The Dr. Hyman Show - The Cholesterol Test You Should Be Getting

Episode Date: April 23, 2021

The Cholesterol Test You Should Be Getting | This episode is brought to you by Belcampo Many of us have been told by our doctors that we need to lower our cholesterol levels. But what does that mean, exactly? And do standard lipid profiles really tell us the full story about what is going on with our cholesterol? In this minisode, Dr. Hyman sits down with Dr. Elizabeth Boham to discuss the importance of cholesterol particle testing. They explore why other cholesterol tests are outdated and why information about particle size and particle number is the only way to know what’s really going on with your cholesterol.  Elizabeth Boham is a physician and nutritionist who practices Functional Medicine at The UltraWellness Center in Lenox, MA. Through her practice and lecturing, she has helped thousands of people achieve their goals of optimum health and wellness. She witnesses the power of nutrition every day in her practice and is committed to training other physicians to utilize nutrition in healing. Dr. Boham has contributed to many articles and wrote the latest chapter on Obesity for the Rankel Textbook of Family Medicine. She is part of the faculty of the Institute for Functional Medicine and has been featured on the Dr. Oz show and in a variety of publications and media including Huffington Post, The Chalkboard Magazine, and Experience Life. Her DVD Breast Wellness: Tools to Prevent and Heal from Breast Cancer explores the Functional Medicine approach to keeping your breasts and whole body well. This episode is brought to you by Belcampo. Right now, you can order Belcampo’s sustainably-raised meats to be delivered to your door using my code HYMAN at Belcampo.com/Hyman for 20% off for first-time customers.  Find Dr. Hyman’s full-length conversation with Dr. Elizabeth Boham, “Cholesterol Is Not The Cause Of Heart Disease” here: https://DrMarkHyman.lnk.to/CholesterolIsNotTheCauseOfHeartDisease

Coming up on this episode of The Doctor's Pharmacy. When you get your traditional cholesterol panel done, your traditional lipid panel done, they're giving you the LDL cholesterol, the HDL cholesterol, the total cholesterol. And that's one piece of information, like you said, but we're missing a lot of information there. Hey everyone, it's Dr. Mark. Now there's so much debate in the diet world about eating meat, but whether you're vegan, paleo, or a pegan like me, one thing we can absolutely agree on is that conventionally raised feedlot meat is dangerous for our health and the

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great about the meat that you eat. Now let's get back to this week's episode of The Doctor's Pharmacy. Hi, I'm Kea Perowit, one of the producers of The Doctor's Pharmacy. For so long, we've been told that having normal cholesterol levels is the key to heart health. But what constitutes normal? And what is actually being measured and overlooked through traditional cholesterol testing? Dr. Hyman recently explored this topic with his colleague, Dr. Elizabeth Boham. So let's talk about cholesterol, because with his colleague, Dr. Elizabeth Boham. So let's talk about cholesterol because in my opinion, and I've written a lot about this, the test that you get when you go to your doctor is antiquated. It's outdated. It's not the cholesterol test you should be getting. And it doesn't give you the right information to make

a decision about what to do. So you need something called what? Like particle size testing. It's telling us about those things that are carrying around your cholesterol. Yeah. So LabCorp does NMR. Yep. NMR. And Quest does something called Cardio IQ, which is similar.

And you can ask your doctor for these. And you shouldn't stand for any other test but these tests. Absolutely. So when you get your traditional cholesterol panel done, your traditional lipid panel done, they're giving you the LDL cholesterol, the HDL cholesterol, the total cholesterol. And that's one piece of information, like you said, but we're missing a lot of information there. So the the, it's really important. I love this analogy of the dirt and dump trucks. So dirt and dump trucks, and think of think of all the dump trucks that are going around carrying dirt. And we can make

this analogy with cholesterol. So think of your cholesterol like the dirt and the dump trucks are the particles carrying around your cholesterol. So what we're learning is it's not just the amount of dirt somebody has that's important. It's the amount of dump trucks that they have carrying around that dirt and that the size of the dump trucks are actually really important. And so when you get a typical lipid panel done, you know, you're just finding out the amount of dirt that you have and how much of it is LDL and HDL and triglycerides. And that's important. And we will talk about that, but what's even more important or at least as important, right, is the amount of dump trucks you have carrying around that dirt.

