There are some common misconceptions about cholesterol.
- Absolutely first thing is to realize and understand is that correlation ≠ causation, or association does not equal causation. It’s like you were hanging out with some friends and everyone except you did something wrong and the police came. The police may assume you did something bad because you were with the group. Remember this even when you read other articles and some studies that I link to.
- Cholesterol is NOT THE cause of heart attacks or cardiovascular disease! (1, 2, 3 take your pick from countless sites.)
- Cholesterol is a waxy, fat-like substance that is CRUCIAL for important body functions. The body makes the cholesterol that it needs. (read)
- HDL and LDL are lipoproteins and aren’t even cholesterol, so neither is technically “good or bad” cholesterol! Both lipoproteins contain cholesterol! A lipoprotein is basically a ball that carries lipids (fats and cholesterol) around the bloodstream. HDL is high-density lipoprotein that transports cholesterol TO the liver to be excreted. LDL is a low-density lipoprotein that transports cholesterol FROM the liver to be used within the body.
Everyone says cholesterol is bad.
My doctors and most of the articles by the mainstream authoritative sources conditioned me to think (by regurgitating similar narratives) that I must get my cholesterol numbers down as low as possible. They said to especially reduce that LDL or “bad and evil cholesterol,” and raise my HDL. It didn’t really make sense to me, but they’re the doctors and “experts,” and I’m not, so whatever. I quit smoking, started exercising, ate better, and took my statin like a good patient. My standard/basic lipid test results showed my bad levels returned to “normal” within four months except for the HDL. The LDL is the only thing my old-school cardiologist was concerned about. 🤦♂️
Much better! Woohoo! My cardiologist lowered my Atorvastatin from 80 mg to 40 mg, and I continued my new healthy journey.
Ratios tell more than any of the individual cholesterol numbers.
I learned through reading several sites that ratios are important indicators of cardiovascular issues. I discovered the Omni Cholesterol Ratio Calculator, where you enter your numbers, and it will update with the ratios, AND it has some good information about the ratios! Check it out. Let’s look at my ratios from the two tests. (If you use that calculator, be sure to enter the LDL, HDL, and TRI and let it calculate the total. There are a couple of different formulas that labs will use to get the total. Your total may be slightly off than what your lab shows but the total is not the most important anyway.)
OH MY GOODNESS!!! It’s no wonder I had a heart attack! My ratios were all too high! But wait a second, cholesterol doesn’t cause heart attacks. Something seems odd. If “cholesterol doesn’t cause heart attacks,” as I stated earlier, then how did I have one? My cardiologist at the time was only concerned about my LDL, but it wasn’t extremely high. In fact, it was only “borderline high” according to the Omni site (and others, but that’s how they classified it with the name.) Triglycerides were “high,” and my HDL was “risk of heart disease” at lower than 40. I kept hearing about how a bad diet, smoking, and no exercise causes havoc on the body AND cardiovascular issues. These things cause inflammation. Maybe that had something to do with it. Anyways, I had a win with those good numbers!
Let’s look at April vs September.
As you can see, everything raised, but the Triglycerides only went up 1, and the HDL went up 10! My HDL went up and my ratios improved. I saw a fill-in physician for my PCP as she was out-of-office at the time, but he was very knowledgeable about this stuff. I told him I wanted him for a cardiologist! 😆 He loved my progress and reduced my statin down from 40 mg to 20 mg, EVEN THOUGH my LDL went up. So there is proof in the pudding that ratios matter more than a single number. But why? I’ll cover that later, but keep this in mind as I’m setting the stage.
My Cholesterol / Lipid Panel Results History
Hover over the lines to see the values for each month.
Optimal Cholesterol numbers: Total < 200, Triglycerides < 150, LDL < 100, HDL > 60
I believe that ratios are more important than any single number.
Optimal ratios: Cholesterol:HDL < 3.5, TRI:HDL < 2, LDL:HDL < 2
That graph will help for reference while discussing the next section.
Digging deeper into cholesterol.
