Remnant Cholesterol Part 2: Obesity and Insulin Resistance
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Remnant Cholesterol Part 2: Obesity and Insulin Resistance

October 28, 2019

recently I did a video on remnant
cholesterol it was supposed to be a definition meaning and explanation but I
kept it to 90 seconds so really all you got was sort of a definition remnant
cholesterol is the cholesterol that includes all of the triglycerides so
we’re going to talk about that and give a little bit deeper discussion because
remnant cholesterol has been getting bad rap recently and I think it may be
deserved coming up so okay let’s take a look at remnant
cholesterol you just take your to find out what your remnant cholesterol is you
take your HDL and your LDL and you take that out of your total cholesterol then
you count everything else IDL which is well let’s go back and remember the
names HDL is high density lipoprotein LDL is low density lipoprotein IDL
intermediate density lipoprotein VLDL very low density lipoprotein and
chylomicrons which are again all of these big ones have these big fluffy
ones have a lot more triglyceride in them when you look at the density of
these lipoproteins the you’re looking at APOA and APOB APOA is in the HDL
it’s the high density lipoproteins and what does APOA and APOB APO just
means the protein section so the protein that holds these tiny fat globules or
all globules together it’s the APOA protein for HDL you have one protein and
and it’s called APOB for LDL VLDL IDL chylomicrons you tend to get APOB and by the way LP little a is a variation of this APOB it’s a
variation of L of LDL so again back to this point if you want to calculate your
remnant cholesterol just calculate those by taking your total cholesterol and
subtracting your HDL and LDL now wait a minute real quick l density lipoproteins
what is this almost all about just a reminder if you put what oil in water it
doesn’t mix right those globules would form a and what we call an embolus a big
ball if we had that in our bloodstream and in fact that happens when you get
major trauma like multiple broken bones and even some surgery
that’s called a fat embolism and it can kill you so how does
the body keep that from happening proteins APOA and APOB so the body
puts this APOA and APOB in our GI gastrointestinal and blood system and it
takes these these masses of fats and oils and takes them into microscopic
particles that will not cause a nimble ISM so just a brief mention from Brad
and Amy this is some of Brad Bale’s old work he had a family member do some
cartoons for it but that’s a side issue Pardon the digression here’s the point
as Brad’s saying here LDL why do I get all the attention very very a good point
LP little a or lipo a is a big big deal a mass-murderer many people would call
it that these other ones are even bigger issues maybe remnant cholesterol VLDL
ideal and triglycerides so let’s go back and again that’s what we’re looking at
the LDL cholesterol test basically remnant cholesterol if you want to hear
it from somebody else just go to Wikipedia it’s very simple it’s always
there now here’s one of the key things to remember about remnant cholesterol
this is a graph showing BMI versus fraction of remnant cholesterol and what
you see here is there’s a good linear pattern meaning the heavier you are the
more likely you are to have higher remnant cholesterol so here’s a remnant
cholesterol down less than 19 maybe 15 for somebody with BMI in the 18 to 19
rate just range this black would excuse me the red one is a BMI greater than 30
and they’ve got rim that cholesterol is way over 19 so obesity is one one thing
for sure but here’s the bigger issue what really causes increased ugh
Lestrade well you can have unusual genetic problems hypertriglyceridemia
and we’ve done videos on that but what’s the most common problem insulin
resistance insulin resistance not knocks that triglyceride right up that’s in
fact one of the things that we look for the first thing I look for on a on a
cholesterol test triglyceride over HDL because when you’ve had insulin pouring
out like you do with insulin resistance that insulin stops the triglyceride
burning so you get more and more triglycerides in addition it burns up
HDL so again that’s just a little bit about remnant cholesterol obesity
genetics and most importantly our old nemesis insulin resistance thank you so
much for your interest my name is Ford Brewer I started off as
an ER doc I became very frustrated with the fact that most
things that bring people into the ER were preventable like heart attack and
stroke I went to John Hopkins to get training and ended up running the
program there in prevention there I trained dozens of docs and again that
was three decades ago since then I’ve trained thousands of docs and even more
importantly supervised those docs and even most importantly helped thousands
of patients prevent things like heart attack and stroke
waiting for it for the disease and hoping for a cure for this kind of
devastation doesn’t work come to Louisville on November 8th and 9th we
have a boot camp type of environment for two days where you learn all the things
that you didn’t learn from your doc in terms of heart attack stroke prevention
things like cardiovascular inflammation how to detect it how to measure things
like insulin resistance the number one cause of inflammation how to detect it
how to measure it how to stop it how to manage it you also get you can get the
labs there for that event if you’d like and get a complete evaluation in
addition you get an arterial scan called a CIMT to get the right one of those is
fairly difficult so I’m looking forward to seeing you there Thanks

