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Cholesterol 101: What do your cholesterol labs mean?
Hi B-better family!Let’s help you understand your cholesterol labs today!
Everyone knows at least something about cholesterol. Either through a brief meeting with your doctor who gave you back your results, through the scary headlines in newspapers or through one of the thousands of blogs you can find on the internet.
If your health goal is preventing heart disease or longevity this is for you! A little apology: what was meant as a short ‘tip’ became a compact guide. But most of us at some point in our life will measure cholesterol, so I felt this was an important read!Let’s answer some questions: What is a traditional cholesterol lab result or ‘lipid panel’ and what do the markers on them mean? Is there some extra information on it that can help you assess your risk of cardiovascular disease? And what might be missing on your panel, but is very important as well? But first…
What is cholesterol?
It’s a molecule. You either eat it or make it. What you don’t eat, your body will produce. Dietary cholesterol makes up about 10-15 per cent of your body’s cholesterol.Dietary cholesterol usually doesn’t influence your body’s cholesterol much.
As you may know, cholesterol is needed for several things like:
- You need it to make vitamin D.
- Cholesterol is needed to make steroid hormones like estrogen, progesterone, testosterone & cortisol
- It’s needed to build bile, brains and cell membranes.
What is the difference between LDL & LDL cholesterol?
Cholesterol is a lipid and just like fats, it doesn’t mix with water. The body designed special busses to drive lipids & cholesterol around. These are called lipoproteins. LDL stands for Low-Density Lipoproteins.LDL is just a bus for cholesterol & lipids. It drops lipids & cholesterol into tissues.
When we talk about LDL Cholesterol, we mean all the Cholesterol that is actually in the ‘bus’ called LDL. This measurement is also what you will find in the lab results.
LDL was often called ‘bad cholesterol’ because it is the LDL particles (the busses, not the passengers) that can form plaque in the arteries. We now know that this plaque is trying to bandage small ‘wounds’ or holes in the arteries. It is the holes that are the actual problem. Tips for addressing this problem are for another day.
Now LDL comes in small sizes and big sizes. It’s the small LDL particles that are more plaque forming or atherogenic than the big LDL particles because the small particles can fit more easily in those small holes. This is important because a traditional lipid panel measures LDL cholesterol. The passengers on the bus. Not the number of busses.
The problem with LDL cholesterol:Let’s say Suzy and Ann both have the same LDL cholesterol. Say Suzy has a number of 100 cholesterol passengers sitting in a few big LDL busses. And let’s say Ann has the same 100 cholesterol passenger transported in a lot of small busses.This still means that Ann has a bigger risk for plaque forming than Suzy. So if we would know the number of busses, we could estimate the size of busses and therefore the risk.
What is the difference between HDL & HDL Cholesterol?
Same thing. In the ‘bus’ analogy, HDL is a different bus line. It brings cholesterol back to the liver. HDL Cholesterol is the cholesterol that was on the bus called HDL. HDL stands for High-Density Lipoproteins.HDL (cholesterol) was often called ‘good cholesterol’, but science has these days a much more nuanced opinion on that.
What can you find in a typical lab result (called a ‘lipid panel’) from your doctor?
- Triglycerides (free fats in the blood)
Usually, we want them to be under 150 mg/dl (or 3.8 nmol/l). The optimal range is 50-100 mg/dl (or 1.29-2.58 mmol/l). - Total Cholesterol
This is all the cholesterol in your blood. So all cholesterol in all the possible busses in your blood. Usually, we want total cholesterol below 200 mg/dl (or 5 mmol/l). - LDL Cholesterol
We talked about it. This measures the cholesterol ‘passengers’ on the LDL bus. But for a good risk assessment, we need to know the number of LDL particles as well. The convention in regular medicine is less than 100 mg/dl (or 2.59 mmol/l) for people who don’t have heart disease. Please don’t let your take away from this article be that LDL cholesterol is useless! - HDL Cholesterol
For men, the reference ranges are typically between 35-65 mg/dl (0.91-1.68 mmol/l). The optimal range is 55-75 mg/dl (or 1.42 – 1.94 mmol/l)
The hidden information on your lipid panel:
What you typically don’t see on your traditional lipid panels is the Triglyceride to HDL ratio. To calculate this is pretty simple: Divide the triglycerides by HDL cholesterol (in mg/dl). If the number is above 2.0 there is an increased risk for cardiovascular disease. This ratio is more predictive than the other numbers on the traditional lipid panel.What markers would we like to add to the traditional lipid panel?
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ApoB100 or ApoB
So how can we count the number of LDL busses? Turns out that all sizes of LDL particles have the same ‘backbone’. This backbone of LDL is a protein called ApoB100 or ApoB. So when you see this marker on typically a more advanced lipid panel, this can tell you how many LDL particles there are. It is typically measured in mg/dl (or nmol/l). Together with the LDL cholesterol (the passengers), we can estimate if the busses are small or bigIt is not traditionally measured. If your doctor is a cardiologist, ask him/her.
