Perspective on cholesterol numbers: Better predictors of heart disease - opinion

For those of you who are in your 40s or older, your physician probably would like to see a blood test every year or two. There are many numbers and markers on a complete blood panel, and a simple blood test can often tell us about things that are happening that we can’t see with our own eyes. What is found can even save your life.

Some of the numbers that we pay particular attention to have to do with predicting our future heart health. Our lipid profile or cholesterol numbers are some of the most important numbers on blood tests in the Western world. Today’s references want to see an overall cholesterol number of 200, a low-density lipid (LDL) number under 130 (unless you have heart disease, in which case it is 100), and a high-density lipid (HDL) of above 40. It is better for your overall number to be closer to 150 if possible, your LDL closer to 100 if possible and the HDL 60 or above. Please note that very recent research has practically discounted HDL as a factor.

These numbers receive a lot of attention. But, how much do these numbers really tell us about our future heart health and is it possible there are other factors that can be better predictors of heart health that mainstream medicine has yet to incorporate into our arsenal?

First some perspective. As the cardiologist Dr. Joel Kahn is always pointing out, cholesterol is one risk factor for heart disease but there are many more. Now, let’s clarify something important. These numbers are not something absolute. I have had clients who come in with a cholesterol of 201 and are sure their demise is imminent. On the other side, clients come in with a 198 or 199 and are really happy that they are under the red line and are sure they have nothing to worry about. Well, both of these thoughts are untrue.

How much these numbers play into the equation is not as simple as that. Digest this fact. Half of the people who have a heart attack in the United States of America (once every 39 seconds) don’t have high cholesterol and half of the people with high cholesterol, never have a heart attack. Think about that.

Four years ago, a relative of mine was bragging about phenomenal blood work. His cholesterol was around 160-170, his LDL was pretty close to 100. He works out most days of the week intensely. He would certainly describe his eating as mostly healthy and in comparison to the standard American diet (SAD) it was.

Nevertheless, he had a stroke. He was age 58 at the time. Thank God, he recovered very quickly and is back to normal but he had a stroke. I bring this example in order to illustrate the fact that numbers on a blood test don’t necessarily tell us everything.

We need cholesterol

WE NEED cholesterol. One of the most important jobs of cholesterol is to aid in the production of hormones. Cholesterol is stored in the adrenal glands and other places in the body and is converted to steroid hormones. These steroid hormones perform vital duties to help the body function properly. Without steroid hormones, we will have malfunctions with weight, intimacy, digestion, bone health and mental status.

In addition, cholesterol plays an important role in our body’s digestion. Cholesterol is used to help the liver create bile, which aids us in digesting the food that we eat. Without bile, our bodies are unable to properly digest foods, especially fats. When the fat goes undigested it can get into the bloodstream and cause additional problems, such as blockages of the arteries, heart attacks and heart disease. Yes, you read that correctly: Without cholesterol, we can have a heart attack.

For cholesterol to become harmful, it has to oxidize. Without oxidation, it won’t become a harmful plaque and end up clotting an artery. So, let’s see what might be better predictors of heart disease.

What are better predictors of heart disease?

First, check your blood test of CRP (C-reactive proteins). They are a sign of possible inflammation. Tell your doctor to include it on your test, they don’t always.

Second, although not yet a readily available test, there is an inflammatory factor made in our microbiome called TMAO. There are only a few places to test for it, but if you want to diminish the amount in your body, simply cut way back on meat, chicken, fish, eggs and dairy. These foods contain choline, which you gut bacteria then turn into TMA and TMAO.

Third, has your doctor ordered a blood test to check for lipoprotein (a), referred to as “little a”? If you have it, it is more likely that you can suffer a heart attack and this should act as an incentive to be extra careful with diet and exercise.

Fourth, is your diet rich in fruits, vegetables, legumes, lentils and whole grains? Do you limit processed food, animal proteins, dairy and eggs? Do you include a lot of green leafy vegetables each day? They will keep the endothelial lining of your arteries working well and keep it improbable for plaques to build and inflame. Do you exercise? Even a 30-35 minute brisk walk daily does wonders to prevent all heart disease.

Finally, if you want to know what’s going on inside, there is a pretty benign test one can take. It’s called a Cardiac Calcium Score. It has finally been approved by the American Heart Association (15 years too late). It uses a CT machine with no added iodine. Radiation is minimal. It will give you a good idea about where you stand and enable you to take every measure needed to prevent heart disease.

Dr. Esselstyn of the Cleveland Clinic says that heart disease is a highly preventable and reversible disease that need not exist. Esselstyn also points out that no number on a blood test will give anyone a heart attack but what passes through your lips each day certainly could.

Low cholesterol, unless it is under 150, without statin drugs guarantees nothing. Concentrate on what matters, which is maintaining good lifestyle habits and testing what matters more. It will add hours to your day, days to your year and years to your life.

The writer is a health and wellness coach and personal trainer with 23 years of professional experience. He is the director of The Wellness Clinic. You can reach him at alan@alanfitness.com.