Only registered users can comment.

  1. thanks for explaining in detail about latest and important subject's witch other's wouldn't touch. thank you good doctor. regards from IRAN .

  2. Dave Feldman talked about remnant cholesterol. He said that the lower the number the better and that people on low carb diets tend to have lower remnant cholesterol. You are the first MD that I know of who has mentioned it. Thank you for confirming the significance of remnant cholesterol.

  3. Nice brief explanation of a rather complex subject Dr. Brewer! At some point, I hope that you will discuss the differences between HDL & LDL. Specifically why LDL is preferencially transported across the arterial wall & deposited as Plaque. Especially since it is a much larger molecule than HDL. Does "Density" mean that the molecule is heavier in weight? If so, what would make a smaller sized molecule like HDL weigh more than the larger LDL molecule? Just trying to understand these relationships. Anyway, great video & thanks for your time……………

  4. You are still leaving out leaky gut and fat metabolism. Any easy way to determine is go on a low saturated fat, vegetarian diet and then retest cholesterol. If remnant cholesterol drops dramatically, it was likely caused by either leaky gut and/or saturated fat metabolism.

    Another potential problem is that labs show values for LDL and VLDL. Where is IDL? Dr Davis posted that it is "included in LDL". If correct, might it mean that an increase in LDL is caused by an increase in IDL. It might also mean that the formula Total cholesterol – HDL – LDL = Remnant Cholesterol would not be accurate as some LDL is actually IDL. If IDL is included in VLDL, then the formula works. I think there is also the possibility that chylomicron remnants are hanging around, in some case, much longer than a few minutes.

    Something I am concerned about, but haven't found it addressed anywhere is that chylomicrons (and remnants), VLDL, IDL, and LDL all use LDL receptors on the liver for removal. Can these receptors be overloaded? What happens when there are not enough receptors?

    This point is just speculation, but I believe the liver does cleanup based on a circadian clock. I had a mysterious blood pressure problem where my BP would start spiking late in the day, peak around 1 am, and then slowly come back down again. My theory is that around 1 am, the liver begins a cleanup cycle where continuously circulating remnants are removed from the blood system. I found a web site on Chinese medicine that showed the liver being activated at 1 am, which might be supportive of my theory.

    Unfortunately, when looking for info on remnant cholesterol, one can easily find yourself in a circle of a few guys quoting each other. Here's a few scientific papers:
    . Genetically elevated non-fasting triglycerides and calculated remnant cholesterol as causal risk factors for myocardial infarction
    . Increased Remnant Cholesterol Explains part of residual Risk of All-Cause Mortality in 5414 patients with Ischemic heart Disease
    . Triglyceride-Rich Lipoproteins and Atherosclerotic Cardiovascular Disease.

  5. My TG/HDL ratio is consistently near 1.0. Latest is 50/48=1.04. How likely is it the I have significant insulin resistance?

    My BMI is 20, the the ratio was similar at a higher BMI of 23. Since I have a low BMI, I would think the my TG/HDL ratio should be lower.

  6. Sometimes I feel fear when I hear things that might apply to me. But data is the only game in town. I’ll make a list, pay for some tests, and pick the best course of action. 57 age, BMI 24, triglycerides is my enemy. Need to do the HOMEWORK, I mean bloodwork.

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