Understanding Cholesterol Markers
Getting blood tests is routine for many of us. Most of us do it at least twice a year during physical exams. To empower you to understand what the results mean and what the values reflect in terms of what’s going on inside your body, it is crucial to look beyond the standard explanations.
Here are a couple of things you have to remember when looking at the numbers:
- Lab markers don’t exist in isolation. Each lab marker is related to one another, so we are going to look at them in context of their relationship with other markers.
- The “standard” numbers don’t guarantee that you are healthy. They can even mean that you have a growing problem that needs to be taken care of. Aim for the “optimal” result (explained below).
In this newsletter, I will tackle the cholesterol markers, what they are measuring and what is optimal. So let’s dig in!
Low-Density Lipoprotein Cholesterol (LDL-C)
LDL-C is most commonly known as the “bad cholesterol” and is implicated as the cause of plaque that leads to atherosclerosis. However, LDL is not the ultimate indicator of our cardiovascular health (in fact, it’s not even a type of cholesterol! It’s like a taxi cab shuttling cholesterol around your body). In fact, about half of the people rushed to the emergency room due to heart attack have “normal” cholesterol levels. What is not normal, however, is having higher levels of small cholesterol particles caused by insulin resistance of metabolic syndrome.
Thus, if you want to know your cardiovascular health status, you better go look for triglycerides: they are a much better marker than LDL. The serum triglyceride, when unloaded of its fat at the adipose tissue site, becomes these small dense LDL particles. The triglyceride-to-HDL ratio or the ratio of bad to good cholesterol is the true indicator of cardiovascular disease because it shows the number of small dense LDL. It is also a marker for insulin resistance and metabolic syndrome.
Don’t focus too much on the LDL values alone, but rather on what type of LDL it is that makes up the total number. For your reference, the standard for LDL values is <100mg/dl but the optimal is <70mg/dl.
When calories go unused, triglycerides are stored in fat cells. In the blood, they are carried by VLDL or very-low-density lipoproteins which become LDL minus the triglycerides.
When you have a high level of triglycerides in the blood, it may indicate that you have metabolic syndrome and non-alcoholic fatty liver disease (NAFLD) as well as a high risk for acute pancreatitis.
Increased triglycerides also reflects the quality of your diet because it is associated with high intake of refined and processed foods.
The standard result for triglycerides is below 150 mg/dl, but optimal is below 100 mg/dl or even lower.
As opposed to LDL-C, HDL-C is widely known as “good cholesterol” because it carries some cholesterol back to the liver to be broken down and eliminated from the body as waste (like LDL, it isn’t named properly as it is NOT cholesterol but rather a shuttle for cholesterol back to the liver).
Since HDL removes lipids from cells and blood vessels, a high HDL value is considered to be protective against heart disease.
An HDL value above 60 mg/dl is ideal.
This is a measure of the total cholesterol, including both the HDL and LDL. The normal total cholesterol should be less than 200 mg/dl, but the result should be taken in context to its ratio to the HDL rather than the total number. This is why just looking at the total cholesterol can be deceiving!
Total Cholesterol-to-HDL Ratio
The higher the ratio, the higher the risk of heart disease. A ratio of 5:1 is recommended, but below 3.5:1 is considered very good and even less than 2:1 is the optimal.
This is the most powerful test to predict your risk for a heart attack. If this number is high, you increase your risk by 16 times! This is because triglycerides go up and HDL drops with insulin resistance. So this is definitely the best marker of insulin resistance, metabolic syndrome, and heart attack risk. The bottom line is, this is the one marker you should focus on. Naturally, lower is better. If you have higher than 2:1, you are at high risk. Aim for 1:1-2:1, but less than 1:1 is the best.
I hope that this newsletter has empowered you to take a deeper look at your next blood test’s results. Diet and lifestyle greatly influence triglycerides, insulin, and metabolic syndrome and is, in my opinion, a far more valuable use of your time and energy to improve rather than your total cholesterol level.
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Until next time, I’m wishing you unstoppable health!