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The party problem: You’re serving steak for a nice dinner party and want to add a personal touch.
The party trick: Use silicone candy molds to make super-special butter pats.
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Souvenirs, I think, are an important part of travel. The little objects and tokens that we bring home with us are the holders of our memories; they evoke their place of origin and take us back there, if only for a moment.
Food is an especially evocative way to step back into a beloved place. Oakland is so full of wonderful deliciousness, it’s near impossible to narrow a selection down to just five things so, with one notable exception, I went with portability as my other criteria. All but one of these items are small enough to tuck into a corner of your bag.
http://chriskresser.com/
In this episode we cover:
Show notes:
[smart_track_player url=”http://traffic.libsyn.com/thehealthyskeptic/RHR_-_The_Functional_Medicine_Approach_to_High_Cholesterol.mp3″ title=”RHR: The Functional Medicine Approach to High Cholesterol” artist=”Chris Kresser” ]
Chris Kresser: Hey, everybody. It’s Chris Kresser. Welcome to another episode of Revolution Health Radio. This week, we’ve got a question from Tyler.
Tyler: Hey, Chris, really enjoy the podcast. I’ve been listening and interested in a Paleo diet ever since I heard you on the Joe Rogan Experience podcast last year. I’m somebody who takes statin medication for familial hypercholesterolemia. I’m wondering if you thought a Paleo diet would still work for somebody like me who’s on that statin medication, and I just wanted to get your thoughts on that. Thank you.
Chris Kresser: Thanks for sending in your question, Tyler. It’s a great one, but unfortunately, it’s difficult to answer in a short time. In a conventional paradigm, this is a really black and white, or binary, issue. You have total cholesterol and LDL cholesterol that are tested regularly, and if they are high, then the doctor will typically prescribe a statin and the patient is instructed to take it for the rest of his or her life and that’s the end of the story, but the reality is actually far more complex. We could do several podcasts on this topic. In fact, we could probably just dedicate a podcast to it and do it over and over again because there’s so much information to cover and there is so much new research that comes out that changes the landscape. Four out of 10 people that die each year die of a heart attack, so this is obviously a really big problem and one that doesn’t lend itself well to pat answers on a 20-minute podcast.
I’ve written a lot about this, and in fact, I got my start in this field writing about the relationship between cholesterol, lipids, and heart disease over 10 years ago now. Some of the earliest writings that I did were on this topic. More recently, I wrote an entire updated series on cholesterol and heart disease which we turned into a free ebook which you can download from chriskresser.com. If you haven’t already done that, then definitely check that out. One of the earliest digital programs that I put together was one called the High Cholesterol Action Plan, and if you Google “high cholesterol action plan” you’ll find it, and we can also put a link in the show notes, but this is a course that goes into much, much more detail than the ebook does because I got so many questions about this topic over the years, especially as I was writing about it early on. I just wanted to have a resource that I could direct people to that went into a lot more detail and provided a lot more assistance than I could ever do in a blog post or an ebook. So, if you haven’t checked all that stuff out, I would definitely do that.
In this show, I’m going to just provide an overview of what I think the key factors are to be thinking about with this particular question.
The first factor is to understand that a functional approach to dyslipidemia, high cholesterol, and even familial hypercholesterolemia is really different than the conventional approach. For those listeners who aren’t aware with familial hypercholesterolemia (or FH, as we’re going to call it so I don’t have to say that every time), FH is a disease that is—well, I mean, I don’t like the term disease but that’s what it’s referred to as—it’s a condition that is genetically mediated. There are genetic mutations involved that lead to very high cholesterol levels, often higher than 300 mg/dL. Believe it or not, it’s not that easy to test for. Some of the genetic testing that you have to do to completely be certain that you have it is very expensive and not widely available. In many cases, doctors will just—there are certain criteria called Simon Broome criteria that can be used to get a more accurate indication of whether FH is likely to be present. But I’ve seen that many clinicians in practice, if they see a total cholesterol above 300, they’ll often just diagnose the patient with FH on that basis alone, which is not a particularly accurate way of doing it, but there is certainly an argument to be made that FH is likely if total cholesterol is north of 300 mg/dL.
