Could your gut health be responsible for your high cholesterol?

You are probably aware if you have been reading my blog for a while and following likeminded people that it’s not as black or white as whether or not your high cholesterol level is a problem. Much as I get a bit on edge when I see plates of food without any colourful vegetables (I’m not going to lie to you!), I get a little bit twitchy when I see it professed everywhere that it’s no longer a problem to have a high cholesterol level. Not true. Now cholesterol is essential to life. Without it, we wouldn’t be able to make hormones, repair cell membranes and do 68 other things that require cholesterol. Your body makes 85% of the cholesterol circulating in your bloodstream even, meaning that, for most people, the cholesterol eaten by way of animal products (animal protein, eggs, cream, butter, cheese) will have very little impact on their overall cholesterol level in the body.

One of the main factors that can cause high cholesterol levels is not the cholesterol that you eat (and you’ll be aware that in New Zealand we’ve not had a recommendation around reducing cholesterol containing foods for a while – though the rumour of the egg just will not die). It’s also not just about the fat that you eat. While scientists were busy trying to prove the diet-heart-hypothesis correct over the last 50 years (you know, the one that has pretty much governed our public health nutrition messages and is still today being pushed by nutrition authorities, despite the failure of aforementioned scientists to do so), the powerhouses of the food industry were busy manufacturing and marketing those low fat, processed, refined carbohydrate-based foods that contribute to an inflammatory state which underpins all chronic disease – including heart disease and high cholesterol levels. That is something I have understood well. However after listening to that brainiac Robb Wolf discuss cholesterol with Dr Rhonda Patrick on a recent podcast about cell metabolism the role that the gut plays in both the inflammatory state and our cholesterol levels which could determine whether or not we should be concerned was touched on. One of these was through increasing insulin resistance (IR; and inflammation) at the local level of the gut, and the other was the inflammation that occurs through gastrointestinal or gut issues which may include this IR, but also any challenge which stimulates an immune response.

We know that IR is caused by high circulating blood sugar levels requiring a constant response from our pancreas to produce the hormone insulin to ferret that glucose to where it’s required (working muscle tissue, our carbohydrate stores, red blood cells and retina, brain and excess converted to triglycerides in the liver). Constant and chronic high blood sugar levels and subsequent insulin release causes the pancreas to work overtime which, over time and in some situations, our body is unable to read appropriately or respond effectively – our cells become immune to the insulin trying to deliver glucose and glucose and insulin hang around our blood system causing glycation of proteins, cell damage, oxidation and inflammation. The IR causes systemic inflammation which further drives insulin resistance, higher blood triglycerides, lower HDL cholesterol and weight gain, specifically central weight gain which creates even more inflammation. A bit of a cascade which, if not managed, leads to type 2 diabetes (one of the major ‘end points’ of insulin resistance, if you like). Further, those with type 2 diabetes tend to have higher cholesterol levels. Well, what if this also starts in the gut?

Dr Rhonda Patrick spoke of a paper she read in Nature* that reported on research that showed chronic over consumption of processed refined carbohydrates can cause epithelial cells of the gut to become insulin resistant and unable to take up the sugar. We get IR in the local level of the digestive tract and this is pushed out to the rest of the tissues because of the inherent systemic features of the inflammation. Meanwhile, the bacterial cells that are present in our gut are getting all of the glucose that they want and thriving*. Because the IR means our gut cells aren’t able to take the glucose up, the goblet cells in our gut (the ones responsible for secreting mucus to protect our gut wall) aren’t getting the substrate required for them to make energy and produce the mucus to protect our gut intestinal lining. Over time, with no energy, the gut barrier will begin to break down.

Now – this is where the quality of the carbohydrate matters. Dense carbohydrates such as potatoes, sweet potatoes and minimally processed grains tend not to be metabolised in the upper portion of the small intestine and tend to provide more fermentable substrate that feeds our gut and supports our gut health (for an excellent paper by Dr Ian Spreadbury – incidentally one of the speakers at the upcoming Ancestral Health Society conference in Queenstown in October, click here). This means that these types of carbohydrate are not going to create the inflammation in the way that those refined grains do – the ones that we base our public health recommendations on (cereal, wholegrain bread, pasta and the like).

So, that inflammatory state that is started locally at the gut level is another mechanism that explains how the state of our gut can determine whether your high cholesterol level could be a problem.

The other one more directly affects the LDL cholesterol circulating the body.

FACT: the gut is the nexus to health – it has the largest concentration of immune cells as it is exposed to the external environment (food). Those immune cells are there to fight off things which are pathogenic.  The gut also it has the highest concentration of bacterial cells, and immune cells and bacteria together are NOT a good thing, particularly when they come into contact – that’s why we have that epithelial barrier that protects the immune cells.  As soon as that barrier breaks down, the immune cells come into contact with the bacteria cells and it’s all on, they start firing off these pro-inflammatory cytokines to kill off the bacteria. This results in the bacteria releasing off endotoxin – which is where some of the problem relating to LDL cholesterol can originate.

