Welcome, my name's Dr. Warrick Bishop. I'm a cardiologist, an author and a keynote speaker. I'm CEO of the Healthy Heart Network. I'm all about trying to help people live as well as possible for as long as possible. Heart disease is huge in Australia. Every 20 minutes someone suffers a heart attack. Most of these could probably have been avoided if only we knew what to do. This podcast is all about helping you understand. blood pressure, weight, cholesterol, for better health. If you enjoy this podcast, I would be honored for a five-star review. You can share it with your family and friends. It may well save someone you love. Hi, it's Warrick here, and thank you so much for joining me on my podcast and videocast station. As I've said before, I do appreciate it. Thanks for taking your time to let me share with you. something today interesting informative for yourself or someone you care for i've been told to tell you what i'm going to tell you at the beginning tell you what i want to tell you and then remind you what i've told you at the end thank you for that feedback so today i'm going to talk about high density lipoprotein the so-called good guy i'm going to talk about that and cardiovascular risk then i'm going to talk about vitamin d and bone health and I've got a little surprise for you which is a surprise for me probably because I forgot it and was told this years ago in my medical training but I'm going to share it with you because it is interesting and then I'm going to talk about triglycerides. So let's start with HDL. Is HDL still the good cholesterol? Well we've heard for years that it is labeled the good cholesterol and High HDL is good for you. Low HDL is bad for you. Well, is this always true? We do know that HDL helps remove cholesterol from the arteries and transport it back to the liver. That's called reverse cholesterol transport, and that's accurate. And studies have shown that having higher levels of HDL can be protective, but is not always... protective and what we've found actually as you might imagine because the world is just not as simple as sound bites what we've found is that some people have genetically really very high HDL cholesterol and in fact they run an increased risk of heart disease well how does that make sense it turns out that those high HDL levels which some people have are not protective because the HDL is not functional. So what does that mean? You actually need HDL that not only looks good, is about the right level, but it has to do the right thing. It's not just about how much you have, it's about how well it works. And if you've got HDL that doesn't work very well and it's high, it can drive inflammation, obesity, it can be additive to things like smoking and insulin resistance which are all problematic. On top of that we know that you can alter your HDL's function through things like inflammation, obesity, smoking and just really bad lifestyle choices. It is interesting that we've seen some drugs that have been developed to raise HDL, and these of their own have not shown a clear reduction in heart attack. And that's pretty important to understand. So we know some of the early risk data was looking at total cholesterol to HDL ratios, and this was a reasonably robust predictor, and that was for the vast majority of people. So yes, for the vast majority of people, good HDL levels. are a good sign, but it doesn't always hold. It's nice to be reminded that things can be a little bit more complicated than that. We do touch on that on our most recent book, Cholesterol Explained. Karam Kostner, my friend who I've written the book with, has put a few words in there exactly around this. So keep an eye out for that book if you're interested in understanding more about cholesterol. Cholesterol Explained will be out. Probably June, July of 2025. So do check it out. We think it's going to be a great way to educate people around some of the myths and some of the fiction surrounding cholesterol, statins and cardiovascular disease. Let's talk about vitamin D and does it really build bone? So people will take vitamin D regularly. thinking it strengthens their bones and there's a lot of truth in that because we know if you don't have vitamin D you get weak bones in children. That's called rickets. In adults that's called osteomalacia. But here's the bit that I didn't know. Vitamin D doesn't actually work at the coalface of bone formation. It doesn't actually build the bone. What it does is it makes sure that the building blocks for bone formation are available when the osteoblasts, which are the cells that do all the work at the coalface of bone formation, need calcium. So vitamin D is there to help the gut absorb calcium properly and doesn't necessarily have a role in bone mineralization directly other than supporting it through making sure calcium levels are right interestingly vitamin d probably is involved in maintaining blood calcium levels which is really important has to keep in a really tight range and so ironically vitamin d is required to make sure the calcium is there to build the bone but vitamin d is probably involved in removing calcium from the bone to maintain calcium levels in the bloodstream if those levels