Dr Annette Bosworth: Sizing Up Cholesterol On Keto

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[ruthieslingerland]

Thank you for this comprehensive explanation! I was frustrated when my doc told me my cholesterol was too high just based on the total. Now I know what test to request to really get the full picture. 4 years keto/ low-carb. Eating cleaner and cleaner every year and feeling great.

[AngelaBee_]

Could listen to Dr. Boz all day. Oh wait, I do!

[iainneilson]

Dr Boz, I love your talks on ketosis and the benefits of a ketogenic diet, which I regularly watch with great interest and apply in my journey to better health.

The mechanism by which cholesterol finds its way into the wall of the artery is still not clear, but this explanation sounds like a development of the lipid heart hypothesis. Is it insulin which causes this and, if so, how?

The demonisation of cholesterol (and saturated fat) has done nothing to reduce the incidence of cardiovascular disease, stroke or hypertension, and the lipid heart hypothesis provides no explanation of the mechanism.

Malcolm Kendrick proposes a different hypothesis, namely that hyperglycaemia causes damage to the glycocalyx and that the cholesterol which ends up in the plaque is peroxidized LDL, as macrophages do not take up undamaged LDL. The "zit" is formed when macrophages take up oxidized LDL and bacteria, which subsequently acts as a focus for calcification: all part of a repair mechanism, to prevent further damage to the endothelium and arterial wall.

Clearly, this is still an oversimplification of the process, which also involves inflammation and the clotting cascade, but it makes far more sense to me than insulin causing the damage to the glycocalyx, or LDL randomly finding its way through the glycocalyx and tight junctions.

[casellejohnvisaya]

Than you Dr. Boz. What happen during fasting for 24 hours and 3 days?

[worldwithoutwar]

I had trouble understanding the concept of a "bullet". it's a metaphoric description. A bullet fires if put into a gun. What is the gun? I did not realise that, according to that first pic, the fat/cholesterol buildup occurs in a wall separated from the artery . . . i.e. I never realised the artery had about 3 walls, and th inner one is what keeps the fat cells separate from the red blood cells. So I was not quite clear what a "zit" in the artery is — presumably a place where there is a local build up of the cholesterol, an area of extreme build up that may one day, via a thin wall that will break, pop the cholesterol cells into the main artery chamber and attack the red blood cells. Because I could not grasp these concepts at the beginning, I had trouble picturing what she was talking about later. Look, I am not complaining about her amazing amount of knowledge . . .just trying to explain how I, in terms of the concepts that I carry, could not follow well . . .

[ScottSummerill]

ApoB below 100? Nope. Literature is below 60, even 50.