I am sure you know what cholesterol is and also believe that doctors and scientists all know what cholesterol is and they also should know what cholesterol does. I beg to disagree.

LDL: Is Yours High or Low?

I was thinking about the reason for the high LDL in some folks and low LDL in other folks. Our healthcare is very LDL-focused but does anyone understand what LDL actually is?

LDL is not cholesterol. It never was and never will be a cholesterol. LDL is acronym for Low Density Lipoprotein and, as the acronym implies, it is a lipid (fat) and protein ball. Cholesterol is not a fat but a waxy substance that cannot travel in the blood, which is water-based. LDL on the blood tests is the measure of these little balls made of protein and fat. So why are we calling it a cholesterol and why are we measuring it?

Good question.

HDL: Is Yours High or Low?

Not unlike LDL, HDL is also not a cholesterol. HDL is an acronym for High Density Lipoprotein. Yep, you guessed it, it too is a lipid and protein ball and not cholesterol. So why are we calling it cholesterol and why are we measuring it?

Good question.

TRIGLYCERIDES: IS YOURS HIGH OR LOW?

Triglycerides aren’t cholesterol either. They are actually fats gathered into triplets and connected with a glycerol cap. Triglycerides are interesting because, unbeknown to most people, doctors, and scientists, most human organs use these non-esterified fatty acids as fuel. Yep, our body is not a glucose burner: it is a fat-burner. Interestingly, to show easily that the heart and skeletal muscles use free fatty acids as fuel instead of glucose, I had to go to a UK NHS website.

Getting to the Chase

If the measurement of LDL, HDL, and triglycerides are not measuring cholesterol, then what exactly do we measure under the disguise of a blood test for cholesterol?

And this is where my point becomes interesting. Looking at LDL and HDL we learn how many “containers” we have, each of which carries cholesterol and other things, such as fat-soluble vitamins A, E, and K2–and perhaps D3 (a hormone) as well.

A standard cholesterol test cannot measure cholesterol because cholesterol is not actually present in our blood!

What we have in our blood are these lipoprotein vehicles in which cholesterol travels. Have you seen freeway overpasses in your past where a person stands and presses a counter button every time a vehicle passes under? I have. Every vehicle, be it a motorbike with one person or a buss with 80 people on it get one click. This counter can certainly count how many vehicles are on that freeway but not how many people travel on that freeway.

There are variances in vehicle sizes and also people sizes! If the people are tiny, more can fit into a small car than if the people are large, not to mention the size differences between vehicles, such as a motorbike vs a bus.

And this is where understanding the significance of what we are NOT measuring becomes visibly important. If we want to know about the cholesterol, we need to measure cholesterol and not the container in which it travels.

The reason is simple: if my cholesterol particles are the small and dense (unhealthy) type, I can pack each LDL vehicle chock full of thousands of cholesterol particles and so I need fewer LDLs.

If you were a cholesterol particle and you were small and dense, how many of you could fit into an LDL, which is a given size? A lot… and so with bad types of cholesterol particles--small and dense--a person needs fewer LDLs because each can be packed full of small dense cholesterol particles. So having naturally low LDL is not necessarily a good sign! It may be a terrible sign that the person is unhealthy!

By contrast, I may have very large cholesterol particles (large and fluffy, the healthy kinds). If I have the large and fluffy kinds, I must have more LDLs (the vehicle) to carry these larger and fluffier cholesterol particles, because I can only put a few into each LDL.

If you were a cholesterol particle and you were large, how many of you could fit into an LDL, which is a given size? Very few! So you will need more LDLs because so few can fit into each that you have to produce more to carry the same number of cholesterol particles. Having a large number of LDLs may be very healthy!

Based on this, not only is it a problem to only look at LDL and HDL and not the cholesterol particles within, but by aiming to reduce LDL to some artificially derived ideal may be very harmful!

SO: IS HIGH LDL A PROBLEM?

It may be.

If you have lots of LDLs but each is full of small dense cholesterol particles, it is a problem. If you have lots of large and fluffy cholesterol particles, then high LDL is desired. You need to find out what your cholesterol particle sizes are and not how many LDL or HDL balls they travel in.

This is a mathematical and engineering problem of size.

Conclusion

Do we have cholesterol understanding completely backwards when we want to reduce LDL? Absolutely! Those with naturally low LDL may be a lot less healthy than those with naturally high levels of LDL. The truth is the “pudding” so to speak.

Have your cholesterol checked using NMR. NMR (Nuclear Magnetic Resonance) is able to see the number and size of cholesterol particles inside the LDL and the HDL balls. It can tell you in great detail if your cholesterol is the healthy large and fluffy type or the dangerous small dense type. And the only importance of the letters LDL and HDL will be so you know where they are looking at for your cholesterol size and type. There is zero reason to look at your cholesterol in a regular standard blood test. You are learning nothing about your health.

Comments are welcome, as always, and are moderated for appropriateness.

Angela