The Cholesterol Test You Should Be Getting

when you get your traditional cholesterol panel done your traditional lipid panel done you're they're they're giving you the the ldl cholesterol the hdl cholesterol the total cholesterol and and that's one piece of information like you said but we're missing a lot of of information there hi i'm kaya perrot one of the producers of the doctor's pharmacy for so long we've been told that having normal cholesterol levels is the key to heart health but what constitutes normal and what is actually being measured and overlooked through traditional cholesterol testing dr hyman recently explored this topic with his colleague dr elizabeth boham so let's talk about cholesterol because in my opinion and i've written a lot about this the test that you get when you go to your doctor is antiquated absolutely it's outdated it's not the cholesterol test you should be getting and it doesn't give you the right information to make a decision about what to do so you need something called what like particle size testing um it's telling us about those those things that are carrying around your cholesterol yeah so labcorp does nmr yep nmr quest does something called cardio iq which is similar and you can ask your doctor for these and you shouldn't stand for any other test but these tests absolutely so when you get your traditional cholesterol panel done your traditional lipid panel done you're they're they're giving you the the ldl cholesterol the hdl cholesterol the total cholesterol and and that's one piece of information like you said but we're missing a lot of information there so the the uh it's really important i love this analogy of the dirt and dump trucks so um dirt and dump trucks and think of think of all the dump trucks that are going around carrying dirt and we can make this analogy with cholesterol so think of your cholesterol like the dirt and the um the dump trucks are the particles carrying around your cholesterol so what we're learning is it's not just the amount of dirt somebody has that's important it's the amount of dump trucks that they have carrying around that dirt and that the size of the dump trucks are actually really important and so when you get a typical lipid panel done you know you're just finding out the amount of dirt that you have and how much of it is ldl and hdl and triglycerides and that's important and we will talk about that but what's even more important or at least as important right is the amount of dump trucks you have carrying around that dirt and what we're learning is that or what we've learned is that the the if you have small dump trucks so if you have a certain amount of dirt you could either have a few big dump trucks carrying it around or a lot of small dump trucks carrying it around yeah and what we're learning is that those small dump trucks if you have too many small dump trucks that that's actually more concerning that they can get into the artery lining more they can cause more plaque buildup they can get that that they can help that cholesterol get oxidized through oxidative stress it's much more dangerous so the size of those dump trucks you have carrying around your cholesterol is critically important yeah and something we look at all the time i mean the way i think about it is and i another way i kind of look at it is um you know the the number you get on your test is the weight of your cholesterol so it's milligrams per deciliter it's just basically the weight yep but it doesn't tell you if that cholesterol is made up of a thousand particles or 100 particles right so you could have a cholesterol of 150 and it could be 5 000 particles or it could be 500 particles of cholesterol and that makes a huge difference in your risk of heart disease and you can't tell from a regular cholesterol test whether you have a lot of particles or whether they're big particles or small particles so i think about sort of like golf balls and beach balls you know beach balls these big light fluffy balls that you can bounce and don't hurt anything and the golf ball is small but a hitch in the head will knock you out right and the golf balls are the things that are the small particles that are dangerous that bang up against the arteries and cause the plaque to develop and cause heart attacks so so you can't tell that from a regular test you can have smaller large ldl smaller large hdl smaller large triglycerides and the triglycerides are a little different it's the big triglycerides that are problem not the small ones but you can really get a sense from these newer tests what's really going on there's there's a lot of lifestyle that impacts the size of your ldl particles right the size of those you know are they small and dense and dangerous or are they big and fluffy and not so dangerous i mean there's a there's always a genetic component right there's a genetic component but then there's our lifestyle and we know that that that uh metabolic syndrome where people are insulin resistant gaining weight around the belly they typically have lower hdl they typically have higher triglycerides but they also typically have more of these small dense ldls which are more concerning and so lifestyle makes a huge impact on the the size of those ldl particles and which part of your lifestyle what's the biggest thing the diet that's the one that you know that full of carbohydrates and sugar and refined and processed foods and lots of alcohol and you know it's the sugar that drives it and what does that do to the body that causes these particles and it actually leads to the high triglycerides the low hdl the