Have you ever wondered what the cholesterol numbers on your blood tests really mean? And have you wondered when you should be concerned about them? The numbers may not mean what you think or what you’ve been told.

I had a first hand experience with that discrepancy in the early 1990s. In the clinic where I worked, I experienced multiple organ damage from chronic exposure to toxic chemicals, including pesticides and disinfectants. Routine blood work showed that my cholesterol level had plummeted to 120 mg/dl. By national standards, anything less than 200 mg/dl is considered optimal. No lower limit is given, implying that the lower the cholesterol, the better. My colleagues marveled with envy at my good fortune for having such low cholesterol.

But in reality, such a low cholesterol level was hardly cause for rejoicing. The drastic drop was a result of my liver being poisoned and unable to produce higher amounts of cholesterol.

When the total cholesterol levels drop below around 160 mg/dl, the body lacks what it needs to make sufficient stress hormones, male and female hormones, bile acid to digest fats, vitamin D (produced when exposure to sunlight transforms the cholesterol under the skin), along with many other vital substances that use cholesterol as the basic building block.

And on top of all that, extremely low levels of cholesterol seriously impact the brain and can lead to an increased the risk of depression, suicide, loss of memory, and dementia.

In fact, cholesterol is a vital component of every single cell in the body. Without cholesterol, there would be no life.

Fortunately, as I recovered from the toxic exposures, my cholesterol gradually rose to around 200 mg/dl where it remains to this day.

So what do the lab tests really tell us about cholesterol? Here’s a crash course on the fats that doctors routinely order, called lipids.

1. TOTAL CHOLESTEROL: Total cholesterol is an estimate of all the cholesterol in the blood, consisting of various components, including the lipoproteins—HDL, LDL, and VLDL Unless the total cholesterol is over 300 mg/dl, the total cholesterol is not helpful in determining your risk of heart disease.

At this point, you might be wondering what lipoproteins are. Lipoproteins are molecules that are made up of a fat combined with a protein. Fats, like cholesterol, are not soluble in the blood. When the cholesterol is attached to these special proteins, it becomes water soluble.

There are high density and low density lipoproteins.

2. HDL: HDL stands for High Density Lipoprotein. HDL is known as “good” cholesterol because it helps to remove excess cholesterol deposits from the arterial lining. High levels of HDL are the result of good genes, healthy dietary patterns, and adequate levels of exercise. High levels can reduce the incidence of coronary heart disease. Conversely, low levels of HDL are markers for increased risk of heart disease.

3. LDL: LDL stands for Low Density Lipoprotein. LDL is known as the “bad” cholesterol because it has the potential for depositing in the lining of the arteries when inflammation is present in the vessels. High LDL levels can be a result of a diet high in sugars, simple carbohydrates, trans fats, oxidized fats, and hydrogenated fats. 

4. VLDL: VLDL stands for Very Low Density Lipoprotein. VLDL is made in the liver primarily from triglycerides. The same factors that raise the LDL impact VLDL. High levels of VLDL can increase the risk of heart disease.

We talk about “good” and “bad” cholesterol which is not exactly correct. There is only one kind of cholesterol and it is neither good nor bad. Instead, it is the lipoproteins that are “good” or “bad.”

The lipoproteins come in many sizes. The size of the lipoprotein determines the potential harm. The large LDL molecules are harmless. On the other hand, the very small ones are more concerning. The small LDL particles can squeeze into the lining of the arteries. If they oxidize (turn rancid) they will cause inflammation of the vessel, which in turn can lead to atherosclerosis, formerly known as “hardening of the arteries.”

Lipoprotein (a) is a marker for increased risk of early onset heart disease. Increased amounts of Lp (a) in the body are associated with inflammation in the walls of the arteries. Inflammation can lead to changes in the blood vessels, including atherosclerosis. Although LDL in general is affected by lifestyle and diet, Lp (a) is determined more by genetics. Elevated levels of Lp (a) are cause for concern.

Fear prevails when patients discover that their LDL, the so-called “bad cholesterol,” is elevated. Usually no distinction is made by their doctors between the large LDL particles, which are not harmful, and the small LDL particles which are indeed cause for concern. There are now tests, like the VAP test, that can distinguish between the large LDL particles and the small LDL particles.

If your doctor would like to put you on a cholesterol-lowering drug like a statin, ask for a more advanced lipid panel than the one routinely ordered. I recently learned about the NMR LipoProfile which uses nuclear magnetic resonance (NMR) spectroscopy to provide direct measurement of the size and number of the LDL particles and the VLDL subclasses.

In summary, the culprit for increased risk of atherosclerosis and heart attack is not the total cholesterol level. It is related to the size and number of the LDL particles. Adding to that risk, is oxidation of the fat and inflammation in the vessels.

The most heart healthful action you can take is to pursue an anti-inflammatory diet as we discussed in Part II (a whole foods, plant based diet high in vegetables and high in plant-based fats, with avoidance of sugars, grains, GMO and pesticide-laden foods, dairy, processed foods, alcohol, and meats that are not 100% grass-fed). Consider including anti-inflammatory and anti-oxidant supplements. Get regular exercise and adequate rest, avoid toxic substances, and be sure to spend some time outside in nature.

In these times of heavy marketing by the pharmaceutical companies and questionable science heavily influenced by vested interests, it’s in your best interest to use critical thinking when deciding on the risk/benefit ratio of any drug you’ve been told to take. The benefit needs to clearly outweigh the risks.

Here’s to your good health.