Cholesterol. Just hearing the word likely conjures up negative thoughts. But, unfortunately, most of us know very little about cholesterol, except it’s bad. Synonymous with heart attacks and death, “You have high cholesterol” is a phrase you hope to avoid at your annual doctor’s visit.
But what if we told you that total cholesterol levels are a poor predictor of heart disease? Would you be surprised to learn that cholesterol is not even the main culprit in the development and progression of heart disease?
Likewise, you might be shocked to learn that cholesterol is your friend.
So, where did we get it all wrong? If the conventional markers of total cholesterol, HDL, and LDL do not help assess the risk for heart disease, what does? Inflammation is the real enemy. And to understand it, we must first examine cholesterol particle size.
What is cholesterol?
If someone were to ask you if you wanted to get rid of all the cholesterol in your body, you would probably say yes. After all, cholesterol is not viewed positively.
Primarily produced by the liver, cholesterol is a fatty, wax-like substance found in every cell of the body. More specifically, cholesterol is a sterol – made of steroids and alcohol.
Most people are surprised to learn that cholesterol is one of the most essential substances for health. Cholesterol is the main component of cell walls and is responsible for maintaining cellular health.
Without cholesterol, our bodies would be unable to produce Vitamin D, bile, and sex hormones. Other essential functions of cholesterol include:
- Assists in the smooth functioning of the nervous system
- Helps facilitate communication between cells
- Acts as an anti-inflammatory, helping to repair damaged tissue
There is no “good” cholesterol or “bad” cholesterol. Cholesterol is simply cholesterol.
What are cholesterol particles?
Cholesterol has a hydrocarbon tail and a central ring that are non-polar, meaning they do not mix with water. Since blood is primarily made of water, cholesterol can’t float through the bloodstream on its own. After all, oil and water don’t mix.
As a result, cholesterol is packaged together with proteins to be carried through the body as a lipoprotein. Therefore, lipoproteins are fats combined with proteins.
Much like vehicles, lipoproteins carry cholesterol through the body as cholesterol particles. So, when the doctor orders a cholesterol test, it actually measures your lipoproteins.
There are many different types of lipoproteins, and they are classified by the types of protein they carry. The main types of cholesterol particles are:
- Low-density lipoproteins (LDL)
LDL particles travel through blood vessels, carrying cholesterol and many other important nutrients from the liver to the cells and tissues.
- High-density lipoproteins (HDL)
HDL particles pick up extra LDL from the cells and tissues and carry them back to the liver.
Cholesterol particles: size matters
Not all LDL cholesterol is created equal. Lipoproteins vary in size from very small to very large. The smaller LDL particles present a problem because they are tiny enough to squeeze through the artery lining.
Once lodged there, they have the potential to oxidize, causing inflammation and damage to the artery wall. Larger, fluffier LDL particles, on the other hand, rarely make it through the endothelium to the artery wall.
LDL is best evaluated when it’s categorized by size and density, often referred to as a “pattern.” The two patterns, A and B, help determine the cardiovascular risk.
- LDL – Pattern A
LDL A particles are large and fluffy. They are generally considered harmless unless they become oxidized.
- LDL – Pattern B
LDL B refers to smaller, denser molecules. These smaller particles are more likely to lodge into the arterial wall and become oxidized.
Not surprisingly, people with pattern B are more likely to experience heart complications than those with pattern A. Therefore, two individuals could have the same LDL-C levels, but if one individual leans more towards pattern B, they are at higher risk of heart attack and stroke.
The problem with standard cholesterol testing
A heart attack is most often due to small, oxidized cholesterol found in plaques that breaks off and ruptures, causing a blood clot. The blood clot then obstructs the artery and impairs blood flow to the heart. Unfortunately, this type of “damaged” (oxidized) cholesterol is not tested in most conventional medical offices today.
Cholesterol circulating in the blood does not cause plaque formation unless it lodges itself into arterial walls. This is why traditional cholesterol testing metrics are inaccurate and misleading. Many individuals have died from CHD (coronary heart disease) whose pre-death cholesterol levels were considered “normal.”
