I met with a client today who was concerned with his recent blood test. He works out consistently, eats healthy, looks and feels great. He had a complete blood test and everything was perfect except for his cholesterol numbers or so he thought. His Total Cholesterol was 246 and his doctor strongly recommended he take cholesterol lowering medication (statin). My client, wanting to be healthy was reticent. "Mike, healthy people don't take medications right?"
Looking at his numbers in a little more detail we saw that his HDL (good) cholesterol was 86 MG/DL and the recommended range was over 40 MG/DL, so far so good. His Cholesterol/HDL Ratio was 2.9 and the recommended range was less that 5.0, so far so good.
I have been taught that HDL percentage is a far more potent indicator for heart disease risk. Here are the two ratios that I thought should have been considered but were not:
- HDL/Total Cholesterol Ratio: Should ideally be above 24 percent. If below 10 percent, you have a significantly elevated risk for heart disease. His percentage was 35%, well above the 24% ideal.
- Triglyceride/HDL Ratio: Should be below 2 and his was 0.5, again well below.
So what was the cause for distress here?
- All his numbers were looking pretty good except for the 246 Total Cholesterol number. Why does this seem so high? There were two things causing it to be high. First, his HDL was increased which we discussed above and that is a good thing but more importantly his LDL or what is considered his "Bad" Cholesterol, was 151 where the recommended level was less than 130. All his other cholesterol indicators were great except for this so clearly he needs to be on meds right?
- Recent research into LDL or "Bad" Cholesterol has given us some insight into 4 different kinds of LDL and all of them are not "Bad" for you. There is a big, fluffy form known as large LDL, and three increasingly dense forms known as medium, small, and very small LDL. A diet high in saturated fat mainly boosts the numbers of large-LDL particles, while a low-fat diet high in carbohydrates propagates the smaller forms. The big, fluffy particles are largely benign, while the small, dense versions are cause for extreme concern.
But here's my client's problem:
- The typical LDL test doesn't distinguish between large and small LDL particles — it can't even spot the difference. And people can have mostly large LDL or mostly small LDL in their overall LDL, depending upon a host of genetic, lifestyle, and environmental factors. My client's mix may make all the difference between having a healthy heart and circulatory system and one in a disease state.
Another thing to consider would be his coronary risk factors, which by the way, he passed with flying colors when reviewing them with him.
So, as we sat there and reviewed all this information I told him that if it were me or if he were my wife, father or close relative I would not go on the medication but, and this is a real big but, he must listen to his doctor. I am only a personal trainer and holistic health consultant. I will point out research and educate him. What he needs to do is approach his doctor and go over this research with him to see what his doctor wants to do. I am hoping that he will have an open minded doctor that will further analyze his LDL and look into his other factors. He exercises regularly, he eats healthy, he doesn't smoke, his parents did not have heart disease, he looks and feels great and doesn't want to be on a medication and enjoy the benefits of it's side effects!
The moral of this story is to take your Cholesterol readings into your own hands, do your research and have a discussion with your doctor-question everything and only take a medication when it is absolutely necessary (there is a time and place for everything). And never, ever stop a medication without your doctors permission.
