 Is cholesterol all we have to to think about when it comes to heart health?
There are actually hundreds of cardiovascular risk factors. Total serum (blood) cholesterol is just one of these. It's my impression that many people (including those with medical degrees) believe that high cholesterol is a disease. In fact, high cholesterol is not a disease. Having high cholesterol is not even necessarily unhealthy. Elevated serum cholesterol is a cardiovascular risk factor. Statistically, if a person has elevated cholesterol he or she is more likely to develop cardiovascular disease. It is not a guarantee. It is certainly not a disease. For example, people over 80 years of age who have elevated blood cholesterol have less heart disease. If you have a blood test and your total cholesterol is high, don't be overly concerned until you have further evaluation. The total cholesterol is comprised of different components. Some of these that are routinely measured include LDL and HDL. Triglycerides are also usually reported. When it comes to heart disease risk, higher LDL and triglycerides are bad and lower HDL is bad. This is generally true but is not the complete story. (See my prior newsletters: "Is Your Cholesterol Too Low", "Is Your HDL [Good] Cholesterol Too High?"). So, you do want to look at your total, LDL, and HDL cholesterol levels. I like to see total cholesterol about 160-180 mg/dl and a good 25% of this should be HDL. Half of people who suffer fatal heart attacks have normal cholesterol levels. There are several reasons for this, including the fact that there are many cholesterol-independent risk factors. (See "Elevated Cholesterol: Flat Earth Theory of Heart Disease?" and
"Nitric Oxide: The Miracle Molecule. Neo 40: The Miracle Supplement"). However, when it comes to cholesterol, there is some value in doing the right test. I use Health Diagnostic Laboratory as my first choice for cholesterol testing. This lab offers a number of cutting-edge, proprietary tests. (See: "If You Value Your Health, You'll Want This Test!"). The cholesterol test from this lab is actually a measure of lipoprotein particle concentration by NMR spectroscopy. The most important cholesterol-related risk factor is the number of LDL cholesterol particles. Two people can have the same LDL cholesterol blood level but have different numbers of LDL particles in circulation. Health Diagnostic Laboratory has a very accurate way of making this measurement. It is not good to have too many LDL cholesterol particles. If you do have a lot of cholesterol particles, you don't want them to be too small and dense. Small dense particles are more likely to penetrate artery walls and contribute to plaque build-up. Health Diagnostic Laboratory's profile gives a measure of LDL particle size and a lot more. |
| | Small-dense LDL particles contribute to arterial plaque. |
An actual case study illustrates the value in this type of in-depth analysis. A patient of mine brought recent blood test results to our consultation in November, 2014. His lipid (cholesterol) profile revealed the following: - Total Cholesterol 172
- LDL Cholesterol 118
- HDL Cholesterol 36 (Low)
- Triglycerides 90
Only the HDL cholesterol was abnormal. Low HDL cholesterol is a cardiovascular risk factor, as this type of cholesterol is involved with removal of cholesterol from the artery walls. So, treatments to raise his HDL cholesterol would be indicated. However, there is no treatment needed for his LDL cholesterol; all the other numbers are normal. This patient was in fact on a cholesterol-lowering drug; Zocor, which is in the class of statin drugs. In the past, his cholesterol was abnormally high and that is why his medical doctor had him taking the medication. The patient's medical doctor told him to continue what he was doing; the drug was working well. I wasn't so sure. We had his blood drawn to have a thorough work-up, including the lipoprotein particle concentration by Health Diagnostic Laboratory. What a difference! He was in very bad shape. Take a look at his results below. Results are color-coded: green is normal, yellow is borderline (he has no yellow), red is abnormal. This test confirmed major problems with his HDL cholesterol. He did not have enough HDL particles, including the most protective type - HDL2. He lacked adequate amounts of protective Apolipoprotein A-1, the protein that carries the good (HDL) cholesterol. Only his lipoprotein (a) was normal. This is a component of LDL cholesterol, which is largely determined by genetics. The thing that is surprising is the fact that his LDL cholesterol is very abnormal. What? How can that be? He is taking a drug to lower his LDL cholesterol and his LDL cholesterol number of 118 is normal. He has too many LDL cholesterol particles. He has too many small dense particles. Apo B, the protein that transports the "bad" LDL cholesterol, is elevated. The ratio between the Apo B and Apo A-1 is too high. This patient is at elevated risk to cardiovascular disease because of these values. He certainly has indications of less than healthy blood vessels given the fact that he has elevated blood pressure and erectile dysfunction. These are signs of endothelial dysfunction: the cells lining the blood vessels are not producing enough nitric oxide, which is essential for healthy blood vessels. ( See: "Want Your Penis to Work? Try Flossing Your Teeth!...But Skip the Mouthwash!" ). If we did not perform this test, this patient would have continued his current treatment with the belief that his LDL cholesterol was being controlled by the drug. This patient's cholesterol problems are obviously not the result of a statin drug deficiency. What might be causing his cholesterol problems? His high-risk lipoprotein particle profile, his high blood pressure, and his erectile dysfunction are all likely caused by insulin resistance. This is when the blood sugar-regulating hormone insulin does not work properly. There are many factors that contribute to insulin resistance. To improve this patient's cholesterol (lipoprotein) values requires an approach to make his insulin work better. Certain medications can impair insulin functioning, including statin drugs! A study of 7396 people evaluated the effectiveness of Health Diagnostic Laboratory testing. Half of the group received Health Diagnostic Laboratory testing, the other half did not. The group that received Health Diagnostic Laboratory testing had 41% fewer heart attacks. If you would like this cutting-edge cholesterol test or help with other health issues, give my office a call. Sincerely,
Joseph Debé, DC, DACBN, CDN
Board Certified Nutritionist
552 Middle Neck Road * Great Neck, N.Y. 11023 * (516) 829-1515
2103 Deer Park Avenue * Deer Park, N.Y. 11729 * (631) 522-1555
www.drdebe.com | 
