5 Health Markers That Matter More Than Total Cholesterol And LDL-C

Cholesterol Clarity by Jimmy Moore & Eric Westman MD
Cholesterol Clarity by Jimmy Moore & Eric Westman MD
If you go to virtually any doctor’s office these days, and have your cholesterol panel run, then undoubtedly most physicians would immediately zero in their focus on two specific numbers to determine your state of heart health risk and treatment—total cholesterol and LDL-C. I remember after losing 180 pounds on the Atkins diet in 2004, I went for a checkup with my family doctor to see how my cholesterol numbers were. When the results came back, I was thrilled to see my HDL cholesterol was 72 and my triglycerides were 43. We’ll get back to those markers in a moment.

The enthusiasm I had about my cholesterol test results was quickly tempered by the look of somberness and distress on the face of my traditionally trained medical doctor. He took a quick look at my total cholesterol and LDL-C—285 and 185, respectively—and urged me to go on a cholesterol-lowering statin medication, like Lipitor or Crestor, as soon as possible. When I weighed over 400 pounds he had already put me on both of these drugs, and I had experienced severe joint and muscle pain that forced me to quit taking them. Naturally, I was not very thrilled with the prospect of going back on those again simply because a number or two on a piece of paper told my doctor I was supposedly unhealthy. I questioned him further about some of the other numbers that were on that piece of paper.

“What about my HDL being so high? Isn’t that a good sign of spectacular heart health?” I asked him.

My doctor replied, “Yes, that’s an amazing HDL level — take a statin!”

“But what about my triglycerides being so low? Have you ever seen a patient with numbers like that before?” I inquired.

He responded, “That’s the lowest triglycerides I’ve ever seen — take a statin.”

At this point I realized there wasn’t much I was going to be able to say to him to convince my doctor that the other numbers on my cholesterol test mattered beyond his narrow focus on total cholesterol and LDL-C. This made me wonder why they even run all those other numbers if all physicians are going to do is base their treatment decision exclusively on these two numbers. This was the genesis for what would become my 2013 book release Cholesterol Clarity: What The HDL Is Wrong With My Numbers? with Dr. Eric Westman, MD. I knew there had to be more to this story than what we’ve been told. And there is — a LOT more!

So if it’s not total cholesterol and LDL-C that matter the most on your cholesterol panel, then what does matter? Here are the 5 key health markers everyone who is concerned about their heart health should pay attention to – these matter more than total cholesterol and LDL-C:

1. Triglycerides

This is one of two numbers that I describe in my book as the “forgotten and ignored” part of your cholesterol panel. This is critically important to not just your cardiovascular health, but your overall health as well. Although my own doctor quickly dismissed my low triglycerides as a positive sign of my state of health, virtually every single one of the 29 experts I interviewed and featured in Cholesterol Clarity agreed that lower triglycerides are a much more relevant marker than total cholesterol and LDL-C. The goal to shoot for with your triglycerides is under 100 (mainstream medicine says it should be 150 or below, but you can show signs of metabolic health issues at this level), and optimally under 70. The best way to do that is to reduce the amount of carbohydrates you are consuming to suit your own personal tolerance level. I have to personally stay around 30g total carbohydrates in my diet or I’ll see my triglycerides go back up again. You’ll need to tinker and tweak your intake to see what level is best for you. Your triglyceride number will precipitously rise above 100 if you’re consuming too many carbs, so use this marker to your advantage.

2. HDL-C: High-Density Lipoprotein

The second leg in that “forgotten and ignored” part of your standard cholesterol panel is your HDL-C. Sometimes referred to as the “good” cholesterol, it’s definitely a healthy thing to have this number above 50 at the very least, and optimally above 70. There are many ways to get your HDL cholesterol higher, but the best way is to eat more fat in your diet, especially saturated fat. While things like butter, coconut oil, full-fat meats and cheeses, and other delicious fat-rich foods have been vilified as being “artery-clogging” in our culture for decades, the reality is these are the very foods that can help you become heart-healthy by raising your HDL-C. When you reduce your triglycerides by cutting the carbohydrates in your diet, while consuming more fat to increase your HDL, it’s a fantastic one-two punch that gives you a distinct advantage in your pursuit of optimal health. Higher HDL and lower triglycerides are much more indicative of robust heart health than whatever your total and LDL cholesterol numbers are.

3. LDL-P: LDL Particle number

You might be wondering what in the world this is since you won’t find it on a standard cholesterol panel. That’s true, you won’t. But it is important to know your LDL-P number. This can be obtained by asking your doctor to run what’s called an NMR Lipoprofile test. Many people erroneously believe LDL is just one number because all they’ve ever seen on their cholesterol test results is LDL-C. But the reality is there are many subfractions of LDL particles that can be measured directly through the use of some pretty sophisticated technology, like the nuclear magnetic resonance (NMR) testing. Getting this run by your doctor (who may push back at you when you request it claiming it is unnecessary) will begin to give you a much clearer picture about what is actually going on inside your body. The more LDL particles you have floating around in your blood, the greater the risk of those particles penetrating the arterial wall. There’s still some debate amongst the cholesterol experts about whether it is the total number of particles or the size of the particles that matters most. Since the science isn’t settled on this, we present both sides of that argument in Cholesterol Clarity and let the reader decide for themselves which side they choose to believe.

