Dyslipidemia

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Dyslipidemia literally means abnormal blood lipid or fat levels. On its face, this is an oversimplification. Not only are the amounts abnormal, but the compositions are also often abnormal (due to genetic and dietary factors). Dyslipidemia is a critical risk factor for the development of cardiovascular complications such as ischemic heart disease and stroke.

Although statins are effective anti-dyslipidemic drugs, their usage is fraught with issues such as failure of adequate lipid control in 30% of cases, dysmetabolism (ie Diabetes), and intolerance in select patients because of neuropathy (neurologic dysfunction)  and or myopathy (muscle dysfunction). There are many other pharmaceuticals used and in the pipeline for dylipidemia, but it is always prudent to start with the proper diet, nutrients, and supplements, then work our way into the pharmaceuticals, which we will discuss later. 

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As shown above, fats are absorbed in the gut and made into Chylomicrons, lipoprotein (LP) packages made in the small intestinal lining cells. They then travel in our blood to the liver cells, where other LPs are made, and then to the tissues, where they are used for fat deposition and membrane assembly. The most popular LP is LDL (low density lipoprotein), which contains mostly the lipid Cholesterol. When elevated (ie over 100), this increases the risk of inflammation and atheroscletotic plaque buildup in the artery walls, and resulting coronary artery, cerebrovascular, renal, and preipheral artery disease. Another composition factor that adds to risk is the “small dense LDL” which occurs in diabetes and the Metabolic Syndrome. Think of it in this way: The small dense LDLs get stuck in the arteries’ nooks and crannies, and this leads to more plaque development. So generally, small and dense is bad, and large and fluffy is good. Below is the list of all liproteins:

Chylomicrons (made in gut lining cells)

HDL (High Density Lipoprotein) is the good lipoprotein. Increased amounts of the fluffy large HDL reduce atherosclerotic deposits and risk- again related to amount and composition. HDL transports lipids from the tissues to the liver, for elimination in the bile.

LDL (Low Density Lipoproteins)

VLDL (Very Low Density Lipoprotein) is another important player. It carries mostly Triglycerides, which are also considered atherogenic.

IDL (Intermediate Density Lipoproteins)

Since Diabetes and the Metabolic syndrome are so prevalent in industrialized societies, we will discuss the common forms of dyslipidemia found in these conditions: Diabetic Dyslipidemia (DD), and Familial Combined Hyperlipidemia (FCHL).

DD: Elevated small dense LDL, Elevated VLDL and Triglycerides (TG), Low HDL. These features definitely increase the risk of MIs and Strokes.

FCHL: Elevated VLDL, LDL. Recent literature shows that these patients often have decreased blood Vit D levels and that there are also genetic abnormalities of Androgen Receptor (AR) levels. Perhaps this relates to the Androgen insensitivity, poor libido, and erectile dysfunction (ED) seen in pts with The Metabolic Syndrome and or Diabetes, who also have this condition.

Both have genetic predispositions which are expressed and promoted by stress, poor diet, lack of exercise, excess calorie intake, decreased Pre and Probiotic intake, and deceased O3 fatty acid intake.

Several herbs have shown promise in recent studies by lowering and improving the composition of the LPs discussed above.

For example:

Butea monosperma bark ethanolic extract modulates dyslipidemia in streptozotocin-induced diabetic rats

Blighia sapida methanolic extract at all doses used reduced blood glucose level and prevented oxidative stress and dyslipidemia in alloxan-induced diabetic rats

Mangifera indica bark reported to produce hypoglycemic and antidiabetic activity in an animal model of genetic type 2 diabetes and in streptozotocin diabetic rats.

Newbouldia laevis leaf extract protects against dyslipidemia and hepatorenal dysfunction in diabetic rats.

Cleome gynandra ethanolic extract shown to inhibit blood glucose levels and dyslipidemea in diabetes rats.

As discussed previously, all antioxidants are helpful in reducing the oxidation and harmful effects of bad LPs, and PhytoLife (TM) offers the widest range and highest potency of Polyphenols and Phospholipids (PC) available. See www.drflam.com or www.myphytolife.com to purchase.

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This describes common ways to combat dyslipidemia

Lastly, Vitamin D supplementation (no more than 5000 IU/day), and O3 Fatty Acid intake (4g Fish oil/day) also fight the harmful effects of dyslipidemia.

References:

 

Baila-Rueda, L., Mateo-Gallego, R., Jarauta, E., De Castro-Orós, I., Bea, A.M., Cenarro, A. & Civeira, F. 2014, “Bile acid synthesis precursors in familial combined hyperlipidemia: The oxysterols 24S-hydroxycholesterol and 27-hydroxycholesterol”, Biochemical and biophysical research communications, vol. 446, no. 3, pp. 731-735.

Berge, K., Musa-Veloso, K., Harwood, M., Hoem, N. & Burri, L. 2014, “Krill oil supplementation lowers serum triglycerides without increasing low-density lipoprotein cholesterol in adults with borderline high or high triglyceride levels”, Nutrition Research, vol. 34, no. 2, pp. 126-133.

Catapano, A.L., Farnier, M., Foody, J.M., Toth, P.P., Tomassini, J.E., Brudi, P. & Tershakovec, A.M. 2014, “Combination therapy in dyslipidemia: Where are we now?”, Atherosclerosis, vol. 237, no. 1, pp. 319-335.

