Hello Reader,
The Cholesterol Test Your Doctor Probably Isn’t Ordering (And Why Those “Normal” Numbers Might Be Misleading)
Dear Commander,
I have a confession: At my last annual physical my physician ordered the typical lipid panel and, as it has for years, my LDL was high, my HDL was super high and my triglycerides were super low. My physician said maybe I should take a statin, I said, "No." I said no because I had been reading that people with numbers like mine didn't show a benefit from taking statins. However, I didn't know why they didn't benefit. Would I benefit?
I knew my diet wasn't to blame for my numbers. Why did I always have high LDL. I decided to do a deep dive into cholesterol research. What I discovered completely changed how I think about those little numbers on a lab report.
Here’s the truth your doctor might not be telling you…
Your Cholesterol Numbers Are Lying to You
Picture this: You and your neighbor both have the exact same LDL cholesterol level of 130 mg/dL. Your doctor says you’re both “borderline high” and need to watch your diet.
But here’s what’s actually happening inside your bodies:
You: Your 130 mg/dL is carried in large, fluffy particles that bounce harmlessly off your artery walls like beach balls.
Your neighbor: Their 130 mg/dL is packed into small, dense particles that slip through artery walls like bullets, causing inflammation and plaque buildup.
Same number. Completely different risk.
This is why traditional cholesterol panels miss the mark. They’re measuring the cargo (cholesterol) but ignoring the vehicles (particles) carrying it.
The Test That Changes Everything
The advanced testing you should know about:
LDL Particle Number (LDL-P)
This counts the actual number of LDL particles, not just the cholesterol content. Fewer particles mean less danger.
ApoB (Apolipoprotein B)
Each LDL particle has exactly one ApoB protein. This test essentially counts your particles and many cardiologists now consider it more predictive than basic LDL cholesterol.
Particle Size Analysis
Advanced testing can measure whether you have the dangerous small, dense particles or the less harmful large, fluffy ones.
Key Research Supporting Advanced Testing: - Framingham Offspring Study: 3,066 participants followed for cardiovascular events - showed LDL particle number was more predictive of heart disease than LDL cholesterol - EPIC-Norfolk Study: Large UK population study found LDL particle number better predicted coronary artery disease than traditional cholesterol measures
- European Society of Cardiology Guidelines (2019): Concluded that ApoB is a more accurate marker of cardiovascular risk than LDL cholesterol - Multiple studies published in Journal of the American Heart Association: Consistently show ApoB superiority over LDL-C for predicting cardiovascular events
The Coconut Oil Controversy (Solved)
While we’re talking cholesterol, let’s address the something I get questions about: coconut oil. As many of you know, I Iove coconut oil and blend it in with my coffee often. MCT oil, which is what I get from my coconut oil has a ton of benefits. It is my version of a Bulletproof coffee. (If you try this, you must use a blender or immersion blender to incorporate it into your coffee. )
The reality: A 2025 meta-analysis of 26 studies spanning 40 years found that coconut oil does raise LDL cholesterol compared to unsaturated oils, but it also significantly raises HDL (the “good” cholesterol). More importantly, research suggests it may create the larger, less harmful LDL particles rather than the small, dense ones.
Key Research: - 2025 Analysis of 26 Studies: Published in Nutrients, analyzed 984 lipid profiles and concluded “coconut oil does not pose a health risk for heart disease” - Nature Reviews Cardiology (2020): Meta-analysis of 16 studies confirmed coconut oil raises LDL by 10.47 mg/dL but also raises HDL by 4.00 mg/dL - Randomized Controlled Trials: Multiple studies show coconut oil creates less harmful cholesterol profiles than butter, though not as neutral as olive oil
The bottom line: If you have high LDL cholesterol, ask your doctor about particle size testing before making decisions about coconut oil. The type of LDL particles you have (large vs. small) should inform your dietary choices, and this conversation is best had with your healthcare provider who knows your complete health picture.
Your Action Steps This Week
- At your next doctor visit, ask about advanced cholesterol testing. Specifically mention LDL particle number (LDL-P) or ApoB testing.
- Schedule a comprehensive cardiovascular risk assessment with your doctor. Many cardiologists now offer more thorough evaluations that go beyond basic cholesterol numbers.
- Don’t panic about your current numbers. Knowledge is power, but stress isn’t helpful. Focus on what you can control: diet, exercise, and getting better information.
- Get a calcium score test. A calcium score test, also known as a coronary artery calcium (CAC) scan, is a non-invasive procedure that measures the amount of calcium buildup in the coronary arteries. This information helps assess the risk of developing heart disease. FYI: A coronary artery calcium (CAC) score test doesn't show the presence of soft, non-calcified plaque. A zero score is good news, but doesn't eliminate risk because early, soft plaques can still cause problems, and results must be considered alongside other health factors.
The Real Truth About Heart Health
Here’s what I wish someone had told me years ago: Your heart health isn’t determined by a single number on a lab report. It’s about the complete picture—your particle count, particle size, inflammation levels, blood pressure, family history, and lifestyle factors.
Traditional cholesterol testing is like judging a book by counting the pages instead of reading the content. The advanced testing gives you the actual story.
Your mission (should you choose to accept it): Become an informed advocate for your own heart health. Ask better questions. Demand better testing when appropriate. And remember—you have more control over these numbers than you think.
Stay strong,
P.S. Next week, I’m diving into the truth about inflammation markers and why your C-reactive protein might be more important than your cholesterol. If you’ve been following along with the Matrix of Squares method, this is all part of taking control of your health transformation. Small, consistent actions in the knowledge square lead to big changes in your health outcomes.
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