Beyond Cholesterol Numbers: Heart & Blood Sugar Health Ep 93

Every endurance athlete remembers the moment when things finally click. Your swim feels smoother, your pacing makes sense, your fueling works, and suddenly the sport feels not only easier, but more fun. And for many athletes, that moment happens at training camp. That's exactly why we created the Endurance Edge Triathlon Training Camp happening April 22nd through 26th at Lake Jocassee in South Carolina. For 4 incredible days, you'll train in a small group with expert coaches, sports nutrition support, and sports psychology guidance, all designed to help you train smarter, race stronger, and finally connect the dots in your performance. We swim in crystal clear mountain water, ride beautiful and challenging roads, run scenic trails, and spend the rest of the time recovering, learning, laughing, and eating some seriously amazing chef-prepared food. Mm-hmm. Camp is intentionally small, just 20 athletes, so you get real coaching, true connection, and amazing breakthroughs. So if you want an experience that can transform your entire season, we invite you to join us. Head to theenduranceedge.com and click training camp and reserve your spot with just a $100 deposit. Come train hard, learn a ton, and leave stronger than you ever imagined. I'll see you there. Hey y'all, and welcome back to the Find Your Edge podcast. My name is Coach Christina Fiumara Newport, and I am excited you are here. So today's podcast topic, which is uncovering cardiometabolic health, what many people may be missing, is inspired by one of our athletes who recently reached out to me and said, hey, my cholesterol numbers are high, What should I do about it? And that inspired one of our calls in our Longevity Nutrition Coaching program. We have regular weekly accountability calls, a discussion about our metrics, but more importantly, not only cardio metabolic health, but trends and nutrition factors, lifestyle factors, and genetics. How do all those pieces come together and what are the things that we need to be concerned about? Rather than dialing in on very specific numbers but taking into account the bigger picture. So I'm going to talk through some of those things today. So let's dig in a little bit, starting off with a bit of a startling fact. Did you know that fewer than 12% of Americans are quote-unquote metabolically healthy? Even people who are considered normal weight. So what is cardiometabolic health? It's more than just heart health. It's your metabolic function, blood sugar control, your lipid levels, inflammation, and more. So conditions like hypertension or high blood pressure, insulin resistance, or something like PCOS, and that visceral belly fat often cluster together, and this is referred to as metabolic syndrome. So some of these risk factors exist on a spectrum and aren't necessarily like a check the box or a yes or no diagnosis. So first of all, I want to talk about the role of lipids or fats and how LDL, as many of you may think of it, is not the whole story. So cholesterol, what y'all may think of as getting your cholesterol checked, which is great, not encouraging you to stop doing that, but consider that you're looking at part of the story. So oftentimes if you go in for your regular checkup, which is awesome, continue doing that please, you're going to get your total cholesterol, your LDL or low-density lipoprotein, your HDL or high-density lipoprotein, and more than likely your triglycerides. So triglycerides are one of the things that typically rise after you've had a meal, which is why it's important for you to do them fasting. So what we want to be thinking about, because oftentimes HDL, we coin those as good cholesterol, and LDL is bad cholesterol. I really don't like that characterization. What we want to be more concerned about are those small, dense LDL particles. They're more dangerous than the big sort of like fluffy ones. I think of them as like big dopey cotton balls just sort of floating around your arteries. What we want to be thinking more about are the VLDLs, or very low density lipoproteins. So dividing them up into shapes and sizes. And one way that you can do that is with what's called an NMR lipid panel, which includes those different particle sizes, especially the, those VLDLs that can sort of pick off plaques. That's what we want to be considering. But also consider that there's a test called ApoB, which gives a clearer picture of your heart disease risk more than just LDL or total cholesterol alone. So ApoB measures the number of cholesterol-carrying particles in your blood that can contribute to plaque buildup in your arteries. This includes LDL, VLDL, like I just mentioned, IDL, and Lp(a), all of which are linked to increased risk of heart disease. ApoB provides a more accurate picture of cardiovascular risk than LDL, or what you might see as LDL-C, alone. Even if your LDL-C appears normal, a high ApoB level may still indicate a higher risk for heart disease. So this is particularly important for people with high triglycerides, potentially with diabetes, obesity, or metabolic syndrome. So most people can benefit from ApoB testing, but it's certainly a valuable addition to anyone with a routine cholesterol panel or has a family history of any sort of heart disease, or as we look at it in the Longevity Nutrition Coaching program, what are your cholesterol genetics? Do we need to be concerned about it? Because ApoB gives us a clear understanding of your heart disease risk rather than just honing in on, oh, my total cholesterol is high or my LDLs are high. ApoB is going to be more effective in determining what a potential treatment plan is, or nutrition and lifestyle factors. Another thing that I had mentioned in there was Lp(a). So Lp(a) is a type of LDL with an extra protein called apolipoprotein A attached. It can build up in arteries and is a strong risk factor for heart disease independent of