Short answer to the above question, NOTHING when taken out of context, which is most, commonly what happens.  Cholesterol has really gotten a bad rap, almost to the point where we would want to remove it completely, but cholesterol is not a dirty word.  As always we need to start with what is cholesterol.  Cholesterol is fatty acids attached to a glycerol backbone, in essences its an alcohol and fat but is classified as a lipids due to its function in the body.  The liver manufactures cholesterol for the most part and only 5-7% is obtained from the diet.  So, next time you read about low fat diets do your health a favor and flip the page.  Now would be a good time to touch on the good fat bad fat.  Most natural fats such as olive oil, flax seed, fish oil are good for us in proper balance.  We get in trouble with the manufactured or processed oils that become oxidized and harmful to us, they are usually labeled trans fats.

 So, what does cholesterol do? 

-Cholesterol makes up our sex hormones such as DHEA, testosterone, and estrogen.  It is a precursor to the synthesis of bile salts.  Bile salts are important to break down and absorption of fatty nutrients like Vitamin A, D, E, K and CoQ10.  Without proper bile salts we become malnourished and often gassy or bloat after meals.

 -Cholesterol is present in almost every cell in the body and makes up the cell membranes, which allows body chemicals to flow in an out at a regulated rate.

 -Cholesterol helps to create vitamin D and is a component of the myelin sheath or the covering around all our nervous tissue.

 Lower serum cholesterol level was associated with worse cognitive function in the community sample.”1

 Low cholesterol has even been associated with premature cognitive (memory) decline. Cholesterol is absolutely essential for life so why do we go through so much trouble to lower it?

Like most things the cholesterol-lowering pandemic is driven largely by money.  According to Forbes Magazine, statin medication is the most widely prescribed drug in history with annual sales of $26 billion.  Pfizer alone spends $3 billion a year just on ads to convince us that we NEED statins to keep us healthy. With such a high volume of these drugs being fed to patients they must be doing well.  Unfortunately heart disease, the very reason statins are prescribed, is the leading cause of the death in the United States.  Every 34 seconds someone has a heart attack.  We are clearly mis-managing these patients.  When you look at your LDL cholesterol on your labs roll your finger to the right and you’ll see “(calc)” which stands for calculation.  Now we have this somewhat useless drug being pushed onto to patients due to a calculated value?!  The following is a quote from the longest running heart study currently, the Framingham Study:

“…majority of individuals who develop coronary events are not in a high-risk group according to the Framingham risk assessment of traditional risk factors for coronary heart disease (CHD), and because one half of those who suffer myocardial infarctions have normal lipid values, measurement of inflammatory markers has been suggested as an adjunct to lipid testing to better identify individuals at increased risk.”

Screen Shot 2014-02-26 at 12.42.26 PM

If total amount of cholesterol doesn’t matter and statins clearly are not working than what is the problem and what do we look for?  As stated above when cholesterol number are taken out of context it becomes hazardous to our health.  We can begin to see that lowering cholesterol is just playing with numbers.  On my cardiovascular risk patients (and all those over 35) I run a lipid fractionation panel.  Every lab will call it something different so talk to your doctor about running the right test.

” …In elderly females a low cholesterol values (<155mg/dl) increased death rates by 5.2x when compared to females with high cholesterol of 272mg/dl”5

Screen Shot 2014-02-26 at 5.55.31 PM

The following are values you will receive when ordering a lipid fractionation panel (more specifically the VAP test).  I will go through them one by in hopes to clarify the entire cholesterol picture.  Keep in mind these values must also be compared to patient’s current sugar status, thyroid dysfunction, stress level and response, toxic load etc.  All poor health processes begin with inflammation.

 Total LDL:  Considered the “bad” cholesterol.  It oxidized it can become harmful to vessels and the heart but is also necessary to create productions of the body as mentioned above.

HDL Cholesterol:  For long time touted at “good” cholesterol but it is important to   note that there are sub fractions of HDL.  HDL2 and HDL3.  HDL2 is large and buoyant and is also most protective.  HDL3s are smaller and less protective.  Some research is also showing that HDL3s can even harm the heart.

VLDL: Very low density lipoprotein; commonly elevated with excessive triglycerides and sugar consumption.  Can be harmful.

Total Cholesterol: The amount of cholesterol (all sub fractions) circulating throughout the body

Triglycerides: elevated levels associated with excessive sugar/carbohydrate consumption or poor sugar regulation

Non-HDL Cholesterol:  LDL+VLDL some research points to this value as a better predictor for cardiovascular risk

Total apoB100:  protein that moves cholesterol around the body – research is mixed but most say this is another good estimate of “bad” cholesterol

Lipoprotein a, Lp(a): In my opinion, the most important value of a lipid fractionation test.  Some call it the “Heart Attach” protein.  Increased in inflammatory states.  It is not effects by traditional cholesterol lower medications.

IDL Cholesterol:  Found elevated in patients with metabolic syndrome/diabetes

Real LDL Cholesterol, LDL-R: Direct measurement of LDL cholesterol unlike the calculated version found in traditional testing.

LDL Cholesterol Size pattern: Overall size and buoyancy of the cholesterol particle.  In my opinion, the second most important piece of information from lipid fractionation testing.  Pattern A is ideal.

Total apoA1:  The building block for HDL cholesterol and is thought to be a cardio-protective marker.

apoB100/apoA1 ratio: I am not a big fan of ratios.  To have a ratio be off then one of the independent values must be out of functional range as well.  That being said this is used as another marker of whether you are in a cardio protective state.  The lower the number is said to be better.

VLDL3:  Most dense of all VLDL and considered the greatest risk.

In conclusion, you need to be evaluated completely for cardiovascular risk, which may include a lipid panel; but definitely should not stop there.  Ask you doctor about the fractionation panels available as well as inflammatory markers such as: fibrinogen, CRP, ESR, homocysteine and others to get a complete look at the cardiovascular system.  There is a lot more to cardiovascular health than cholesterol numbers and concentrating on that basic lipid panel will get you in trouble quickly as we can see from the recent statistics.  Have you ever heard of the lean, healthy 35 year old that eats well, has a good state of mind and a normal cholesterol who goes running in the morning and dies from a heart attack?  Clearly there is more going on then just the amount of lipids.

Since the writing of this article our office has began using the Berkeley Heart Labs: Cardio IQ profile.


Works Cited:

1.  Low cholesterol, cognitive function and Alzheimer s disease in a community population with cognitive impairment. J Nutr Health Aging. 2002;6(5):320-3.
2.  Hanukoglu I (Dec 1992). “Steroidogenic enzymes: structure, function, and role in regulation of steroid hormone biosynthesis.”. J Steroid Biochem Mol Biol 43 (8): 779–804. doi:10.1016/0960-0760(92)90307-5PMID 22217824
 3.  Kochanek KD, Xu JQ, Murphy SL, Miniño AM, Kung HC. Deaths: final data for 2009. National vital statistics reports. 2011;60(3).
 4.  Roger VL, Go AS, Lloyd-Jones DM, Benjamin EJ, Berry JD, Borden WB, et al. Heart disease and stroke statistics—2012 update: a report from the American Heart AssociationCirculation. 2012;125(1):e2–220.
5.  Forette, B. Cholesterol as a risk factor for mortality in elderly women. Lancet. 1:868-870.1989