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A Whole9 guest post by Dr Sult, medical doctor, medical educator, inspirational speaker & the author of Just Be Well: A Book For Seekers of Vibrant Health.

The Inside Story on Cholesterol
Looking to lower your risk of heart disease? Conventional wisdom says you should exercise regularly, eat well and keep your cholesterol levels in the recommended range. Sounds simple, right?

Not so much. Cholesterol is actually a lousy predictor of whether you’re going to have a heart attack. In fact, lowering cholesterol has been shown to reduce your risk of heart attack only if you’ve already had a heart attack. If you haven’t, lowering cholesterol as a whole doesn’t affect your risk. Instead, we need to look more closely at cholesterol levels to determine what they can—and cannot—tell us.

What is Cholesterol?
Cholesterol itself isn’t a bad thing. It is a waxy, fat-like substance naturally found in all human cells. It helps make hormones, vitamin D, and other substances that help us digest food. Although our bodies make cholesterol, it is also found in foods, such as fatty meats, saturated fats like butter, and trans fats, which are often found in crackers and cookies.

Cholesterol travels through the bloodstream in carriers called lipoproteins. Two kinds of lipoproteins provide this transportation, LDL and HDL. LDL is commonly known as “bad” cholesterol because too much of it results in a buildup of cholesterol in the arteries, making it more difficult for blood to squeeze through and deliver oxygen to the cells. HDL, or “good” cholesterol, acts like a garbage truck: it brings cholesterol from other parts of the body to the liver, where it leaves the body.

The higher the LDL or bad cholesterol, the greater the chance of getting heart disease. The higher the level of HDL (the cleanup lipoprotein), the lower the chance of getting heart disease.

So it’s not just your cholesterol level that makes a difference in your risk of a heart attack—it’s the numbers inside.

For many years, the medical community has focused on advising patients to decrease the LDL or bad cholesterol. But newer studies have shown that it’s more important to have a high level of good cholesterol than it is to have a low level of bad cholesterol. In his article “Forget LDL—Think HDL,” cardiologist Stephen Sinatra says that even when heart patients have tremendously lowered their LDL, they are still at significant risk for heart problems. In addition, he says that many patients who have coronary artery disease have low HDL levels, and that a higher level of “good” cholesterol could help keep the “bad” cholesterol moving on out of the body.

Understanding Your Cholesterol Levels
The typical blood test that tells you your total cholesterol level will not give you enough information to understand how LDL and HDL are operating in your body. If you’re concerned about your risk of heart disease, stroke, or your level of cholesterol, talk with your doctor about getting one of the new-generation lipid tests that delve deeper to look at LDL and HDL numbers, as well as LDL particle numbers and size.

Although finding out your individual cholesterol levels is helpful, it’s even more important to look at your actual cardiovascular function. Many functional medicine doctors can measure the compliance of the “cardiovascular tree” in the office, determining the elasticity, or compliance, of the veins and arteries. The buildup of plaque or cholesterol can make the arteries stiffen, increasing the risk of blood clots, stroke, heart attack, angina and other coronary diseases, as well as kidney disease.

The Centers for Disease Control and Prevention say that one in six American adults has high cholesterol levels, meaning high levels of “bad” cholesterol. Most people who have it don’t even know it, because few symptoms may precede a cardiac event, such as a heart attack.

By consulting with a doctor to get the inside story on your cholesterol levels and cardiovascular function, you can understand what risks you might face, and develop an effective strategy to improve your health.