The LDL Cholesterol Pattern

A single LDL cholesterol number does not tell you the entire story. And if we only look at LDL without looking at blood sugar regulation, insulin, triglycerides, HDL, inflammation, thyroid function, liver health, diet history, stress, sleep, and family history, we are being incredibly irresponsible. 

Context matters. Nuance Matters. There is absolutely a connection between LDL cholesterol and Blood Sugar - and we're going to talk about it. 

Transcript

Copy Transcript Copied

SPEAKER_00 0:00

Hey, hey, welcome back to Healthy Period. I'm Coach Kate, and today I am totally gonna ruffle some feathers because I'm gonna talk about a pattern I see all of the time in my practice. And sometimes I just literally want to fight conventional medicine, like punch them in the face fight. So today we're gonna talk about LDL cholesterol. Now, this is not medical advice. I am a nutritional therapist, so I coach and I give educational content. So this is for education. This podcast is not a don't worry about LDL podcast, but it is a let's understand the nuance and the patterns that LDL is associated with podcast. And high LDL cholesterol is a very real cardiovascular risk. I'm not ever in this episode saying that it's not. However, this podcast is to highlight the pattern for you, especially if you have PCOS, insulin resistance, metabolic disease, or thyroid issues. And if your doctor has ever told you to eat less saturated fat, eat more oatmeal, be scared of red meat, don't eat eggs, and come back in six months. I'm making this episode for you. But please do not start, stop, or change any medications based on this podcast episode. This is about helping you understand your labs, ask better questions, and see the bigger picture. Okay, so we're just gonna dive right in and get your booties unclenched or clench them because I'm gonna make them clench, okay? Because while LDL cholesterol matters, the conventional conversation around LDL is often very oversimplified. You've probably heard it like your LDL is elevated, that means your cholesterol is bad, so you have to eat less fat. Maybe you're gonna take a statin, and time for the next patient. And I want to be really clear. I'm I'm not saying that LDL is irrelevant. I'm not saying cardiovascular risk is not serious. I am not saying medication is never appropriate. There are absolutely people for using lipid lowering medication, it's going to be beneficial, it's going to be necessary, especially based on their personal history, family history, genetic risk, and overall cardiovascular profile. What I am saying is a single LDL cholesterol number does not tell you the entire story. And if we only look at LDL without looking at blood sugar regulation, insulin, triglycerides, HDL, inflammation, thyroid function, liver health, diet history, stress, sleep, family history, we're not practicing that root-cause medicine. We're actually being really irresponsible if we're only looking at one data point and not looking at anything else. We look at one flag on a lab report and pretend it's the entire map and it's not. So I want to talk about the connection between LDL cholesterol and blood sugar stability, specifically the pattern I see every single day in my practice with women who have normal annual labs but are dealing with insulin resistance underneath the surface. So these women may have LDL that's creeping up, they may have triglycerides that are elevated, maybe they have lower HDL, they might be struggling to lose weight despite eating very little. These women have energy crashes at 2 or 3 p.m. They might have intense sugar cravings, they might wake up wired at night, there's belly weight that won't move. These women have PCOS or regular cycles, heavy periods, acne, anxiety, or chronic fatigue. And these women are getting told that their blood sugar is fine, and their blood sugar is not necessarily fine because a fasting glucose level alone does not tell you whether you have insulin resistance. Your A1C alone does not tell you whether you have insulin resistance. And that's why we need to talk about it. So a fasted insulin level is not always included in standard annual wellness blood work, especially in New York State. You often have to specifically ask for it. And I think that that is just a huge problem. If you've ever had a conversation with me before in my DMs or if you're a client of mine, you know I am literally obsessed with a fasted insulin number because insulin resistance can be developing years, sometimes decades, before your fascist glucose and your A1C become completely abnormal. So insulin is the hormone that helps move glucose or sugar out of your bloodstream and into your cells to be used for energy or to be stored. So when your body becomes less responsive to insulin, your pancreas has to produce more insulin to get the same job done. So the higher the insulin number, the harder your body is working to regulate your blood sugar. So if there's a high insulin number, that's insulin resistance. In the early stages, your body may still be keeping your glucose in a normal range, but only because it's pumping out more and more insulin to manage it. So you can have a normal fasted glucose, you can have an A1C that looks fine, and you can still have chronically elevated insulin. And this is why someone can be told your labs look great while they're exhausted, hungry all