- Lipoprotein a or LP(a)
When a protein called “apolipoprotein a” binds to the backbone ApoB as mentioned above of LDL it becomes a ‘special’ form of LDL called LP(a). You pronounce this as ‘LP little A‘.LP(a) is more atherogenic (more plaque-forming) and it is important to know because more than 15% of the world population has due to genetic reasons elevated LP(a) levels (according to research scientist Benoît Arsenault it would be closer to 20 per cent.)
In contrast to LDL, HDL and triglycerides, LP(a) doesn’t change much over time. Measure it once and you have a pretty good idea of how your LP(a) will be in ten or twenty years. People with elevated LP(a) should pay a little more attention to living a low inflammation lifestyle.
It is not traditionally measured. If your doctor is a cardiologist, ask him/her.
Copy & save this little guide. Most people at some point in time will measure cholesterol. If nobody ever measured your cholesterol, this guide will help you later!I hope this read-up was insightful!
Daniel
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11 Replies
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Thank you Daniel for your “tip”. Comprehensive as usual.
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I take lipator but was told I needed to have my liver checked every three months for signs of damage… I suck at exercise but I’m trying eat healthier and actually take my time eating my food.
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If you haven’t yet taken the Blood Sugar Regulation course, I highly recommend that you focus on that next. Lipids are very closely tied to diet/stress and blood sugar levels. I’ve had clients get off statins after changing their diet.
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I don’t know exactly why your doctor prescribed Lipitor. There are a variety of reasons possible why LDL cholesterol is elevated. Do you know your reason?
For most (if not all) statins there is a small risk of liver damage. It might be that your doctor is checking your liver enzymes, just to be careful.
As a personal trainer I would like to add, that if you are just trying to exercise, you are doing so much more than most people. And trust me, I sucked big time at exercising myself! But the benefits of even doing just something are so much better than doing nothing. I could write a book about it (if I had the time!)
You don’t need to become a professional athlete to get the health benefits from exercise!
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Hey Daniel, thank you for the super insightful post!
I have recently tested my lipids and turns out my LDL levels are quite elevated (185 mg / dl), which I was surprised to hear as I lead a relatively healthy lifestyle so it must be genetic.
What should my next steps be in order to rectify that? Can I test for LP(a)? Is it safe to supplement with Niacin in an attempt to bring it down?
would you happen to know of any doctors/clinics in Dubai where I can get the comprehensive test at? would love a recommendation
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further to Daniel’s post, LDL is not inherently “bad” and evidence linking LDL cholesterol to cardiovascular illness in individuals is weak – especially with optimal triglyceride and HDL levels. Also, the relative amount and percentage of oxidized LDL are more predictive of CVD than LDL alone (which can also be measured in functional tests). Would you mind sharing your full lipid profile with reference ranges here so we can take a look?
As Daniel mentioned, gaining insight into the patterns (Pattern A – small, dense and vulnerable to inclusion in arterial plaque inside inflamed arteries vs. Pattern B – large, light, fluffy and less atherogenic within arteries) can be valuable and reassuring in terms of cardiovascular disease risk.
I’ve been working on setting up a web shop with a lab for B Better members to be able to order their own functional tests. In the meantime however, here’s an oxidized LDL & Liposcan panel report that I can help you access if you’re interested. No need to visit a physician however it’s an out of pocket expense (~$210 + shipping). If interested, please email support@bernadetteabraham.com and we can assist you with this.
Alternatively, Dr. Makk at Zia Medical center might be able to help as well if you’d like to go through a physician and get insurance reimbursement. She’s pay and claim back.
In terms of possible root causes for elevated LDL, it could be from fatty liver, insulin resistance, increased stress (especially in men), and/or hypothyroidism (mostly in women). Have you explored any of these areas before?
Hope this helps.
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I agree with . Elevated LDL cholesterol to me is a symptom. My first step would be finding out why your cholesterol is elevated. A good discussion with your doctor can open doors. If you prepare the discussion, your doctor might draw more labs which can provide you with a deeper insight into your health.
You could ask your doctor if he could examine your liver, kidney & thyroid health. Insulin resistance can also cause elevated LDL cholesterol. Keep in mind that chronic stress can elevate LDL cholesterol as well.
If you feel pain in the upper right quadrant of your body gallstones (which are made of cholesterol) can block the exit of your bile flow. Cholesterol leaves the body through your bile. In this case, the supplement d-limonene could be helpful. It is a cholesterol solvent.
If you are using drugs, some of them can raise LDL Cholesterol as well (progestins, corticosteroids (used with allergies, asthma, rheumatoid arthritis, IBS, and many more), and anabolic steroids (for example with testosterone replacement therapy)).
