The Cholesterol Test You Should Be Getting

The Cholesterol Test You Should Be Getting

Many of us have been told by our doctors that we need to lower our cholesterol levels. But what does that mean, exactly? And do standard lipid profiles really tell us the full story about what is going on with our cholesterol?

In this minisode, Dr. Hyman sits down with Dr. Elizabeth Boham to discuss the importance of cholesterol particle testing. They explore why other cholesterol tests are outdated and why information about particle size and particle number is the only way to know what’s really going on with your cholesterol.

Elizabeth Boham is a physician and nutritionist who practices Functional Medicine at The UltraWellness Center in Lenox, MA. Through her practice and lecturing, she has helped thousands of people achieve their goals of optimum health and wellness. She witnesses the power of nutrition every day in her practice and is committed to training other physicians to utilize nutrition in healing. Dr. Boham has contributed to many articles and wrote the latest chapter on Obesity for the Rankel Textbook of Family Medicine. She is part of the faculty of the Institute for Functional Medicine and has been featured on the Dr. Oz show and in a variety of publications and media including Huffington Post, The Chalkboard Magazine, and Experience Life. Her DVD Breast Wellness: Tools to Prevent and Heal from Breast Cancer explores the Functional Medicine approach to keeping your breasts and whole body well.

This episode is brought to you by Belcampo. Right now, you can order Belcampo’s sustainably-raised meats to be delivered to your door using my code HYMAN at for 20% off for first-time customers.

Find Dr. Hyman’s full-length conversation with Dr. Elizabeth Boham, “Cholesterol Is Not The Cause Of Heart Disease” here:


  1. It’s very sad that these MDs have bought into the social media “broscience” regarding cholesterol. Particle size is insignificant according to cardiologists. Particle NUMBER is the factor you need to be concerned about. They touch on this in the video but continue to focus on particle size. That’s why practicing cardiologists recommend knowing your Apo B number. And saturated fat is the primary dietary contributor to particle number.

  2. carb free , healthy fat diet raised my LDL to the roof.
    everything else is on low end of normal spectrum.
    TG to HDL ratio is only 0.3

  3. I’m on a Low Carb diet and intermittent fasting. Lost 25 lbs. My LDL is going up but all my other markers are falling inline. Dr is concerned about my LDL. I asked my Dr about options for blood tests and he said there are none. I’m getting a Calcium scoring CT scan to make sure my arteries do not have buildup
    I’ve heard that folks like me may have elevated LDL but as you state here that I may have the less harmful LDL not the small particle LDL

  4. Why do only arteries clog with cholesterol and not veins or small capillaries?

    Scurvy = No vitamin C in your diet.
    Symptom: Your blood vessels break and you bleed to death. Think of the sailor of the past.

    Scurvy of the heart = Just enough vitamin C from food.
    Symptom: Arteries around the heart are not strong enough to resist high blood pressure. Damage is repaired with cholesterol to prevent worse. After years of repair, your arteries become clogged.

    Enough vitamin C supplement of at least 3000 mg. per day gives strong and flexible arteries. Cholesterol is not needed as a repair agent. Cholesterol in your coronary arteries is broken down and burned in your liver.

    Source: Cardiovascular disease and vitamine C (Dr. Rath Foundation)

  5. I have been on statins for 5 years because of "genetic high levels". I workout daily, my diet is mostly vegetables, absolutely no red meats since I don’t like the taste and I eat very little sweets/desserts. My HDL, as part of my lipid panels are high, contributing to high total numbers. I went off my statin last week because I just feel like I would rather get a good holistic doc that can do some deeper dives into my levels with other tests not included in the lipid panels. I am 56, 123 lbs, 5’6", a size 4 prolific hiker and fitness buff. Does anyone have a similar experience?

  6. My GP told me my total Cholesterol is 6.1, she wants me to give up grass fed butter, eat margarine and take statins, says I’m a 20% risk of a heart attack. I have no idea what she;s talking about!

  7. Just received my NMR results – PLEASE HELP!! Don’t understand…

    NMR Lipoprotein Profile, S
    LDL Particles, S 2440 H nmol/L

    HDL Particles, S 32 mcmol/L >30 mcmol/L
    LDL Cholesterol (NMR), S 177 H mg/dL
    NMR LDL-C results compare to measured LDL-C but may be
    discrepant from estimated LDL-C values.

  8. WHY IS THE TRANSCRIPTS BUTTON MISSING FROM YOUR VIDEO? Transcripts are great to make notes from!! Great video but to make notes I had to pause and replay to key in my notes.

  9. It’s impossible for my HDL to reach 50… 42 was already years of exercises and hatd changes on diet.

    Trygicerids 70? Are you out of reality? I was able to reduce from 250 to 100.

  10. Great discussion. Have to remember that the whole problem is Big Pharma’s greed. Big Pharma drugs are NOT meant to cure any disease. Just control them to continue their slow death which in return causes more complications, then having to prescribe yet another drug. On and on it goes..

  11. It may be that Lp(a) and ApoB serum concentrations are more important than LDL, HDL, Triglycerides, etc. Unfortunately, there are no treatments for these lipoproteins.