As with everything, there is more to something than what is on the surface. Around September, I was learning about particle size and number of the LDL and HDL. A test called Nuclear Magnetic Resonance (NMR) that I order through RequestATest.com measures the particle sizes and numbers.
The NMR test also gives an LP-IR score that determines if you’re insulin resistant or insulin sensitive. Ok, cool, a bonus! (It isn’t a bonus, but remember this.) Diabetes runs on both sides of my family, so this will be good to know. I accidentally ordered the incorrect test when I first got it in September, so I didn’t get ALL of the following information, but I got the right one in December 2019. This image will look very confusing but notice each item. We want to be going into the green. Green = good 👍. The colored triangles correspond to the date’s color at the top.
LDL Particle Size
Are you confused yet? Let’s break some of this down. I initially learned to think of LDL as the particles that get stuck in cracks within the arteries that CAUSE plaques. Some sites even say they stick to the walls, but that’s not entirely true. There is also a theory that larger LDL particle sizes won’t get stuck in the arteries’ cracks and crevices that end up causing blockages. Simply put, an inflated beach ball won’t fit into a golf cup. While this theory seems perfectly logical, it isn’t the entire reason we want larger particles. As you can see, the LDL particles’ size got bigger as time went on. There are two entries for this on the main image. The top one is just grouped into two categories.
Note that in February 2020, the LDL-C was 91, and in December 2020, the LDL-C was 90 (LDL-C numbers are generally what is provided from the basic standard lipid test, these two can be found hovering the basic line graph above the colored image.) Both are considered good or optimal (even though some cardiologists want it under 70 for heart patients). The interesting part is the size… notice the difference between the orange triangle to the black one. Basically the same LDL-C number, but larger particle sizes!
HDL Particle Size
My HDL particle sizes got larger. If you check the history in the line chart, you’ll notice the HDL numbers also increased. One note of exception is February 2020. The HDL dropped to 45 from December 2019’s 51. Total also dropped from 173 to 146; however, the size continued to get larger (red and orange triangle.) So there is another reason to look deeper than just the basic numbers. My initial old-school cardiologist didn’t care… not one bit! 😡
Becoming Insulin Sensitive.
The “bonus” result. I was concerned with insulin resistance as diabetes runs on both sides of my family. Taking a statin can also cause insulin resistance and/or higher blood sugar count as a side effect. Let’s take a peek at those readings.
This keeps getting better! Over the course of the year, I’ve progressively become more insulin sensitive, where I’m now at low risk of diabetes! Look at that image again. The SIZE of all of these LipoProtein markers is associated with insulin resistance. Wait, what? Yes! Keep reading.
Making more sense of all of this.
It isn’t a good idea to get your news by reading only the headlines; it is best to read the whole story. A basic lipid panel/cholesterol test is like a news headline. An NMR test that measures the particle numbers and sizes tells more of the story.
I’ve read a few articles and watched videos that discuss cholesterol more in-depth that contradict MUCH of what is told by mainstream doctors and cardiologists for various reasons that I won’t go into. The important thing is the information and the studies that back them up. I’m not going to post the articles and videos because they end up promoting their preferred diet(s); HOWEVER, there is good information that makes logical sense. This is similar to many of the food documentaries that I watched early in my journey. They all had great points but ended up promoting various diets.
Inflammation & Oxidative Stress
This article is very interesting and sums up what those videos were getting to. The big takeaway is that inflammation and oxidative stress are what seem to cause atherosclerosis, the build-up of fats, cholesterol, plaques in the arterial walls. Smaller particle sizes are the result of oxidative stress/inflammation. So THAT must be why bigger particles are better! That nasty inflammation causes the smaller particles. Also, as those smaller particles float around, they can get stuck in the cracks and crevices of arteries and that is where plaques and blockages form and the fingers point to those innocent LDL particles that get trapped in the inflamed arteries. Association & correlation do NOT equal causation.
Triglycerides and sugars.
From EVERYTHING I’ve seen since day one, inflammation appears to be the root cause for most ailments! I was constantly eating and drinking inflammation! Unburned carbohydrates/sugars are converted to fat and are called triglycerides. I didn’t exercise (let alone higher heart rate exercise or strength training which primarily burns carbs), so that was one main reason why I had high triglycerides. Smoking causes a lot of oxidative stress and inflammation within the body, and I loved smoking!