other cholesterol markers. So since Lp(a) is similar in size to other fats in the blood, it needs a special test to measure it accurately. So again, like we talked about with the traditional cholesterol tests— your total cholesterol, your LDL, your HDL, your triglycerides— again, totally fine, but it doesn't explain all the heart disease risk. Lp(a) is one of the lesser-known risk factors that can better predict who's at risk for those problems. So Lp(a) not only contributes to plaque buildup in the arteries— so as you may know, atherosclerosis— but it can interfere with your body's ability to break down blood clots. Its structure mimics a natural clot-dissolving protein, blocking its action and potentially increasing clot risk even if plaque isn't present. So high Lp(a) levels are again mostly genetic, which is why it's nice to see we have a specific cholesterol module in our Longevity Nutrition Coaching program that lists all this out. And lists out all of the different genetic SNPs and alleles that you might have. That way you can take yours, compare it to what's in the module, and then sift out what you don't need and focus on the things that you do need. So high LPL levels are again one of those things that is genetic, so we may be able to see that. You can get it tested, and some treatments like niacin, which is vitamin B3, may help lower LPL in certain people. And the benefit of that is it's often cheap, although there are pharmaceuticals that do that too. So anyway, that's at least part of the picture. Other things that we often encourage people— again, depends on your genetics, depends on your family history— but things that might be important to potentially measure are your hs-CRP, or high sensitivity C-reactive protein, homocysteine. Again, that's got a massive genetic component, and again, we see that in the genetic testing that we do. B12, Same thing, massive genetic component and folate as well. Little pro tip there, if you are on B vitamins or like I just mentioned, B12 and folate, and you get your blood drawn and you've had your supplements 2 or 3 days before you get your draw, it may throw you a higher number. So it may behoove you to be off of those for a few days so that you get quote unquote a clean number that's not offset by any additional supplements. Anyhow, other things that you may want to consider, again, big picture: vitamin D. And like we had talked about in terms of metabolic syndrome, looking at what's your fasting insulin, what's your hemoglobin A1c, because high sugar and carb diets can also contribute to high cholesterol. Again, a lot of this is genetic, so staying on top of your blood glucose is really important. So let me give you an example of a client who came to us normal weight. She is menopausal, and her fasting blood sugar is consistently in the 80s. So very well controlled on paper with her fasting blood sugar, but then goes and gets her A1C, and it's getting close to 6, which tells me— A1C is almost like an average of what your blood sugar has been for roughly the last 3 months. So that tells me what's going on with the rest of the day. What's going on with what is the glycemic potential load of some of those meals? Where is she incorporating exercise or movement? Where is the issue with her blood sugar going a little higher, and how can we mitigate that with better carbohydrate timing, with better meal timing, with better movement timing? So all of these things are really important when it comes to cardiometabolic health. So consider that it's not just the heart that these things are impacting, but it can potentially impact whole body systems. Cardiometabolic disorders increase the risk for dementia, especially if you have an APOE4 SNP. So that's one of the things that we look at in our genetic testing and then give you an entire plan, including a meal plan on what do we do about that from a dietary perspective so that we can help prevent that. Similarly, depression and anxiety, there's an increased risk for that. PCOS, infertility, and any pregnancy complications. So we definitely want to stay on top of those things. So these are system— potential system-wide imbalances, and it's not fully about diet and exercise, but again, what's going on in terms of stress, what's going on in terms of toxic exposure, potential infections, et cetera. So another thing to consider is something called metabolic flexibility. So our ancestors adapted to periods of fasting and feasting, and today we're kind of always on, always having the opportunity for food being right around the corner or in the kitchen or DoorDash or whatever, and rarely allowing ourselves to recover, if you will. So metabolism is a bit like a spring, and then once it gets stretched, it's hard for it to come back, but still definitely possible. So insulin resistance is related to this metabolic flexibility, or lack thereof, and it can start years before your blood sugar starts to rise. So again, one of those things to keep an eye on— your insulin, to keep an eye on your A1C, and certainly your fasting blood sugar. This is where oftentimes I'm having patients use continuous glucose monitors, or CGMs, if they are in a position with which they're able to come into it with a lens of curiosity and be able to understand and be curious about what their body is doing and what foods they're eating. They might find that quote-unquote healthy foods will raise their blood sugar, and there's bigger context in terms of stress, in terms of exercise that we want to look at. So I feel like it's a really good fit for certain patients, but also may not be the quite right fit for someone depending on where they are in their life. Anyhow, early signs of that insulin resistance or that metabolic inflexibility are things like increasing belly fat, increasing levels of fatigue, and again, higher fasting insulin, even with a normal blood sugar. All right, so things to keep an eye on there. So quick