Introduction to Cholesterol



so this is part two in our introduction or basic series and this one is on cholesterol yes so today I'm gonna start out by asking Ford tell me we all hear about LDL bad cholesterol and that is the data point that's put forward to us when we meet with our internist how is our LDL in our practice we look at things a little bit differently we look at triglycerides and HDL and look at that ratio can you define these types of cholesterol and what they mean to patients sure you know when we were talking about this video one of the things you brought up was the dump truck analogy Amy in our shop or who used to be in our shop used to use that dump truck analogy a lot she said that LDL which is what most people call the bad cholesterol is like a full truck and HDL is like an empty truck and what she's referring to is that HDL pulls cholesterol away from the body back to the liver so the liver can burn it up whereas LDL on the other hand is taking cholesterol out and it is full and it does tend to dump it in the in the arteries okay so getting a little more specific about it I mentioned there's a triglyceride HDL ratio what are we looking at there and what is the importance of each of those numbers and why in our practice do we look more at those numbers versus LDL well first of all you bring up that point why does everybody focus on LDL and why do we not we went down this path in medicine a hundred years ago what happened was they noticed that plaque in arteries was made up of LDL that's most of what black in arteries is and still is it's oxidized LDL so logically that's where we headed down that path that turned out to be incorrect that well if you eat cholesterol then you'll get plaque and most of us know that's not the case but still we don't have a better model in medicine yet or we haven't really focused yet on a better model there's a fellow named Paul Ridd Kerr really smart guy at Harvard who began to see this 20 years ago and has been pushing that it's not LDL it's inflammation okay so we're saying that maybe LDL is not the villain that we've been told it is there's something else that's more important yes sir so it's a really good point and where's the logic there here's the thing if you look at people that have had heart attack half of them have a normal LDL so we keep running around saying well LDL is the problem and you go see your dock and your dock what does the dock do they look at the LDL we all of the risk are most of the risk paradigms for treatments for statins and things like that all focus on LDL level but again it breaks down really quickly when you realize half the people having heart attacks have a normal LDL so there's something else going on so you refer to the empty dump truck with HDL mmm-hmm so that kind of brings us more into what HDL and triglycerides mean and why is that ratio important you've been getting to that HDL and triglycerides a couple of times and thanks for your patience on me getting there the first thing I look at when I look at a cholesterol panel is not the LDL its triglycerides over HDL and why is that and what does that show me that actually shows me something very important about the carbohydrate metabolism our ability to to manage glucose or carbohydrates when we eat them why is that because again what we found is that it's not LDL it's died prediabetes and triglycerides over HDL is a very important warning of pre-diabetes or insulin resistance let me just stop you there one second when he says triglycerides over HDL if you have those two numbers on your labs you are doing a division formula yeah of triglycerides divided by HDL right so to get back to another question that I think you asked and maybe I jumped over triglycerides what are triglycerides triglyceride a dry glissade molecule there's three fatty acids hooked together by glycerin in other words another way to look at it is it's our jellyroll here it's our saddlebag it's our fat stores that's triglyceride okay so then if we're looking at that ratio or that division problem and we get a number of one versus three can you explain what you know what does that mean for heart attack and stroke and are we looking for a larger number in the HDL which is the denominator to offset the number in the numerator the triglycerides and why that's important well for a second let's just forget about numerator denominators numerator stuff like that let's get you some real numbers let's say a patient has or I have a triglyceride level of a hundred and fifty and a an HDL of 30 then that hundred and fifty over thirty is five that's really bad that's a really bad number on the other hand we've got I've seen several places just over the past week that had HDL numbers higher than triglycerides they had a triglyceride in the 60s and a HDL in the 70s so that's less than one that's less than one it is a really good number I'm very jealous I haven't had that in a long time I tend to be around one and a half so one and below is really really good one-and-a-half is starting to get there too and above is a very strong indicator that you have insulin resistance in other words your your body is constantly fighting against high glucose levels so it's putting out a lot of insulin here's why this happens to your ratio insulin keeps your body from burning fat it wants you to burn sugar so it stops off stops the fat burning so your triglycerides to start going up in addition when that happens your HDL that empty dump truck is overworked you don't have any more empty dump trucks now because they're trying to pull all of those fats back out of the artery wall to the liver to the liver so the liver can burn those fats up okay so that's the importance it's the ratio but it's important knowing what those numbers mean that go into it and what the value indicates in terms of your diabetes pre-diabetes diabetes and heart health it's a good point I tend to get focused on connecting the dots because it's hard to remember things things like a ratio well if a ratio is just a number then it doesn't mean very much no you have to understand what goes into it well I think that's all for introductory video today unless you want to add anything else that's it I hope that I hope it helps get that message across and helps create some understanding of what we're looking at here thank you very much if you hit the like button and for sure if you subscribe or share the algorithm reads that as a strong message that humans think this is interesting and important information and the algorithm can share it more than any of us humans speaking of sharing the one of the best ways of sharing is on social media we've got active Facebook Instagram and LinkedIn activities going on right now we've recently started things in Pinterest and Twitter so we'd love to see you there check us out finally with over 500 videos a lot of people are saying I can't find this video or that video our new social media manager Kim Hermosa is starting to 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10 Comments

