (liver), fish, poultry, and red meats.
B5 Pantothenic Acid	Organ meats, mushroom, avocado, and broccoli
B6 Vitamin	Meats, fish, poultry, potatoes, and non-citrus fruits.
B7 Biotin	Bacteria in the GI tract can make biotin. Eggs
Folate or Folic Acid	Spinach, broccoli, carrots, sweet potatoes, okra, asparagus.
B12	Meats, poultry, fish, shellfish, and eggs.
Vitamin C	Citrus fruits, most vegetables and fruits.

The paleo folks have nothing to worry about. The foods listed in the above table provide sufficient vitamins and there is no need to consume any water soluble vitamin supplements.
 
Fat Soluble vitamins
 
   The fat soluble vitamins are A, D, E and K. The fat soluble vitamins can be stored in the fat tissue and are used by the body on the need basis. Because of their long term storage, they don't need to be consumed often. On the flip side if consumed in large quantities, they can be toxic. Below is an simplified function of each fat soluble vitamin:

• Vitamin A exists in three active forms in the body:  retinol, retinal, and retinoic acid. Collectively they are called retinoids. One of the major roles of vitamin A is promoting vision. Vitamin A helps maintain crystal clear outer window, the cornea, and participates in the conversion of light energy into nerve impulses at the retina. Despite its most important role in vision, only one thousandths of the body's vitamin A is in the retina. Much more is available in the cells lining the body. In this role vitamin A participates in protein synthesis and cells differentiation. Other words, vitamin A differentiate inner cells from the outer cells. Thanks to vitamin A, otherwise our outer skin could have mucous, not a good thing for our social life. Retinol, one of the active form of vitamin A participates in creating sperms in men, and in women supports normal fetal development during pregnancy. One of the major deficiency of vitamin causes blindness, and overdose of vitamin A is simply toxic to the body. Beef liver eaten in large quantities can provide almost an overdose of vitamin A. 
• Vitamin D There is no need to consume vitamin D via foods. Just spend enough time in the sun. Vitamin D plays a major role in bone growth. Vitamin D is not an essential vitamin, our body can make it from ample exposure to sunlight.
• Vitamin E is a fat soluble antioxidant and one of the body's main defenders against free radicals molecules. There are literally hundreds and hundreds of chemical reactions happening every second inside our bodies. These chemical reactions are occurring whether we are sleeping or in a waking state. The by products of these chemical reactions are the free radical molecules. These molecules are usually missing electrons or some critical carbon, oxygen, or hydrogen to make them stable. Most often these free radicals end up bonding with iron, magnesium, and other trace minerals to complete their existence. Of course this is bad for the body, now these trace minerals are not available for absorption. Vitamin E actively stops the chain reactions of free radicals producing more free radicals. If free radicals go undetected for a period of time, they end up making compounds and may even lead to cancerous cells. You can certainly over do vitamin E and high dosage is toxic and may interfere with blood clotting actions of vitamin K. 
• Vitamin K The main function of vitamin K is to create blood clot. The vitamin name comes from the Danish word koagulation coagulation or clotting. If vitamin K was not present in our bodies, a simple pin prick on the skin will drain all the blood in our body in matter of hours. A bucket with a small hole is rendered useless for holding water. Because of the importance of blood clotting, the bacteria in our GI tract produces vitamin K in abundant supply. 

Vitamin Name      Food Source

Vitamin A              Spinach, broccoli, carrots, sweet potatoes, beef liver, and butter squash.

Vitamin D              Sun bathing. 

Vitamin E              Nuts seeds, oils, liver and eggs.

Vitamin K              Mostly leafy vegetables, liver, and synthesized by the bacteria in GI tract. 

The paleo folks have nothing to worry about. The foods listed in the above table provide sufficient vitamins and there is no need to consume any fat soluble vitamin supplements.

Conclusion

 
   There are many factors why we are obsessed with vitamins and supplements. One of the major factor is media influence. The media tends to sensationalize everything and creates a fear factor. If we don't do this then this will happen. Usually, the worst possible scenario is presented as the consequence for not taking the supplements. The real fact is that most foods contain the necessary vitamins and there is absolutely no shortage of vitamins in our diet. But somehow, we have collectively bought into the plethora of messages from the media that we need to take supplements for our well being. So most adults simply take vitamin supplements as dietary insurance, just in case they are not getting enough nutrients from their food. In 1930's many discoveries were made in the biochemical science and most of the vitamins were named and classified, still the primary source of obtaining vitamins was eating variety of foods. About 50 years ago, no one was spending their money on buying the dietary supplements for a simple reason--the dietary supplements did not exist. The dietary supplement are a recent phenomena, of course popularized by the media. The prenatal vitamins hit the market about 30 years ago. Since, the responsibility of giving birth to a new baby lies exclusively with women, the women became the first consumers for vitamins, calcium, folic acid, and host of other prenatal care nutrients. This perhaps explains the reason, why women are more prevalent users of vitamins and supplements than men. As mentioned earlier that just few decades ago, no one even heard of buying vitamin supplements. The women gave birth as usual. The men went about their business. There were no prenatal vitamins like folic acids, or calcium. The expecting mothers simply ate different foods and their cravings changed from child to child. I have observed many pregnant ladies in my country eating a dried piece of clay from the local river. It never made any sense, why would pregnant ladies want to eat a piece of dirt. The piece of clay probably contained many trace minerals that expected mothers could use during their pregnancy. The various cravings also force the expectant mothers to eat different foods to fullfil the deficient vitamins or nutrient gaps left by their diet. An advice for the fathers to be; don't argue with your pregnant wife when she asks for the peanut butter, jelly, banana, ice cream, avocado sandwich in the middle of the night. It is not her, the growing baby inside her is probably deficient in some nutrient that only the sandwich can provide. Nature has all the bases covered. During the year, the human body  requires and craves for different foods. That is why eating seasonal fruits and vegetables is very beneficial. The seasonal vegetables and fruits provide the optimal nutrients at the right time of the year. The watermelon just doesn't taste good in the month of December. 

   

   The role vitamins play for our well being is uncontested; they are essential part of our diet. The good thing is that foods that we eat contain all the vitamins. Heck, the foods our paleolithic ancestors ate contained sufficient vitamins. I am a big fan of herbal medicine, I believe herbal extracts are good and should be incorporated in our diets. I personally use spices like turmeric and cumin. Not only they are good for flavoring many dishes, but they also have many medicinal qualities. Like everything in the nutritional field, the nutritionist scientists took another wrong turn in promoting the use of vitamin supplements. Maybe the big profit producing industry had something to do with influencing the nutritional scientists. Vitamin supplements are a very recent phenomena. We are all looking for that silver bullet or one pill that fixes everything. The media plays to this sentiment and we humans in search for that ultimate fix always end up buying into the hoopla. After being on the paleo diet for more than a year, I recently had my blood works done and found no deficiency of minerals or vitamins. This past year I have not consumed a single multivitamin pill or any other mineral supplement. Our paleo ancestors were pretty smart, they ate good wholesome foods, got plenty of sun, exercise, and sleep. Buying family size vitamin packs from Costco was never in their daily plans, instead they looked for fresh game to kill. So the question is do we need vitamin supplements? The answer is not really, especially, if you are on paleo diet. Common sense advice is to save your money and spend it on grass fed beef, free-range eggs, or eat some liver.