Category Archives: Evaluation of Cholesterol

Cholesterol: How Low Can You Go?


Many people ask me what the maximum acceptable level is for blood cholesterol.   Recently, however, I was asked the opposite question; what is the minimum healthy amount of cholesterol – in other words, how low can you go?   According to the Merck Manual, the definition of hypolipidemia (excessively low cholesterol) is: total cholesterol (TC) less than 120 mg/dL or low-density lipoprotein (LDL) cholesterol less than 50 mg/dL.   In SI units the levels are 3.1 mmol/L and 1.3 mmol/L[1] respectively.   These would be the minimum acceptable values.

A healthy adult on a low fat, low cholesterol diet will be near these lower limits.   However, if your cholesterol is abnormally low, or if it plummets without any reason, (good reasons being exercise, medication etc.) see your doctor and have it investigated as there are numerous primary or secondary causes of low cholesterol.   The phrase “secondary cause” essentially means another disease which causes the condition in question.   Secondary causes of hypolipidemia must be treated, but the treatment of primary hypolipidemia is often unnecessary.   In either case, have it checked out.

What are the risks if the levels are too low?   Cholesterol is a necessary component for the functioning of the human body.   For example, it is a necessary component of all cell walls, and is the raw material for the production of the steroids and bile that the body needs to function properly.   Some research suggests that excessively low levels of low-density lipoprotein (LDL), or “bad,” cholesterol may be associated with an increased risk of certain types of cancer[2].   Other studies associate an abnormally low total cholesterol level with depression and anxiety, perhaps because low cholesterol may reduce levels of the brain chemical serotonin.    Pregnant women who have very low total cholesterol may be more likely to give birth prematurely and have babies who have low birth weights.[3]

Finally, it is also important to remember that high-density lipoprotein (HDL), or “good” cholesterol counts too.   A high HDL level decreases the risk of heart disease, and because of this risks due to cholesterol are evaluated using both LDL and TC (which includes HDL).

For complete information including full service and a comprehensive guide to lower cholesterol, please see “E-book”.

Good Luck!


 [2] Renana ShorJulio WainsteinDavid OzMona Boaz; Zipora MatasAsora FuxAaron Halabe, “Low Serum LDL Cholesterol Levels and the Risk of Fever, Sepsis, and Malignancy”, Annals of Clinical & Laboratory Science Autumn 2007 vol. 37 no. 4 343-348

 [3] Thomas Behrenbeck, M.D., Mayo Clinic

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Are My Cholesterol Levels Normal or High?

Am I Normal

Many of you ask me if your cholesterol levels are normal or not.   This is not a question that can be answered accurately without quite a few facts, and when cholesterol is concerned, it is better to be safe than sorry.

First of all, there are three cholesterol levels which are of interest (and possibly four, see LDL Particle Size-Does it Matter?).   Each type has different meaning so you need to be clear on which cholesterol level your doctor is talking about.   HDL is the (“good”) cholesterol, LDL is the (“bad”) cholesterol, and total cholesterol is a combination of HDL, LDL, and some other players.   Naturally, we want the HDL to be high, and the LDL to be low, so most analyses use a kind of average of HDL and total cholesterol.

Furthermore, the reason we are interested in cholesterol levels is because they can increase the risk of heart disease, but this depends on more than just cholesterol levels.   This means that the same test results can be good for one person, but bad for another.

It is possible to calculate your Framingham Heart Risk Score (a well-known method of assessing the risk of heart disease) which will tell you if your cholesterol levels are acceptable for you.   However, there is more data needed than merely your cholesterol readings.   Of course, we need the total cholesterol level and the HDL (“good cholesterol”) levels, but the risk of heart disease also depends on your age, smoking status, and blood pressure; and whether you have any other risk factors, such as diabetes, high blood pressure, or being overweight.

With all this information it is possible to calculate the Framingham Heart Score, which gives you the risk of heart disease in the next ten years.    It is only at this point that you can determine whether your cholesterol levels are acceptable for you.

This is usually done by a physician, but if you want to be proactive and do it yourself, as well as lower your cholesterol levels using natural means, all the necessary information and methods are included in my e-book  “Lower Your Cholesterol, Save Your Life”.

Good Luck!