have gone down so we know that it's not that simple as well we know that there is an interplay between vitamin d magnesium vitamin k2 and all these things really come together this podcast is Certainly not the forum for going into the depth of that. But vitamin D critical for healthy bones, but not immediately involved at the coalface, but essential to make sure that calcium is absorbed from the gut and delivered to where it's needed. Don't forget the bit about vitamin D and sunlight and all those other things. Again, a little bit too much for the depth of this particular podcast today. Last thing I wanted to touch on was triglycerides now. I don't know if you know what they are, but they're often overlooked. They're compared to cholesterol, but they're not quite the same. They can actually tell us quite a lot. They are the most significant fat transport within the body and get fat out. to the periphery for storage and bring fat back for utilization for energy and they go up particularly if you consume carbohydrates who would have thought so if you eat sugar your body turns that into fat now we can't immediately grab that but think about it if you eat sugar which is relatively low in terms of energy density, the body turns that into fat which is very high in energy density so that it can store it more effectively. Because if we stored all our energy as sugar, carbohydrate, we'd be several times bigger than we are now. So we turn it into fat so that we can carry it around. Very efficient energy store is fat. The other things that push up carbohydrate, well carbohydrates, sorry, other things that push up triglycerides are carbohydrates which include sugar and alcohol. And the liver converts these calories into triglycerides and packages them up which is really super neat. If your triglycerides are high, it's usually a marker of metabolic dysfunction. That sort of means that your diet's not right, you've got some insulin resistance, you may be at risk of fatty liver, you might be at risk of prediabetes. Often this is genetically driven and often it points to poor dietary choices, poor lifestyle choices and not a lot of exercise. If we see that sort of picture, that pre-diabetic picture, then those high triglycerides are often seen with low HDL levels. So this metabolic process can reduce HDL levels. And if you do have good functioning HDL, remember the first bit that we were talking about was HDL and its function. If you've got good functioning HDL and you push it down, you're going to reduce its benefit. Raised triglycerides is also associated with a change in the... bad cholesterol particle size the so-called ldl or bad particle goes from a large fluffy less concerning particle to a small dense particle which we think has a greater chance of being mischievous within the arteries high triglycerides associated with fatty liver together with weight gain and even obesity and raised insulin levels, which we think tie in with inflammation. So keep an eye on those triglycerides when you get your bloods done. Check with your doctor where they are. Understand that if you've been consuming alcohol, if you've been consuming carbohydrate, including sugar, they are likely to be up. So they're a little bit of a canary in the mineshaft and they give you a clue as to metabolic. wellness of that individual uh reducing carbs reducing alcohol and exercise can have a dramatic impact on triglycerides and adding in an omega-3 fish oil if required can also do it as well so in summing up again feedback from one of you wonderful listeners what i've told you about is hdl the so-called good cholesterol is good if it's good functioning cholesterol we well Good functioning particles, I should make that distinction. HDL particles are helpful if they function well. Not all of them do. Be aware, so that can be a false reassurance if your HDL is high. Vitamin D, essential for healthy bones, but not actually working in the process to build bone. working to make sure that the calcium is present and the bone building is enabled. Triglycerides, an excellent canary in the mineshaft indicating what's going on in the body. Is there metabolic upset? Is there problems in that individual? For now, I'm going to wrap up. Do keep an eye out for Cholesterol Explained. That is either out now or will be out in the middle of 2025, somewhere around there. We do cover some of those points in a bit more detail. And if you found this interesting, you'll certainly find Cholesterol Explained interesting. It's been a pleasure writing it with Karim Kostner and my co-writer Penny. We've been going back and forth, to be honest. It's been exhausting just in recent time. And as I do this podcast, we are so close to a final, final draft. Anyway, I'm going to wrap it up there. I am going to wish you the best. I do hope you live as well as possible for as long as possible. Again, thank you so much for tuning in. And till next time, take care and bye for now. Join the Healthy Heart Network and become part of our growing community. If you're interested in your heart health and risk of heart attack, then join the Healthy Heart Network for only $5 as a lifetime member. 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