Cholesterol 101

As you know, I’m always trying to stress the importance of “owning your health.” It can be an abstract concept at face value.

So today, I’m focusing on what “owning your health” might look like when you're preparing for your annual physical, particularly when it comes to thinking about understanding your cholesterol panel.

In the past, when it came to running standard labs … I didn’t question the doctor at all. Blood was drawn; results came in. The doctor called to say everything looked good. I couldn't even tell you what the labs were measuring, and I just continued on in my usual way.

I certainly wasn’t owning it.

So then the past few years when that call came in, the doctor would say… your cholesterol is creeping up. And I would ask, “what should I do about it?” And he would respond: “just eat healthy and exercise.”

And I would think … Ok … I’m pretty much doing that … but the following year I would still be in the same boat. Cholesterol continuing to creep up.

It wasn’t until I went to another doctor who ordered a more comprehensive cholesterol test called a particle size test (Cardio IQ through Quest Labs or NMR Lipid Panel through LabCorp) that I was able to put a plan in place that finally got my cholesterol going in the right direction.

These tests are rarely ordered by doctors, but they should be open to doing so if you request it. You’ll find that this particle test will give you a more complete picture of what is going on in your body, including detecting inflammation levels.

So here’s a little Cholesterol 101. Just enough to get you to ask the right questions.

First, cholesterol isn’t only a bad thing; it’s a good thing too. Our bodies manufacture cholesterol in the liver - and it’s essential to enabling our body to function properly. Cholesterol is crucial for making cell walls, tissues, hormones, and Vitamin D. Our liver uses cholesterol to make bile acids to enable the process of digesting fat in the food we eat.

The standard cholesterol panel gives us our LDL, HDL and Triglyceride levels.

And for those of you that always have a hard time remembering what each of these are, maybe this will help.

LDL or Low-Density Lipoprotein - it’s LOUSY! A friend of mine changed my life when she described it this way; I finally can remember which is the bad cholesterol and which is the good.

So LDL, our bad cholesterol, carries cholesterol directly to our arteries, and can lead to plaque build up in our veins.

HDL or High-Density Lipoprotein is our HAPPY cholesterol. It is the happy helper that travels through our bloodstream, collecting cholesterol and carrying it back to the liver, where the body can get rid of it.

The TRIGLYCERIDES are essentially unused calories that are stored as fat in the blood. These can build up from consuming fatty food, refined carbohydrates, essentially foods high in simple sugars and alcohol.

So here’s the rub.

There’s new learning in the field indicating that our standard cholesterol tests are a bit antiquated and don’t tell us the full story.

Certainly knowing these key numbers (LDL,HDL and Triglycerides) is helpful and can give us some insight into our heart health … but understanding the particle size/weight of that cholesterol is important.

Dr. Elizabeth Boham, a Functional Medicine Doctor, explains it well through the visualization of dirt and dump trucks.

Think of cholesterol as the dirt, and the dump trucks as the vehicles (particles) that carry the dirt (cholesterol) around our body. It’s not just about the amount of dirt that we have in our body (total cholesterol); it’s also about the amount of dump trucks that we have carrying around that dirt. And the size of our dump truck matters.

Are you following? Keep your toddler hat on and we’ll keep going. Would you rather have a small dump truck or a big dump truck?

Easy answer! BIG!

So here’s the epiphany: If you have too many small dump trucks carrying around your dirt, this is concerning since the smaller dump trucks can more easily nestle into your artery linings and cause plaque build up.

If you have more large dump trucks - that’s good. They are big enough that they keep moving through your system, and don’t tend to hide or get trapped.

Dr. Mark Hyman, another functional practitioner, also uses the analogy of golf balls and beach balls when talking cholesterol particle size. The small golf balls can more easily lodge into the artery wall. The beach balls, however, are large and fluffy, and keep moving along without creating damage.

So this is where this knowledge can come into play. You get your lab results back and your total cholesterol is 150. On paper that’s a good result. No worries there.

But if you have requested a test which identifies particle size, you may get a result that your LDL, even though seemingly “normal," contains a very high level of small particles - too many small dump trucks.

You can see now that you may get quite a different story when you look at this more comprehensive particle test.

If that’s the case, the good news is that you’re now in the driver seat and can figure out what to do with that information, starting with a conversation with your doctor.

Don’t think of it as scary; think of it as empowering.

Another bit of wisdom. When you get your standard cholesterol panel, you can take it one step further by calculating your Triglyceride to HDL ratio.

This ratio has the strongest association with cardiovascular disease, more so than any other lipid marker. In fact, this ratio is five times more predictive of heart attack risk than looking at your total LDL.

A ratio level that is out of range (above 4:1) can indicate diabetes and insulin resistance. It also indicates that you most likely have a lot of little dump trucks.

Optimally you want this ratio to be lower than 2.5:1 (source: Levels Health Panel).

If the ratio is low, it indicates that you have good insulin sensitivity, which means that your insulin is doing its job of moving glucose into your cells. This lower ratio also indicates that you have large and fluffy LDL - the big dump trucks - and therefore you’re less prone to coronary disease.

The beloved Tim Russert can help demonstrate this example further. Tim Russert was an accomplished journalist who died from an untimely heart attack a few years ago.

If you look at his numbers, his total cholesterol was normal. His LDL cholesterol was normal. His protective HDL cholesterol was low (32) and his triglycerides were very high (300). If you take his triglyceride to HDL ratio, it was 9.4:1 - putting him in a high risk category for cardiovascular disease. Just before his heart attack, he had passed his stress test. At the time, this level of understanding these panels and associated ratios were not available.

So what behavior changes can you make if you find that your numbers are not where you want them to be?

Well, your lifestyle choices probably matter the most. While genetics can play a role with your cholesterol, more than anything, it's our lifestyle factors that contribute to the size of LDL particles.

And it’s the standard culprits - starch and sugar - that wreak the most havoc on our systems. Limiting refined carbohydrates, anything with sugar, and alcohol can make a big difference.

So, what to do?

First, go into your doctor’s visit with a plan. Ask for a more comprehensive cholesterol particle test. The results will tell you whether all is good, or you need to dial down and come up with a tighter plan.

Look up your last cholesterol panel. Calculate your triglyceride to HDL ratio. If it’s not in the optimal range, make a plan.

I hope this small tutorial sheds some light on how you can better understand and manage your cholesterol. And remember, we all want BIG dump trucks!

As always, feel free to reach out with any questions or comments.