Cholesterol Explained: What Most Doctors Won’t Tell You

Dr Avi Charlton on what cholesterol does, the markers she looks at and staying curious about your own health

TL;DR

• Cholesterol isn't the enemy. Your body needs it for hormones and cell membranes, and makes its own.
• Dr Avi says LDL isn't all "bad". She looks at particle size, the triglyceride to HDL ratio and other tests.
• She assesses heart risk using the whole picture, including blood sugar, insulin and, for some patients, a coronary artery calcium score.
• Whatever your numbers, have the conversation with your own doctor and stay curious.

Introduction

Cholesterol is one of the most common questions I get from clients, both in person and online. There's a lot of conflicting information out there, so I asked Dr Avi Charlton to explain it. Dr Avi is a Melbourne GP, breathwork coach and founder of the Melbourne Low Carb Clinic. This short clip comes from our full conversation.

Please read this first: this is general information from one doctor's perspective, not medical advice. Don't start, stop or change any medication, including statins, without talking to your own doctor.

Lesson 1: Your body needs cholesterol

Insight: Dr Avi explained that cholesterol is made up of small fat molecules that your body needs, including for hormones and cell membranes. Your body also makes it. If you don't get enough, your body will make what it needs to function. In her view, having cholesterol isn't a dangerous thing in itself, and healthy fats can improve your profile.

Action: Next time you get a blood test, ask your doctor to walk you through each marker on your cholesterol profile, not just the total.

Outcome: You understand what your numbers actually mean.

Lesson 2: Not all LDL is the same

Insight: A standard cholesterol profile includes total cholesterol, triglycerides, HDL and LDL. Dr Avi says triglycerides tend to rise when you eat too many carbs and can be a sign you're not metabolically healthy. HDL is often called "good" cholesterol, and higher is generally better.

LDL gets labelled "bad", but she says there's more to it. There are larger, "fluffy" LDL particles and smaller, denser ones, and she pointed to studies linking the small, dense particles to a higher risk of clogged arteries, heart attacks and strokes. She believes lifestyle factors like high glucose, processed foods, seed oils, pollution and stress can damage LDL particles and push them towards that riskier type. She sometimes orders an LDL subfraction test to look at particle size.

Dr Avi also shared her own numbers. Her total cholesterol is about nine and her LDL is high, but her triglycerides are very low and her HDL is very high. She sees the triglyceride to HDL ratio as more useful than total cholesterol or LDL alone.

Action: Ask your doctor what your triglyceride and HDL results look like, and whether further testing would be useful for you.

Outcome: You get a fuller picture than a single number.

Lesson 3: Look at the whole person

Insight: When Dr Avi assesses a patient, she doesn't look only at cholesterol. She also checks:

• HbA1c: your average blood glucose over about three months
• fasting glucose and fasting insulin: she says high insulin can show insulin resistance before someone becomes diabetic
• a coronary artery calcium score: a CT scan she uses for some patients over 40 or 50 to check for existing blockages in the heart arteries.

She uses all of that to judge whether someone is at higher or lower risk of a heart attack, rather than relying on LDL alone.

She told me many patients come to her feeling pressured to start a statin. Her approach is to give them information and remind them that it's their choice. Sometimes she writes to the patient's GP to share her view. She described the GPs as meaning well, and said she used to practise the same way herself about five years ago before she changed her approach.

I've had a couple of clients with high cholesterol who are among the healthiest people I know, and their doctors wanted them on medication. That's exactly why I think it's worth asking questions and having an open, informed conversation with your doctor.

Action: If you've been told your cholesterol is high, write down your questions before your next appointment and ask how your overall risk was assessed.

Outcome: You're part of the decision instead of just being told what to do.

Quick wins

• Ask for a copy of your blood test results.
• Learn what triglycerides, HDL and LDL each measure.
• Ask your doctor how they assess your overall heart risk.
• Focus on whole foods, managing stress and moving every day.

Closing insight

Dr Avi's message, and mine, is to be curious. Just because someone tells you something doesn't mean you can't ask questions and try to understand it. Work with a doctor who will explain your results and talk through your options with you.

Connect with Dr Avi Charlton

Visit the Melbourne Low Carb Clinic or Breathe in Health, or follow her on Instagram.

Listen to the full episode

The full conversation is on Spotify, Apple Podcasts and YouTube, or press play at the top of this page.

Related episodes: Prescribing Lifestyle with Dr Avi Charlton and What I Learned From 5 Powerful Podcast Guests