It's a conundrum. You would be hard pressed to think of many health topics covered more than cholesterol, yet most people know little beyond some elemetary (and somewhat flawed) basics. Cholesterol coverage in the media, as common as it is, often feeds more drama than information. Even in the doctor’s office, many of my clients come away with more of a vague impression than a concrete understanding of the role lipids play in their overall health—or the meaning of their own individual numbers. Nonetheless, significant decisions surrounding lifestyle and medications (along with their corresponding cost and side effects) are made based on routine—and simplified—tests every day. Lipids are an important part of your health picture—and of your longevity and vitality. Knowledge matters.
Let’s play out this concept in a casual conversation. Hypothetical as it may be, know it bears uncanny resemblance to many I’ve had with past clients. See what you think.
Weight Loss Hopeful (WLH): “Well, my Doctor says my cholesterol is ‘borderline’.”
Me: “Okay. Do you know how the pattern looks (HDL, LDL, triglycerides, etc.) or just the total cholesterol? When was the last time it was measured, and when does your doctor want to look at it again?”
WLH: “I guess it was almost a year ago. The doctor just said to come back again next year…and that I should try exercising and losing some weight for now. He said we’d talk about meds next year. I don’t really remember what the good and bad cholesterol numbers were.”
Me: “Great, your doctor encouraged you to take charge of your health. What have you been doing to lose weight, exercise, and manage your cholesterol?”
WLH: “Well, that’s why I’m here. I’ve been watching my fat intake, eating more fruits and vegetables (although I’m sure I could do better), and I’ve even switched to brown rice and whole wheat everything (my family hates it). I can’t seem to lose weight, though, even though I’ve been jogging every day for about an hour or taking fitness classes. I’m getting kind of frustrated.”
Me: “Wow; that sounds like dedication. You must be thinking there’s more to losing weight and managing cholesterol than simply watching fat intake and moving more regularly.”
WLH: “I hope – or I’m just the odd-ball!”
Me: “There’s a chance, but why don’t we take a more detailed look at your cholesterol pattern. Considering we make most of our blood cholesterol as a protective substance to help us control and repair inflamed or damaged tissues, there may be inflammation issues at work in your body. Without assessing, we just don’t know. There’s plenty we can do about inflammation, and addressing that would in all likelihood positively impact your cholesterol levels. It’s better to know now before you’re asked to go on medication or end up with cardiovascular disease. Would you agree?”
WLH: “I’ve never heard that before, but I’d like to avoid medications if possible. What do you mean by taking a ‘more detailed look at cholesterol pattern’?”
Me: “It’s not common knowledge, but the standard method used to assess total cholesterol, HDL cholesterol, triglycerides, and calculate LDL cholesterol is not the most accurate way to identify those at highest risk for vascular disease. It’s a decent screening tool at best but can vary greatly from day to day – especially in those whose weight is not stable. Much more accurate measures for heart disease risk include LDL particle size and number and inflammation patterns as well as any relationship those patterns have to your metabolic syndrome risk.”
WLH: “Does my doctor test for that? Can I just wait until I go back in?”
Me: “In my experience, unless you already have active heart disease it’s difficult to get that test approved by insurance. I know it sounds frustrating, but that’s how most healthcare plans are set up: you get the basic screening but have to pay out of pocket for the more detailed, proactive approach. You’d think that since heart disease is the number one cause of death for adults in the US, we’d be all over screening with the best tools available. Go figure.”
WLH: “What should I do?”
Me: “Well, if you want to find answers rather than guess and wait and possibly end up on medications you said you don’t want, I’d suggest doing a more thorough assessment with the more accurate measures. From that, you’ll learn what the results means to you, your goals, and recommended lifestyle changes. So, the next time you see your doctor you’ll already be working on an action plan to lower your personal risk factors--whatever they may be. What are your thoughts?”
WLH: “That sounds great, but what will it cost me?”
Me: “Honestly, it will likely cost you less than one year of taking a cholesterol-lowering medication. It will also cost far less than actually having a heart attack, which can be really expensive, especially given that half the time the first sign of a heart attack is death. An added bonus is different side effects.
WLH: “No, really, I’ve heard blood tests are expensive. And what do you mean by ‘different side effects’?”
Me: “Let me show you the cost but first say this. When you’re thinking of making lifestyle changes, you can save yourself a lot of time, money, effort, and frustration by really understanding the current condition of your health. Honestly, I think it’s smarter and a lot more efficient to invest in the most correct and direct plan for you. No one wants to work for meager results. You might just end up on medication anyway in that scenario. About the side effects, these medications often have many effects, only one of which may be positive to your cholesterol numbers or overall health. On the other hand, if we do the assessment and see cause for concern, we’ll work together to alter your nutrition and lifestyle habits in ways that will have very different effects--more energy, fewer aches and pains, less belly fat, possibly better blood pressure, better skin, and possibly improved fitness and mood, to name a few. These are all side effects of managing cholesterol from a comprehensive, wellness-centered, instead of pharmaceutical, approach.”
WLH: “All right. Sign me up.”
As I suggested earlier, I’ve had this conversation hundreds, if not thousands, of times. Those who struggle with losing weight are often affected by “sub-clinical” inflammation, which can frequently manifest as disrupted blood cholesterol and lipid patterns. The connection between underlying inflammation and the commonly recognized term “cholesterol” is often misunderstood or, frankly, left out of conversation. Before we explore let alone recognize the connection, we’re placed on medications without a clear exit strategy.
Anyone concerned with their true heart disease risk as it relates to their cholesterol patterns needs to look deeper using what’s known as an NMR lipo-profile: Nuclear Magnetic Resonance method. This test, also referred to as the ‘particle test,’ allows the patient and physician to better understand not only how much cholesterol is being carried through the bloodstream (for necessary repair and other important maintenance of tissues and hormones) but also gives an accurate head count of how many lipoprotein particles are needed to carry this cholesterol safely. The particle size and number matter far more to our overall heart health risk than simply total cholesterol or LDL cholesterol as it is commonly measured.
Perhaps worse, conventional advice for lowering cholesterol can steer us in the wrong direction. For example, the foods that are touted as cholesterol-lowering wonders may contribute to our inflammation problems! For many people, eating less fat and more carbohydrates does not adequately control inflammation and blood lipids. In fact, it often exacerbates the underlying inflammation problem.
If you’re interested in understanding more about your inflammation patterns, cholesterol particle number and size, or even concerned about how your dietary and exercise efforts are truly helping your heart health, take the smartest step and get your NMR lipo-profile done. This panel is included in both the Men’s & Women’s Longevity & Vitality Premium lab panels and comes with an interpretation with one of our Registered Dietitians to shape your nutrition strategies and habits, lifestyle alterations, exercise process, and supplement strategies based on your unique situation.
Your results should also be shared with your physician at your next physical to discuss your best care plan if necessary. There’s a specific segment of the population for which statin therapy might be warranted. Unless you’re a person who’s already had a heart attack, however, it’s my opinion that you should exhaust all options before considering medications. Depending on which studies you look at, it may take several hundred people using these medications daily for several years to avoid even one cardiovascular “event.” It’s called NNT (number necessary to treat). While pharmaceutical medications offer us critical options we should be grateful for and use wisely in given situations, the truth is we have a whole spectrum of solutions to take advantage of in choosing better health. You have incredible power at your disposal to drastically enhance your wellbeing. It all begins with knowledge.
Have you or your doctor been concerned with your lipids? What questions or interventions have come into play for you? I hope you’ll share your thoughts as well as experiences for understanding cholesterol and the relationship it has for your health.
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