A Whole9 guest post by Dr Sult, medical doctor, medical educator, inspirational speaker & the author of Just Be Well: A Book For Seekers of Vibrant Health. After you finish this article, read part 2 in this series on Cholesterol.
The Inside Story on Cholesterol
Looking to lower your risk of heart disease? Conventional wisdom says you should exercise regularly, eat well and keep your cholesterol levels in the recommended range. Sounds simple, right?
Not so much. Cholesterol is actually a lousy predictor of whether you’re going to have a heart attack. In fact, lowering cholesterol has been shown to reduce your risk of heart attack only if you’ve already had a heart attack. If you haven’t, lowering cholesterol as a whole doesn’t affect your risk. Instead, we need to look more closely at cholesterol levels to determine what they can—and cannot—tell us.
What is Cholesterol?
Cholesterol itself isn’t a bad thing. It is a waxy, fat-like substance naturally found in all human cells. It helps make hormones, vitamin D, and other substances that help us digest food. Although our bodies make cholesterol, it is also found in foods, such as fatty meats, saturated fats like butter, and trans fats, which are often found in crackers and cookies.
Cholesterol travels through the bloodstream in carriers called lipoproteins. Two kinds of lipoproteins provide this transportation, LDL and HDL. LDL is commonly known as “bad” cholesterol because too much of it results in a buildup of cholesterol in the arteries, making it more difficult for blood to squeeze through and deliver oxygen to the cells. HDL, or “good” cholesterol, acts like a garbage truck: it brings cholesterol from other parts of the body to the liver, where it leaves the body.
The higher the LDL or bad cholesterol, the greater the chance of getting heart disease. The higher the level of HDL (the cleanup lipoprotein), the lower the chance of getting heart disease.
So it’s not just your cholesterol level that makes a difference in your risk of a heart attack—it’s the numbers inside.
HDL v. LDL
For many years, the medical community has focused on advising patients to decrease the LDL or bad cholesterol. But newer studies have shown that it’s more important to have a high level of good cholesterol than it is to have a low level of bad cholesterol. In his article “Forget LDL—Think HDL,” cardiologist Stephen Sinatra says that even when heart patients have tremendously lowered their LDL, they are still at significant risk for heart problems. In addition, he says that many patients who have coronary artery disease have low HDL levels, and that a higher level of “good” cholesterol could help keep the “bad” cholesterol moving on out of the body.
Understanding Your Cholesterol Levels
The typical blood test that tells you your total cholesterol level will not give you enough information to understand how LDL and HDL are operating in your body. If you’re concerned about your risk of heart disease, stroke, or your level of cholesterol, talk with your doctor about getting one of the new-generation lipid tests that delve deeper to look at LDL and HDL numbers, as well as LDL particle numbers and size.
Although finding out your individual cholesterol levels is helpful, it’s even more important to look at your actual cardiovascular function. Many functional medicine doctors can measure the compliance of the “cardiovascular tree” in the office, determining the elasticity, or compliance, of the veins and arteries. The buildup of plaque or cholesterol can make the arteries stiffen, increasing the risk of blood clots, stroke, heart attack, angina and other coronary diseases, as well as kidney disease.
The Centers for Disease Control and Prevention say that one in six American adults has high cholesterol levels, meaning high levels of “bad” cholesterol. Most people who have it don’t even know it, because few symptoms may precede a cardiac event, such as a heart attack.
By consulting with a doctor to get the inside story on your cholesterol levels and cardiovascular function, you can understand what risks you might face, and develop an effective strategy to improve your health.
Continue to part 2.
Tom Sult is a medical doctor, medical educator, inspirational speaker & the author of Just Be Well: A Book For Seekers of Vibrant Health. Board-certified in family medicine & integrative holistic medicine, Tom is on faculty with the Institute for Functional Medicine and maintains a private practice in Willmar, MN. Join Tom’s crusade to change the way doctors treat their patients at www.justbewell.info. For more information on Tom’s practice please visit the 3rd Opinion website.
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Are the new-generation Lipid Tests to be interpreted the same as the old ones?
Tom Sult says
The newer tests are different. They include parts of the old tests such as total cholesterol, HDL, LDL, triglycerides etc. but they look at those parameters in different ways. It might be by looking at particle number, particle size, lipoprotein fractions or Apo lipoprotein. In addition it will look at inflammatory marker such as highly sensitive C reactive proteins and LP-PLA2.
Additionally tests that measure the stretchability, called compliance, of your large, medium and small arteries can be done. This test can measure the “stiffness” or hardening of your arteries. Additionally heart rate variability testing can indicate another parameter of risk. This test is basically a measure of your autonomic nervous system balance. There are many other test that can be productive as well.
Thank you for the follow up. My insurance covers just standard, myopic doctors. If I get the testing you describe, would positive results be enough to convince the doctor that the results outweigh the elevated standard cholesterol results?
I am an MD covered by insurance. I am not myopic. I am usually willing to order tests that have evidence of usefulness. But the insurance won’t cover the tests that are being recommended in this article so it is the insurance that does not want to help patients, not the doctors. Everyone’s approach should be to maximize their lifestyle modification and reduce inflammation. Heart disease is a problem of poor lifestyle. Waiting for the numbers to determine risk before this intervention is rather shortsighted in my opinion.