  1. Interesting discussion Dr. Brewer! Most people know, or have heard, the terms LDL & HDL but what are the real differences between these low & high density lipoproteins? An explanation along those lines would be very informative to the novice. Question: I still don't understand how HDL's can cross the arterial wall lining, pick up LDL's, & then transport them to the liver? Unless it has something to do with Macrophages & the breaking down of the LDL's first? Aren't HDL & LDL inert molecules just floating around in the blood stream to begin with? Just trying to get a handle on this & how it relates to IR? Just looked up my Lipid panel test results of 3/21/19: Total Chol was 161 mg/dL; Trigly was 98: HDL was 46; LDL was 95. The Chol/HDL ratio was 3.5. Although they don't give the Trigly/ HDL ratio, I calculated it as approx. 2.1. Just curious as to how you would interpret those results? Thanks for all of your videos.

  2. Dr. Brewer – How low carb is to low? Do you see any drop-off in thyroid or testosterone levels when going low carb for too long? Both are heart protective hormones for males. Thank you

  3. My Mom had a stroke. She did survive. Her cholesterol was always in the norm before, after and still is normal. She always had and still has high blood pressure. She eats loads of carbs as in Bread and Potatoes everyday. Before the stroke, deep fried foods fried in vegetable oils maybe 3 times a week… Overweight all her life. I follow keto and IF. I'm thin and no health issues, no high blood pressure. Her quote. She'd rather die than give up her potatoes and bread.

  4. I think there is considerable momentum building across the board on the reality of Cholesterol, Inflammation, and Dietary Guidelines as they are now. There have some really good high level lectures in recent times attacking the old paradigms.

  5. As a reference regarding the Keto diet I can provide that after 12 months on a Solid Keto Diet a dramatic improvement across the board for me… LDL 4.4 HDL 1.7 Trigs 0.8 hsCRP 0.46 now HbA1c 5.1 Recent fasting glucose now 4.9 In fact many of these results were evident after 6 months. Also average at rest Blood Pressure down by more than 10 points. weight now down 13Kg This diet has made a massive difference in my risk – especially considering early heart attacks run in my family.

  6. Thanks for another great video. Sorry for the dumb question (I don't have any medical education) but when the LDL dump trucks are working overtime dumping LDL into the liver, is that the cause of fatty liver disease or is the cause of non-alcoholic fatty liver something else?

  7. Thanks mom and dad! How can we boost HDL? Also can you speak to myself and others about alcohol damage? I'm full on health nut that is only surviving but drink myself to death.

  8. Hum, lab quest provides hdl/trigs- you all are using its reciprocal. Must be a East Coast thing.

  9. I really wish there was a standardised set of numbers that are Universally used for Cholesterol, and in fact many other things like hba1c. Outside of the U.S.A (certainly in UK) we use mmol/L and it gets so frustrating trying to work out the differences 🙁

  10. I had high LDL and high cholesterol for over 30 years. Im 60 now and my recent CAC score was 73. But, my tri/hdl is 2.0. So, despite terrible cholesterol numbers for decade, my cardio health is in the ok range.

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