Missing the mark two years earlier.
One month shy of two years before my heart attack, I had a physical which included a lipid panel. I didn’t notice this until late 2020 when I went through my online health portal with the medical center. Knowing what I know now, I was a prime candidate for a heart attack back then, and NO ONE told me I was at risk! I called that doctor’s office to ask because it said the total cholesterol was high. The lady replied, “If the doctor thinks it is bad, he’ll call you.” He never called. I couldn’t stand that “doctor” anyways, and I never saw him again; however, I would LOVE to have a discussion with him! Let’s take a look.
At the time of my heart attack, my LDL was LOWER, and my Triglycerides were HIGHER than in 2016! The ratios were out of whack both times. This was a ticking time-bomb waiting to go off. That was a check engine light that I ignored, but in my defense, I didn’t know any better, and even the doctor’s office said that if the doctor thought it was bad, he would have called. 😡
This is one reason I put this site together, to help inform of what I have learned, so hopefully, it’ll help someone change what needs changing so they won’t go through what I did. Based on this and IF LDL is the sole thing we should watch out for (old-school cardiologist and mainstream health sites), why didn’t I have a heart attack in November 2016 when it was higher? Because LDL is NOT the root cause of cardiovascular disease!
Addressing the REAL root cause of cardiovasular disease.
I’ve always said that we must address the root cause of a problem instead of treating a symptom, which is no different. The cholesterol numbers are a component of a larger picture, but none are the actual culprit.
OXIDATIVE STRESS + INFLAMMATION = THE ROOT CAUSE!
Oxidative stress is the imbalance of antioxidants and free radicals in the body that causes cell and tissue damage. It is a natural part of aging. It can also be premature due to an unhealthy lifestyle which includes a bad diet. You can think of oxidative stress as rust within the artery walls.
Inflammation is the body’s response to cellular injury and is often accompanied by redness, swelling, heat, pain, soreness, etc. Inflammation is necessary for the body to heal; however, chronic (long-term) inflammation wreaks havoc on the body. Be sure to read my article on inflammation.
This is a long document, but I encourage you to read it. It focuses on the role of antioxidants in the treatment and/or prevention of oxidative stress and inflammation, but there is a LOT of information about oxidative stress and inflammation. The first sentence of the abstract says it all, “Inflammation triggered by oxidative stress is the cause of much, perhaps even most, chronic human disease including human aging.”
Applying the learnings.
My primary doctor and new cardiologist are AMAZED at the progress I’ve made since my heart attack and since each prior visit. I quit going to the old-school cardiologist for several reasons that I won’t mention here, but I am grateful that he helped save my life that day. You could say that I am focused on keeping my cholesterol numbers in line, but mainly the ratios and the sizes. However, my main focus is simply being healthy by living a healthy lifestyle. Here are things that I CONSISTENTLY do:
- Eat Clean. I can’t stress this enough. It takes care of many of the next few things on this list. Read that article that I wrote. All of the common fad diets can work for losing weight and can be healthier (than fast food and even common misconceptions about “healthy” food), but if the foods aren’t nutrient-dense and the best available, then they’re really not healthy diets. There are many proponents of a 100% plant-based diet for “reversing” or “preventing” heart disease. I have problems with that, however, I do eat a LOT of nutrient-dense plants!
Omega-3 is non-inflammatory
- Eat Omega-3 rich foods such as fatty fish, avocados, flax & chia seeds, and walnuts; and whole grains, high-fiber fruit. Make sure you’re getting DHA & EPA forms of Omega-3!!! THIS is what the body needs mostly! Almost all plant-based Omega-3 is ALA which the body inefficiently converts into DHA & EPA. In addition to eating Omega-3 rich foods, I also take these Omega-3 capsules. Don’t go overboard with supplementing because too much can have harmful side effects.
Don’t consume inflammatory grains.
