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Dealing with your Cholesterol Panel
A guide to making sense of your lipid "cholesterol" panel numbers
Most people who visit their doctor expect to get a cholesterol check. It's one of several ways to determine heart disease risk. The problem is, many people do not know how to properly interpret the lipid, A.K.A cholesterol panel. The components of a standard lipid panel are HDL-C, LDL-C, VLDL, and triglycerides. Scientific research over the last half-century has greatly modified or reversed much of what we once thought we knew about cholesterol. The latest thinking may surprise you.
Total Cholesterol: (No longer considered useful) In the ’50s and '60s doctors believed high total cholesterol was the cause of heart attacks. The plaques in blood vessels that cause heart attacks are laden with cholesterol-rich material, so it was (incorrectly) reasoned that reductions dietary cholesterol intake would similarly reduce heart attack risk. This assumption was later proven incorrect. President Eisenhower, for example, who had his first heart attack in 1955 had his cholesterol tested weekly. He followed a strict low fat, calorie, and cholesterol diet….and went on to have seven more heart attacks. Very low total cholesterol is associated with an increased risk of strokes, depression, and cancer. Since total cholesterol is the sum of all cholesterol fractions, knowing it provides about as much as knowing the total score of both teams in a football game put together. You know how many points were scored in the game but you don't know who won the game and by how much.
HDL: High-Density Lipoprotein ("The good cholesterol”) This is a type of particle in the blood called a lipoprotein. HDL particles transport cholesterol that is contained within the blood vessel walls to the liver. In women: a value of 50 mg/dL or higher is associated with less heart disease risk. Men: 40 mg/dL or more is acceptable. Low HDL is associated with greater heart disease risk. There are no medicines that raise HDL. We used to give large doses of niacin to increase HDL but scientific studies eventually showed it wasn’t reducing heart attacks so the practice is now largely abandoned. Eating more saturated fat, reducing starch & sugar intake, and vigorous exercise raise HDL. You read that right, saturated fat increases your good cholesterol. (See image below)
LDL, Low-Density Lipoprotein “The Sometimes Bad Cholesterol” (particle size matters) Under certain circumstances, LDL particles can cause disease when they are damaged by oxidation and then get stuck in diseased artery walls. There is a weak association between high LDL-C and heart disease. Many doctors prescribe a statin drug if the LDL-C is above 130 mg/dl. This may or not be the correct action depending on your risk factors for heart disease. People over 60 do better with higher LDL-c(1). Statins do lower LDL-C and may modestly lower risk of future heart attacks in people with known coronary disease, but not because of effect on LDL-C. The truth is, we don’t know why statins work. Recent studies suggest statins increase diabetes risk by 47%(2). Having lots of small LDL particles causes heart disease, but having lots of big LDL particles do not. It is, therefore, possible that two people with the same LDL-C numbers will have different heart attack risk. The best way to find out which kind of LDL is present is through advanced lipid panel testing. This blood test can determine LDL-P particle size and number. It's a better test of heart disease risk.
VLDL, Very Low-Density Lipoprotein: This value tends to be high when you have other unfavorable markers that occur in people with insulin resistance. VLDL isn't always reported on standard panels.
Triglycerides: Triglycerides are liquid fat blobs in blood circulation. Having high triglycerides is not healthy because usually occurs in insulin resistance. Eating a diet high in sugars and carbohydrates causes triglyceride elevations. Most labs say less than 150 is normal, but less than 80 may be optimal for health. Low carb diets make it drop dramatically. (see image below)
Triglyceride to HDL ratio: In my view, this is the most important number of all. When triglyceride is divided by HDL you get a very useful number called triglyceride to HDL ratio. It is more important than either number alone. Ideally, This value should be no more than a 2:1 ratio of triglycerides to HDL-C. Say triglycerides are 100 mg/dl, HDL cholesterol should be > 50 mg/dl. I really don't like to see a ratio that's over 5:1. Sometimes Non-HDL cholesterol is reported on lipid panels. It is also a useful value to assess cardiac risk.
