What tests are MORE important than cholesterol?

In the conventional practice of early heart disease prevention, cholesterol testing takes center stage. Rarely does it go any further, aside from questions about family history and obvious sources of modifiable risk such as smoking and sedentary lifestyle.

So standard practice is to usually look at your LDL cholesterol, the value that is calculated, not measured, then--almost without fail--prescribe a statin drug. While there are indeed useful values in the standard cholesterol panel--HDL cholesterol and triglycerides--they are typically ignored or prompt no specific action.

But a genuine effort at heart disease prevention should go farther than an assessment of calculated LDL cholesterol, as there are many ways that humans develop coronary atherosclerosis. Among the tests to consider in order to craft a truly effect heart disease prevention program are:

--Lipoprotein testing--Rather than using the amount of cholesterol in the various fractions of blood as a crude surrogate for lipoproteins in the bloodstream, why not measure lipoproteins themselves? These techniques have been around for over 20 years, but are simply not part of standard practice.

Lipoprotein testing especially allows you to understand what proportion of LDL particles are the truly unhealthy small LDL particles (that are oxidation- and glycation-prone). It also identifies whether or not you have lipoprotein(a), the heritable factor that confers superior survival capacity in a wild environment ("The Perfect Carnivore"), but makes the holder of this genetic pattern the least tolerant to the modern diet dominated by grains and sugars, devoid of fat and organ meats.

--25-hydroxy vitamin D--The data documenting the health power of vitamin D restoration continue to grow, with benefits on blood sugar and insulin, blood pressure, bone density, protection from winter "blues" (seasonal affective disorder), decrease in falls and fractures, decrease in cancer, decrease in cardiovascular events. I aim to keep 25-hydroxy vitamin D at a level of 60 to 70 ng/ml. This generally requires 4000-8000 units per day in gelcap form, at least for the first 3 or so years, after which there is a decrease in need. Daily supplementation is better than weekly, monthly, or other less-frequent regimens. The D3 (cholecalciferol) form is superior to the non-human D2 (ergocalciferol) form.

--Hemoglobin A1c (HbA1c)--HbA1c represents glycated hemoglobin, i.e., hemoglobin molecules within red blood cells that are irreversibly modified by glucose, or blood sugar. It therefore provides an index of endogenous glycation of all proteins of the body: proteins in the lenses of the eyes that lead to cataracts; proteins in the cartilage of the knees and hips that lead to brittle cartilage and arthritis; proteins in kidney tissue leading to kidney dysfunction.

HbA1c provides an incredibly clear snapshot of health: It reflects the amount of glycation you have been exposed to over the past 90 or so days. We therefore aim for an ideal level: 5.0% or less, the amount of "ambient" glycation that occurs just with living life. We reject the notion that a HbA1c level of 6.0% is acceptable just because you don't "need" diabetes medication, the thinking that drives conventional medical practice.

--RBC Omega-3 Index--The average American consumes very little omega-3 fatty acids, EPA and DHA, such that a typical omega-3 RBC Index, i.e., the proportion of fatty acids in the red blood cell occupied by omega-3 fatty acids, is around 2-3%, a level associated with increased potential for sudden cardiac death (death!). Levels of 6% or greater are associated with reduced potential for sudden cardiac death; 10% or greater are associated with reduced other cardiovascular events.

Evidence therefore suggests that an RBC Omega-3 Index of 10% or greater is desirable, a level generally achieved by obtaining 3000-3600 mg EPA + DHA per day (more or less, depending on the form consumed, an issue for future discussion).

--Thyroid testing (TSH, free T3, free T4)--Even subtle degrees of thyroid dysfunction can double, triple, even quadruple cardiovascular risk. TSH values, for instance, within the previously presumed "normal" range, pose increased risk for cardiovascular death; a TSH level of 4.0 mIU, for instance, is associated with more than double the relative risk of a level of 1.0.

Sad fact: the endocrinology community, not keeping abreast of the concerning issues coming from the toxicological community regarding perchlorates, polyfluorooctanoic acid and other fluorinated hydrocarbons, polybrominated diphenyl ethers (PDBEs), and other thyroid-toxic compounds, tend to ignore these issues, while the public is increasingly exposed to the increased cardiovascular risk of even modest degrees of thyroid dysfunction. Don't commit the same crime of ignorance: Thyroid dysfunction in this age of endocrine disruption can be crucial to cardiovascular and overall health.


All in all, there are a number of common blood tests that are relevant--no, crucial--for achieving heart health. Last on the list: standard cholesterol testing.

Comments (8) -

  • stuart

    5/13/2013 12:56:55 AM |

    Great summary Dr. Davis.  You're the best!

  • Sol y Sombra

    5/13/2013 11:07:44 AM |

    Thank you for the useful information you provide, Dr. Davis. But I have a question: Does it really take 3-4 years to replenish vitamin D stores in the body?

