Ooo buddy, so much to talk about with cholesterol and lipid panels. So many myths to bust, or at least clarify.

I’m sure at some point, or many points, or maybe even currently, you have heard that high cholesterol causes heart disease. And along those lines, you have heard to avoid eating too much cholesterol because it will raise your serum cholesterol and that will then of course put you at risk for heart disease. 

First of all, for the majority of people, dietary cholesterol has very little effect on serum cholesterol. Like, very very little. So little that even the USDA said in 2015 that dietary cholesterol is no longer a nutrient of concern. They used to say to eat no more than 300mg per day, which is about the equivalent of 2 eggs. But then when they realized the research just does not show that dietary cholesterol is a problem the way it was thought to be, they changed their tune, saying it is no longer of concern.

Lipid Testing

That’s pretty big, in my opinion. I don’t put a lot of stock in the dietary advice of the USDA but if even THEY are acknowledging that dietary cholesterol isn’t the boogie man, that is worth noting. 

Secondly, we are going to have to break down the idea of “high” cholesterol and why we’ve been understanding cholesterol incorrectly and what we really need to be aware of, for not only heart health, but the rest of our health too!

So, let’s dig in. Actually, first I have to clarify something in this particular post. The theme of this series is things you didn’t know about your routine lab work. But actually, today we’re going to be talking more about what your routine lab work cannot tell you. When it comes to the standard lipid panel, we can learn some things, but there are some important factors to your heart disease and stroke risk that the general lipid panel just cannot tell us. 

Luckily though, there IS a test that can tell us more. We’ll get to that. 

Okay, back to your typical cholesterol testing. You’ll generally see your total cholesterol, your LDL-C, HDL-C, and triglycerides. And sometimes VLDL, but for timing sake, we’re not going to talk about that one (it’s just a calculation and is equivalent to 20% of your triglycerides).

Now, the HDL is “good” cholesterol and the LDL is “bad,” right? Actually, all cholesterol is the same in the body. You don’t have different types of cholesterol. 

You DO have different types of lipoproteins, which are what carries cholesterol around in the body. Because cholesterol is a fatty substance, it can’t just travel through the blood on its own. Lipoproteins are proteins that carry around cholesterol, triglycerides, and other free fatty acids around the body. These are extremely important for life, but the quantity and quality do matter.

HDL, or high density lipoproteins carry cholesterol from other parts of the body back to the liver to be recycled or excreted. Yes, HDL is a beneficial lipoprotein but it actually can be too high. This can indicate the body is trying to clean up a lot of used cholesterol and bring it back to the liver. If there is a high amount of cholesterol being used by the body, that could be a sign of something. What is the body trying to heal or clean up? 

LDL, or low density lipoproteins, carry cholesterol from the liver to the rest of the body to be used for cellular repair, to build cell membranes, hormone production, and more. 

There is a bit more to pay attention to with LDL particles. We need to pay attention to not only the number of LDL particles, but also what size they are. This is completely different than how much cholesterol is IN the particles, which is what your standard lipid panel is testing. LDL-C is testing the amount of cholesterol IN the lipoprotein particle; it is not testing the number of actual particles. Nor is it testing the size of those particles, which is also important. It is also not testing the amount of oxidized LDL particles, which is also very important. More on that in a bit. 

This matters because you can have two different people with the same LDL-C but different particle numbers and different particle sizes. So what? Well, studies have shown that half or more of people with heart attacks have normal cholesterol levels and often normal LDL-C levels(1).

These next pictures can illustrate the difference between LDL-C (cholesterol), LDL-P (number of LDL particles), and the LDL particle size.

LDL Comparison

In this first picture, you can think of each bridge as a person. There are the same number of passengers (cholesterol) on each bridge but a different number of vehicles (LDL lipoproteins). Additionally, the vehicles on the top bridge are small and more easily damaged if they were to get into an accident.

In the second picture, think of each road as a person but this time the LDL-C is different. The one on top has a lower LDL-C than the one on the bottom. But, the one on the top has more vehicles, and they are smaller. The one on the bottom has a higher amount of passengers (cholesterol) but less vehicles. And those big buses are less likely to be damaged in an accident (this translates to larger LDL particles being less likely to get damaged and stuck in arterial walls).

Now with standard lipid testing, the top scenario with lower LDL-C would be seen as better than the one on the bottom with higher LDL-C. But, what cannot be seen with that testing is that the bottom person might have that higher LDL-C but has a much better LDL-P (particle) count. 

This can explain why so many people who have heart attacks actually have “normal” LDL-Cholesterol. A person can have normal cholesterol levels but too many small dense LDL particles, which are more easily oxidized and damaged. Damaged lipoproteins are not a good thing for arterial walls.

LDL good and bad

Oxidized LDL

Another important factor the standard lipid testing cannot tell you is the amount of oxidized LDL. As I just mentioned, a higher particle number, particularly with more small, dense LDL particles is going to greatly increase the chance that those LDL particles are going to be oxidized. This is a higher risk situation for heart health issues(2). 

An imbalance of free radicals to antioxidants in the body is going to increase the likelihood of oxidized LDL. This can result from consuming industrial fried food, refined carbohydrates, trans fats, smoking, glyphosate/pesticides, excess sugar, vegetable and seed oils, etc. Not only do those foods and toxins lead to oxidative stress in the body, resulting in oxidized LDL-P but they also displace foods rich in antioxidants that help counteract the normal amount of oxidative stress. When we eat fried foods, processed foods, damaged oils, and sugar, we aren’t going to be eating as many fresh vegetables, quality meats and seafoods, and healthy natural fats. This tips the oxidative stress scales in a bad way.

What the standard lipid test CAN tell you

LDL-C and HDL-C that are out of range are worth looking into to find out more (like the LDL-particle number and size as we just talked about), but in my (non-medical, strictly information-giving) opinion, decisions about medications should not be made on those numbers alone.* They serve a purpose but to see the bigger picture requires more investigation.

This panel can be helpful to see what the HDL-C and triglycerides are. Triglycerides are the most abundant type of fat in the body. Standard ranges suggest triglycerides are fine as long as they’re under 150. Optimal ranges are between 50-100. Optimal ranges for HDL are between 50-80 for men and 60-85 for women. Knowing the triglyceride to HDL (TG/HDL) ratio is a pretty good check engine light for high risk for CVD or stroke. Ideally this ratio should be under 2. If it’s not, this is worth further investigation and potential dietary and lifestyle adjustments (which can have a huge impact on this!)

The NMR Lipoprofile Test

This test not only includes the standard panels but also includes the LDL particle number and particle size, as well as an insulin-resistance score. This score is helpful as well because insulin resistance is a major component of metabolic disease. 

Your doctor can order this test for you, or you can even order it yourself through various online labs, though it is important to have a practitioner who understands these markers along with the whole picture of what else is going on with you. 

To really use this tool effectively, it is important to look at your other labs (not just the lipid panel or NMR test), your diet, your lifestyle, and what symptoms you are experiencing. This is where nutritional therapy can really shine because in my practice, I look at you as a whole person. We address your health at the cellular level, bringing your body into balance so we can create an opportunity for healing. You can have massive improvements in not only your lab work, but also your quality of life, by working with a practitioner who can lead you on that road. 

If you’re interested in how you may benefit from additional blood testing, or a new set of eyes looking at not only your existing labs but also you as a whole, I’d love to chat. Sign up here for your free consultation!


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