And what we're learning is that, or what we've learned, is that if you have small dump trucks, so if you have a certain amount of dirt, you could either have a few big dump trucks carrying it around or a lot of small dump trucks carrying it around. And what we're learning is that those small dump trucks, if you have too many small dump trucks, that that's actually more concerning, that they can get into the artery lining more, they can cause more plaque buildup, they can get that, that it can help that cholesterol get oxidized through oxidative stress, it's much more dangerous. So the size of those dump trucks you have carrying around your cholesterol is critically important. Yeah. And something we look at all the time. I mean, the way I think about it is, and another way I kind of look at it is, you know, the number you get on your test is the weight of your cholesterol. So it's milligrams per deciliter. It's just basically the weight.

Yep. But it doesn't tell you if that cholesterol is made up of a thousand particles or a hundred particles. Right. So you could have a cholesterol of 150 and it could be 5,000 particles or it could be 500 particles of cholesterol. And that makes a huge difference in your risk of heart disease. And you can't tell from a regular cholesterol test whether you have a lot of particles or whether they're big particles or small particles. So I think about it sort of like golf balls and beach balls.

You know, beach balls are these big, light, fluffy balls that you can bounce and don't hurt anything. And a golf ball is small, but it hits you in the head and knock you out, right? And the golf balls are the things that are the small particles that are dangerous that bang up against the arteries and cause the plaque to develop and cause heart attacks. So you can't tell that from a regular test. You can have smaller, large LDL, smaller, large HDL, smaller, large triglycerides, and the triglycerides are a little different. It's the big triglycerides that are a problem, not the small ones. But you can really get a sense from these newer tests what's really going on.

There's a lot of lifestyle that impacts the size of your LDL particles, right? The size of those, you know, are they small and dense and dangerous? Or are they big and fluffy and not so dangerous? I mean, there's always a genetic component, right? There's a genetic component, but then there's our lifestyle. And we know that that metabolic syndrome where people are insulin resistant, gaining weight around the belly. They typically have lower HDL. They typically have higher triglycerides, but they also typically have more of these small dense LDLs, which are more concerning. And so lifestyle makes a huge impact

on the size of those LDL particles. And which part of your lifestyle? What's the biggest thing? The diet. That's the one that, you know, that full of carbohydrates and sugar and refined and processed foods and lots of alcohol and, you know, simple sugars. It's the starch and sugar that drives it. And what does that do to the body that causes these particles? And it actually leads to the high triglycerides, the low HDL, the small particles. Right. It's that whole process of insulin resistance, and it results in this really

unhealthy pattern. And so, you know, we sometimes get clues of that with a standard lipid panel, right? We sometimes get clues when somebody has a low HDL. That's the one, the HDL is the one you want higher. And for men, you want it at least over 40. And for women, at least over 50. And then if that triglycerides are over- I'm like 50 and 60. I'm more aggressive than you. Yeah, well, that's really true. Like what's optimal, right?

What's optimal, right? If your cholesterol is, HDL is 40, probably not optimal. It should be over 50. It really should. It really should. You're right. It's not optimal. I'm a tough customer here.

Mm-hmm. And then the triglycerides, you want at least under 150. Or what would you say? What's optimal? 70. There you go for triglycerides. If your triglycerides are over 100, you're definitely flirting with danger. And there's some genetics involved.

And we're going to talk about the genetics in a minute. But it is usually a sign of increased carbohydrate load. And I don't mean broccoli. I mean like flour and sugar. Absolutely. Right. So, you know, you can get some sense of if somebody is prone to metabolic syndrome insulin resistance with that.

