Is your ‘high’ LDL cholesterol actually a problem? Here’s what your doctor isn’t telling you.
- manuelcarlycreate
- Oct 13
- 6 min read
Cholesterol is CONFUSING AF. I was today years old when I realized there is still SO much to learn about it and it can be very confusing, so I am here to help you understand it better and to simplify it for you.
Today, we’re going to start with LDL because this is a common freak-out point for my ladies when they get blood work back and their total cholesterol or LDL is elevated—and docs want to put them on a statin. Hold up a second first…let’s go to school 😉
LDL—low-density lipoprotein. What is it?
LDL is a mix of a fat and a protein—lipo (fat), protein (protein). It’s a particle that carries cholesterol throughout the body to where it's needed.
Think of LDL as an Uber for cholesterol—its job is to deliver cholesterol to the cells that need it for repairs, hormone production, and more.
When you see LDL on a lipid panel, it’s typically LDL-C, which is the amount of cholesterol carried by low-density lipoprotein particles. Think of it as the number of people (cholesterol) in the Uber.
There’s also something called LDL-P (LDL particle number), which counts the actual number of LDL “Ubers” on the road—not just how much cholesterol they’re carrying. This isn’t on a standard panel, but I’ll explain why it matters in a minute!
The real story?
LDL is not ‘bad’—it’s just misunderstood.
Without LDL, your body couldn’t heal, think clearly, or make hormones. The cholesterol that is carried within LDL is essential for brain health, hormone balance, and cell structure. We need some of it.
Many doctors are working from older guidelines that don't always account for the whole picture. What we should be doing is looking at labs through a lens of optimal metabolic health and understanding the full picture, not just one number. An elevated LDL-C in and of itself should not be a cause for concern…read on my friend.
What we REALLY need to look at is your whole cholesterol panel—triglycerides, HDL, LDL, and especially your triglyceride-to-HDL ratio. These numbers together tell a much clearer story about your metabolic health and actual risk. And if we really want a full picture, a couple of other markers would be very helpful here! We’ll get there in a minute…
So What About the Rest of Your Cholesterol Panel?
Let’s break down what these other numbers actually mean (in plain English)...
Triglycerides: What Are They?
Triglycerides are the most common type of fat found in your blood. When you eat, your body turns any extra calories it doesn’t need right away into triglycerides, which get stored in your fat cells for later.
If your triglycerides are high, it’s usually a sign your body isn’t handling carbs or sugars well—think insulin resistance, prediabetes, or metabolic syndrome.
Bottom line: chronically high triglycerides = your metabolism waving a big red flag.
HDL: The Designated Driver
HDL stands for high-density lipoprotein. If LDL is the Uber delivering cholesterol out to your cells, HDL is the designated driver at the end of the night—swooping in to pick up all the drunkies from the bar (cholesterol particles) the ones that have been hanging around in your bloodstream a little too long- and safely taking them back to the liver. Everyone needs a DD if they are going to drink right?
We love HDL! Once the cholesterol is back at the liver, it can be recycled or eliminated (think: go to bed and sleep it off).
And no, I am not condoning drinking but this analogy helps it all make sense in my brain so maybe it’ll help you too!
Higher HDL means more cleanup, less buildup, and real ‘superpowers’—it reduces inflammation, has antioxidant effects, and helps keep the whole system running smoothly.
It’s important to note that HDL is influenced by genetics, alcohol, movement, and micronutrient status.
A Little Review: How Are HDL and LDL Different?
LDL = the Uber taking cholesterol to your cells (delivery).
HDL = the designated driver picking up leftover cholesterol and getting it home safe (removal).
You need both! The balance—and how well each is doing its job—matters more than the numbers alone.
Going Deeper: Advanced Markers We Test To Get A Full Picture
ApoB (Apolipoprotein B): Counting the Ubers, No Traffic Jams Please
Here’s where it gets next-level (and honestly, many doctors don’t even talk about this)-you’ll have to likely work with a coach like myself or pay out of pocket for your provider to pull this:
Every LDL Uber particle has exactly one ApoB license plate. ApoB plates also appear on a few other atherogenic Ubers (like Lp(a) and remnant particles), so counting ApoB is like counting all the plates on the road—not just the LDL Ubers.
When you measure ApoB, you’re counting the number of atherogenic particles on the road—not just the cholesterol cargo. More cars = higher chance of a traffic jam (plaque), especially on pothole-filled roads (inflammation/insulin resistance).
Over time, this means cholesterol is being deposited into artery walls which raises your risk for heart disease.
Simplified? High ApoB is no bueno. You can have 'elevated' LDL in regards to standard Western medical ranges but have low ApoB and much less to be concerned about.
LDL-P (LDL Particle Number):
Think of LDL-P as literally counting the number of LDL Ubers on the road.
Why does this number matter?
You could have a normal amount of cholesterol (LDL-C) but a LOT of small Ubers (high LDL-P) crowding the road, which is more likely to cause traffic jams (plaque risk), especially if your body is inflamed or insulin resistant.
Think of inflammation and insulin resistance being like a road full of potholes. If there are lots of cars on a pothole filled road, you’re more likely to have damage, right? In our bodies that means plaque buildup on our artery walls-no bueno!
Lp(a) [Lipoprotein(a)]: The Sticky, VIP Uber
Lp(a) is a special type of LDL Uber, with a VIP badge that makes it a bit stickier and more likely to get stuck in your arteries. I like to think of it as the UberX that you think is fancy but then you get in and it smells of horrible cologne and terrible music. It’s NOT good.
Lp(a) is actually a type of ApoB-containing particle.
High Lp(a) is mostly genetic and is an independent risk factor for heart disease.
You can’t really change Lp(a) much with lifestyle, but knowledge is power, and knowing your number gives you a more complete picture of your heart health.
If you know Lp(a) is elevated, we need to double down on the other lifestyle factors we can control!
Quick Summary: LDL-C, LDL-P/ApoB—What to Watch For
High LDL-C, normal ApoB and LDL-P:
You’ve got fewer Ubers on the road, but each one is carrying more passengers (cholesterol). This is usually less risky—especially if your other markers (triglycerides, HDL, inflammation) look good.
High LDL-C and high ApoB and LDL-P:
Now you’ve got a traffic jam: lots of Ubers, each loaded up. More cars on the road means a higher chance of some getting stuck (plaque risk), especially if your “roads” (your body) are full of potholes (inflammation, insulin resistance, or high triglycerides/low HDL).
Here’s a TL;DR version:
Fewer Ubers, more passengers: Usually not a big deal.
Lots of Ubers, lots of passengers: More risk—especially if your roads are rough (inflammation/insulin resistance).
Bottom Line: Don’t panic about one high number. Always look at the full picture. Context is everything! This is what we break down in coaching when we do labs.
Brain Starting to Turn to Mush?
You don’t have to figure this out alone! If you’re still scratching your head about your labs, or just want someone to help you navigate all these numbers, that’s exactly what I do with my clients.
We take a deep dive into your labs, your lifestyle, and your goals, then create a custom plan that actually works for you (no generic advice, no overwhelm, just real results).
Ready for clarity and confidence with your health?
Book a discovery call and let’s make your next lab panel make sense—together and with a comprehensive plan to maximize your health!
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