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Total Cholesterol — Who cares?

For years, I have been telling patients that I don’t care what their total cholesterol is. It’s like how much do you weigh? Again, I don’t care. What I care about is what your body fat percentage is, not your weight. I know a 160-pound woman who is in shape and I know a 160-pound woman who is fat. So, it’s not the weight, it’s the percentage of the body which is fat which really matters.

Similarly, with cholesterol, we can measure the weight of cholesterol (example 200 mg/dL), but that doesn’t tell us what the composition of the cholesterol is. How much is the cholesterol transport (the “bad” LDL cholesterol) and how much is the reverse cholesterol transport (the “good” HDL cholesterol).

More important even still is “What is the composition of the “bad” LDL cholesterol”. When we measure your LDL cholesterol, we are basically straining 100mL of blood for all the “bad” LDL and weighing that amount. We get a measurement like 140mg/dL. It’s simply a weight of “bad” LDL cholesterol. The composition of the “bad” LDL cholesterol is much more important.

 

 

Are you packaging the “bad” LDL cholesterol into a few large particles carrying a lot of this cholesterol, or are you packaging the “bad” LDL cholesterol into a lot of small particles. An example is if you are transporting 100 people on one bus, or are you transporting 100 people in 100 cars? The numbers matter. The more vehicles you have on the road, the more the congestion. Also, the more vehicles you have on the road (like cars) which are smaller than buses, the more chance these small cars can get into the small nooks and crannies which as the artery wall.

Also, are these vehicles driven by “drunk drivers”? You see, these cholesterol transport vehicles (especially the small vehicles) are often coupled with impaired drivers called ApoB. These ApoB are proteins which sit on top of the cholesterol particle and steer these particles into the walls of the artery (not good).

Finally, are your small vehicles (which are dangerous to begin with) packed tightly? We call these small dense LDL particles (sdLDLs). In these small densely packed “bad” cholesterol vehicles, when the body attacks them because they have managed to get into the vessel wall, they explode and release a large amount of “bad” cholesterol into this space. Prompting the immune system to activate and attack these cholesterol particles.

So, don’t ask what your Total Cholesterol is, it matters little in the discussion. What matters more is “Are these “bad” LDL cholesterol small, dense, and numerous?”

There are now many labs which offer to patients the ability to evaluate their cholesterol much more in depth. One of the companies which I am fond of is HDL Laboratories.

This company offers a unique plan in which patients can obtain from their doctor a full testing panel including cholesterol comprehensive evaluation, genetic markers, inflammation markers, Omega 3-6-9 evaluation, hormones, and much more. The wonderful thing about HDL is that they bill your insurance for the cost of the labs, and there is little to no expense incurred by the patient themselves.

Finding doctors who are knowledgeable in properly interpreting the data may be a challenge, but HDL offers a clinical health consulting to patients and helps them understand what the test means to them.

So, what is your Particle Number, your genetics, your inflammation? That’s really the important question to ask.

And yes, there are many options opened to treat these numbers, including nutrition, exercise, sleep and supplements!