Looking at the Numbers

This article was originally published as an op-ed in The Jerusalem Post (20 Feb. 2023): https://www.jpost.com/opinion/article-732077

For those of you who are in your 40’s or older, your physician probably would like to see a blood test every year or two.  There are many numbers and markers on a complete blood panel, and a simple blood test. These markers can often clarify things that we can’t see with our own eyes. At times, this information is lifesaving.

Predicting future heart health

The lipid profile, or cholesterol numbers, are among the most important numbers on blood tests in the Western world.  Today’s references want to see an overall cholesterol number of 200, a low-density lipid (LDL) under 130 (unless you have heart disease in which case it is 100), and a high-density lipid (HDL) of above 40.  If possible, it is better for your overall number to be closer to 150, your LDL closer to 100, and the HDL 60 or above.  Please note that very recent research has practically discounted HDL as a factor.

These numbers receive a lot of attention.  How much do these numbers really tell us about future heart health? Is it possible there are other factors that can be better predictors of heart health?

Some perspective

Cardiologist Dr. Joel Kahn often points out that cholesterol is one risk factor for heart disease. There are many more. Now, let’s clarify something important: The lipid profile reference numbers are not something absolute.  I have had clients who come in with a cholesterol of 201 and are sure their demise is imminent.  On the other side, clients come in with a 198 or 199 happy that they are under the red line and sure they have nothing to worry about.  Well, both of these thoughts are untrue.

How much these numbers play in to the equation is not so simple.  Digest these facts: Half of the people who have a heart attack in the United States of America (once every 39 seconds) DO NOT have high cholesterol. Half of the people with high cholesterol never have a heart attack.  Think about that one!

Sad truth

Four years ago, a relative of mine was bragging about phenomenal blood work.  His cholesterol was around 160-170 and his LDL was pretty close to 100.  He works out most days of the week intensely. He would certainly describe his eating as mostly healthy, and in comparison to the standard American diet (SAD) it was.  Nevertheless, he had a stroke.  He was age 58 at the time.  Thank G-d, he recovered very quickly and is back to normal, but, he had a stroke.

I bring this example in order to illustrate the fact that numbers on a blood test don’t necessarily tell us everything.

We need cholesterol!

One of the most important jobs of cholesterol is to aide in the production of hormones. Cholesterol is stored in the adrenal glands and other places in the body. It is converted to steroid hormones. These steroid hormones perform vital duties to help the body function properly. Without steroid hormones, we will have malfunctions with weight, intimacy, digestion, bone health, and mental status.

In addition, cholesterol plays an important role in our body’s digestion. Cholesterol helps the liver create bile, which aids us in digesting the food that we eat. Without bile, our bodies are unable to properly digest foods, especially fats. When fat goes undigested it can get into the bloodstream and cause problems such as blockages of the arteries, heart attacks, and heart disease.

Yes, you read that correctly—without cholesterol, we can have a heart attack!

For cholesterol to become harmful, it has to oxidize.  Without oxidation, it won’t become a harmful plaque and end up clotting an artery.

Better predictors of heart disease

1. Check your blood test of CRP—C-reactive proteins.  They are a sign of possible inflammation.  Tell your doctor to include it on your test; they don’t always.
2. Although not yet a readily available test, there is an inflammatory factor made in our microbiome called TMAO. If you want to diminish the amount in your body, simply cut way back on meat, chicken, fish, eggs, and dairy.  These foods contain choline which your gut bacteria then turn into TMA and the TMAO.
3. Has your doctor ordered a blood test to check for lipoprotein (a), referred to as “little a”?  If you have it, it is more likely that you can suffer a heart attack; this should act as an incentive to be extra careful with diet and exercise.
4. Ask yourself:
   • Is your diet rich in fruits, vegetables, legume, lentils, and whole grains?
   • Do you limit processed food, animal proteins, dairy and eggs?
   • Do you include a lot of green leafy vegetables each day? They will keep your endothelial lining of your arteries working well and keeping it improbable for plaques to build and inflame.
   • Do you exercise?  Even a 30-35 minute brisk walk daily does wonders to prevent all heart disease.
5. Finally, if you want to know what’s going on inside, there is a pretty benign test one can take. It’s called a Cardiac Calcium Score.  The American Heart Association has finally approved it (15 years too late).  It uses a CT machine with no added iodine.  Radiation is minimal.  It will give you a good idea where you stand and enable you to take every measure needed to prevent heart disease.

Preventing heart disease

Dr. Esselstyn of the Cleveland Clinic says that heart disease is a highly preventable and reversible disease that need not exist.  Dr. Esselstyn also points out that no numbers on a blood test will give a heart attack, but what passes through your lips each day certainly could.

Low cholesterol, unless it is under 150 without statin drugs, guarantees nothing.  Concentrate on what does matter: maintaining good lifestyle habits and testing what matters more.  It will “add hours to your day, days to your year and years to your life.”