Overview of important laboratory tests
A simple lipid profile including total cholesterol, LDL, and HDL, as commonly used in many medical practices, is not sufficient to reliably assess cardiovascular risk. Various additional laboratory parameters are important for a more differentiated risk assessment and also help to evaluate the course of treatment. Below, we explain the significance of the individual laboratory parameters.
The standard parameters
The following parameters are routinely measured:
- Total cholesterol: The current reference value is 200 mg/dl. In Part 1 of our series, we explain – based on studies – that higher values may even be beneficial for health. On its own, this parameter has only limited informative value.
- LDL cholesterol: This value is often the basis for initiating statin therapy. The current reference value is 160 mg/dl. However, this approach is problematic, as LDL alone does not provide information about particle size, density, or inflammatory status. In addition, this value may be inaccurate because laboratories usually do not measure LDL directly but calculate it. More on this below.
- HDL cholesterol: This is an important parameter that should ideally be above 60 mg/dl. HDL cholesterol is capable of transporting oxidized and “used” cholesterol away and is itself only very difficult to oxidize. It therefore protects the blood vessels.
- Triglycerides: Elevated triglyceride levels correlate with unfavourable forms of LDL cholesterol that more readily promote plaque formation in blood vessels. High triglyceride levels typically result from excessive carbohydrate intake and an overcaloric diet, both of which increase inflammation in the body. Ideally, triglyceride levels should be between 50 and 100 mg/dl.
In summary, total cholesterol and LDL cholesterol alone have limited diagnostic value. An exception are extremely elevated levels, which may indicate familial hypercholesterolemia (see Part 1). HDL cholesterol and triglycerides are important parameters for assessing metabolic and cardiovascular health.
Cholesterol levels fluctuate naturally
It is also important to note that numerous factors can lead to temporary fluctuations in cholesterol levels. These are natural regulatory processes of the body that usually normalize once the underlying cause is resolved.
Important influencing factors include stress, infections, micronutrient deficiencies, hypothyroidism (e.g., in Hashimoto’s disease), and intensive physical exercise.
LDL is calculated, not measured
Another important point is that in most laboratory tests, LDL cholesterol is not measured directly but calculated from total cholesterol, HDL cholesterol, and triglycerides. For this purpose, the so-called Friedewald formula is used, which dates back to the 1970s. However, with very low or very high triglyceride levels, this formula can lead to falsely elevated LDL values.
If a healthy, young person unexpectedly shows high LDL cholesterol levels (e.g., 190 mg/dl), this may be due to low triglyceride levels (e.g., 50 mg/dl), which are actually favourable for health. If the laboratory values of this person were entered into a more modern calculation formula (e.g., according to Cordova (1)), the LDL values would suddenly be significantly lower.
The Friedewald formula is as follows:
LDL cholesterol = total cholesterol – HDL cholesterol – (triglycerides / 5)
By inserting one’s own laboratory values into this formula, it is possible to determine whether LDL was calculated in this way.
Extended diagnostics
For a more precise assessment of cardiovascular risk, the following laboratory parameters are useful:
- LDL subfractions: As explained in Part 1, so-called “small dense LDL” particles represent a particularly high risk. These particles mainly develop under conditions of high inflammatory burden. Specialized laboratory tests can differentiate between the various LDL subfractions.
- Oxidized LDL: Measuring oxidized LDL makes it possible to determine which LDL particles have already undergone inflammatory modification. Atherosclerosis is ultimately driven by oxidized LDL. Small dense LDL oxidizes particularly easily.
- Lipoprotein A: This is a genetically determined risk marker for cardiovascular disease. Lipoprotein a should be measured at least once in a lifetime, as it can hardly be influenced by lifestyle. An elevated value indicates that particularly consistent attention must be paid to diet and lifestyle.
- ApoE genotype: The ApoE4 genotype is also a genetic risk factor for cardiovascular disease. Here too, affected individuals must pay particularly close attention to their diet and lifestyle and may require specific forms of omega-3 fatty acids. Further information can be found in Part 1. Additional genetic risk factors may also be assessed.
In addition, it is advisable to evaluate insulin metabolism, as insulin resistance promotes inflammatory processes, favours the formation of “small dense LDL,” and thus plays a key role in the development of atherosclerosis.
Assessment of liver enzymes and liver ultrasound imaging are also important, as the liver plays a central role in lipid metabolism. Disorders such as non-alcoholic fatty liver disease can significantly impair cholesterol and triglyceride metabolism.
To evaluate vascular health, ultrasound examinations of the carotid arteries or the abdominal aorta may also be useful, as they can provide early indications of plaque formation or changes in the vessel walls.