the time, craving sugar, gaining weight around your midsection, and watching your triglycerides and LDL climb. So your body is compensating. There is not one system in your body that is going to work in isolation. Your body will compensate. And conventional labs often do not show the compensation until it progressed further. So if you're concerned about metabolic health, insulin resistance, elevated cholesterol, PCOS, stubborn weight gain, energy crashes, or a family history of diabetes, it is totally worth asking your clinician for a faceted insulin number because it is likely appropriate to assess it. I actually find it's very irresponsible that they don't order that automatically, especially if we're looking at PCOS, especially if we're looking at the fact that you might not be able to lose weight, right? I just think it's super irresponsible. But I also want to be careful here, there's no one universal perfect fasted insulin number, and the results need to be interpreted in context. So your lab's reference range is not necessarily the same thing as an optimal range, and one test never tells the whole story. But generally, we do not want to see a fasted insulin climbing while faster glucose is being held in range. That can be a sign that the body is working much harder than it needs to. So high triglycerides are often not just a you ate too much fat problem. They can be a sign that your body's having trouble handling carbs and energy overall. When insulin stays elevated, the liver gets the message to make and export more triglycerides. So over time, that can create the classic insulin resistance lipid pattern. Triglycerides go up, HDL goes down, and LDL can become more concerning in quality or particle number, even if the LDL number itself is not super high. So let's talk about why insulin resistance can show up alongside changes in cholesterol. So when insulin is chronically elevated, it affects more than your blood sugar. It affects your fat storage, your appetite regulation, it affects your inflammation, liver function, triglyceride production. It affects how your body packages and transports cholesterol. So your liver is actually playing a central role here. When the body is dealing with chronic excess energy intake, frequent blood sugar spikes, alcohol, inflammation, poor sleep, unmanaged stress, or insulin resistance, the liver can begin producing more triglyceride-rich particles. And this often is going to create a lipid pattern. Sorry, guys, I am on a roll and apparently I can't speak, but this often creates a lipid pattern that includes higher triglycerides, lower HDL cholesterol, higher non-HDL cholesterol, increased small dense LDL particles, and elevated LDL cholesterol in some cases. So I want you to think of insulin as the key that helps sugar leave your bloodstream and enter your cells for energy. In insulin resistance, the cells stop responding as well to that key. So the body has to make more and more insulin just to keep your blood sugar looking normal. Meanwhile, all that extra fuel has to go somewhere. The liver starts converting some of it into fat, especially triglycerides, and shipping it out in little transport packages. Okay. So high triglycerides are often a sign that the liver is overwhelmed by excess fuel and high insulin. And as and as those triglyceride-rich particles circulate, they can also change the cholesterol pattern. HDL often goes down, and LDL particles can become smaller, denser, and sometimes more numerous. And that is why we often see elevated triglycerides lower HDL and changes in LDL together in insulin resistance. And this is why I get so frustrated when women are only told your LDL is high, stop eating eggs. Because the question is not just how do we lower this one number? The question is why is your liver producing and handling lipids this way? What is your insulin doing? What are your triglycerides doing? What is your HDL doing? Are you eating enough protein and fiber? Are you living on coffee until noon and then getting ravenous at 4 p.m.? Are you skipping meals and binging at night? Are you chronically underslept? Are you drinking alcohol several nights a week because you're stressed? One glass of wine a night is a lot of alcohol. Are you dealing with PCOS, perimenopause, hypothyroidism, fatty liver, chronic dieting, or high levels of inflammation? Are you sedentary or are you over-exercising and underfueling? Because all of that matters. Your lipid panel is not just a report card on whether you are good or bad at eating. It is information about what your metabolism may be doing. And the tricky part, like I said before, is that blood sugar can look normal for years while insulin is quietly rising. The body is working overtime to keep your glucose in range. So a normal fasted glucose or A1C does not automatically mean insulin sensitivity is great. Looking at fasting insulin along with triglycerides, HDL, glucose, A1C, all of these other numbers can help us see whether the body is compensating behind the scenes. So when I see higher triglycerides, lower HDL, your waist circumference is huge, energy crashes, cravings, a normal-ish glucose level, I start wondering where's the insulin resistance? Give me that number. That can be high even before you meet the criteria for pre-diabetes or diabetes. So I want to get a little bit more spicy. LDL cholesterol is commonly used as a major marker