little reality check. The American Heart Association created something called Life's Essential 8, which I think is a, is a beautiful little picture of the 8 things that we need to do in terms of managing cardiovascular metabolic health. Less than 1% of Americans meet all 8 markers of optimal heart health. I hope some of the— I hope that some of you guys out there— but if it's not, this is our special announcement. It's time to start taking care of your body. So I will link to it, but I want to make sure that you guys are aware of these because I just think they made this lovely wheel called Life's Essential 8. So those 8 include eating better. And of course, we dig in in our Longevity Nutrition Coaching program into what exactly does that mean and what does that mean for you specifically and your genes, and also digging into some psychological aspects as well. Number 2, being more active. I'm going to assume that most of you are active out there because we've got a lot of triathletes and runners and people who are fitness enthusiasts. So do not stop that, right? So definitely be more active. It's really essential, and not just exercise, but also something called ADLs or activities of daily living. So right now I happen to be sitting at my desk. I definitely need to finish this podcast and get up and move around because I know I've been sedentary for certainly the last hour or so. So being more active, not just in your exercise, but also in those activities of daily living. Quit tobacco, any type, any form. Get healthy sleep. I feel like that's a bit of a bad word or maybe something that feels a little bit uncomfortable, especially to you out there who are listening who are likely high performers or are likely really getting at it and have a lot of things to do, a lot on your plate. So getting healthy sleep is really key and critical there. Managing your weight. So that's a piece of the puzzle. Controlling your cholesterol. As we were discussing, it's not just about your total cholesterol, your VLDL, HDL, and triglycerides, although that is important. But what's the bigger picture? What's the ApoB? What's the Lp(a)? And what are those different particle sizes? Managing your blood sugar, and again, not just your fasting blood sugar, but what's going on throughout the rest of the day. What does your A1C look like? What does your insulin look like too? And then managing blood pressure, and some of those are genetic as well. So I wanted to make sure that you guys knew those life's essential 8 from the American Heart Association. And lastly, I want to make sure to touch on it because there are certainly social and environmental factors that go into cardiometabolic health too. Things like access to healthy food, being in a safe neighborhood, and having access to healthcare all impact your metabolic health. And certainly the pandemic amplified those issues and showed us how our social connections are certainly implicated in our cardiometabolic health too, especially with our immunity, with inflammation, et cetera. So while we can't always control our genetics, we can control our nutrition, our lifestyle, and environment. We can also assess what our body is doing, what's happening on the inside, so that we can better pivot or better adjust those nutrition, lifestyle, and environmental factors to take care of ourselves as best as we possibly can. So small changes, remember, those are also massive changes. So if you're thinking, oh my gosh, how do I eat better? Or how do I get more sleep when I have I've got small children and I've got a really demanding job. It's okay. There are small things that you can do that lead to better health outcomes. Are there things like maybe going to bed 5 minutes earlier? Are there things like, I can definitely get my supplements every single day. I can get my water in. I can make sure I have protein at every meal. There are little things that matter. That are going to help you in whatever stage of life you are in. If you wanna know where you fall on the spectrum of cardiometabolic health, you can dig more into this with your genetics, with science, with psychology, and our Longevity Nutrition Coaching Program, where we help you to track key biomarkers, explore your genetics so that you can make proactive choices in your lifestyle, health, and environment, and create that tailored plan for your metabolism, for your goals, for your lifestyle. So let us help you build a stronger, more resilient metabolism for life. And in fact, little side note there, you do get 20% off of metabolic testing as part of being our longevity nutrition coaching. So if you wanna get your RMR tested, if you wanna get your VO2 max tested and actually see what type of substrate you're using, carbs, fat, et cetera, both at rest and during exercise, that's a great opportunity to do it. So you can find more information about that at theenduranceedge.com/longevity. So again, that's theenduranceedge.com/longevity. So hopefully this was helpful to give you a bigger picture of what cardiometabolic health is and how it's important to not just hone in on one or two particular markers, but taking into account the whole picture. Also what's going on with your nutrition, what's going on with your sleep, what's going on with the social aspect of your life so that we can best help you live a more vibrant, active life. So thank you again for listening, and I will catch you next time.

Thanks for listening to the Find Your Edge podcast. If you like what you heard, don't forget to subscribe on your favorite podcast platform so you never miss an episode. And if you're interested in learning more about our endurance coaching, sports and wellness nutrition, metabolic and sweat testing, triathlon training team, or our triathlon training library, be sure to check us out at the Endurance and don't forget to follow us on social media at The Endurance Edge. Thanks again. And we'll catch you next time.