Anyways, back to the factors here. As I said, the first factor to consider is that the functional approach to dealing with this issue is very different than the conventional approach because in functional medicine, we view high cholesterol not as a disease but as a symptom. What is it a symptom of? Well, there at least six key underlying processes that can lead to hypercholesterolemia:
There are, of course, others, but those are the six main ones that we look for in functional medicine. We explore all of these causes to determine and address whatever the underlying or root pathology is because if you treat the root, that will often fix the branch. If you think of the disease process like a tree, the roots are those core pathologies or underlying mechanisms that lead to the symptoms, which in this analogy are the branches. You can mess around with the branches and try to deal with things on that level, which is the conventional approach, or you can try to address the roots of the problem, which is what we’re doing in functional medicine.
In a conventional paradigm, it’s really a lot more about symptom suppression. If you have high cholesterol, you take a drug to lower it, a statin drug in this case. If you have high blood pressure, you take a drug to lower that, and it’s the same for many other conditions.
In your case, Tyler, you mentioned that you have FH, which means we know you have at least one of the six underlying factors present—the genetic predisposition, but that doesn’t mean that other factors aren’t also playing a role. In fact, I see this very often in my practice where the patients come in and they already know that they have FH but when we do a full comprehensive workup, we find that they also have poor thyroid function, SIBO and gut dysbiosis, maybe a latent chronic infection and heavy metal toxicity and all of those things are exacerbating the genetic predisposition to high cholesterol.
The second factor to consider is that conventional lipid markers, which are the ones that we typically have tested for if you go to your doctor for routine blood work, so I’m talking about total cholesterol, LDL cholesterol, and HDL cholesterol, are not accurate predictors of cardiovascular risk. The most recent research has shown that these markers, total and LDL cholesterol, are not strongly associated with heart disease. The ratio of total-to-HDL cholesterol as well as non-HDL cholesterol, which is similar, are better predictors than total cholesterol or LDL cholesterol, but they are nowhere near as predictive as some of the newer markers like LDL particle number, which in turn itself isn’t as predictive as lipoprotein(a), or Lp(a). These markers, they tell us something different than the standard lipid markers.
The standard lipid markers tell us how much cholesterol is inside of the lipoproteins, so if we use an analogy in your bloodstream as like a highway, the passengers inside of a car are equivalent to cholesterol inside the lipoproteins, whereas the cars themselves would be equivalent to the lipoproteins. Extending this analogy, if you have a lot of cars on the road, there is a much greater likelihood that they’ll get into an accident, they’ll be off the road and slam into the side of the road, and the side of the road here would be the fragile lining of the artery, the endothelium. If you have a lot of LDL particles, which is reflected in the LDL particle number measurement, then because atherosclerosis is a gradient-driven process, there’s a much greater likelihood that one of these LDL particles is going to damage the fragile endothelium and initiate the process of plaque formation.
With lipoprotein(a), we know this is a different type of lipoprotein. I’m not going to go into a lot of detail here because it’s, I guess, pretty geeky, but it’s known as one of the most atherogenic lipoproteins that have been identified and it’s the single most significant lipid risk marker for heart disease. Of all of the things we could measure in terms of lipid markers, lipoprotein(a), or Lp(a), is the most predictive for future risk of heart disease.
The point of this second factor is that what we measure is important. Usually, doctors are only measuring total and LDL cholesterol, but what we really should be measuring as clinicians are things like LDL particle number, HDL particle number, and lipoprotein(a). These give us a much better idea of overall risk.
Third factor is that lipid markers, even the good ones, are only one part of the puzzle when it comes to quantifying overall risk. We need to look at things like family history, inflammatory markers like C-reactive protein, fibrinogen, Lp-PLA2, oxidized LDL, metabolic markers, so things like fasting insulin, fasting glucose, fasting leptin, post-meal blood sugar, hemoglobin A1c, and a variety of other markers that tell us what’s happening with metabolic function. Hypertension and smoking are two of the strongest risk factors for heart disease, hands down, so those of course should always be looked at. Diet, lifestyle, stress, nutritional status—either not enough of nutrients like vitamin D or too much of a nutrient like iron can increase the risk of heart disease. Status of the gut microbiota, there is an increasing amount of research that shows that this plays a significant role in heart disease pathogenesis.
