New way to treat cholesterol may be on the horizon

A breakthrough discovery by scientists at Houston Methodist could change the way we treat cholesterol. Researchers found new evidence that challenges a 40-year notion of how fast we eliminate it from our bodies.

Related image

This accidental discovery, made by medical biochemist Henry Pownall, Ph.D., and his team at the Houston Methodist Research Institute, reveals a new pathway in the cholesterol-elimination chain that will be key to developing new drugs to lower cholesterol. Their findings are described in an article titled “ABCA1-Derived Nascent High-Density Lipoprotein-Apo AI, and Lipids Metabolically Segregate,” appearing online Oct. 26 and in print Nov. 21 in the American Heart Association’s Arteriosclerosis, Thrombosis, and Vascular Biology journal. Pownall, who is the corresponding author, said the initial purpose of their study was to prove the current model of cholesterol transport through the body was correct. It turns out, however, that the model was not quite right.

“The model people have been using for 40 years presumed that cholesterol was transported from the arteries with other lipids and proteins and entered a particle that stayed in the blood for several days before being cleared by the liver for disposal,” Pownall said. “What we discovered in the process was something different. We discovered the cholesterol skips all these steps and goes directly from this first particle to the liver in two minutes. This is a thousand times faster than what was formerly suspected.” Related image

While most studies look at HDL cholesterol in its mature form found in blood, Pownall and his colleagues studied cholesterol in nascent HDL, an early kind of HDL produced by cells. Cholesterol in the nascent HDL goes directly to the liver, mainly skipping conversion to the mature form of HDL. Pownall stresses that it’s not that current practices of treating “bad” LDL cholesterol are incorrect, but instead that physicians and researchers need to better understand how the “good” HDL cholesterol contributes to cardiovascular disease and how to raise it in a way that protects the heart, because some patients with very high HDL numbers, which were always thought to be beneficial, are actually at risk. “LDL cholesterol, the so-called ‘bad cholesterol’ is well controlled with the current statin therapies. The track record for these cholesterol-lowering drugs is indisputable, and they will continue to work,” Pownall said. “HDL, or the ‘good cholesterol,’ however, is a much trickier system. Not everything that raises it protects the heart and not everything that lowers it is terrible for you. We will need to redesign new drugs to lower plasma cholesterol in a way that takes into account this new mechanism. We will look for interventions, maybe dietary (why of course!), perhaps pharmacological, that raise HDL cholesterol in a way that helps protect the arteries and prevent cardiovascular disease.”

Adapted from: Bingqing Xu, Baiba K. Gillard, Antonio M. Gotto, Corina Rosales, Henry J. Pownall. ABCA1-Derived Nascent High-Density Lipoprotein–Apolipoprotein AI and Lipids Metabolically SegregateArteriosclerosis, Thrombosis, and Vascular Biology, 2017; ATVBAHA.117.310290 DOI: 10.1161/ATVBAHA.117.310290

Nutritional Nugget

Move to low-fat or fat-free milk or yogurt! Smoothies are a great way to enjoy dairy during the early morning rush. For a quick breakfast, blend yogurt with banana, peanut butter & ice.

WODal Nugget 

Timeous: In good time; sufficiently early

Inspirational Nugget

 

“There are three categories of suffering or pain to include: All-pervading pain, the pain of alternation and the pain of pain. All-pervading pain is the general pain of dissatisfaction, separation and loneliness. The sense of alternation between pain and its absence, again and again, is itself painful. And then there is the pain of pain. Resisting pain only increases its intensity.”

~Chogyam Trungpa Rinpoche

 

 

 

Weight loss after bariatric surgery can improve heart health

In overweight and obese people, fat often gets deposited into the midsection of the body. Large amounts of this belly fat can lead to unhealthy changes in a heart’s function and size. However, according to new findings presented at the American College of Surgeons Clinical Congress 2017, a bariatric surgical procedure, and the weight loss that follows it, actually may allow the heart to return to its natural shape and function.

Related image

 

When a person lifts weights, pushing against resistance, their muscles eventually get bigger. The same is true for the heart muscle. When a person is overweight, the heart has to generate more force to pump even more blood throughout the body. This extra workload causes the heart muscle to grow bigger, but contrary to what some people think, a bigger heart muscle does not mean a stronger heart. In fact, the larger the heart, the less efficacious it is in fulfilling its functions.

“We know that obesity is the most prevalent disease in the United States. And that the cardiovascular system is significantly affected by this disease process,” said lead study author Raul J. Rosenthal, MD, FACS, chairman, Department of General Surgery at the Cleveland Clinic in Weston, Florida. “But we wanted to know to what degree the shape of the heart changes in someone who is obese, what the heart looks like in someone after having bariatric surgery and losing weight, and how that change in geometry affects heart functionality.” For this study, researchers at the Cleveland Clinic reviewed data on 51 obese men and women who underwent bariatric surgery between 2010 and 2015. The analysis included factors such as body mass index (BMI) and coexisting health problems. The average age of the patients was 61 years, and the average BMI was 40; approximately 100 pounds overweight.

