Lab time
Let’s do lipids/cholesterol - part one?
FYI: Lipid profile is another name for Cholesterol profile.
If I had a dime for every time a patient asked with a nervous face,
“How is my cholesterol Doc? Is it too high?”
I’d be retired on my favorite island somewhere. Well probably not because I actually enjoy my job. But I could if I wanted to…..
EBM or Evidenced Based Medicine believes that LDL cholesterol independently causes heart and vascular disease and should be lowered aggressively. This is why most docs, when reviewing lipid cholesterol levels quickly look at the LDL cholesterol number and recommend medications called statins to lower that number. But while Evidence Based Medicine can be very helpful, it is also dependent upon bias, funding, politics and ……
So I prefer to look not only at EBM as evidence when discussing options for evaluation and treatments, but also another type of EBM. I call the other type Experienced Based Medicine. Thirty years of experience testing and managing patients and their lab results tells me that lowering LDL with statin medications rarely substantially reduces the risk of heart disease. The statins do indeed lower the measured blood cholesterol. But it does not greatly affect a reduction in heart disease. This is especially true in people who have never had a heart event, women, and people over 80 years of age with no previous heart disease. In fact there is data that indicates that Seniors with higher cholesterol live longer than those with low cholesterol.
IMW WOW= Institute for Medical Wellness Words of Wisdom
IMW WOW#1
High Cholesterol is as much a risk factor for heart disease as Low Cholesterol is.
In other words, Cholesterol is NOT an independent risk factor.
There are differences in Experience and Evidence and in a real scientific discussion, these differences would be debated openly, without any mocking, name calling or threats to research funding. But we appear to be in a unique time in healthcare and the world.
Let’s get back to the lipids. Woah, sounds like a cult movie???
Now showing:
“Back to the Lipids”
- starring the cast of the #StatinDenialCult
- Being shown at a LabCorp/Quest drawing center near you
- Coupons available at your local CVS and Walgreens pharmacy
While traditional docs laser focus on LDL, I look at the entire lipid profile which also includes Total Cholesterol, Triglycerides, HDL and sometimes VLDL.
From studying a whole bunch of research articles, meeting with many colleagues at medical conferences, having lengthy discussions with anyone who will have one, as well as closely following the experiences of thousands of patients over 30 years, my belief is that LDL, while important to look at and test is not necessarily an independent risk factor for heart disease. Key word being “independent”. This means lowering LDL via pharmaceuticals is not the wonder treatment for preventing heart disease as most believe. The statin drugs do minimally reduce some heart disease risks, but the mechanisms known as pleiotropic effects appear to be independent of their LDL lowering effects. But somehow these questions are not asked or the questions are ignored as to why?
What do I prefer to look at in the Lipid profile?
My preference is to look at your Triglycerides and HDL. I then calculate your Triglyceride to HDL ratio.
An optimal Triglyceride to HDL ratio is less than 1. This means you want more HDL than Triglycerides. This Triglyceride to HDL ratio below 1 is a good indicator of optimal Insulin Sensitivity.
Insulin Sensitivity is awesome!!!
Insulin Resistance, the opposite of Insulin sensitivity, is not so good. In fact it is my belief as well as many others that Insulin Resistance is the largest cause of heart and vascular disease.
Strive for a Triglyceride to HDL ratio of below 1 for greatest Insulin Sensitivity and lower heart and vascular disease risk.
A decent Triglyceride to HDL ratio is between 1 - 1.5. This means you want your Triglycerides no more than 50% higher than your HDL.
You do not want a Triglyceride to HDL ratio greater than 1.5.
A ratio above 1.5 is a marker of Insulin Resistance and a higher risk of heart and vascular disease.
Some examples:
Example 1:
Triglycerides 50
HDL 75
Ratio 50/75 = 0.67
This is less than 1 so is optimal and is low risk for heart disease.
Example 2:
Triglycerides 90
HDL 65
Ratio 90/65 = 1.4
This is greater than 1 but less than 1.5 so this is still lower risk but not as optimal for heart disease.
Example 3:
Triglycerides 140
HDL 45
Ratio 140/45 = 3.1
This is greater than 1.5 so it is higher risk for heart disease.
FYI
All of the above examples are of my own lipid profiles over the past 15 years. At no time did I use medication to change the levels. I did make a change in diet and lifestyle to attain Example 1, the optimal and lowest risk level.
If you know me you probably already know how I did this. If not you really should ask how.
I could be persuaded to explain more in a future post. If you would like that, please leave a comment below.
Yes, please share your story!
Would be very interested in learning how you lowered or improved your triglycerides to HDL ratio