Cholesterol Medication – Careful Attention to Blood Testing Can Tell for Sure

One of the ironies of the way doctors decide to put their patients on cholesterol medication is that the harder a patient works to control cholesterol by diet, the more likely they are to be told they have failed-even though the problem usually is the blood test, not the diet. Here is what every potential high cholesterol patient needs to know about blood tests.

Ordinary blood testing does not actually measure LDL cholesterol. LDL cholesterol is estimated as a percentage of the “left-overs” once total cholesterol, HDL, and triglycerides are estimated. The way the math works, your LDL number goes up when your triglycerides number goes down, because:

Estimated LDL = 1/5 of (Total Blood Lipids – Triglycerides – HDL Cholesterol)

Your triglycerides go down when you eat less sugar, when you exercise more, or when you get diabetes under better control. Doing these things for your health will make your LDL number-which is just a “guess”-go up.

Something else that can cause your LDL number to go up is going on a low-fat, low-calorie diet. If you eat less than your body needs every day, fat will be released from your fat cells for the rest of your body to use. This fat coming out of your fat cells raises your total blood lipids, and your estimated LDL number.

Go on a crash diet, start working out, and your doctor will tell you that your efforts aren’t working and you need to take a pill. This common method of measuring LDL cholesterol discourages taking control of your health, and causes some people to take potentially dangerous statin drugs they don’t really need.

There is a test that measures LDL cholesterol directly. It costs about $500. But if you are going to have an expensive test, you really shouldn’t be getting just an accurate LDL measurement.

There are actually two kinds of LDL cholesterol. One of them is attached to a protein called apo-A, and the other is attached to a protein called apo-B. The kind of cholesterol attached to apo-A does not clog your arteries. The kind of cholesterol attached to apo-B does.

At least when you start taking cholesterol medication, your doctor should know that your LDL cholesterol is mostly apo-B, or you don’t actually need the medication. Then once treatment is underway, the cheaper lab test may be a way to “estimate” your progress. The $500 or so you may have to pay out of pocket to get the right blood test may save you far more by keeping you from taking years of medication you don’t really need.

Even better, go to the doctor for apo-A and apo-B numbers, and then if you don’t need medication, start tracking your progress at home with a home cholesterol monitor. You will be able to see if your diet, exercise, and supplements are increasing your cancer-protective HDL cholesterol, something doctors can’t give you a pill to increase.