Cholesterol Rises in an Order

Cholesterol Rises in an Order

What a lipid panel records is how much cholesterol and triglyceride are in the blood. How many particles carry that amount is not recorded.

Ordinarily the two go together. When the amount rises, the particles rise; when the amount falls, they fall. But depending on what is happening in the body, there are times when they part company. The particle count has risen while the cholesterol amount is unchanged. Then the sheet says normal.

How that comes about becomes visible if you follow the order in which the four lines move. Lipid values do not worsen all at once. There is a line that moves first, and a line that moves only much later.

Triglyceride Is Shaken First

The liver makes fat from surplus calories and sends it out into the blood. While insulin is doing its job, this sending out stops at a reasonable point.

But once the state is reached where the same amount of insulin no longer gets as much done, the liver makes more fat and stops sending it out less readily. As a result, particles heavily loaded with triglyceride increase in the blood. This is why triglyceride is the first of the four lines to rise.

Next Comes the Swapping of Loads

Lipid particles in the blood do not each carry only their own load. They swap loads with one another. When particles carrying a great deal of triglyceride increase, those particles hand their triglyceride over to HDL and LDL and take cholesterol in return. There is a protein that manages this exchange, called cholesteryl ester transfer protein (CETP).

HDL that has taken on triglyceride is whittled down as it passes the liver, and whittled HDL does not last long before it is cleared. So the HDL value falls. That HDL is the second line to move is not because HDL itself has gone bad; it is a consequence of the first line moving.

What Moves Last Is the Size of LDL

LDL that has been through the same exchange is also whittled while holding triglyceride. Whittled LDL becomes smaller and denser. Particles altered this way are called small dense LDL.

Here is where the parting mentioned at the start arises. When particles become smaller, more of them are needed to carry the same amount of cholesterol. So the particle count can have risen while the amount of cholesterol is unchanged. The LDL value written on the sheet is an amount, not a count.

There is a separate test, apoB, that measures something close to particle count, but it is not always included in a routine check-up. So total cholesterol and LDL can sit within the reference range while the four lines have already worked through their sequence. The sheet is not wrong. This test looks at amount, and what changed in the body is count and size.

There Is an Order on the Way Back Too

That there is a sequence means there is a sequence on the way back as well. When daily life changes, triglyceride comes down comparatively quickly. HDL follows up more slowly, and particle size finding its place again comes after that.

Without knowing this order, it is easy to look at a repeat test a few weeks later, see HDL unchanged, and conclude it was pointless. If the line that was going to move first has moved first, the direction has already turned.

When I use herbal medicine I follow this same order. Rather than aiming at one value that has already risen, I look together at the circumstance in which the first line moved. Knowing the order settles what to check first.

However, if triglyceride has come back in the hundreds, or if someone in the family had heart or vascular disease at an early age, it is better to arrange testing regardless of the sequence.

A normal cholesterol value means that line has not moved yet. It does not mean all four lines are where they were.

Knowing the order lets you read from a single sheet roughly where you are. And it also settles which line to work on first. I take that to be the job that comes before lowering a number.