  • Amy Crain

    5/15/2013 2:26:51 AM |

    Dr. Davis..
    My husband decided to give going gluten free a try after I read your book, and shared many things with him.  He has a number of issues.  HBP and taking meds.  Asthma, knee injuries with multiple surgeries over the years, and based on his lipid panel numbers, his dr. like you said, wanted to put him on a chol. reducer.  He went gf for a month, this past month, and just this week had his blood work done.  His LDL # went up from 146 to 164, and his HDL went from 45 to 47.   His Trig at least, dropped from 190 to 122,  So he now has in hand a scrip for atorvastatin (sp.?)..  Even though my husband would be considered a slender 48 year old, he has lost 6 pounds during this month of being wheat free.  I personally began a trek of losing weight a year ago by cutting wheat and sugar, and lost over 30 pounds, going from a size 12 to a 2.  I never had any blood work done, since I didn't have any health issues.  I was really hoping for better results for my husbands numbers so that we could provide a valid testimony to those unbelievers within our family.  I don't have your book memorized, but I've scanned through the blog posts and comments and found bits and pieces about numbers and how some people experience an increase like my husband Bill did.  Could you give me a bullet point laymen's version of the reason for the increase, if it's a concern, and if not, should he get the prescription filled like the dr. ordered so that he can then do the 3 month follow up to see if the med. worked for lowering the #'s?
    OR should I just go back and do some more reading like of the above post and reread the book?
    Thanks!
    Amy

  • Lowering cholesterol diet

    5/17/2013 3:10:25 PM |

    Hey there,

    thanks for the article. I would also like to know does Vitamin C plays any role in lowering cholesterol? I am thinking about writing a blog post about it so thank you in advance dr. Davis.

  • Geoffrey Levens, L.Ac.

    5/17/2013 8:23:48 PM |

    List makes great sense to me but one question arises: In light of recent research showing increased risks outside range of 20–36 ng/ml, do you anticipate any change in your recommendations as to Vitamin D blood level?
    J Clin Endocrinol Metab. Published online March 26, 2013. Abstract

    Thank you.

  • [...] between triglycerides and HDL, those improve with LCHF diet. You can start reading more here;  What tests are MORE important than cholesterol? | Track Your Plaque Blog  Lipid researcher, 98, reports on the causes of heart disease | News Bureau | University of [...]

  • Stephen in Jacksonville

    6/14/2013 9:20:30 PM |

    Tests are important, and I think that there are more people today who are interested in keeping track of their cholesterol levels. This is why I think we live in such a special time. We have access to more information than ever before, and now people can learn about high cholesterol risks without having to go to the doctor. In fact, I have found a number of sites that allow people to track their cholesterol levels online. Obviously, there are some people who may go overboard with access to this information, but I do think that there are plenty of benefits to be had.

Loading
Alternatives to fish oil capsules

Alternatives to fish oil capsules

Occasionally, someone will be unable to take fish oil due to the large capsule size, excessive fishy belching, or stomach upset. The easiest solution is usually just to try a different brand, e.g., Sam's Club (Makers' Mark brand) enteric-coated.

However, sometimes liquid fish oil preparations may be preferred. Here'a list of products we've used successfully. All cost more than plain old fish oil capsules, but fish oil is so crucial to your heart scan/coronary plaque control efforts, that it really pays to search out alternatives.



Liquid fish oil alternatives to capsules:

Liquid fish oil--e.g., Carlson's liquid fish oil. Most liquid fish oil comes flavored either lemon or orange.



Frutol--A very clever re-formulation of fish oil that makes it water-soluble and non-oily. The Pharmax company has put their fish oil into a fruit flavored base that tastes pretty good and is not too expensive.
Go to www.pharmaxllx.com for more information. Unfortunately, I do not believe it's available in stores.





Coromega--another non-oily preparation, though available in some health food stores. Coromega comes in little single-serving foil dispensers. It tastes kind of fruity (though I personally like the Frutol better for taste and consistency). It's kind of pricey ($1.40 per day for two packets).



Regardless of what preparation you choose, you can determine the dose needed by adding up the EPA+DHA content. For the basic prevention effect, the starting dose for the Track Your Plaque program, you need a total of 1200 mg per day of EPA+DHA. Higher doses, e.g., 1800-2400 mg per day, may be required for correction of high triglyceres or postprandial (after-eating) abnormalities.

Comments (2) -

  • buy jeans

    11/3/2010 7:01:54 PM |

    Regardless of what preparation you choose, you can determine the dose needed by adding up the EPA+DHA content. For the basic prevention effect, the starting dose for the Track Your Plaque program, you need a total of 1200 mg per day of EPA+DHA. Higher doses, e.g., 1800-2400 mg per day, may be required for correction of high triglyceres or postprandial (after-eating) abnormalities.

  • cheap viagra

    4/25/2011 2:38:16 PM |

    I think you're right that'll be the easiest solution and it'd be nice if you can add more about the same topic with different solutions and versions to understand all the alternatives.
    23jj

Loading