of cardiovascular risk. And again, that's totally true, relevant in matters. But total LDL cholesterol does not always tell us how many particles are circulating in the blood, right? There's two different types of LDL cholesterol. There's big LDL cholesterol and small LDL cholesterol. I'm just keeping this super simple for you, right? The particle number can matter because it's not only how much cholesterol is inside the particles, it can also be about how many particles are repeatedly interacting with your artery wall. So non-HDL cholesterol is another useful calculation. It includes LDL and other cholesterol-containing particles that may be relevant to your cardiovascular risk. So depending on your situation, family history, current lipid panel, there's other things that you might want to ask your clinician about. And if that is you, DM me the word cholesterol panel. So two words, cholesterol panel, DM me that to my Instagram. My Instagram handle is at underscore coachkate. DM me cholesterol panel and I will send you the full lab work that I would want your clinician to run for you. So that way we can see the entire picture. And if you have very high LDL, a strong family history of early heart disease, relatives with known familial hypercholesterolemia that need medical attention, like those things are real. Genetics is real. Not every LDL pattern comes down to blood sugar or lifestyle. Some people have inherited lipid disorders and you do need more aggressive care. So that's not what I'm saying. Functional medicine should not mean pretending that genetics don't exist. It just means that you have to understand your risk profile and understand that it's bigger than just one number. So I want to talk about something that I see all of the time. My I have so many clients that are in their 30s or 40s. Their doctors have said their glucose is normal. A1C is 5.2. Her LDL is a little high. Her triglycerides are technically in range, but they are creeping up. Her HDL has dropped from where it used to be, and she feels like garbage. She is tired after meals. She needs caffeine to function. She gets hangry. She can't stop thinking about food. She has intense cravings at night. She's gained weight around her stomach. And she's doing more workouts and eating less food, and her body is literally just not responding. And the doctor just tells her to eat less fat. No one ran her fasted insulin. No one asked her how she sleeps. No one asks if she's been dieting for 15 years. No one asks whether her bowel movements are regular. No one asks if she's drinking coffee in an empty stomach and not eating breakfast. And no one asks whether she's on the pill, on an SSRI, in perimenopause, dealing with thyroid issues, or living in a nervous system state of fight or flight every single day. No one looked upstream. And that is the issue. And that is why so many women come to me because we need to look upstream. Because if insulin resistance is part of the pattern, simply avoiding eggs or eating a low-fat cereal bar for breakfast is not going to work. In fact, for some women, a low-protein, ultra-processed, low-fat approach makes your blood sugar regulation worse. You do not stabilize blood sugar by eating less and suffering harder. You stabilize blood sugar by creating metabolic safety and consistency. So, what are the most foundational things you can do to support healthier LDL levels, triglycerides, insulin sensitivity, and overall metabolic health? I'm gonna make this so practical for you, baby girl. Like we are totally, I'm gonna make it practical. So, number one, you're gonna stop skipping breakfast, right? You're not gonna start your day with sugar and caffeine. You are not going to skip breakfast. You are going to start your day with a blood sugar supportive breakfast. Eggs, vegetables, fruit, sourdough, or potatoes, Greek yogurt, cottage cheese with berries, chia seeds, nuts, a protein smoothie, not my favorite option, but hey, we need to get the protein in. With fruit, nut butter, fleet flax, or chia, added protein to that. Leftover dinner, yeah. You don't have to eat breakfast food for breakfast. Like you can eat dinner food for breakfast. It's fine. Um, if you are vegan, you might want to do a tofu scramble with vegetables and avocado. The goal is not perfection. The goal is to stop sending your body into a blood sugar roller coaster as soon as you wake up. The second thing you're gonna do is prioritize protein at every single meal. Protein supports you want to be satiated. Like you want to feel satiated and satisfied when you eat food. It's going to stabilize your blood sugar, it's going to help your muscle mass, and it's going to improve your metabolic health. So those are all the things that protein does. And honestly, the Instagram world is like high protein, high protein, high protein. And like, I'm kind of sick of it, but they're also not wrong because a lot of women are under-eating protein, especially at breakfast and lunch. And then you wonder why you're feeling out of control at night. So we need to have protein in every single meal. And then you need to eat more fiber. Not just fewer calories. Fiber makes you satiated, it supports your bowel movements, it supports your blood sugar response, and it also does help your cholesterol metabolism. So if you're not doing beans and lentils, oats, chia seed and flax seeds, berries, apple and