Let me start off by saying cholesterol IS important to the process of plaque buildup in the arteries (atherosclerosis). HOWEVER, it is a disservice and likely harmful to focus solely on it, for a few reasons. First being, about half of people who get heart attacks don't even

Multiple studies have shown that high cholesterol (LDL <100 mg/dL) reduces the risk of death. It even is protective against dying from heart disease! The goal is to not just be protected from heart disease, but other diseases / causes of death too. https://x.com/Outdoctrination/...

In fact, a recent study showed that, in people with heart disease, after adjusting for various factors (including the use of cholesterol lowering drugs), having a super low cholesterol was linked to a HIGHER risk of dying. Meanwhile having a very low level was associated with a

In order to understand where cholesterol fits in, and how to more robustly reduce our risk, we need to understand how heart attacks happen to begin with. First, let's look at the structure of arteries. There's 3 layers: 1. Tunica intima 2. Tunica media 3. Tunica adventitia

The first layer of the artery, the tunica intima, is where the plaque happens. Within this layer, there are a few key structures: 1. The glycocalyx - a network of molecules that are like hairs on the endothelial cells. Basically its main role is to sense blood flow. If blood

Then you have the tunica media. It's full of two proteins: elastin and collagen, and muscle cells. All of these are needed for the proper pumping action. Lack of elasticity → high blood pressure → permeability (injury, glycocalyx) Importantly, COPPER is vital for the

Now how exactly does the plaque form? There's a few steps here. First, LDL, a lipoprotein which contains cholesterol, get underneath the endothelial cells. How does it get under there? There's a few determinants. 1. How much LDL cholesterol you have in the blood. 2. Depletion

Next, that LDL gets OXIDIZED underneath the surface. What specifically oxidizes? The phospholipids in this lipoprotein. The only type of fat that can get oxidized? Polyunsaturated fats. That's right, from the cholesterol lowering seed oils.

Some other factors can influence how oxidizable LDL particles are. A key one is how small and dense they are. These small, dense LDL particles are smaller and more dense due to them taking up lots of triglycerides. Triglycerides come from the liver, after repackaging free fatty

LDL particles also contain their own antioxidants to prevent this from happening. The primary one is vitamin E, but also coenzyme Q10, and polyphenols from things like fruits and olive or coconut oil. These are some of our best protection.

Underneath the endothelium, the environment can be more or less likely to cause LDL to be oxidized based on a few factors. 1. Inflammatory milieu - immune cells can be churning out reactive oxygen species due to existing systemic inflammation. 2. Excess iron or copper, both of

Once LDL is oxidized, it gets "eaten" by immune cells called macrophages. These then become foam cells, which is really the core of the plaque. At this point, more immune cells flood into the artery. So the plaque is not really all about cholesterol. It's a lot of oxidized

The immune system's ability to resolve the immune response is also heavily dependent on: 1. Mitochondrial energy production 2. Omega 3 to 6 balance (omega 3 promotes resolution, omega 6 inflammation)

Then, the plaque calcifies. This essentially takes the plaque from being a soft piece of fat to a brittle hard one. Once again, we see the same players here. The more inflammation, the more mitochondrial dysfunction present, the greater the macrocalcification.

Another key player is nitric oxide. Nitric oxide is a primary vasodilator, it opens up our blood vessels. This is good because it maintains the proper flow of blood which in itself is a signal as we've discussed. It also acts as a direct signaling molecule within the

There are a TON of factors that govern how much cholesterol is in your blood. It's about understanding cholesterol balance instead of just blindly shutting off its synthesis. Cholesterol can get metabolized into: 1. Steroid hormones 2. Bile acids and its precursors can get

What does the body need to lower its own cholesterol? ➥ Vitamin A ➥ Thyroid hormone - same ➥ Vitamin B3 / NAD+ ➥ Vitamin B1 These are all important to steroid metabolism. Taurine + glycine are needed to convert cholesterol into bile acids. Dietary fiber prevents the

We should also look at the LDL receptor. This is a protein in the liver primarily which breaks down excessive LDL in the blood. When it doesn't work right, you're at much higher risk of heart disease. What increases its activity? ➥ Thyroid hormone ➥ Vitamin D What

Finally, we have to talk about dietary fat. Of the best controlled long term studies in humans, we see that seed oils actually increase the risk of heart disease, despite lowering total cholesterol. https://x.com/Outdoctrination/...

It's also important to note that yes - saturated fats can be problematic. But the context is key. There are multiple different types of saturated fat, and there are multiple forms of each. The free fatty acid form of palmitic + myristic acid (mainly in palm oil + butter) can

Saturated fats like stearic acid do not have the same effects on inflammation + cholesterol. And medium chain, short chain, and odd chain fatty acids all have unique benefits and even anti-heart disease properties. More on odd chain fats in this thread https://x.com/Outdoctrination/...

Optimizing the antioxidant network is key. ◇ Maintains mitochondrial function / health ◇ Prevents excessive ROS gen from immune cells ◇ Prevents calcification ◇ Prevents glycocalyx damage ◇ Protects LDL particles ◇ Spares NO More on that here: https://x.com/Outdoctrination/...

Lowering stress will be vital too. ➥ Prevents rise in free fatty acids ➥ Lowers inflammation ➥ Increases LDL receptor Optimize stress here: https://x.com/Outdoctrination/...

There are a few key drivers of inflammation that are important. The primary one is from the gut. Optimize gut function here: https://x.com/Outdoctrination/...

As we've discussed, insulin sensitivity is also important for this entire process: https://x.com/Outdoctrination/...

Thyroid function is also crucial: https://x.com/Outdoctrination/...

Finally, I detail the keys to optimizing mitochondrial function here. https://x.com/Outdoctrination/...

sources Omega 6/3 and inflammation resolution https://pmc.ncbi.nlm.nih.gov/a... Shear stress dynamics #sec0095 class="text-blue-500 hover:underline" target="_blank" rel="noopener noreferrer">https://www.sciencedirect.com/... Energy metabolism x foam cells https://pubmed.ncbi.nlm.nih.go... https://pubmed.ncbi.nlm.nih.go... Energy improves cholesterol efflux https://pmc.ncbi.nlm.nih.gov/a... CRP v LDL

@Outdoctrination Facts bro, understanding the full picture beats blindly following one metric every time

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@Outdoctrination That’s not what this study says. It’s U shaped for CVD mortality

@AB00001234 which is what i said

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@Outdoctrination Tell us more about the small molecule rna synth'd bye the lung and how immunogen plans to