Why cholesterol is an important health indicator

There are many numbers that people talk about when it comes to health. Your weight, your BMI, your waist size, resting heart rate. Cholesterol may be one of the most important. Recently, there has been some press which has attempted to lessen the importance of cholesterol. Certainly, any number taken in isolation has the potential to be misunderstood. I have always believed that a number is just that a number. It doesn’t reflect one’s true health and a healthy lifestyle/diet may negate the need for regular cholesterol checking. The majority of Americans, however, believe that their lifestyles/diets are generally healthy, which contradicts research and common sense that we aren’t as healthy as we think. Cholesterol is a glimpse into our body’s inner working and keeps us honest about how healthy our diet and lifestyle really are.

According to William C Roberts, MD, the editor-in-chief of the American Journal of Cardiology, “the only critical risk factor for atherosclerotic buildup is cholesterol.”[1] Atherosclerosis is “a disease in which plaque builds up in your arteries. Arteries are blood vessels that carry oxygen-rich blood to your heart and other parts of your body.”[2] Atherosclerosis is the basis of coronary artery disease, some types of chronic kidney disease, some types of stroke, and some types of peripheral vascular disease. Cholesterol matters in the development of these diseases, by way of atherosclerosis.

atherosclerosis
Atherosclerosis

Here’s the deal on cholesterol. There are 2 kinds: HDL and LDL. For the purposes of this article, we are going to focus on LDL cholesterol.

In general, LDL cholesterol should be kept low. This is the bad type of cholesterol which is the basis of atherosclerosis. Our LDL cholesterol may begin having an impact on our body, even before we are born. Some fetuses of mothers with high LDL demonstrated arterial lesions or streaky formation within the fetal aorta. Early atherosclerosis or fatty deposits within the vessel walls.[3] Your mother’s choices may already put you at risk. If you are a mother, bearing a child or considering having a child, your current cholesterol levels may impact the vessels of your developing child’s heart. All the time we spend, as parents, preparing the nursery, the perfect life, but are we preparing our own health?

Another study found that accidental death victims between 3 and 26 nearly all had fatty streaks by age 10.[4] If you aren’t born with it, you are likely on your way to early fatty deposits in your vessels by age 10. If you are a parent of a child less than 10 years old, you likely help them brush their teeth, brush their hair, wash their face and bath them. You do all of this, because you love them. Isn’t it time we considered the impact our lifestyles have on their insides. You aren’t a mean parent if you help them avoid fatty streak deposits in their vessels. Your choices of what your child eats can literally mean the difference between a life filled with health problems and one filled with peace and good health.

cholesterol-blocking-artery
Cholesterol Blocking Artery

By way of atherosclerosis, high LDL cholesterol is associated with the leading killer in the US: heart disease. Atherosclerosis starts young. In one article in the Journal of the American Medical Association from 1953, autopsies of 300 American casualties of the Korean war were studied, with an average age of 22 years old. These were young men, who were physically fit enough to serve in a foreign war. The results of the autopsies showed a shocking 77% of them already had visible evidence of coronary artery atherosclerosis. Some with as much as 90% blockage.[5]  Coronary arteries are the heart’s overlying vessels responsible for most heart attacks, when blockage occurs at significant levels. When these vessels are blocked, a heart attack occurs. Had these young men survived the war, they would have fallen victim to heart disease.

Let’s review what we have discussed, atherosclerosis is the basis of heart disease, most strokes, most vascular disease, and many incidences of kidney disease. These are some of the leading causes of death. Dr. William Roberts points out that cholesterol is the most important part of development of atherosclerosis. LDL cholesterol is the bad cholesterol associated with atherosclerosis and all of the above diseases. Here’s the good part, LDL can be tested. The best way to do it is by asking your primary care provider to have it tested. Many people can’t get into their primary care provider. If they can, they have to wait. Often the tests are ridiculously expensive, so what are your options?

cholesterol-lipids-test-by-everlywell
Cholesterol & Lipids Test by EverlyWell

Believe or not, you don’t need a doctor’s prescription to have cholesterol testing. You can literally buy a test on Amazon. There are several options. Everly Well™ offers a convenient, home testing solution. It costs $49 or less, requires a few drops of blood and has easy-to-follow instructions. As a caveat, I have not personally tested the fidelity of the results. I can’t attest to its accuracy, but here’s the deal. Most tests that your doctor does in a lab aren’t 100%. In fact, most aren’t. Sometimes one test requires a follow up test. Other times, it leads to unnecessary investigation. It’s a starting point for discussion. It’s a starting point to understanding where you are at. It is substantially less expensive that the cost of a doctor’s appointment, lab testing in a large health center, etc. What’s the harm? I suppose if it gave you an inaccurately low number that could lead to a false sense of security, but if it’s abnormally high, then I guess you will end up eating healthier than you needed to J.  I did reach out to Everly Well™, but haven’t heard back…I will update this post when and if I do.

Pick the home test you are most comfortable with, but please consider testing your cholesterol, if it hasn’t been tested in the last 1 year. Ok, so the results are in…now what? The optimal LDL cholesterol level is probably 70 or 70 mg/dl and the lower the better.[6] That’s the level where no deaths were recorded in the Framingham study.[6] The goal for total cholesterol should be less than 250 mg/dl, according to Dr. William Roberts. “If such a goal were created, the great scorch of the Western World would be essentially eliminated.”[7]

statin-drug
Statin Drug

When people have heart attacks, strokes and vascular diseases, they are typically placed onto statin medications to lower their LDL cholesterol. If your levels are high, depending on your situation, this may be the right temporary solution for you. Here’s the problem with statins. Patients and even some physicians often view this as an invitation to eat whatever one wants, because the statin medication will lower the cholesterol. Here’s the problem, statins are associated with muscle pains, fatigue, and other chronic issues. It’s not free. And, who wants to have to take another pill! The better approach is to adopt a lifestyle and diet, associated with extremely low LDL, total cholesterol and thus low levels of atherosclerosis and heart disease. This a topic we are deeply interested in at Doctor of Level and have many resources to help guide you on your way to adopt a lifestyle which promotes a low cholesterol.


[1] Benjamin, et al. “Facts and Principles learned at the 39thn annual Williamsburg conference on heart disease.” Baylor University Medical Center. 2013; 26 (2):124-36.

[2] “Atherosclerosis.”National Heart, Lung and Blood Institute. Health Topics. Atherosclerosis. https://www.nhlbi.nih.gov/health-topics/atherosclerosis. Accessed on September 21st, 2018.

[3] Intimal accumulation of low density lipoprotein and its oxidation proceed monocyte recruitment into early atherosclerotic lesions. J of Clinical Invest. 1997;100(11):2680-90.

[4] Voller, et al. 1981.:101(6):815-36.

[5] Enos, et al. coronary disease among United States soldiers killed in action in Korea; preliminary report. JAMA. 1953; 15(12): 1090-3.

[6] Esselstyn, et al. “In cholesterol lowering, moderation kills.” Cleveland Clinic Journal of Medicine. 2000; 67 (8): 560-564.

[7] Roberts, et al. “The cause of atherosclerosis.” Nutrition Clinical Practice. 2008; 23 (5) 464-467.

Leave a Comment