Improving cholesterol levels naturally
Diet, physical activity, and targeted micronutrients play a central role in positively influencing cholesterol metabolism and reducing the risk of cardiovascular disease. The following measures are easy to integrate into daily life and support the body in reducing inflammation, regulating fat metabolism, and improving vascular health.
Anti-inflammatory nutrition as the foundation
A Mediterranean-style diet is recommended, rich in vegetables, healthy fats and proteins, and sufficient dietary fibre. At the same time, it is important to avoid processed foods and excessive carbohydrate intake.
Why dietary fibre is so important
Dietary fibre binds bile acids in the intestine. Since bile acids are produced from cholesterol and are normally recycled via the enterohepatic circulation, binding and excreting these bile acids forces the body to convert more cholesterol into new bile acids. As a result, cholesterol levels decrease naturally.
Average fibre intake is only about 5–10 g per day, which is far below the recommended range of 30–50 g per day. A gradual increase is advisable so that the digestive system can adapt to the higher intake and discomfort can be avoided.
Bitter substances provide additional support
Bitter compounds further stimulate bile production and thereby support fat digestion and the elimination of cholesterol. Natural sources include various types of cabbage and bitter salads such as arugula or dandelion. Bitter herbal preparations or plant extracts may also be used as supplements. They are most effective when taken before meals, as this allows bile acid production to be stimulated in advance.
Supplementing important micronutrients
Adequate intake of essential micronutrients is a key prerequisite for healthy fat metabolism and healthy blood vessels:
- Omega-3 fatty acids: An omega-3 index of 9–12% is considered optimal for cardiovascular health and inflammation regulation. Our product DHA plus EPA provides high-quality, vegan omega-3 fatty acids in a high dosage.
- Choline: Choline is important for liver function, fat metabolism, and cell membranes. In the Gut–Brain Complex, choline is combined with additional important nutrients such as L-glutamine and propionate to support gut health.
- S-acetyl-glutathione: Glutathione is the body’s most important endogenous antioxidant and is present in particularly high concentrations in the liver. Our S-acetyl-glutathione supplement provides highly bioavailable glutathione to support liver function and protect against oxidative stress.
- Plant-based antioxidants: Phytoextracts provide valuable secondary plant compounds that often have strong antioxidant effects. One example is Curcumin Plus, which combines highly bioavailable curcumin with numerous additional plant extracts. Phyto Redox is another key product in our range, combining various antioxidant and adaptogenic plants and distinguished in particular by its regulatory properties.
- Nattokinase: In Nattokinase Complex, high-quality natto derived from fermented soybeans is combined with a vegetable powder blend, amino acids, and coenzyme Q10 to support mitochondrial function.
Adequate physical activity
Physical activity is another key factor for healthy cholesterol metabolism. It stimulates intestinal activity, promotes muscle development, and improves insulin sensitivity as well as inflammation regulation. Even regular brisk walking has positive effects; in addition, moderate endurance training and strength training are recommended to improve metabolic function in the long term.
Supporting liver function
The liver is the central organ of fat and cholesterol metabolism. It produces cholesterol, breaks it down, forms bile acids, and regulates inflammatory processes. Proper liver function is therefore essential for healthy cholesterol levels.
Supportive measures include:
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Liver wraps, which are used in naturopathy to promote circulation and metabolic activity.
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Stress reduction and emotional relief, as chronic stress can impair liver function and exacerbate inflammatory processes.
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Phytoextracts and antioxidant micronutrients, such as S-acetyl-glutathione or Phyto Redox, which support liver function and the neutralization of free radicals.
Conclusion
Cholesterol is essential for many bodily functions. A cholesterol level that is too low can therefore be just as problematic as a significantly elevated one. What matters most is balance: cholesterol levels should be regulated in a way that supports metabolism without increasing cardiovascular risk through oxidized or “small dense” LDL.
Rather than lowering cholesterol at any cost, priority should be given to a healthy lifestyle, the reduction of inflammation and oxidative stress, and good LDL and HDL quality. Modern diagnostics therefore take far more into account than LDL or total cholesterol alone. Initiating statin therapy based solely on an isolated elevated LDL value does not do justice to the complexity of human metabolism.
Sources
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de Cordova CM, de Cordova MM. A new accurate, simple formula for LDL-cholesterol estimation based on directly measured blood lipids from a large cohort. Ann Clin Biochem. 2013 Jan;50(Pt 1):13-9. doi: 10.1258/acb.2012.011259. Epub 2012 Oct 29. PMID: 23108766.