To better understand the impact of a bariatric operation and weight loss on heart health, the researchers compared preoperative and postoperative echocardiography readings. An echocardiogram is an ultrasound of the heart that measures not only its size and geometry but also its function. An echocardiogram measures how much blood is in the heart, how much blood goes out of the heart, and how much blood remains in the heart. One year after bariatric surgery, the researchers found significant improvements in patients’ heart health. Nearly half of the patients had hearts that had gone back to their natural shape or geometry. They also found that there was a significant improvement in the size of the ventricles: On average these chambers of the heart decreased in size by 15.7 percent (left ventricle mass: 229 grams before surgery; 193 grams after surgery. Left ventricular wall diameter: 60.1 mm before surgery; 53.7 mm after surgery.)Related image

Larger chambers lose some of their pumping power. This loss means that more blood stays in the heart, and ultimately increases a person’s risk of heart failure. “When the size of the chambers gets bigger, and the walls of the heart get thicker, the blood flow to the heart is not as good, the functionality of the heart is not as good, and the heart itself doesn’t get enough blood,” Dr. Rosenthal said. “The whole body suffers because there is less blood going to your feet and to your toes and to your brain.” This study is the beginning of a series of studies that will be conducted by these researchers over the next few years. They will perform follow up studies to find out what the window is in which losing weight allows the heart to go back to its normal geometry.

“We don’t know if being obese for 20 years and having changes in your heart geometry is different from being obese for 10 years,” Dr. Rosenthal said. “The question is: Will the heart always come back to normal? It could be if you wait too long, the changes in your heart are irreversible.”

Adapted by: American College of Surgeons. “Weight loss after bariatric surgery can improve heart health: Significant improvements in heart shape and function can happen one year after an operation for weight loss.” ScienceDaily. ScienceDaily, 24 October 2017. <www.sciencedaily.com/releases/2017/10/171024232822.htm>

Nutritional Nugget

Take a walk instead! Replace a coffee break with a brisk 10-minute walk. Ask a friend or colleague to join you.

WOD Nugget

Relume: Relight or rekindle (a light, flame, etc.)

Inspirational Nugget

I smile because I have survived everything the world has thrown at me. I smile because when I was knocked down I got back up.

“Ego could be defined as whatever covers up basic goodness. From an experiential point of view, what is ego covering up? It’s covering up our experience of just being here, just fully being where we are so that we can relate with the immediacy of our experience. Egolessness is a state of mind that has complete confidence in the sacredness of the world. It is unconditional well-being, an unconditional joy that includes all the different qualities of our experience.”

~Pema ChÖdrÖn

 

 

Genetics may put a person at risk of high triglycerides, but adopting a healthy diet can help

Triglycerides, a type of fat in the blood, are essential for good health. However, having high triglycerides might increase a person’s risk of heart disease, and could be a sign of metabolic syndrome, a combination of high blood pressure, high blood sugar, and too much fat accumulation at the waist. People with metabolic syndrome have increased risks for heart disease, diabetes, and stroke.

Related image

A new study from nutrition researchers at the University of Illinois shows that some individuals with variations of a “gene of interest” may be at an even higher risk of developing high triglycerides. Specifically, researchers looked at genetics and risk in a group of young Mexican adults. Despite genetic predisposition, the study shows that maintaining healthy body weight or changing diet can help reverse the risk. Katie Robinson, a former doctoral student in the U of I Division of Nutritional Sciences and fellow of the I-TOPP program, explains that the study is a collaboration between the University of Illinois and the Autonomous University of San Luis Potosi in Mexico (UASLP), also known as UP AMIGOS. “Obesity is a growing problem in the U.S. and Mexico. In the U.S., obesity affects over a third of our population. We’re concerned because obesity is associated with other diseases such as diabetes, heart disease, and high triglycerides,” Robinson explains. Compared to Caucasian groups, Hispanics in the U.S. have higher rates of type 2 diabetes and other obesity-related diseases. Of all Hispanic subgroups, those of Mexican heritage have one of the highest risks for obesity and associated diseases.”