There are certain calculators out there that are available for free online that use at least a small number of these risk factors. The Reynolds Risk Score, for example, uses C-reactive protein and systolic blood pressure in addition to age, total cholesterol, HDL cholesterol, and family history to determine the 10-year risk of heart disease expressed as a percentage. You enter all of your information in and it turns back up a percentage of what percent of the risk you have for having a heart attack in the next 10 years based on all of these validated criteria. The lowest it could be is 1 percent, and then it goes up from there, and you can put different numbers in there and play around and see what has the biggest impact on risk, and you’ll see that it’s not total cholesterol or even HDL cholesterol, but age actually is the biggest risk factor for heart disease. You’ll see changing the age around has the biggest impact on that risk prediction.
There are other types of testing that look for objective evidence of plaque accumulation, like a calcium score and CIMT, and these are tests that a doctor can do when/if they are warranted, and they provide a different angle. The lipid markers are just looking at blood markers that are typically associated with heart disease, but a calcium score and carotid intima-media thickness test can tell you what’s actually happening in terms of plaque accumulation.
Those are three factors to consider, and here’s how I would approach someone with FH: I’ve had many patients with FH, so this is what I actually do. I would start with a more advanced testing to determine what their LDL particle number, lipoprotein(a), and other important markers are like—fasting insulin, fasting post-meal glucose, inflammatory markers etc.—and then I do a thorough history and get a thorough family history as well. We do then an entire functional medicine workup to determine if they have other contributing factors like SIBO, dysbiosis, infections, heavy metal toxicity, hypothyroidism, etc. We address all of those factors that we discover in that extensive workup. Then we retest all of these markers, and if they are then normal, great, our work is finished.
If the markers are still elevated, we’ll move onto a more detailed risk quantification. We may refer them out for calcium score, a CIMT, and we may look at some of the other risk factors, lifestyle, stress, etc. Then if we deem that the risk is still significant, we’ll try more advanced diet modification strategies. If they are a hyper-responder to saturated fat and that increases their LDL particle number, we might put them on more of what I call a Mediterranean Paleo approach, which is Paleo that’s lower in fat and higher in Paleo-friendly carbohydrates, whole-food carbohydrates like starchy plants, and even whole fruits, non-starchy vegetables, and then we’ll emphasize monounsaturated fat more than saturated fat. Then, we might use some supplements that have been shown to reduce LDL particle number and address inflammatory processes like delta and tocotrienols, pantethine, curcumin, etc., and these will often lead to a significant reduction in these various biomarkers that are risk factors for heart disease, even lipoprotein(a), which is in the conventional paradigm, thought to be almost entirely genetically mediated and not really amenable to diet and lifestyle change. Furthermore, it’s not typically affected by statins.
If the numbers are still high after all of that, which is a lot, that process takes typically several months if not longer because of all of the testing and all of the dietary intervention and the retesting, exploring, and investigating all of those various underlying causes, then if the numbers are still high and the patient is in a very high risk group, only then would I, especially if it were me, consider statins and other medications. Statins are not effective, as I mentioned, for reducing lipoprotein(a) in many patients, and so if that’s the primary marker that’s still elevated after all of this workup and treatment, those patients may need new drugs called antisense nucleotides, or ASOs, that specifically target lipoprotein(a). That’s just one example of how even the pharmaceutical aspect of the treatment, if it’s determined that it’s needed, can be more individually tailored based on the patient’s unique circumstances and based on the most recent evidence rather than just using a one-size-fits-all, black-and-white approach, which is the typical way that it’s done in the conventional paradigm.