- Limit sugars and refined grains. This is one of the leading causes of inflammation that we consume! In addition to minimizing inflamation, this also helps to keep those triglycerides low. Even though fruit sugars are better for you than added sugars, I keep my total sugar content at roughly 15% of my daily calories, and added sugars are limited to 15% of that. So without exercise factored in, my base (before exercise is accounted for) daily sugar allowance is 100g, and my added sugar allowance is 15g.
Move the booty!
- EXERCISE! Zone 2 heart rate training is great to get your body used to burn fat as fuel. Some of those videos I mentioned earlier promote KETO, but I can’t entirely agree with that for various reasons that I won’t get into now. Their point is to burn fat as fuel, and Zone 2 does that! If you read that long article I linked to about oxidative stress and inflammation being the root cause, you would have read the part about oxidative stress originating in the mitochondria from reactive oxygen species. Zone 2 is beneficial to building mitochondria density, as I covered in my heart rate training article, AND here is a study that states, “Exercise restores mitochondrial content back toward levels observed in younger individuals, and at the same time reduces mitochondrially-produced ROS (reactive oxygen species) and apoptotic signaling.” KETO will NOT do what Zone 2 exercising does!
Final thoughts on managing cholesterol.
I found it is best to look at the bigger picture rather than focusing on any single lipid profile number. For instance, in February 2020, my HDL went down from 51 to 45, but the total went down from 173 to 146. However, two of the three ratios improved, and the HDL particle size increased! In fact, all of the particle sizes and numbers got better! The bigger picture reveals that I was becoming more insulin sensitive instead of insulin resistant due to lowering the inflammation within my body, which was the real cause of my cardiovascular disease that lead to my heart attack.
What about genetics?
Other factors can come into play for abnormally high cholesterol values, such as genetics. I cringe when I hear someone say that it is a genetic issue (especially knowing or finding out what they eat and lack of exercise) because, more often than not, it is unhealthy habits that people tend to inherit rather than a genetic issue. So before you say, “it’s genetic because this person and that person in my family has it.” I urge you to look closely at your lifestyle and what you eat regularly. As I mentioned earlier, diabetes runs on both sides of my family, and my first LP-IR score was in the middle and could see that diabetes could be in my future too, but look what happened. I’ve trended all the way to being far from insulin-resistant. That is habitual changes, not genetics. 😉
Good information, but pushing a certain diets.
I didn’t post some videos that explained really well some of what I’ve learned because they end up promoting the KETO diet, and I’m not a proponent of it or ANY named diet for that matter! I believe one reason that KETO can work for this is mainly due to the highly reduced carbohydrate intake. Even too many of the good complex carbs can be bad and cause inflammation.
Another reason I believe KETO can work is that it gets the body burning fat as fuel, but so does exercising primarily in Zone 2 heart rate! I could go on about this, but I’m not because this article is long enough. I only brought it up because if you research this further on your own, you will see it, but understand that KETO is NOT necessary! IF you do KETO, then at least eat clean while following it such as eating grass-fed vs grain-fed beef. 😉
I also didn’t link to a couple of articles and a video that gave some information because they are all about a 100% plant-based / vegan diet. PLANTS ARE EXCELLENT AND DO WONDERFUL THINGS FOR THE BODY AND I EAT A LOT OF PLANTS, however, there are other things we need from animals. I’ll say this, eat mostly plants and a bit of animals, but above all EAT CLEAN! There is a lot of junk out there disguised as healthy, even products marketed as “plant-based” and “vegan.” I like to take vegan dishes and add some pasture-raised chicken or wild-caught sockeye salmon to them. Yummy and oh so healthy!
What about statins?
I didn’t discuss statins very much, but statins exhibit an anti-inflammatory benefit. I still take my Atorvastatin because I have over 20 years of inflammation inside my arteries due to poor life choices. It will never get fully reversed, but I am without a doubt healthier and more fit than I ever have been.
“Eat Clean. Get Sweaty. Rest. Live Well!” It is a saying that I’ve come up with over time through this journey, and it has evolved slightly, but it TRULY is a meaningful slogan that, if done consistently, can make some health problems a thing of the past.