The UP AMIGOS project addresses genetic and environmental factors associated with obesity and related conditions among younger adults in Mexico. “A lot of existing data are from Caucasian cohorts, which means we needed to replicate and better understand those findings in groups with different ethnicities. That’s the main goal of the UP AMIGOS project. “It was a great opportunity that we were able to look at this rich data set from young Mexican adults because we know that this population has a greater likelihood of developing not only obesity but also high triglycerides and diabetes,” Robinson adds. For the current study, Robinson was interested in a protein made in the liver called fetuin-A (FetA). “It’s an interesting marker connecting inflammation with obesity and its associated diseases,” she says. “FetA is a protein that is released from adipose tissue and also the liver. We know FetA is integral to insulin sensitivity, and that’s where most of the research has been done to look at its function.

“We also know that FetA is elevated in obesity and diabetes. Therefore, we were interested in looking at the genetic implication. If there are alterations or single nucleotide polymorphisms within the gene that codes for FetA, does that change somebody’s risk for obesity or the associated diseases?” To answer that, the researchers looked at bloodwork from 641 young Mexican adults to analyze biomarkers and genotypes. They also checked body mass index (BMI), took measurements of fasting glucose levels, and had the participants report on their dietary habits. From the genotyping, they were explicitly looking for occurrences of two mutations of the gene, AHSG, a gene that influences the protein FetA. They were interested in the association of those gene mutations with dietary intake, weight, and also biological markers of health.

The AHSG polymorphisms were found to be associated with triglycerides. Robinson explains the most critical finding is that one of these polymorphisms, or mutations, was associated with higher circulating triglycerides, but that correlation was very dependent on BMI and dietary intake, the relationship was exaggerated in individuals who were overweight. “So with an elevated BMI, we saw greater disorder within those carrying the risk genotype. But if these individuals who had the high-risk AHSG genotype had a lower BMI, their triglycerides were lower. It suggests that even if you carry the high-risk genotype, you don’t have a greater risk of high triglycerides if you can maintain a normal BMI or a lower BMI, which I think is a positive finding when we look at genetics.”

Robinson says diet also played a role in higher triglycerides. “Higher carbohydrate intake, specifically sugar or sucrose intake, was associated with elevated triglycerides. This association was mainly in one genotype group. The thought was perhaps these individuals are more sensitive to certain diets than the other genotype groups.” Regardless of genotype, elevated BMI was associated with higher triglycerides. Due to the relationship between FetA and diabetes, the researchers also wanted to see if there was an association with AHSG mutations and glucose, but surprisingly, they did not find any.

Related image

While the study looked at relatively healthy young adults in a Mexican population, results were different than what has been observed in previous research from Caucasian groups. Robinson explains that they might have seen different results if they had looked at older Mexican adults with poorer health. Some good news from the study’s findings is that maintaining a healthy body weight often can overcome the effects of gene related metabolic disease and type 2 diabetes. “We know that genes aren’t everything,” Robinson says. “There are a lot of things we can do, behaviorally, to change our individual risk. It’s a silver lining in our research. We can’t modify our genetics, but we can modify our epigenomes and some behaviors. You can still have positive health outcomes.”

The results are also significant for the future of developing personalized nutrition as interventions for disease, Robinson says. “In practical terms, it would be ideal to start by understanding someone’s basic biology, which may influence how they’re metabolizing and utilizing the nutrients they are eating. It would be great to bring people in, find out where their biology is at, and then tailor a diet for them, but we need a lot more research before we get to that point.” Margarita Teran-Garcia, assistant professor in the Division of Nutritional Sciences and the Department of Human Development and Family Studies at U of I adds, “In order to advance the full potential of precision medical and nutritional sciences, there is a need to invest and create new sustained resources, financial and technological, to build the evidence base needed to guide clinical practice and strategic planning in public health.”

Adapted from:  Katie N. Robinson, Itzel Vazquez-Vidal, Courtney Marques, Flavia Cristina Drumond Andrade, Celia Aradillas-Garcia, Margarita Teran-Garcia. Circulating Triglycerides and the Association of Triglycerides with Dietary Intake Are Altered by Alpha-2-Heremans-Schmid Glycoprotein PolymorphismsJournal of Nutrigenetics and Nutrigenomics, 2017; 75 DOI: 10.1159/00047

Nutrition Nugget

Model healthy habits! Adults who choose low-fat or fat-free milk or yogurt show kids that dairy is an important part of a healthy eating style. When kids model this behavior, their growing bones will thank you.

WOD Nugget

Bitts: A pair of posts on the deck of a ship for fastening mooring lines or cables.

Inspiration Nugget

Sometimes all it takes is one small prayer to change someone's life.

 “When you come from the view that you’re fundamentally good rather than fundamentally flawed, as you see yourself speak or act out, as you see yourself repress, you will have a growing understanding that you’re not a bad person who needs to shape up but a good person with temporary, malleable habits that are causing you a lot of suffering. And then, in that spirit, you can become very familiar with these temporary but strongly embedded habits. We all carry around trunk loads of old habits, but very fortunately for us, they’re removable.”

~Pema ChÖdrÖn