Tyler, I realize this may have raised more questions than an answer perhaps. Unfortunately, that’s what happens when you dig into some of these topics. And this is, as I said at the outset of the show, certainly one of the most complex and nuanced areas of medicine and treatment. There are so many different things to consider and I think the big public health campaign during the latter part of the 20th century was oriented around making this message as simple as possible, so that people would comply with the diet and lifestyle recommendations that were being made. This really oversimplified the message of “cholesterol is bad and if you have high cholesterol you need to bring it down and you should take a statin to do that” is really out of date and not in sync with the most recent scientific evidence, and the lipidologists, the folks out there like Dr. Tom Dayspring and others, are way, way ahead of how they approach cardiovascular disease and have been for many many years but that has not trickled down into the mainstream understanding at lexicon and to the average primary care doctor’s office. The training for primary care doctors is really out of date unless someone is really taking an initiative to stay on top of all of this stuff or if they are lipidologists themselves. Even a lot of cardiologists are not current with this information and so it’s a problem for patients who are trying to get help. It is really difficult to do that from your local doctor unless they are really staying abreast of all of these more recent developments. At least this podcast can give you some food for thought and places to look for further information and discussion with your practitioner.
We’ll put some links to all of the resources that I mentioned here in the show notes, and for everybody else, keep sending in your questions. Tyler, thanks again for sending your question in, and that’s it for today. I’ll see you next time. Take care everybody.
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Looking for an easy app that’s a breeze to pull together and will be more of a hit in your game-day spread than the half-time show? When it comes to quick snacks with the power to deliver a big reward, basic party dip — be it bean, cheese, or yogurt — is your very best starting point. It’s already a crowd favorite, and with a simple upgrade this is the app that can go all the way.
Here are 10 flavor-packed ways to turn basic dip into the hit of the party.
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I can’t count how many times I set out to host a killer movie night and watched helplessly as it fell apart before my eyes. While it might seem simple, there’s more to movie night than pushing “play” and throwing some popcorn into a bowl. There are a lot of ways for movie night to go wrong!
But there’s one mistake you should definitely avoid: picking a movie dud.
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This is the second installment in my Olympic lifting series for Girls Gone Strong and builds on some of the information from my first article on the snatch.
The clean, much like the snatch, is one of the best training options available for developing strength and power. It requires a little less speed but more strength than the snatch. The full-body movement teaches your body to work as a connected unit, improving your ability to perform complex movement patterns efficiently.
Performance benefits aside, how often do you really get to go all out and relish in the power of being aggressive and throwing some weight around?
Seventeen years ago, when I began weightlifting, the possibility of traveling around the world to share my knowledge and experiences in weightlifting just didn’t exist. Let’s be honest, finding anyone interested in learning the lifts was rare, especially outside of the athletic arena. Locating any instructional information was a challenge. Even YouTube wasn’t around until 2005 — six years after I started lifting! I owned a VHS tape from USA Weightlifting and that was about it.
Now, as interest in the Olympic lifts has skyrocketed, there’s no shortage of information available. Almost everyone has their own YouTube channel, and it can be overwhelming to know who to follow and learn from, especially for those who have little or no experience. The pursuit of Olympic lifting at any level is a continuous learning process and it’s best to start by creating a solid foundation. You may find it easiest to learn these positions and movements with a very light bar or even just a PVC dowel, but will probably find that you can work up to using the regular bar and even adding some weight relatively quickly.
Before diving into the key positions and movements of the lift itself, let’s review some foundational principles that will simplify your learning process and help prepare you for success.
The four foundations that I shared in the snatch article also apply to the clean, with one addition. Preparation in these areas will make learning the lifts much easier:
The mobility requirements for the clean are slightly different. Some people experience restrictions in the wrists or shoulders when the bar is sitting on the shoulders in the front rack position. Ankle mobility restrictions are also common when attempting to maintain an upright torso at the bottom of the clean.
When evaluating mobility, be sure you also have control and stability throughout your entire range of motion. Sometimes, this lack of control can cause you body to lock down in its attempt to create a more stable position, thereby decreasing your available range of motion. The result is a feeling of “tightness” often in the hamstrings or in the lats and shoulders when reaching overhead. When you feel “tight,” you may assume that the area needs to be stretched, when in fact, what you actually need is more specific strength to create stability so your body will trust you in that position. If you’ve been stretching a “tight” area regularly and feel like you’re not making any progress, it’s a good idea to try working on building control.
