What do my Cholesterol numbers REALLY mean?
The short answer to the above question is NOTHING when these numbers are taken out of context, which is what most commonly happens. Cholesterol has really gotten a bad rap. Almost to the point where we want to remove it completely, but cholesterol is not a bad thing or dirty word.
What is cholesterol. Cholesterol is a collection of fatty acids attached to a glycerol (a simple sugar alcohol for you chemistry buffs) backbone. In essence it’s an alcohol and a fat but is classified as a lipid due to what it does in your body. Most of your cholesterol is made by the liver with only 5-7% being obtained by diet. So, next time you read about low fat diets do your health a favor and flip the page. Now would be a good time to touch on the good fat/bad fat issue. Most natural fats such as olive oil, flax seed, coconut oil, and fish oil are good for you in proper balance. Where we get in trouble is with the manufactured or processed oils. These oils become oxidized and thus become harmful to our bodies and they are usually labeled trans fats.
So, what does cholesterol do?
Cholesterol does many necessary things in our body. In fact, it is essential for life. Cholesterol makes up our sex hormones such as DHEA, testosterone, and estrogen. It is a precursor to the synthesis of bile salts. Bile salts are important in the break down and absorption of fatty nutrients like Vitamin A, D, E, K and CoQ10. Without proper bile salts we become malnourished and often gassy or bloated after meals.
Cholesterol is present in almost every cell in the body and is an important part of the cell membrane of each cell. These membranes are what allows substances to flow in an out of the cell at a regulated rate.
Cholesterol helps to create vitamin D and is a component of the myelin sheath that is the covering around all our nerves.
“Lower serum cholesterol level was associated with worse cognitive function in the community sample.”1
Low cholesterol has even been associated with premature cognitive (memory) decline. Since cholesterol is absolutely essential for life, why do we go through so much trouble to lower it?
Like most things the cholesterol-lowering pandemic is driven largely by money. According to Forbes Magazine, statin medications are the most widely prescribed drug in history with annual sales of $26 billion. Pfizer alone spends $3 billion a year just on ads to convince us that we NEED statins. With such a high volume of these drugs being use by patients they must be doing a great job, right?? Well, unfortunately heart disease, the very reason these statins are being prescribed, is the leading cause of the death in the United States. Every 34 seconds someone has a heart attack. We are clearly missing the boat with these patients.
The following is a quote from the longest running heart study currently, the Framingham Study:
“…the majority of individuals who develop coronary events are not in a high-risk group according to the Framingham risk assessment of traditional risk factors for coronary heart disease (CHD), and because one half of those who suffer myocardial infarctions have normal lipid values, measurement of inflammatory markers has been suggested as an adjunct to lipid testing to better identify individuals at increased risk.”
If total amount of cholesterol doesn’t matter and statins clearly are not reducing the number of cardiac events, then what is the problem and what do we look for? As stated above when cholesterol numbers are taken out of context it may become hazardous to your health. We can begin to see that lowering cholesterol is just playing with numbers and may not have any real relationship to reducing cardiac events.
” …In elderly females a low cholesterol values (<155mg/dl) increased death rates by 5.2x when compare to females with high cholesterol of 272mg/dl”5
The following are values you will receive when ordering a lipid fractionation panel (more specifically the VAP test). Let’s go through them one by in hopes to clarify the entire cholesterol picture. Keep in mind these values must also be compared to patient’s current sugar status, thyroid dysfunction, stress level and response, toxic load etc. All poor health processes begin with inflammation.
Total LDL: Considered the “bad” cholesterol. If oxidized it can become harmful to vessels and the heart, but is also necessary to create necessary products in the body as mentioned above.
HDL Cholesterol: For long time touted at “good” cholesterol but it is important to note that there are several sub fractions of HDL. Two of them are HDL2 and HDL3. HDL2 is large in size and buoyant in nature and is the most protective or “good”. The HDL3 subfraction is smaller in size and not protective. Some research is showing that the HDL3 subfraction can even be harmful for the heart. So it’s possible to have elevated HDL cholesterol and think that everything’s ok but in reality if the HDL3 subfraction is elevated , a high HDL cholesterol isn’t so good.
VLDL: Very low density lipoprotein; commonly elevated with excessive triglycerides and sugar consumption. These can be harmful and need to be monitored.
Total Cholesterol: The amount of cholesterol (all sub fractions) circulating throughout the body
Triglycerides: elevated levels associated with excessive sugar/carbohydrate consumption or poor sugar regulation
Non-HDL Cholesterol: LDL+VLDL some research points to this value as a better predictor for cardiovascular risk
Total apoB100: a protein that moves cholesterol around the body – research is mixed but most say this is another good estimate of “bad” cholesterol
Lipoprotein a, Lp(a): In my opinion, this test is the most important value measured in a lipid fractionation test. Some call it the “Heart Attack” protein. It is increased in inflammatory states and is not effected by traditional cholesterol lower medications. It is, in my opinion, the best indicator of potential cardiac issues in the fractionation testing lab.
IDL Cholesterol: Found elevated in patients with metabolic syndrome/diabetes
Real LDL Cholesterol, LDL-R: Direct measurement of LDL cholesterol unlike the calculated version found in traditional testing.
LDL Cholesterol Size pattern: Overall size and buoyancy of the cholesterolparticle. In my opinion, the second most important piece of information from lipid fractionation testing. Pattern A is ideal.
Total apoA1: The building block for HDL cholesterol and is thought to be a cardio-protective marker.
apoB100/apoA1 ratio: This is used as another marker of whether you are in a cardio protective state. The lower the number is said to be better.
VLDL3: Most dense of all VLDL and considered the greatest risk.
You need to have a complete evaluation for cardiovascular risk. This evaluation may include a lipid panel; but that’s just one of the tools used and in my opinion, it's not the most important one. In addition to fractionation panels and other tests, ask us about inflammatory markers (which I believe are most important) such as: fibrinogen, CRP, ESR, homocysteine, so we can get a more complete look at your cardiovascular health. There is a lot more to cardiovascular health than cholesterol and its numbers. Concentrating on just the basic lipid panel may very well get you into trouble as we have seen from the recent statistics. Have you ever heard of the lean, healthy 35-45 year old that eats well, has a good state of mind and normal cholesterol that goes running in the morning and dies from a heart attack? Clearly there is something else going on than just the amount of fat and cholesterol in the body.
1. Low cholesterol, cognitive function and Alzheimer s disease in a community population with cognitive impairment. J Nutr Health Aging. 2002;6(5):320-3.
2. Hanukoglu I (Dec 1992). “Steroidogenic enzymes: structure, function, and role in regulation of steroid hormone biosynthesis.”. J Steroid Biochem Mol Biol 43 (8): 779–804. doi:10.1016/0960-0760(92)90307-5. PMID 22217824
3. Kochanek KD, Xu JQ, Murphy SL, Miniño AM, Kung HC. Deaths: final data for 2009. National vital statistics reports. 2011;60(3).
4. Roger VL, Go AS, Lloyd-Jones DM, Benjamin EJ, Berry JD, Borden WB, et al. Heart disease and stroke statistics—2012 update: a report from the American Heart Association. Circulation. 2012;125(1):e2–220.
5. Forette, B. Cholesterol as a risk factor for mortality in elderly women. Lancet.