Cardiac Risk factors other than Cholesterol
People generally want their cholesterol checked because they want to know their risk of a heart attack. But honestly, there are better ways to assess this risk:
A> The simplest and cheapest is waist circumference. Carrying too much weight around the middle is a sure sign of increased risk for heart problems and many other metabolic diseases. Waist circumference is more strongly associated with heart disease than body mass index or total weight.
B> A common blood test called the Hemoglobin A1C measures your average blood sugars over the last few months. A value of less than 5.5% is “normal” but even lower is better here. A1c correlates strongly with heart disease.
Your risk of heart disease, diabetes, and metabolic syndrome is something can be fixed! Most of my patients do not want to go on statin medicines for the rest of their lives. Cholesterol numbers reflect what you've been eating. There are dietary changes that can be made that will improve cholesterol numbers, weight, blood pressure and diabetes risk to boot! No single medicine or cocktail of medicines can do that, but nutrition can. The current diet guidelines from many of our most trusted institutions (USDA, American Heart Association, American Diabetes Association) have failed to prevent the current epidemic of diabetes, obesity and heart disease. In fact, their bad advice is probably the cause. The current guidelines official guidelines were crafted under the heavy influence of the giant processed food and drug manufacturers who do not have Americans' health at the center of their agendas. The present guidelines advise a high carbohydrate intake.
The Low Carbohydrate, High Fat Diet:
Chances are you’ve been told that low-carb diets (like Atkins) may be dangerous. This idea is based on 1950s era science, that natural fat is "artery-clogging". Never mind that humans have always been eating animal fats, somehow it was supposed to raise our cholesterol and give us heart attacks.
The good news is we now know this idea was simply wrong. The official diet advice and the actual science supporting them have been very far apart since the 1980s. There have been several fascinating books and documentaries produced which have attempted to explain the discrepancy. I recommend Why We Get Fat: And What to Do About It by Gary Taubes.
Just about everybody already knows that low-carb works for weight loss. Because of recent research, we now also know it's a safer way to eat too.
How to raise HDL: Eat more saturated fat and reduce concentrated carbs: Saturated fats (long, wrongly demonized) Is found in whole milk dairy, red meat, red palm oil and, coconut oil is now known to raise your HDL “good” True, it also raises LDL, but only the harmless, large fluffy variety. Exercising (a whole lot) more and smoking cessation raises HDL a little as well.
How to lower your triglycerides and raise HDL.
A> Cut out grains, potatoes and sugars AKA, refined carbs
Grains, wheat, corn, barley, and rye. Includes breads and pastas
Potatoes
Sugar: Soft drinks, fruit juices, agave, candy, and many others. don’t eat much fruit.
B> Eat more fat: Here is something which is counterintuitive: Eating more fat doesn’t make you fat nor does it cause you to have more fat (triglycerides) in the bloodstream. Fat is your friend... sugar is not.
Dietary Cholesterol is OK: found in eggs, meat, dairy: restrictions have finally been lifted by the USDA because of lack of any evidence that cholesterol consumption does any harm. It reduces your chance of stroke, depression suicide.
Man-made trans-fat is NOT OK: It causes inflammation is incompletely metabolized by the body which leads to unhealthy accumulation. This was discovered in 1968. Finally, in June 2015, partially hydrogenated oils, the primary source of trans fats were banned. Vegetable oils such as corn, soybean and, canola, which have only been around for only the last hundred years, are not that healthy either especially when used for frying. They turn into highly reactive toxic aldehydes.
Sugar & starches: cause triglycerides to rise & your LDL particles to shrink (both bad).
Healthy fats are coconut, olive oil, avocados, most nuts and, animal fat are the healthy fats.
The unhealthy oils are soybean, canola, vegetable oil, cottonseed and anything listed hydrogenated.
further reading on this topic:
A guide to making sense of your lipid "cholesterol" panel numbers
Most people who visit their doctor expect to get a cholesterol check. It's one of several ways to determine heart disease risk. The problem is, many people do not know how to properly interpret the lipid, A.K.A cholesterol panel. The components of a standard lipid panel are HDL-C, LDL-C, VLDL, and triglycerides. Scientific research over the last half-century has greatly modified or reversed much of what we once thought we knew about cholesterol. The latest thinking may surprise you.
