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?

  • 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.

You're at the cutting edge

You're at the cutting edge

If you're a participant in the Track Your Plaque program for atherosclerotic plaque regression, you are at the cutting edge of health.

Few physicians give this issue any thought. Chances are, for instance, that if you were to bring up the subject of reversal of heart disease to your primary care physician, you'd get a dismissive "it's not possible," or " Yeah, it's possible but it's rare."

Ask a cardiologist and you might make a little more progress. He/she might tell you that Lipitor 80 mg per day or Crestor 40 mg per day might achieve a halt in plaque growth or a modest reduction of up to 5-6%. If they've tried this strategy, they would likely also tell you that hardly anybody can tolerate these doses for long due to muscle aches. I'd estimate that 1 of 10 of my colleagues would even be aware of these studies.

Both groups are, however, reasonably adept at diagnosing chest pain, an everyday occurrence in hospitals and offices. Chest pain, for them, is a whole lot more interesting. It holds the promise of acute catastrophe and all its excitement. It also holds the key to lots of hospital revenues. Did you know that 80% of all internal medicine physicians are now employees of hospitals? They're also commonly paid on an incentive basis. More revenues, more money.

Ask Drs. Dean Ornish or Caldwell Esselstyn about reversal of heart disease and they will tell you that a very low-fat diet (<10% of calories)can do it. That's true if you use a flawed test of coronary disease like heart catheterization (angiograms) or nuclear stress tests (Ornish calls them "SPECT"). It would be like judging the health of the plumbing in your house by the volume of water flowing out the spigot. It flows even when the pipes are loaded with rust.

In the Track Your Plaque experience, extreme low-fat diets (i.e., high wheat, corn, and rice diets) grotesquely exagerrate the small LDL particle size pattern, among the most potent triggers for coronary plaque growth. This approach also makes your abdomen get fatter and fatter and inches you closer to diabetes. Triglycerides go up, inflammation increases.

If you were able to measure the rust in the pipes, that would be a superior test. You can measure the "rust" in your "pipes," the atherosclerotic plaque in your coronary arteries, using two methods: CT heart scans or intracoronary ultrasound. Take your pick. I'd choose a heart scan. It's safe, accurate, inexpensive. I've performed many intracoronary ultrasounds for people in the midst of heart attacks or some other reason to go to the catheterization laboratory. But for well people, without symptoms, who are interested in identifying and tracking plaque? That's the place for heart scans.

In our program, 18-30% reductions in heart scan scores are common.

Comments (3) -

  • farseas

    12/6/2011 5:01:54 PM |

    Dr. Eselstyn claims that animal protein damages the endothelium.  Dr. Weil says that a high fat meal lowers artery function.   But I had a heart attack and have a stent and have been following your diet for about a year.  If I start eating significant quantities of carbs, I used to get chest pains.  Since then I have went from 305 to 235 and want to get to 175.  I got the stent three years ago.

    Is there any truth to either Weil's or Esselstyn's claims?

    Now I take no medication except a daily 325mg aspirin and a bunch of supplements, including hawthorne and of course, fish oil.  I control my blood pressure with medical MJ and it works great to lower my blood pressure.

    Do I need to worry about saturated fat and high blood pressure?  I used to be on Plavix, blood pressure medication, and statins.  I tried three different statins and they all caused me leg pains.  In fact I seem to have chronic but intermittent leg pain since the statins.

  • Dr. William Davis

    12/6/2011 5:28:45 PM |

    I don't think so.

    They understand this disease incompletely. I can't blame an ENT surgeon for not fully understanding a disease he has never treated.

  • bob stanton

    12/13/2011 3:39:07 PM |

    Esselstyn says this based on the fact that animal protein has higher levels of methionine.  But this study,  Toxicity of Methionine in Humans, by Peter J. Garlick, refutes this claim:
    Conclusions. Although methionine was labeled as being the most toxic amino acid in relation to growth in animals (1), the evidence in humans does not point to serious toxicity, except at very high levels of intake. Despite the function of methionine as a precursor of homocysteine, and the role of homocysteine in vascular damage and cardiovascular disease, there is no evidence that dietary intake of methionine within reasonable limits will cause cardiovascular damage. A single dose of 100 mg/kg body weight has been shown to be safe, but this dose is about 7 times the daily requirement for sulfur amino acids, and repeated consumption for 1 wk was shown to result in increased homocysteine levels (37,42). Daily doses of 250 mg (i.e., 4 mg/kg per day) are only 25% of the daily requirement and have been shown to be safe. Overall, the literature suggests that the single dose which is typically given in the methionine loading test (100mg/kg/d) does not cause any serious complications, except in the extreme case when a 10-fold excess of methionine appears to have been given, and in patients who have schizophrenia or inborn errors of sulfur amino acid metabolism, such as hypermethioninemia.