When your doctor suspects familial hypercholesterolemia (FH in short) it means he thinks it is genetics. Usually, you can find clues in your family history as well. Do heart problems run in the family? Anyway, here in ‘The Netherlands’ where I come from, doctors can do a genetic test to be sure, but you will have to actively ask the question.
Why I personally don’t recommend niacin as a first-line intervention
Although niacin can raise HDL and lower ApoB and thus LDL Cholesterol, the dosages used in research are really high. On a daily base, we estimate that we need 15 mg of niacin. The dosage used in research is between 500-2000 mg a few times a day.Those types of dosages come with their own risks, like something that is called a niacin flush, damage to the liver and bleeding in the GI tract.
If you are going to use niacin, I would also discuss this with your doctor/practitioner.
Addressing LDL cholesterol is important
If you do use niacin (or a low-dose statin) as a temporary solution, it can help you prevent plaque from forming. But it doesn’t necessarily address the root cause!
So to summarize: first find out the root cause, then address the root cause!Your best approach is still living a healthy inflammation-avoiding lifestyle. Remember: damage in blood vessels is the true root cause of plaque forming.
• Focus on fibre-rich food.
• Make sure your carbs are low glycemic, don’t avoid them but eat them in moderation.
• Moderate alcohol (also the organic biodynamic alcohol).
• Moderate saturated fats, remove transfats & focus on omega 3 fats from fish and algae products. Choose a good quality olive oil. (We have done a post on that here in the general tips section)
• Ideally, incorporate a mix of cardio and strength training into your daily routine.
• Sleep, wake up with energy, reduce stress & do things that make you smile!In general, the last three tips will move the needle the most!
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Thank you Bernadette & Daniel for your input!
I don’t believe that I fit any of the root causes mentioned, and follow a mostly ketogenic diet with about 3-4 days a week of strength training (but will start incorporating more cardio).
In terms of genetics, there is some association of cardiovascular disease on one side of my family which leads me to assume that it is largely due to familial hypercholesterolemia. Regarding gallstones, there is nothing that I am aware of, however I did notice slightly enlarged gallbladder polyps during a routine ultrasound – could that be a factor? attaching my blood work report for your reference .[mustafa 2.pdf]
As a next step, I will consult with Dr Makk and take it from there. Thanks for the recommendation! -
without knowing much about your health history, lifestyle habits, diet, overall level of stress, your state of being prior to the test, and the time of blood draw, I can only make some assumptions and offer some potential areas to further explore based on these black and white, one-moment-in-time results:
From a functional perspective:
• There seems to be some suboptimal elevation in your liver markers ALT & GGT, which means there is something causing a higher turnover of these liver enzymes. What is possibly taxing the liver? Alcohol? Smoking? Environmental toxins/mycotoxins? Prescription and over-the-counter medications? Virus? You mention that you eat well and live a healthy lifestyle, but I would be curious to see a fasting insulin or c-peptide and fasting glucose level given the higher triglycerides. How is stress? Keep in mind, stress can be emotional, physical, and/or physiological (think hidden infections in the gut and mouth for example, bacterial overgrowths creating LPS bacterial by-products, etc) – stress will impact blood sugar regulation. If you have not taken that course yet, please do so.
• There is also some suboptimally lower levels of both thyroid hormones T4 and T3 but it would be interesting to see the full thyroid panel that includes the free T4 and free T3 levels, as well as the antibodies anti-TPO, anti-TG, and Reverse T3. Could it due to nutrient insufficiencies like zinc, vitamin A, selenium, iodine? What are your cortisol levels? And again, what’s your fasting blood sugar status?
• The suboptimally lower Total Protein, BUN and Globulin may indicate a need for HCL/digestive support, and liver support since the liver impacts protein production. I thoroughly discuss hypochlorhydria (low HCL) in the Gut Health Masterclass along with possible root causes for that. Other symptoms that can indicate liver dysfunction is pain between the shoulder blades, nausea, pain under the right rib cage, an upset stomach with greasy foods, easily intoxicated with alcohol, sensitive to chemicals, and hemorrhoids or varicose veins. Do any of these resonate with you from a symptom perspective?
• Another thought that came to mind when I saw a uric acid closer to the high end of the reference range is the possibility of oxidative stress, which again can be connected to liver dysfunction. Have you ever lived or worked in a water damaged building that may have mold? Again, what is blood sugar status? What is your zinc status (check RBC zinc)?As you can see, interpretation from a functional lens brings up many more questions as it really is just 1 small piece of the puzzle. But hopefully I’ve given you some areas to explore and be able to better advocate for additional testing with your physician.
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I do not know the reason my ldl was so high at the time. my numbers have definitely come down since I have been on the medication. but just recently ( yesterday) I went swimming in a lappool for 30 minutes. I really struggled with getting worn out. but I am proud of my self for trying.
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That’s fantastic! You should be proud! I hope you enjoyed it!
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