Les Proctor says
Great article, Dr. Sult! It’s about time (for the new generation lipid tests).
The Ridker Circulation Study showed people with low hs-CRP (“Inflammation”) and Low LDL (“Bad Cholesterol”) have the best chances for cardiovascular “event-free” survival. “Event-free” means “no heart attack (or stroke).”
Omega-7 fatty acids have been shown to help significantly with both, i.e., reduce CRP and maintain healthy cholesterol levels.
Have you seen this? In a recent double-blind placebo controlled study¹, a daily intake of 210 mg of Omega 7 was better than placebo at managing cholesterol, triglycerides, and healthy c-reactive protein levels. *
(1) “Purified palmitoleic acid for the reduction of high-sensitivity C-reactive protein and serum lipids: A double-blinded, randomized, placebo controlled study”, The Journal of Clinical Lipidology, August 2014; Adam M. Bernstein, MD, ScD; Michael F. Roizen, MD; Luis Martinez, MD, MPH; [http://www.lipidjournal.com/article/S1933-2874(14)00281-5/abstract]
What is Omega7? I’ve heard of taking Omega 3 but never heard of Omega 7.
Les Proctor says
HIn the human study that I referenced above it had a positive impact on all lipid markers, including -44% CRP, -18% TGs, -8% LDL, and +5% HDL. It also regulates blood sugar and helps with weight control. I feel very grateful to have had the opportunity to launch the product that was used for the study. Dr. Oz and Dr. Roizen, the “YOU Docs”, have said “Start taking another odd omega, Omega 7” — in their nationally syndicated “YOU Docs” columns, in their newly updated book: “YOU: The Owner’s Manual“, and recently on the Dr. Oz Show.
Thank you Dallas & Melissa, I do not mean to be self-serving on your website. Hope I’m able to ananswer the question and offer valuable information that not a lot of people know about yet. I’m a believer in food as medicine, and am a big fan of what you’re doing here. Thank you!
Tom Sult says
As a functional medicine doctor focused on personalized biochemistry I frequently do red blood cell fatty acid analysis. This test can help increase anti-inflammatory omega-3 fractions, help the patient limit the more inflammatory omega six arachidonic acid and optimize Omega seven and Omega nine fatty acids.
As to whether or not these tests are covered by insurance that’s a bit of a case-by-case basis. The Cardio IQ test through quest diagnostic laboratories is sometimes covered. Many of the other vascular tests I mentioned however are not. All of my patients as part of their new patient intake get vascular compliance and heart rate variability testing and that helps us stratify those who are going to get more extensive testing.
The traditional train primary care doctor is unlikely to change their opinion about needing to lower your cholesterol because it has become a part of the catechism.
Dictated from my iPhone.
hubby had a heart attack this past May. he had 2 blockages…one @ 99% and another @ 55%. :( one stent and many, many meds now. It’s “heartbreaking.”
Cardiologist basically said, “see ya in a year!” Primary care has been a little better, but ordering the standard tests and prescribing the standard meds.
What tests, and with what frequency would you recommend for him? And do you do telephone (or electronic) consultations??
Matt Gersper says
Great article. I have been measuring my LDL particle numbers and size for many years now and it completely changed my prognosis, keeping me prescription medicine free!!
I have been amazed at how little doctors or their patients know about this “new” test.
It’s one of the reasons I started my new company, Happy Living.
Would you be interested in a phone call to discuss potential synergies between Whole 9 and Happy Living?
Chris Wheeler says
Would any primary care doc doing an annual physical know what is meant by “new-generation lipid tests” or do they have more specific names?
Tom Sult says
As I mentioned above a national laboratory by the name of quest diagnostic laboratories does a test called a Cardi IQ. Also the Cleveland heart lab does a number of inflammation and lipid fraction tests. As to finding a doctor that might be familiar with this kind of testing you could go to the website functionalmedicine.org.
A quick Google search will bring up Omega seven fatty acids. Basically they are a type of unsaturated fatty acid found in macadamia nuts and other foods. It’s also felt thatKetogenic diet raises a mega seven fatty acids.
Check dr attia’s eating academy blog for a complete cholesterol brief… He has a lot to say about the numbers of partials being indicative of inflammation and the likelihood of vascular disease.
VLDL’s are also as bad as LDL cholesterol … watch out for those compounds as well!
About 30 yrs back doctors found out Cholesterol as the main culprit to cause
heart attack and started treating the patients with STATIN.
This drugs came on the market in 1987 and since then
only they started the medication of STATIN drugs
advised diet control. Now we can see that, the rate of heart
attack is increasing day by day. This itself is a proof that their
prediction is wrong. Doctors from all over the world has
difference of opinion on this issue.
One early opponent was a medical doctor by the name of Dr. Paul Dudley White, who was known as “the father of modern cardiology,” one of the founders of the American Heart Association and personal physician to President Eisenhower following Ike’s heart attack.
Our body needs 950 mg of cholesterol for our daily needs and liver is the main producer
of cholesterol. Medical science has no legal power to forcibly stop an endogenous
production of human body. If cholesterol is the main culprit, there is harmless and cheap
vitamins (VIT E) which can dilute cholesterol. Instead what they do???