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LDL Particle Size. Does it Matter?

There is much talk about LDL size playing a role as a more accurate indicator of heart disease than using the traditional LDL cholesterol concentration metric.    The claim is that small LDL is more atherogenic (causing plaque in arteries) than large LDL, and that the higher the number of small LDL particles, the more risk there is of developing heart disease.   This article will help clear up the confusion.

bus-taxi-sign clear3

I will use an analogy to help explain these somewhat confusing concepts.Imagine that your body is a city, with the streets being  your arteries. People are being transported throughout the city in  buses and taxis.   In this analogy the people represent cholesterol,  taxis represent small LDL particles, and buses represent large LDL  particles.   So cholesterol is being delivered via small and large LDL  particles throughout your body. Just as taxis tend to have more accidents than buses,  small LDL is more damaging to your arteries than large LDL.


There are two types of LDL measures.  The tradition LDL count, denoted as LDL-C, is the average concentration of cholesterol in LDL particles per litre of blood.   It does not take into account whether the particle is large or small, nor does it consider the actual number of particles involved.   The newer LDL count, the LDL-P, is the number of particles in one litre of blood, and so the measure of small LDL-P is the number of small LDL particles per litre of blood.

Another definition before we really get going.   The Metabolic Syndrome is a group of risk factors and metabolic abnormalities that has been shown to be an important risk factor for cardiovascular (heart) disease incidence and mortality[1].   Researchers used data from The Framingham Heart Study, a multi-generational study of heart disease, to arrive at the following conclusions about the relationship of small LDL-P and Metabolic Syndrome[2]:

1. Small LDL-P is elevated in The Metabolic Syndrome, and increases with the number of syndrome components.

2. Increased small LDL-P identified the Metabolic Syndrome with high sensitivity.

Interesting, but how does this affect me?

Now here is the problem with using LDL-C.   Many patients who have metabolic syndrome have normal LDL-C levels and they are misdiagnosed as being healthy.    The measure of LDL-P is a much better predictor of heart disease for those people.   So to answer the question in the title, yes, size does matter.

Does this mean that we should throw out the LDL-C measurement and have everyone have their LDL-P measured?   Not at all.   Whether or not you should ask for the new measurement has been investigated by a panel of experts.   The National Lipid Association convened a panel of clinical experts from the American College of Cardiology and the American Diabetes Association to evaluate the use of selected biomarkers in clinical practice as either tools to improve risk assessment or as markers to adjust therapy once a decision to treat had been made.[3]    In other words, these are the recommendations for when physicians should ask for the LDL-P test, among others.   The chart below gives guidelines based on the Framingham Cardiovascular Risk Score.   You can ask your doctor for your score, and then see where you fall in the chart to determine if you should ask for the test.

Evaluation of LDL-P for Initial Risk Assessment

Low risk (<5% 10-year CHD event risk)Not recommended
Intermediate risk (5-20% 10-year CHD event risk)Reasonable for many patients
CHD or CHD EquivalentConsider for selected patients
Family HistoryReasonable for many patients
Recurrent EventsReasonable for many patients

 Of course, you may have to educate your doctor about all of this, but that’s another topic altogether…

Good Luck!

For a complete package including full service and a comprehensive guide to lower cholesterol, please see “E-book”.

 [1] Am J Med. 2006 Oct;119(10):812-9. Metabolic syndrome and risk of cardiovascular disease: a meta-analysis.Galassi A, Reynolds K, He J. Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, La 70112, USA.

 [2] Circulation. 2006 Jan 3;113(1):20-9. Epub 2005 Dec 27. Increased small low-density lipoprotein particle number: a prominent feature of the metabolic syndrome in the Framingham Heart Study. Kathiresan S, Otvos JD, Sullivan LM, Keyes MJ, Schaefer EJ, Wilson PW, D’Agostino RB, Vasan RS, Robins SJ. Source: The National Heart, Lung, and Blood Institute’s Framingham Heart Study, Framingham, MA, USA.

 [3] Journal of the American College of Cardiology, Vol. 51, No. 15, 2008, Lipoprotein management in patients with cardiometabolic risk, John D Brunzel et al.

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Lower Your Cholesterol, Save Your Life.   Now in it’s second edition! Choose a package,  save your life!