But then the particle size testing also gives us a lot of information. The NMR, for example, gives you something called your insulin resistance score. So you can get a sense based on the analysis of the particles of cholesterol that you have, how at risk you are for insulin resistance. So it's just one more piece of the puzzle. And I see people with a cholesterol of 150 who have like 2000 particles of LDL, which should be under 1,000, who have like 900 particles of small LDL, which should be under 300 ideally, probably less than 90 is perfect. And you see that often. And yet their doctor, well, your cholesterol is 150, it's fine. And so you really can get duped by just looking at the total numbers. If it's 300, it might be fine. If it's 150, it might be

highly dangerous to you. And it's not so easy without looking at the total numbers. If it's 300, it might be fine. If it's 150, it might be highly dangerous to you. And it's not so easy without looking at the specific tests. I just want to point out because this is really a very easy, cheap way to check to see if you have insulin resistance. And it's a far better predictor of your risk of heart attacks than your LDL, which is your triglyceride to HDL ratio. If it's over one, not great. One of the things that we're really bad at in medicine is personalizing care. And there's no place that's more important to personalize your care than dealing with your heart attack risk and cholesterol, because it's different for different people. That's very true. So when you're talking about people's cholesterol, how do you decide what to do for each patient?

How do you decide from a functional medicine perspective, how to work these patients up to decide whether that should go on a drug or whether you just do lifestyle? How do you figure that out? I mean, it is a complex process, right? Where we're taking a really detailed history and we're looking at more than just those numbers. We're looking at what are their markers of oxidative stress? We can measure those.

Yeah, I think we are so stuck in this paradigm of treating the symptom, the cholesterol, instead of the cause. Absolutely. I mean, it's estimated that 50% of people in this country and in Europe and 40% worldwide have what's considered elevated cholesterol. And obviously, that, you know, for those 50% of people, not all of them have to be really concerned about that cholesterol number. It doesn't mean that all 50% of us have to be taking a medication to lower that cholesterol. And so people come in all the time with those questions of, is this cholesterol too high? And how do I get it down? Do I need to get it down? And the reason we're really looking at cholesterol is because it's one factor that influences somebody's risk of cardiovascular

disease, right? I like how you said one factor, not the factor. Exactly. I think we really have to understand that heart disease is a complex disorder. It's not just about cholesterol, that from a functional medicine perspective, we do much more detailed workups looking at inflammation, oxidative stress, looking at the particle size and number, looking at even your gut, heavy metal toxins, other factors that relate to nutrition like homocysteine. And we get a really good sense of what's going on and we then personalize the treatment. And it's very, very different approach to reducing your risk. It is so important to be sure you're getting the right cholesterol tests.

Be sure to ask your doctor to do a particle size test. This will check both your particle size and particle number. And you want to see results that show lots of safe, light, fluffy, big cholesterol particles. You do not want to see small, dense, artery-damaging cholesterol particles. Ultimately, your ratio of total to LDL cholesterol and particle number and size are a far bigger predictor of heart attacks than LDL itself. If you'd like to learn more about anything you heard today, I encourage you to check out Dr. Hyman's full-length conversations with Dr. Elizabeth Boham, where they go into much more detail about how they work with patients to treat and prevent heart disease.

If you enjoyed this episode, please consider sharing it and leaving us a review below. Until next time. Hi, everyone. I hope you enjoyed this week's episode. Just a reminder that this podcast is for educational purposes only. This podcast is not a substitute for professional care by a doctor or other qualified medical professional. This podcast is provided on the understanding that it does not constitute medical or other professional advice or services. If you're looking for help in your journey,

seek out a qualified medical practitioner. If you're looking for a functional medicine practitioner, you can visit ifm.org and search their Find a Practitioner database. It's important that you have someone in your corner who's trained, who's a licensed healthcare practitioner, and can help you make changes, especially when it comes to your health.