Total Cholesterol: (No longer considered useful) In the ’50s and '60s doctors believed high total cholesterol was the cause of heart attacks. The plaques in blood vessels that cause heart attacks are laden with cholesterol-rich material, so it was (incorrectly) reasoned that reductions dietary cholesterol intake would similarly reduce heart attack risk. This assumption was later proven incorrect. President Eisenhower, for example, who had his first heart attack in 1955 had his cholesterol tested weekly. He followed a strict low fat, calorie, and cholesterol diet….and went on to have seven more heart attacks. Very low total cholesterol is associated with an increased risk of strokes, depression, and cancer. Since total cholesterol is the sum of all cholesterol fractions, knowing it provides about as much as knowing the total score of both teams in a football game put together. You know how many points were scored in the game but you don't know who won the game and by how much.
HDL: High-Density Lipoprotein ("The good cholesterol”) This is a type of particle in the blood called a lipoprotein. HDL particles transport cholesterol that is contained within the blood vessel walls to the liver. In women: a value of 50 mg/dL or higher is associated with less heart disease risk. Men: 40 mg/dL or more is acceptable. Low HDL is associated with greater heart disease risk. There are no medicines that raise HDL. We used to give large doses of niacin to increase HDL but scientific studies eventually showed it wasn’t reducing heart attacks so the practice is now largely abandoned. Eating more saturated fat, reducing starch & sugar intake, and vigorous exercise raise HDL. You read that right, saturated fat increases your good cholesterol. (See image below)
LDL, Low-Density Lipoprotein “The Sometimes Bad Cholesterol” (particle size matters) Under certain circumstances, LDL particles can cause disease when they are damaged by oxidation and then get stuck in diseased artery walls. There is a weak association between high LDL-C and heart disease. Many doctors prescribe a statin drug if the LDL-C is above 130 mg/dl. This may or not be the correct action depending on your risk factors for heart disease. People over 60 do better with higher LDL-c(1). Statins do lower LDL-C and may modestly lower risk of future heart attacks in people with known coronary disease, but not because of effect on LDL-C. The truth is, we don’t know why statins work. Recent studies suggest statins increase diabetes risk by 47%(2). Having lots of small LDL particles causes heart disease, but having lots of big LDL particles do not. It is, therefore, possible that two people with the same LDL-C numbers will have different heart attack risk. The best way to find out which kind of LDL is present is through advanced lipid panel testing. This blood test can determine LDL-P particle size and number. It's a better test of heart disease risk.
VLDL, Very Low-Density Lipoprotein: This value tends to be high when you have other unfavorable markers that occur in people with insulin resistance. VLDL isn't always reported on standard panels.
Triglycerides: Triglycerides are liquid fat blobs in blood circulation. Having high triglycerides is not healthy because usually occurs in insulin resistance. Eating a diet high in sugars and carbohydrates causes triglyceride elevations. Most labs say less than 150 is normal, but less than 80 may be optimal for health. Low carb diets make it drop dramatically. (see image below)
Triglyceride to HDL ratio: In my view, this is the most important number of all. When triglyceride is divided by HDL you get a very useful number called triglyceride to HDL ratio. It is more important than either number alone. Ideally, This value should be no more than a 2:1 ratio of triglycerides to HDL-C. Say triglycerides are 100 mg/dl, HDL cholesterol should be > 50 mg/dl. I really don't like to see a ratio that's over 5:1. Sometimes Non-HDL cholesterol is reported on lipid panels. It is also a useful value to assess cardiac risk.
Cardiac Risk factors other than Cholesterol
People generally want their cholesterol checked because they want to know their risk of a heart attack. But honestly, there are better ways to assess this risk:
A> The simplest and cheapest is waist circumference. Carrying too much weight around the middle is a sure sign of increased risk for heart problems and many other metabolic diseases. Waist circumference is more strongly associated with heart disease than body mass index or total weight.
B> A common blood test called the Hemoglobin A1C measures your average blood sugars over the last few months. A value of less than 5.5% is “normal” but even lower is better here. A1c correlates strongly with heart disease.