Bacteria in the gut have a cell wall called lipopolysaccharide which holds endotoxins –it gets released into the circulation when the bacteria are dying (which is why anyone who is undergoing diet or supplemental changes to change the bacteria in the gut might experience initial discomfort as the bad bacteria die off). This increases production of very low density lipoprotein (and LDL eventually) because these bind endotoxins – they soak it up like a sponge. However, instead of being delivered back to the liver to be recycled it remains in circulation as the endotoxin binds to the LDL receptor on this particle and prevents it from being taken back up by the liver. This will increase the likelihood of the LDL particle being oxidised – a major risk factor for cardiovascular disease. You know it’s not about LDL cholesterol or total cholesterol, it is to do (in part) to particle size –the small dense particles have been associated with heart disease.

Now the problem with these LDL particles that have an endotoxin attached is that they are the smaller, denser LDL particles. These particles, already a risk factor for heart disease now have a bacterial signal floating around the blood stream. This causes your immune cells to suddenly be on high alert. The macrophages that come to kill off the bacteria are attacking the LDL and endotoxin and the subsequent action of the immune system starts a cascade of events which over time will lead to the stiffening and narrowing of the artery as it gets stuck there.

Is your head spinning? Tell me about it. And I’m not a brainiac and suspect this could have been explained far more simply by someone far more intelligent than I. However, the main take home from this is that if you are someone that leads a lifestyle which promotes inflammation (high intake of processed carbohydrates and vegetable oils, little to no vegetable fibre, no exercise, lack of sleep, too much exercise, smoking, high consumption of alcohol…) then your high cholesterol reading could be a problem. That, for most people, should by now be a no-brainer.

However, if you are someone who has these factors dialled in and still has a high cholesterol reading, perhaps it wouldn’t hurt to consider the health of your gut.

*try as I might, I couldn’t find this paper. Let me know if you can as I’m interested to read it. Thanks George.

(Not me, though I'm as cute as this dude IMO) - and thanks to for image.

(Not me, though I’m as cute as this dude IMO) – and thanks to for image.

AHSNZ Wanaka: a taste of what you missed

ICYMI, the second Ancestral Health Society of New Zealand symposium took place over Labour weekend, giving me a great excuse to head down to the South Island and reconnect with the geographical region I’ve spent much of my time over the years, and with the people who are part of my ‘tribe.’ I love love love the South Island and particularly Central Otago. It was so great to reconnect with fellow Ancestral Health New Zealand crew, meet up with old Dunedin friends and meet other like-minded people.

I am not going to give a detailed account of each presentation – in fact, I don’t need to as the presenters are each writing up a post that summarises their talks – two of which   I am sharing today so you can get a taste of what you missed. As a brief overview, there were a mixture of practitioners and advocates of evolutionary health – touching on topics from sustainable farming to endurance training to perceptions of body size ideals. While our first symposium had more of a focus on nutrition, this conference extended well beyond that.

The programme from the conference can be found here, and below are two posts already written up by Kate and Andrew. Read, ponder, and definitely keep an eye out for details of our next symposium looking to be held in the first quarter of next year.

Kate, the Holistic Nutritionist, an Australian import, did a detailed talk on the importance of the gut microbiome in determining our health

Dr Andrew Dickson (from Massey University), self-proclaimed Clydesdale and lover of trail running spoke about body mass and endurance athletes: perception via psycho-sociology

The day ended with a movement session that didn’t involve exercise; Max Bell (from MovNat New Zealand), Aaron Callaghan (Peak 40) and James Murphy (of Synergy Health) took us through movement and activity patterns that challenged the uncoordinated amongst us (i.e. me) but was suitable for all levels. This enabled pretty much all of the conference attendees to take part. Check out some of the pictures from this (and the conference in general) on the AHSNZ Facebook page here.

Overall – it was a brilliant day and a taste of things to come over the coming year. Along with the  one-day symposiums in the pipeline, we have our first international event planned for Queenstown next Labour weekend – with Melissa and Dallas Hartwig (Whole 9) and Dr Emily Deans already booked to present. I’m already counting down the days to this one – it’s 346 sleeps away.

AHS14 Pt 2: quick debrief

Wow, what a whirlwind 12 days. I arrived home this morning from LA at 5.45am with an additional suitcase and minus $85 for the 10kg it was carrying. I’m just thankful that I checked the luggage restrictions before heading to the airport or it could have been a lot worse. I am glad to be on home soil, not least because I think I averaged about 6h sleep a night for the time I was overseas. Now don’t go thinking it was because I was hitting any kind of night scene in a ‘bright lights, big city’ kind of way. Unless your version of that includes a cup of tea then you’re bang on. It was really that Caryn and I had so many things we wanted to see that sleep didn’t take priority. Thankfully, real life resumes and that will be rectified in the next week.