Maintaining alignment of the pelvis and ribcage is vital to supporting a heavy load on the shoulders without “giving” into an arched or rounded back position. This is especially true when moving and catching weight with the speed used in the lifts.
Deadlifts and squats develop a great base, and the addition of front squats helps you to get stronger and reinforce the same position you’ll use in the catch phase of the clean.
One of the most important things to learn when performing the clean (or any Olympic lift) is how to fail safely. Your safety is always more important than your lift! That said, I also often see people drop their bars carelessly. Learning to actually drop a weight can be a bit intimidating at first, but you definitely want to do this correctly to ensure your safety as well as to protect the equipment.
When you miss a clean, the bar will fall forward, even if it pushes you backward. Keep your hands on the bar as it falls – don’t try to slow the bar down, just guide its path, pushing it away from you. Release the bar when it is about two or three feet from the floor. As the bar is falling, also begin to quickly move your body clear out of the way of the bar. Once the bar hits the floor, it will bounce and roll. When you know you’re out of harm’s way—usually after one bounce—go back and prevent your bar from rolling too far.
In addition to learning how to miss a lift, learning to accept and learn from your failed attempts will help you come back stronger each time you miss a lift, always moving forward. A great principle for anything in life!
Generally the weights you’ll eventually lift in the clean will be heavier than in the snatch. Most people don’t struggle to stand up out of a snatch unless the bar is wildly out of position. However, with the clean, you’ll need to dig deep and keep pushing when you start to get stuck while trying to stand up. If you stick with it and keep pushing, you’ll often find unexpected success!
Practicing the following positions and movements for the clean will set you up for a successful lift. Drill them often, especially when you’re first learning.
Most people tend to grab the bar with their hands too close together. You can alter the width of your grip over time until you find what is most comfortable and effective, but at the start, place the tip of your thumb about a half inch to one inch past where the knurling (the rough part of the bar) starts, lay your thumb flat along the bar, and then grasp the bar. It may feel wide at first, but it should place the bar at just the right spot on the thigh in your power position.
The Hook Grip
The hook grip allows for a more secure grip on your bar and is best learned early on. It’s never fun, but I promise you, it truly helps! When you grab the bar, simply place your thumb around the bar first, then place your first two or three fingers (index, middle, and possibly your ring finger, depending on the size of your hands) on top of your thumb and around the bar. Ouch, I know, but with practice you’ll get used to it over time and it will strengthen your pull.
The first position I always teach in both the snatch and the clean is the power position. Although this is arguably the most important position to hit effectively and consistently, this is also the most often missed position in a lift.
You should feel as if you could jump from this position. The legs are loaded, you’re connected to the ground, and you’re ready to explode up into the finish of the pull to transfer all that force to the bar before getting yourself underneath it.
To find your power position:
It’s best to first learn the turnover slowly. Reinforce your movement pattern first, and then speed it up. This is easiest when using a very light bar or even a PVC dowel so you can focus entirely on the pattern.
The tempo of the clean should accelerate throughout the pull.
Begin with control and finish with power. For best results, create consistency hitting these key positions:
Begin by learning and drilling these basic positions, starting light—even with just a PVC dowel—and working your way up over time. While it doesn’t (and shouldn’t) replace the instruction of a qualified, experienced coach, it will start you on an amazing, frustrating, exhilarating journey, on which you’ll build significant strength and power, learn to go all-in and trust yourself and your abilities!
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This year’s Budweiser ad for the Super Bowl is lighter than usual on the cute animals, but heavy on the big emotions. The commercial was released on January 31, less than a week before the Big Game. Have you watched it yet?
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Buffalo chicken dip is the lazy person’s trick for serving Buffalo wings for a crowd. You get all the tangy, fiery flavors of hot wings coated in a rich, creamy dip. You know it’s good when it’s just as delicious on celery as it is on chips! And maybe best of all, you won’t go through a tower of napkins while enjoying it!
But what makes this the ultimate? It’s not the sauce or the cheese — it all comes down to the chicken.