4. Small LDL-P: Small LDL Particle number

As I just shared, when you get an NMR Lipoprofile test run by your doctor, it will let you see exactly how many LDL particles there are in your blood (this comprises your LDL-P number). But it also will show you the size difference between those LDL particle subfractions. This is an important marker that you really need to know about, especially if you have a high LDL-C number that your doctor wants to lower by use of stains. When you have mostly the small, dense, and dangerous LDL particles in your blood, that’s what is known as Pattern B. Conversely, when the majority of your LDL particles are the large, fluffy, and buoyant kind, that’s referred to as Pattern A. The Small LDL-P begins to become much more problematic when this number comprises more than 20 percent of your total LDL particles. For example, if your LDL-P is 1000, then your Small LDL-P needs to be 200 or less. Not to sound like a broken record, but if you consume less carbohydrates to your own personal tolerance level, and eat more healthy saturated and monounsaturated fats in your diet, then your Small LDL-P will go down. Incidentally, that statin drug your doctor is trying to push on you will indeed lower your LDL cholesterol, but it will do so by eliminating the large, fluffy kind first, leaving you with a higher percentage of small LDL particles that put you at a greater risk for having a heart attack. It’s something to consider the next time your physician pulls out his prescription pad because of your “high cholesterol.”

5. hsCRP: high sensitivity C-Reactive Protein

Technically, this blood test is not a part of your “cholesterol panel.” But it is perhaps the most indicative test you could have run to see if actual heart disease is beginning to manifest itself in your body. The high sensitivity C-Reactive Protein (hsCRP) is the marker that shows you the level of systemic chronic inflammation in your body. Without inflammation, there is no risk for heart disease. Period, end of story. So wouldn’t you want to test to see what your level of inflammation actually is? Absolutely. That’s why everyone needs to know what their hsCRP is, sometimes referred to simply as CRP. I’ve seen ranges of CRP between 0-10 being touted as healthy, but the ideal number should be below 1.0. Mine is currently at .55 which means I have minimal inflammation in my body and a very low risk for heart disease despite having a total cholesterol level of 306. Eliminating stress, cutting carbohydrates, and ditching those so-called “healthy” vegetable oils are all pro-active ways to greatly reduce your inflammation and make yourself healthier than you ever thought possible.

Jimmy Moore and Eric Westman
Jimmy Moore and Dr. Eric Westman, Authors of Cholesterol Clarity

As you can see, there are many other health markers that are more important in determining your current state of cardiovascular and overall health than total cholesterol and LDL-C. We need to shift the focus away from such a blinded view on cholesterol, as it relates to health, to more of an overall, inclusive examination of what is really happening. We attempted to lay the foundation for this in Cholesterol Clarity and to arm patients with solid scientific advice that is written in easy-to-understand language so they can make an informed decision about their health. Individual responsibility is the future and it’s time to take back control of your own health by becoming educated about what really matters the most.

Learn more about the Low Carb Lifestyle and Cholesterol:

Check Also

5 un-heart healthy products Statin Drugs/Red Yeast Rice/Niacin/Plant Sterols

5 ‘Heart-Healthy’ Products That Are Damaging Your Health

Think about the myriad of images that pop into your head whenever you hear the simple yet overused phrase “heart-healthy.” We see this wording plastered across the packaging of so many products these days that it seems consumers appreciate that they are being marketed foods and other products that will ostensibly help keep their cardiovascular health in tip-top shape. The 5 top products/foods being marketed as 'heart-healthy" where there is proof that they actually are not.


  1. I thought hsCRP levels correlated as poorly as LDL-C with heart disease? I’m not saying it should be ignored, but is there any evidence supporting that it’s “most indicative test” you can run? Other than a low carb/high fat diet (and statins), what else lowers hsCRP?

    • Relieving stress is a big part of reducing hsCRP as well as moderate amounts of exercise. It’s a good marker to see where you stand with inflammation and most certainly a lot better than looking at your calculated LDL-C number. Especially in the context of a low-carb, high-fat diet, your LDL-C can be miscalculated as being “worse” than it really is. Plus, it doesn’t tell you anything about the particle makeup of that LDL. With C-Reactive Protein, you can tell what’s going on with inflammation with the results you get from this marker. That’s why it’s on my list of five. THANKS for your comments, Gerard!

  2. Thanks for the article. My take away from all of the stuff I have read over the years is that we don’t have absolutely concrete information. For example, the old cholesterol stuff that so many relied on wasn’t by any means absolutely concrete…….. and it turned out to be misleading to say the least!

    The things you talk about in this article….. we’re at a place where we are more definite about what we know than they were back when they came up with the cholesterol advice/theories, right? I’m just trying to get a handle on how much more concrete things are now. (If any of this makes sense)

  3. “The more LDL particles you have floating around in your blood, the greater the risk of those particles penetrating the arterial wall. There’s still some debate amongst the cholesterol experts about whether it is the total number of particles or the size of the particles that matters most. Since the science isn’t settled on this, we present both sides of that argument in Cholesterol Clarity and let the reader decide for themselves which side they choose to believe.”

    This is TOTAL BS and you know it!! You do not present BOTH sides of the argument! If you did you would have presented more from Dr Thomas Dayspring

    BUT – why has you small LDL-P DOUBLED on your diet – it’s now almost 20% of the total!

Leave a Reply

Your email address will not be published. Required fields are marked *

This site uses Akismet to reduce spam. Learn how your comment data is processed.