Standard lipid panels tell us how much cholesterol is sitting inside a lipoprotein by weight. So when the doctor measures your LDL-C or calculates your LDL cholesterol level, it is a cholesterol mass measured in milligrams per deciliter (mg/dL). Unfortunately, this calculation tells us nothing about heart disease risk.
Consider the following analogy: Lipoproteins are vehicles that transport cholesterol through the body. The amount of passengers (cholesterol) in the car has less bearing on arriving safely, as does the number of vehicles (lipoproteins) on the road.
Many LDL particles increase the risk of accidents that can cause damage to the endothelium. Moreover, passengers are safer in large vehicles (pattern A) than in smaller vehicles (pattern B).
Typical cholesterol tests don’t differentiate between large and small LDL particles. Most individuals lean in one direction or another, mainly having large LDL or mostly small LDL, depending on how they live, the environment, and to a lesser extent, genetics.
LDL-C, the standard test for LDL, is an unreliable test. Simply because an individual may have a high LDL-C does not automatically put them at increased risk for heart disease. Conversely, individuals with lower LDL-C are not in the clear when it comes to risk.
Evidence confirms that the risk for cardiovascular disease is more accurately predicted by the number of LDL particles, as opposed to the total amount of cholesterol within these particles.
What tests do I need to measure my cholesterol particles?
To accurately assess heart disease risk, doctors should test for the number of LDL particles in the blood, or LDL-P. Science clearly shows that LDL-P drives heart attack and cardiovascular disease risk.
LDL-P adds up the number of large LDL particles with the number of small LDL particles. Small LDL particles greatly influence total LDL-P. After all, the smaller the particles, the more particles you will have. Larger, fluffier LDL particles take up more room, resulting in fewer particles.
Another important cardiovascular test related to cholesterol particles is apolipoprotein B or Apo B. An increasing body of scientific knowledge shows that Apo-B is one of the best measures of cardiovascular risk.
Finally, it’s important to note that chronic inflammation is the trigger for cardiovascular disease. LDL, by itself, is not generally dangerous until oxidized.
Therefore, testing for inflammation markers, such as C-reactive protein (hs-CRP), oxidized LDL (ox-LDL), and homocysteine, are important indicators of heart disease risk.
Statins and cholesterol particles
Over 35 million Americans take statins to treat high cholesterol levels, and they do work at lowering cholesterol. However, studies show that a drop in cholesterol means nothing when it comes to reducing the risk of heart attack, strokes, and death.
Physicians currently test for a number that means significantly less than it’s portrayed to represent. Then, they write prescriptions for potentially dangerous medications to bring that number down.
Studies show that statins don’t impact the LDL particle number. Therefore, many individuals who have their LDL-C levels lowered with statins likely still have high LDL-P and thus have a significant cardiac risk. Perhaps this is why cardiovascular disease continues to rise despite increased statin use.
How do I decrease cholesterol particles?
Since statins don’t work to lower the number or size of cholesterol particles, is there a better solution? Absolutely!
Individuals with high cholesterol should consider natural supplementation as an effective alternative to statins. OptiLipid contains six proven remedies to improve cholesterol levels naturally.
Other ways to reduce cardiovascular risk markers include:
- Optimize your diet
- Move your body
- Get sunshine
- Prioritize sleep
- Relieve your stress
- Reduce your toxic load
Hearing that conventional lipid markers are not accurate predictors of heart disease risk may blow your mind. Unfortunately, despite plenty of scientific evidence supporting this assertion, many doctors still don’t understand this concept.
The team at Natural Heart Doctor uses the most accurate, evidence-based lipid testing available. Working with our team will ensure that the correct tests are conducted.
Additionally, all test results come with a free 20-minute consultation call with one of our experienced health coaches so that you may fully understand your results and the next best steps.
Medically Reviewed: Dr. Jack Wolfson, 2023