My Cholesterol Test & Some Old School Information

It all started with a routine cholesterol check.

The nurse called and said my results were in, and “everything looked fine”. But they weren’t fine. She didn’t have the heart to break it to me.

My cholesterol had increased!

Naturally that can only mean one thing. Yep, it’s time to activate the cholesterol research project, time to do what I was born to do, time to go learn something, time to go be awesome and shock the world with an insightful knowledge bomb.

Well, that was the plan anyway. Sadly 96 hours, 7 trips to Starbucks and approximately 351 head scratches later, I can confidently say that I somehow still know shockingly very little about cholesterol. I believe I actually lost knowledge during this time.

But all is not lost. I found some really good old school information (not that old school, this old school) and thought I would summarize some of it here, just in case someone else cares about this subject, because that person is officially not me.

Nope, cholesterol is dead to me and the word should never be spoken in my presence again. And by never, I mean Tuesday. Don’t test me on this one.

Basics – What is a Cholesterol Test?

  • Fat and cholesterol are both members of a naturally occurring group of molecules called lipids.
  • They are both oil-based and can’t dissolve in our water-based blood so the body packages them into protein-covered particles called lipoproteins (part lipid, part protein).
  • The purpose of a cholesterol test is to generate a lipid panel measuring the total amount of cholesterol and levels of certain lipoproteins in your blood (typically in mg/dL units).
  • Most lipid panels report levels of low-density lipoproteins (LDL), high-density lipoproteins (HDL), triglycerides (TG) and total cholesterol.
    1. LDL – known as “bad cholesterol”. It carries cholesterol from the liver to the rest of the body. When there is too much LDL cholesterol in the blood, these particles can form deposits in the walls of the coronary arteries which can limit blood flow to the heart.
    2. HDL – known as “good cholesterol”. It collects excess cholesterol from the blood, from LDL particles, and from artery walls to carry it back to the liver for disposal.
    3. Triglycerides (TG) – a type of fat that consists of 3 fatty acids attached to an alcohol (glycerol). They are the main vehicle for transporting fats to cells for energy, and necessary for health, but too many can be a bad thing. VLDL (very-low-density lipoproteins), a measurement seen on most tests, is commonly estimated to be 20% of current TG levels.
    4. Total Cholesterol – a measurement of the total amount of cholesterol in your blood. LDL + HDL + VLDL.

Recommendations

  • General recommendations are to lower LDL and raise HDL to mitigate risk of heart disease and other chronic conditions. [1] General guidelines from the National Cholesterol Education Program can be seen here.

Open Questions & Interesting Points

  • Is elevated LDL always a bad thing? If not, what are we missing?
    • While it’s well established that saturated fat substituted for unsaturated fat (or carbohydrate) increases LDL cholesterol, a link from saturated fat to cardiovascular disease (CVD) is still being debated. [2]
  • Total amount (%) of fat in one’s diet hasn’t been linked to any important health outcome which includes cancer, heart disease, weight gain, etc. But the type of fat is important. [4]
  • The amount of cholesterol a person consumes has a very minor impact on blood cholesterol levels. [3]

Conclusion

That’s it for now. Hope to add to this at some point with more detail, recommendations and/or new research.

Right when I was about to call it quits, I stumbled upon a guy named Peter Attia that seems to be doing some really cool work. Check out this article in the Wall Street Journal about his project and funding for more information.

References
[1] Harvard School of Public Health » The Nutrition Source » Fats and Cholesterol: Out with the Bad, In with the Good. A good overview which discusses the evolution from low-fat, low-cholesterol diets to where we are now.

[2] Saturated Fatty Acids and Risk of Coronary Heart Disease: Modulation by Replacement Nutrients

[3] Dietary cholesterol, atherosclerosis and coronary heart disease

[4] Types of dietary fat and risk of coronary heart disease: a critical review

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