Biography
Biography: Robert Buist
Abstract
For the last 50 years we have been advised to lower fat intake and reduce blood cholesterol. The commercial strategies we have used to try to make these changes have had little impact on the incidence of heart disease. They have, however, resulted in a massive increase in low fat-high sugar products on supermarket shelves with an accompanying world–wide increase in obesity, metabolic syndrome, NAFLD and diabetes. Glycation, oxidation and inflammation are the new risk factors.
Could we change these risk factors through dietary and supplemental control? New dietary advice should emphasize whole, seasonal, high fibre, unprocessed food. We need to place particular emphasis on understanding the effects of sugar in the diet and totally rethink our approach to dietary fat/oil consumption.
Evidence indicates that “cholesterol” per se is not the problem. We are learning that the normal lipoprotein pathology tests are insufficient and that we need data on the lipoprotein subclasses. For example large “buoyant” LDLs are associated with lower CAD risk and small “dense” LDLs are associated with increased CAD risk.
Such new markers of cardiovascular risk are now being looked at with great interest. They include LDL fractionation, number of LDL particles, functional HDL, ApoB:ApoA ratio and triglyceride/HDL ratio. A high triglyceride /HDL ratio can predict a large number of small dense LDL particles whereas lower ratios are associated with large fluffy (buoyant) LDLs. These new markers and ratios should give valuable insight into the standard lipid panel of LDL-C, HDL-C and triglycerides.