Of course, regular followers of my blog may be expecting a synopsis of the talks from the remaining two days of the conference, but I’ve been pipped at the post by the Ancestral Health Society which is brilliant – they’ve already uploaded a number of the talks and you can find them here. Which is great as the simultaneous streams meant that I was unable to see a number of talks I was interested in, so I’ll be able to catch up with them too. It also means I’ll be able to jot down a few take homes from the overall experience rather than focus on the talks. Both Caryn and I really enjoyed the conference as it was largely nutrition, largely paleo-based (unsurprisingly) and largely low carb too. Obviously there were a number of talks around the other tenets of ancestral health – but such a big part of it is around food (or how lifestyle interacts with nutrition) that we both agreed it was one of the most relevant conferences we’ve attended. Equally, we enjoyed that the conference was attended by people from such diverse backgrounds. While we all converged upon the University of Berkley because of our interest in evolutionary health – we mixed with personal trainers, researchers, academics, nurses, IT specialists, functional medicine practitioners…. Most conferences we’ve attended have largely been with others in our field, so it was a good opportunity to mingle with others on the basis of what they value more than what they have studied or teach in. As Caryn and I stayed in the dorms at Berkely we had an opportunity to mingle more than we would have with others, and enjoyed the company of Tim (who we met initially through Jamie and Anastasia), Darcie, Dana and Sarah either through bumping into them at breakfast or in the dorm rooms and all of whom we may see again next year in Boulder, Colorado for AHS15.

An obvious highlight of the trip was to meet in person those people I’ve either followed on Twitter, or that I’ve read their book or blog, or that I listen when I tune into their podcast. There were a number of ‘big hitters’ in the ancestral health space. It was such a pleasure to meet them and to not be disappointed. At the presenters dinner we sat down with Jamie and Anastasia and were joined with Michelle from Nom Nom Paleo, Steph from Stupid Easy Paleo and Dallas, half of the original Whole 9. I regularly direct people to these sites for recipe inspiration or information and it was great to recognise that they were people genuinely interested in helping others rather than only being motivated by making money. I also had a good chat to Dr Cate Shanahan – the LA Laker’s nutritionist and author of Deep Nutrition, and Caryn and I discussed Spartan events with Ben Greenfield and saturated fat and cholesterol over breakfast with Paul Jaminet, creator of the Perfect Health Diet. I also met Jimmy Moore, podcast host of Livin La Viva Low Carb, author of Cholesterol Clarity and Keto Clarity (which I’m reading right now – it is a brilliant guide for anyone interested in ketogenic diets). A further bonus was being invited to dine with Jeffry Geber (Denver’s Diet Doctor) and his family – along with Gary Taubes. We discussed bad science and what to do with it, and at the end of the conference we came away from dinner not feeling in awe of the company that we had kept but more inspired by the work that is going on to help spread the ancestral health message.

Importantly, though, the conference was a great chance to strengthen the ties with the NZ contingent of the ancestral health conference. I’m someone who values relationships over and above most things, and to be surrounded by like minded people is something that makes me feel energised and inspired. We made the most of being in one place to share meals, debrief the day’s events and get to know each other better. It also gave us the opportunity to discuss how the first bigger symposium of AHSNZ may look next year (as we’ve got another mini symposium organised for Labour weekend in Wanaka – more details to come.) I’m sure that Caryn and I weren’t the only ones to come away feeling that the work we are doing as practitioners and also at AUT is strengthening the ancestral health message.

We also got an opportunity to see what is on offer in the US market in the way of paleo-style snacks and supplements. A favourite for me was the Epic Bar – not for everyone, this meat and fruit based protein bar is not unlike jerkey with a softer texture. It really hit the spot one morning when a sit down breakfast wasn’t going to happen. Equally the Exo bar was another eye opener – a protein bar made with crickets as opposed to whey protein – yep, not a typo. It was delicious but, then, anything that includes cacao powder and dates can probably cover up any questionable flavour that a crushed insect might taste like. I am unsure if either of these ship to NZ, but like most things I am sure that something similar will likely be available at some point. Of course in amongst the more ‘real food’ like options were the paleo treats (almond flour cupcake mixture, anyone?) however I would say there is always a place for these items and to give these smaller companies exposure at a conference with 500 attendees is a win-win. They directly target those who will be interested in purchasing, and the AHS is able to raise funds to run the conference. And those Hail Merry Macaroons are super tasty and deserve the exposure they get.

And, with that – I’m done. It is 6pm NZ time, 11pm LA time, I’m exhausted and I’ve managed to get through about 1/8th of what I wanted to share. Not particularly informative in itself, the main purpose of this is to link to other sites which can help inspire and inform as much as to give you my impression of the conference. I’m already planning on attending next year in Boulder, but more importantly, I’m just excited to be part of the AHSNZ team. For those who are interested in being involved, it’s not too long before general membership will be open. The more people we get involved, the further the ancestral health message will spread. In the meantime, get your tickets for the symposium in Wanaka on Labour weekend at Rippon Valley winery here.