citrus, vegetables, avocado, right? If you have been living on protein bars, coffee, random snacks, you might need to gradually increase your fiber rather than going from five grams to 40 grams because you will hate me. So if you're at like five grams of fiber a day, let's increase that to 10 grams of fiber a day and then slowly increase it after that. And then you need to get movement in. We need to be walking after meals, and we need to be getting strength training in. End of story. I'm not even gonna explain that. Those are the two things you need to do. And I want you to stop treating sleep like it's a luxury. I can sleep when I'm dead, I can rest whenever. Like poor sleep impairs insulin sensitivity, increases your appetite, worsens your cravings, and makes your blood sugar management harder. You cannot optimize your way around sleeping four to five hours per night. So if you want better metabolic health, your sleep has to be a central part of the plan. Okay, you have to eat enough. If you've been chronically dieting, you are not eating enough to regulate your blood sugar and to do all the things that you want to do. You need to look at the whole pattern before you blame one food. I'm not here to tell you that food does not influence LDL because it can. But for some people, particularly with certain genetics or higher responder patterns, saturated fat intake may substantially increase LDL. It's an individualized attention situation. But I'm also not here to tell you that one egg yolk, one steak, one tablespoon of butter is the reason your metabolic health is struggling. You need context. What is your overall diet pattern, your fiber intake, your protein intake, your insulin, your sleep, your stress, your movement, your thyroid, your liver? Your body is not a calorie calculator and a cholesterol calculator operating in separate rooms. Your body is a system. So if your LDL is elevated, I don't want you to panic. I don't want you to come here freaking out. But I also don't want you to ignore it. I want you to get curious. I want you to ask for a more complete picture. Ask for a facid insulin. Look at your glucose and your A1C in context. Look at your triglycerides, your HDL, your non-HDL cholesterol. Check your thyroid and your liver function when it's appropriate. Like talk to your physician about your personal risk factors and whether medication is indicated. But then the basics are just so unsexy. Like the basics are not what sells on Instagram. And this is why people are like so quick to find a quick fix because those are the sexy things to do. But like, if you really want to have solid metabolic health and not have cardiovascular risk factors, not be at risk for diabetes, all these things, we need to start with the unsexy basics. You need to eat real meal meals, you need to increase fiber, you need to prioritize protein, you need to walk after meals, you need to strength train, you need to sleep, stop drinking alcohol, stop living on caffeine, stop punishing your body, and actually give your metabolism an environment where it can actually function well. So your labs are not a moral judgment, they're just data. And data gives us the opportunity to make different choices. So this was a lot. There was a lot happening here. I definitely sometimes just want to punch conventional medicine in the face because I want you to understand there's context, there's nuance. A 30-second Instagram reel is not going to teach you the nuance behind the topic. But I need you to understand that there's a pattern. Your body does not work in isolation, your body works systemically. So if you have elevated cholesterol, you have diabetes risk, insulin resistance, cardiovascular disease, all those things are complex topics. There is a lot of nuance there. And if you are not, if you are only going to one lab number and chasing one lab number lower without looking at the full context and the full picture, you're always going to be spinning your wheels. So you need to work with someone who understands how to look at the whole pattern and helps you determine what is the right plan for you. Not just the right medication, not just the right supplement, not just, you know, what is this going to do? But actually look at every piece of the puzzle. Because when you do that, one, you're going to get results really fast. And two, you are going to have to put in the work to get there, but it'll be sustainable. And then you aren't chasing symptoms around. And I think that that's just something that a lot of people miss, and a lot of times conventional medicine misses is we're just going after a symptom, we're just going after a lab value and need to bring it down. Versus wait, what is the context here? So hopefully this was helpful. I know I was really spicy. I talked a lot. I did stutter a lot. Honestly, I don't care. Like, if you want to listen to me, you can listen to me and you're gonna listen through my stutters. Because honestly, I just record my podcast on my phone and my voice memos app, and then I just hit start and stop, and then I upload it for you because I want you guys to have my real raw thoughts and emotion. And sometimes I stutter. That's just it. But anyway, hopefully this was helpful. If you have any questions, let me know. DM me cholesterol panel, and I'll send you over the lab work that I'd love to see. Other than that, I'll see you in the next one. Bye.