Cruz-Bautista, I., Mehta, R., Cabiedes, J., Garci´a-Ulloa, C., Guillen-Pineda, L.E., Almeda-Valde´s, P., Cuevas-Ramos, D. & Aguilar-Salinas, C.A. 2014, “Determinants of VLDL composition and apo B-containing particles in familial combined hyperlipidemia”, Clinica Chimica Acta, vol. 438, pp. 160-165.

Cui, C.-., Li, S. & Li, J.-. 2015, “PCSK9 and its modulation”, Clinica Chimica Acta, vol. 440, pp. 79-86.

De Vries, M.A., Alipour, A., Klop, B., Van De Geijn, G.-.M., Janssen, H.W., Njo, T.L., Van Der Meulen, N., Rietveld, A.P., Liem, A.H., Westerman, E.M., De Herder, W.W. & Castro Cabezas, M. 2015, “Glucose-dependent leukocyte activation in patients with type 2 diabetes mellitus, familial combined hyperlipidemia and healthy controls”, Metabolism: Clinical and Experimental, vol. 64, no. 2, pp. 213-217.

George, M., Selvarajan, S., Muthukumar, R. & Elangovan, S. 2015, “Looking into the crystal ball – Upcoming drugs for dyslipidemia”, Journal of cardiovascular pharmacology and therapeutics, vol. 20, no. 1, pp. 11-20.

Hooper, A.J., Burnett, J.R. & Watts, G.F. 2015, “Contemporary aspects of the biology and therapeutic regulation of the microsomal triglyceride transfer protein”, Circulation research, vol. 116, no. 1, pp. 193-205.

Kandasamy, N. & Ashokkumar, N. 2014, “Renoprotective effect of myricetin restrains dyslipidemia and renal mesangial cell proliferation by the suppression of sterol regulatory element binding proteins in an experimental model of diabetic nephropathy”, European journal of pharmacology, vol. 743, pp. 53-62.

Larsson, M., Caraballo, R., Ericsson, M., Lookene, A., Enquist, P.-., Elofsson, M., Nilsson, S.K. & Olivecrona, G. 2014, “Identification of a small molecule that stabilizes lipoprotein lipase in vitro and lowers triglycerides in vivo”, Biochemical and biophysical research communications, vol. 450, no. 2, pp. 1063-1069.

Lezcano, E.J., Iñigo, P., Larraga, A.M., Barranquero, C., Gimenez, I. & Osada, J. 2014, “Caloric restriction or telmisartan control dyslipidemia and nephropathy in obese diabetic Zücker rats”, Diabetology and Metabolic Syndrome, vol. 6, no. 1.

Miñambres, I., Sánchez-Quesada, J.L., Sánchez-Hernández, J., Rodríguez, J., De Leiva, A. & Pérez, A. 2014, “Vitamin D concentrations in familial combined hyperlipidemia: Effects of lipid lowering treatment”, Diabetology and Metabolic Syndrome, vol. 6, no. 1.

Morley, J.E. 2014, “Cognition and nutrition”, Current opinion in clinical nutrition and metabolic care, vol. 17, no. 1, pp. 1-4.

Oloyede, O.B., Ajiboye, T.O., Abdussalam, A.F. & Adeleye, A.O. 2014, “Blighia sapida leaves halt elevated blood glucose, dyslipidemia and oxidative stress in alloxan-induced diabetic rats”, Journal of ethnopharmacology, vol. 157, pp. 309-319.

Ravichandra, B., Saketh Ram, P., Saritha, C. & Shankaraiah, P. 2014, “Anti diabetic and anti dyslipidemia activities of Cleome gynandra in alloxan induced diabetic rats”, Journal of Pharmacology and Toxicology, vol. 9, no. 1, pp. 55-61.

Saeed, M.A. & Narendran, P. 2014, “Dapagliflozin for the treatment of type 2 diabetes: A review of the literature”, Drug Design, Development and Therapy, vol. 8, pp. 2493-2505.

Salakhutdinov, N.F. & Laev, S.S. 2014, “Triglyceride-lowering agents”, Bioorganic and Medicinal Chemistry, vol. 22, no. 14, pp. 3551-3564.

Skoumas, J., Liontou, C., Chrysohoou, C., Masoura, C., Aznaouridis, K., Pitsavos, C. & Stefanadis, C. 2014, “Statin therapy and risk of diabetes in patients with heterozygous familial hypercholesterolemia or familial combined hyperlipidemia”, Atherosclerosis, vol. 237, no. 1, pp. 140-145.

Vos, M.B. 2014, “Nutrition, nonalcoholic fatty liver disease and the microbiome: Recent progress in the field”, Current opinion in lipidology, vol. 25, no. 1, pp. 61-66.

Zheng, Y., Sun, Q., Chen, K., Yan, W., Pan, C., Lu, J., Dou, J., Lu, Z., Ba, J., Wang, B. & Mu, Y. 2014, “Waist-to-hip ratio, dyslipidemia, glycemic levels, blood pressure and depressive symptoms among diabetic and non-diabetic Chinese women: A cross-sectional study”, PLoS ONE, vol. 9, no. 10.