Seeing the Gray Area in Cholesterol Numbers

Your total lipid number (AKA "total cholesterol") doesn't mean anything...we've covered that already (here and here).  Your low density lipoproteins (LDLs/"bad cholesterol") can be harmful to your health, but they are also necessary and critical to the body's proper functioning.  What truly determines good or bad with your LDLs is not the total number, but the size of the particles: small LDLs are negative, and large LDLs simply do their important job (bringing cholesterol from your liver to other tissues that need it).  A simple blood test will not tell you what size your LDL particles are.  However, these tests can:

1. Vertical Auto Profile (VAP) Test
2. Nuclear Magnetic Resonance (NMR) Lipoprofile

Both tests provide the amounts of total lipids, HDLs, LDLs, triglycerides, and LDL particle size.  LDL particle size is described as being "pattern A" or "pattern B".  Pattern A are the large LDLs, and pattern B are the smaller LDL particles that are associated with poor cardiovascular health and metabolic disease. 

To illustrate how poor of an indicator the total lipid number is, Richard of Free the Animal (a paleo diet blog) took an NMR Lipoprofile test and posted the results online.  If you click on the link to see his results, you will notice that his total lipid number is 275 mg/dL, which would cause many doctors to jump out of their seats and start writing prescriptions for statins.  Mainstream medicine generally recommends keeping the total blood lipids under 200mg/dL.  However, if you scroll down, you will see that his LDLs are strongly considered pattern A, indicating no concern for heart disease whatsoever!  Imagine what would happen to this healthy individual if he had no idea what his particle size was and his doctor convinced him that statins were necessary!

Clearly, LDL and total lipid numbers are poor indicators of cardiovascular health.  To see the gray area that regular blood tests can't show, go for a VAP or NMR Lipoprofile test.