Your risk of heart disease, diabetes, and metabolic syndrome is something can be fixed! Most of my patients do not want to go on statin medicines for the rest of their lives. Cholesterol numbers reflect what you've been eating. There are dietary changes that can be made that will improve cholesterol numbers, weight, blood pressure and diabetes risk to boot! No single medicine or cocktail of medicines can do that, but nutrition can. The current diet guidelines from many of our most trusted institutions (USDA, American Heart Association, American Diabetes Association) have failed to prevent the current epidemic of diabetes, obesity and heart disease. In fact, their bad advice is probably the cause. The current guidelines official guidelines were crafted under the heavy influence of the giant processed food and drug manufacturers who do not have Americans' health at the center of their agendas. The present guidelines advise a high carbohydrate intake.
The Low Carbohydrate, High Fat Diet:
Chances are you’ve been told that low-carb diets (like Atkins) may be dangerous. This idea is based on 1950s era science, that natural fat is "artery-clogging". Never mind that humans have always been eating animal fats, somehow it was supposed to raise our cholesterol and give us heart attacks.
The good news is we now know this idea was simply wrong. The official diet advice and the actual science supporting them have been very far apart since the 1980s. There have been several fascinating books and documentaries produced which have attempted to explain the discrepancy. I recommend Why We Get Fat: And What to Do About It by Gary Taubes.
Just about everybody already knows that low-carb works for weight loss. Because of recent research, we now also know it's a safer way to eat too.
How to raise HDL: Eat more saturated fat and reduce concentrated carbs: Saturated fats (long, wrongly demonized) Is found in whole milk dairy, red meat, red palm oil and, coconut oil is now known to raise your HDL “good” True, it also raises LDL, but only the harmless, large fluffy variety. Exercising (a whole lot) more and smoking cessation raises HDL a little as well.
How to lower your triglycerides and raise HDL.
A> Cut out grains, potatoes and sugars AKA, refined carbs
Grains, wheat, corn, barley, and rye. Includes breads and pastas
Potatoes
Sugar: Soft drinks, fruit juices, agave, candy, and many others. don’t eat much fruit.
B> Eat more fat: Here is something which is counterintuitive: Eating more fat doesn’t make you fat nor does it cause you to have more fat (triglycerides) in the bloodstream. Fat is your friend... sugar is not.
Dietary Cholesterol is OK: found in eggs, meat, dairy: restrictions have finally been lifted by the USDA because of lack of any evidence that cholesterol consumption does any harm. It reduces your chance of stroke, depression suicide.
Man-made trans-fat is NOT OK: It causes inflammation is incompletely metabolized by the body which leads to unhealthy accumulation. This was discovered in 1968. Finally, in June 2015, partially hydrogenated oils, the primary source of trans fats were banned. Vegetable oils such as corn, soybean and, canola, which have only been around for only the last hundred years, are not that healthy either especially when used for frying. They turn into highly reactive toxic aldehydes.
Sugar & starches: cause triglycerides to rise & your LDL particles to shrink (both bad).
Healthy fats are coconut, olive oil, avocados, most nuts and, animal fat are the healthy fats.
The unhealthy oils are soybean, canola, vegetable oil, cottonseed and anything listed hydrogenated.
further reading on this topic:
- Book: The Big Fat Surprise: Why Butter, Meat & Cheese Belong in a Healthy Diet 2014, by Nina Teicholz
- Book: Cholesterol Clarity, by Jimmy Moore
- Web: CholesterolCode.Com Blog of Dave Feldman, engineer, self-experimenter, human pin cushion.
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1. Lack of an association or an inverse association between low-density-lipoprotein cholesterol and mortality in the elderly: a systematic review https://bmjopen.bmj.com/content/6/6/e010401
2. Chogtu B, Magazine R, Bairy KL. Statin use and risk of diabetes mellitus. World J Diabetes. 2015;6(2):352-7.
2. Chogtu B, Magazine R, Bairy KL. Statin use and risk of diabetes mellitus. World J Diabetes. 2015;6(2):352-7.
