The Case for Advanced Cholesterol Testing: Why Your Standard Blood Test Isn’t Enough
When it comes to cardiovascular health, cholesterol is a word that evokes mixed feelings and, too often, confusion. For decades, advice has swung back and forth: Avoid fat. Eat “heart-healthy” foods. Watch your cholesterol numbers. But as Alan Ogden reveals in a recent Your Second 50 podcast episode, much of what you’ve heard about cholesterol—and its testing—is rooted in outdated science and oversimplified metrics.
If you’re nearing 50 or already in your “second 50,” there’s no better time to rethink how you approach cholesterol. It’s not just about lowering a number on your blood test. Alan invites us to look deeper, question old assumptions, and understand how advanced cholesterol testing can provide a far more accurate picture of cardiovascular risk.
Standard Cholesterol Testing: What Are We Really Measuring?
Most of us are familiar with the basic cholesterol panel—the numbers our doctors use to make big decisions about statin therapy and cardiovascular risk. According to Alan, these tests generally look at:
- HDL cholesterol (“good” cholesterol)
- LDL cholesterol (“bad” cholesterol)
- Triglycerides
Alan walks us through the process: “If you go have a blood test, generally it’s a fasting blood test. We want your body to have flushed out anything that it possibly can. And if we still see high LDL cholesterol, our first response to that is not a statin drug. We look at their dietary pattern. How much saturated fat are they actually eating? Do they have some genetics that might indicate that they have an inability to use saturated fat? We look at all their liver enzymes because the liver is where cholesterol is produced.”
But, as Alan points out, this focus on standard markers is rooted in decades-old assumptions—many of which were based on cherry-picked data. “The original research…this doctor that was being elevated as the new expert in cholesterol had done a meta-analysis…he had cherry-picked just a few studies. He didn’t look at all of the research, he just cherry-picked a few studies and then they came up with these guidelines that if you are over a certain level of LDL cholesterol, then you needed therapy.”
This has led to broad recommendations for statin drugs and dietary fat restrictions, even though the original research and statin approvals were highly selective: “The original approval for [statins], you had to be a male, you’d had to have already had a heart attack, they would start you on a statin drug, or you had to have genetically high cholesterol.”
The Limits of Standard Testing
Alan makes it clear that the standard cholesterol panel is just the tip of the iceberg. While doctors commonly measure and react to LDL, HDL, and triglyceride levels, these numbers don’t capture the nuanced reality of cardiovascular risk. Factors such as genetics, liver function, kidney function, and even bowel health play significant roles—and aren’t considered in routine blood tests.
“You know, when you go to your doctor, they don’t do genetic testing. They just do a blood test. They look at some results and then they make this decision on whether or not you should be on a cholesterol drug,” Alan observes. He adds that as guidelines have shifted, “the levels, allowable levels, pre sort of therapy have dropped. They continue to drop…there were certain levels, there was very few people that met them” back in the 80s, but criteria have expanded—and often without sufficient nuance.
Consider postmenopausal women. Alan explains, “As women go through menopause and they become postmenopausal, their LDL cholesterol naturally rises.” Yet many of these women—like previous generations who lived into their 80s and 90s—never developed cardiovascular disease. “Now, you know, we look at our grandparents, many who’ve lived into their 80s and 90s and never had cardiovascular disease. And yet they had this LDL cholesterol.”
Advanced Cholesterol Testing and Analysis
The promise of advanced cholesterol testing lies in its ability to dig deeper. Alan goes beyond the basic blood panel, integrating genetic testing, functional measurements, and comprehensive lipid analysis to better clarify risk and treatment pathways.
- Genetic Testing: According to Alan, understanding your DNA provides essential context. “We have genetics for our dietary cholesterol, saturated cholesterols, unsaturated cholesterols. We have a selection of genetics that we can look at that would indicate a predisposition and then we know what to go look for.” This is vital for identifying those who are truly at risk due to genetic factors like apolipoprotein A, which Alan describes as “a type of cholesterol substrate that we make, which is very inflammatory.” For some, genetic predisposition can override lifestyle changes—Alan notes one doctor he worked with, whose genetics drove his cholesterol levels despite every effort.
- Comprehensive Lipoprotein Analysis: Alan explains, “Then we do a further panel which is called a lipoprotein panel. So what that lipoprotein panel is looking at is the triglycerides…these are the ones that we’ve now identified that actually are doing the damage in our cardiovascular system.” This deeper look helps distinguish between LDL that is merely elevated and LDL that is actually harmful. He gives the example of his wife, Donna: “Her cholesterol was very high. Like she was just looking at those bare numbers that your doctor checked…we went back and said, could we do a lipoprotein test? He did a lipoprotein test. A lipoprotein test came back very good. So what that means is even though the LDL is high, it’s not damaging.”
Advanced testing can also examine liver enzymes, kidney function, and bowel health—all critical for understanding how the body processes cholesterol. “We’ll look at all their liver enzymes…even kidney function. And finally, we’ll look at their bowel function, because when we eat a lot of fat in our body, it goes through the liver…comes back into the intestinal tract, and hopefully we have the bacteria in our intestinal tract to actually emulsify that fat and get rid of it.”
Importantly, Alan stresses that “statin therapy is a requirement for [some] because of the genetics. Maybe even because they don’t have the ability to change their diet too much or the desire to change their diet too much. So there is some.” New cholesterol drugs, he notes, are starting to act in the intestinal tract, “which is where the problems are coming from.”
Comprehensive Health Review: Looking Beyond Numbers
Alan’s approach to cholesterol is holistic. Before jumping to medication, he advocates a review that considers genetics, diet, liver health, and even gut microbiome. Only after these are assessed should intervention be considered—and that intervention might include natural therapies as well as pharmaceuticals.
For example, Alan managed Donna’s cholesterol with dietary changes and a natural product called Stericol, which Health Canada permits for management of high cholesterol. “So all these things that are damaging. So there are ways that we can handle this. But the first thing we wanted to establish is how threatening is this?”
“If we have high cardioprotective cholesterol, then from the very start we have to start minimizing the ultimate effect of LDL cholesterol. Then we do a further panel which is called a lipoprotein panel…these are the ones that we’ve now identified that actually are doing the damage in our cardiovascular system.”
Alan’s philosophy is clear: don’t treat a number, treat the person. Standard cholesterol panels can mislead—especially if they’re interpreted without the broader context provided by advanced cholesterol testing and genetic analysis.
Conclusion: Rethinking Cholesterol, Rethinking Risk
As Alan reminds us, the cholesterol conversation is shaped not just by science but by massive industry forces. “We’re fighting a $35 billion a year industry right now in cholesterol,” he points out. That’s even more reason to question long-standing assumptions and advocate for advanced cholesterol testing.
If you’re concerned about your cardiovascular risk—or puzzled by confusing cholesterol results—consider taking Alan’s advice. Ask for a deeper analysis. Look into genetic testing. Request comprehensive lipoprotein and metabolic panels. Understand not just your numbers, but the story behind them.
Ready to dig deeper? Reach out to a health professional who understands advanced cholesterol testing—or work with someone who can interpret the latest genetic and metabolic information. Knowledge, context, and personalized analysis are the real keys to living your best—and healthiest—second 50.
Take action: Don’t settle for standard cholesterol numbers alone. Explore advanced cholesterol testing options and get the complete picture—because you deserve more than just a number.