small particles right it's that whole process of insulin resistance and it results in this really unhealthy pattern and so you know we sometimes get clues of that with a standard lipid panel right we sometimes get clues when somebody has a low hdl that's the one the hdl is the one you want higher and for for men you want it at least over 40 and for women at least over 50 um and then if that triglycerides are like 50 and 60 i'm more aggressive than you yeah well that's really true like what's that optimal right what's off your cholesterol's hl's 40 probably not optimal should be over 50. it really should it really should you're right here and then the triglycerides you want at least under 150 or what would you say what's that there you go for triglycerides so if your triglyceride is over 100 you're you're definitely flirting with danger mm-hmm uh and there are you know there's some genetics involved we'll talk about the genetics in a minute but but it is usually a sign of increased carbohydrate load like not and i don't mean broccoli i mean like flour and sugar absolutely right so so you know you can get some sense of if somebody has is prone to metabox syndrome insulin resistance with that but then the particle size testing also gives us a lot of information um the nmr for example gives you something called your insulin resistance score yeah so you can get a sense based on the analysis of the particles of cholesterol that you have how at risk you are for insulin resistance so it's just one more piece of the puzzle and i've seen people with a cholesterol i'm 150 yep who have like 2 000 particles of ldl which is should be under a thousand who have like 900 particles a small ldl which should be under 300 ideally probably less than 90 is perfect and you see that often and yet their doctor well your cholesterol is 150 it's fine you know and and so you really can get duped by just looking at the total numbers if it's 300 it might be fine if it's 150 it might be highly dangerous to you right and it's not so easy without looking at the specific test i just want to point out because this is really a very easy cheap way to check to see if you have insulin resistance and it's a far better predictor of your risk of heart attacks than your ldl which is your triglyceride to hdl ratio right it's over one not great you know one of the things that we're really bad at in medicine is personalizing care and there's no place that's more important to personalize your care than dealing with your heart attack risk and cholesterol because it's different that's very true so when you're talking about people's cholesterol you know how do you decide you know what to do for each patient how do you decide from a functional medicine perspective you know how to work these patients up to decide whether that should go on a drug or whether you just do lifestyle how do you how do you figure that out i mean it's it is a complex uh process right where we're taking a really detailed history and we're looking at more than just those numbers we're looking at what are their markers of oxidative stress you know we can measure those yeah i think we we are so stuck in this paradigm of treating the symptom the cholesterol instead of the cause absolutely i mean it's estimated that 50 percent of people in this country and in europe and 40 percent worldwide have what's considered elevated cholesterol and and obviously that you know for those 50 percent of people not all of them have to be really concerned about that cholesterol number it doesn't mean that all 50 of us have to be taking a medication to lower that cholesterol and so people come in all the time with those questions of is this cholesterol too high and how do i get it down do i need to get it down and and the reason we're really looking at cholesterol is because it's one factor that influences somebody's risk of cardiovascular disease right i like how you said one factor one factor exactly i think we really have to understand that heart disease is a complex disorder it's not just about cholesterol that from a functional medicine perspective we do much more detailed workups looking at inflammation oxidative stress looking at the particle size of number looking at even your gut heavy metal toxins other factors that relate to nutrition like homocysteine and and we get a really good sense of what's going on and and we then personalize the treatment and it's very very different approach to reducing your risk it is so important to be sure you're getting the right cholesterol tests be sure to ask your doctor to do a particle size tests this will check both your particle size and particle number and you want to see results that show lots of safe light fluffy big cholesterol particles you do not want to see small dense artery damaging cholesterol particles ultimately your ratio of total to ldl cholesterol and particle number and size are a far bigger predictor of heart attacks than ldl itself if you'd like to learn more about anything you heard today i encourage you to check out dr hyman's full-length conversations with dr elizabeth bowham where they go into much more detail about how they work with patients to treat and prevent heart disease if you enjoyed this episode please consider sharing it and leaving us a review below until next time you

Channel: Mark Hyman, MD

Views: 159,772

Keywords: cholesterol, high cholesterol, testing, lipids, statins, elizabeth boham, mark hyman, health podcast, the doctor's farmacy, nutrition, health, diet, functional medicine

Id: YxKaa2Z3HKw

Length: 10min 56sec (656 seconds)

Published: Fri Apr 23 2021