  12. As someone who did keto carnivore for over 3 years and have lifetime HDL of 18 and high triglycerides….get your Lipoprotein Fractional Ion Mobility blood test from Quest Diagnostic Code# 91604. You will probably find your are "Pattern B" and have lots of small dense LDL particles. Also I did this…. I did a standard Lipid Panel then I stopped eating saturated fat. I ate nothing but salmon and steelhead trout for 4 months. Did another Lipid test. My LDL-C was the same at 180. It did not effect my LDL-C. But……my triglycerides dropped even lower eating fatty fish! Reduce all dairy as dairy is mostly all saturated fat. Beef and pork obviously have saturated fats but they also have other fats that are healthy. Cheddar cheese is basically 100% saturated fat. Triglycerides to HDL ratio is more important than your LDL-C….But your LDL-P and small dense LDL particles are more important than LDL-C. Also statins accelerate the calcification of your arteries this is how they stabilize plaque. I had 4 CAC calcium scores to prove statins accelerate the calcification score. Ezetimibe, prescription fish oil and a PCSK9 Inhibitor Repatha if you can get it. Don’t go on a statin unless your insurance won’t pay for Repatha. Statins raised my ALT liver enzymes way to high, caused my blood sugars to go way up….caused other side effects….statins are bad news. Good luck.

  13. TOTALLY, TOTALLY WRONG! She is relying on old, outdated information. Dr. William Cromwell, an actual expert in lipidology, tells us that the risk from small or large LDL particles is essentially the same. Too much is bad, period. Here you have a person who read a few things a few years ago and thinks she’s an expert. NOT! Dr. Hyman and company get it wrong once again.

  14. All the talk about this subject and rarely do you hear about Lp(a) which, from what I have been told, affects approximately 20% of people. My cardiologist had me tested and I am way up there. Waiting anxiously for the new oral med now in clinical trials. Not a thing you can do to change it.

  15. My ‘good’ number is so far above average that the automated age calculation kicked it out as improbable! My ‘bad’ number is bad. Dr. wants me to consider statins. I said I would do research first. With these deatails in hand, I will have enough questions and answers to guide my decision. Thanks.

  16. Asked my doctor for particle size test he told me my insurance wouldnt cover it and it would cost $3,000

  17. The size doesn’t matter, nearly all the lipids are small enough to penetrate the arterie. But given you already know your LDL cholesterol, Then the smaller they are, the more you must have. It’s the number that counts

  18. long story short, and not mentioned in this ba bla conversation: (1a) remove the cause for endothelial damage + (2a) measure the endothelial damage. (3) correcting oxidative load (1b) remove glucose spikes, overeating, seed oils (most common form of toxins) + stress (2b) measure Lp(a) which is directly proportional to the sum of lesions, homocysteine and hsCRP.
    From there, you can almost automate your decision making. (3b) supplement targeting improving glutathione, taking vit C, fasting

  19. I listen for 10 mins on the small amd big truck talk. She never said what is the big and small truck. Useless to me. Just an ego talk to me.

  20. Thank you…this is very encouraging. I left my dr’s office yesterday with prescriptions for blood pressure and cholesterol. At 70, i have never had the need for these before. My dr kept stressing “genetics, genetics, genetics”. HDL 62, LDL 136, Triglycerides 98, BPressure 135/80…I am going to put these meds aside, eat better, lose some weight and move more…AND request the Cardio ID…I am overwhelmingly grateful Dr Hyman…I started your Gut Health about 2 weeks ago. 😊

  21. My HDL-C is 75
    My TG is 49
    My LDL-C is 350
    TC is 490

    TG/HDL-C is of course 0.6

    My doctor absolutely will not order NMR LIpoprofile with IR marker for me. I told him I will report him to the department of health and any organization that will listen to me.
    I am stick and tired of the grabage bully doctors, lame and arrogant and stupid disrespectful bastards.

  22. I’m a 58 year old woman. Even in my 20’s my HDL was always too low. I work out daily. Since January I’ve been eating lower carb, and avoid all processed foods. I was eating 1600 calories a day and not losing weight, so I went up to 1700 and lost a few pounds. My doctors always tell me I need to work out more. I always respond “more than everyday?”, and they look at me as though I’m lying.

    My husband started eating the same way I have been eating since January, and lost 23 pounds over 3 months. I hover around 7-8 pound weight loss, but very slow.

  23. What about the class III and IV LDLs that don’t get absorbed by the cells as easily, oxidize due to length in circulation, attract antibodies, clump together, and form the notorious inflammazones that stick to, damage, and inflame the endothelial lining; and when inflamed, the endothelial cells emit platelet activation factor which makes it permeable to lipoprotein particles and macrophages?

  24. If the aggressive target for triglyceride is 70 and that for HDL is 60. These numbers are good as Dr. Hyman says. The ratio Dr Hyman talk about around the 7:60 mark will be over 1, which he says is not great. I’m confused.

  25. How can you have small DENSE LDLs (LOW DENSITY lipoproteins)? It seems contradictory. Similarly, why are large fluffy particles good? It would seem that these particles are lower density, which would be bad.

  26. Triglycerides -68
    HDL Cholesterol -72
    VLDL Cholesterol Cal 12
    LDL Chol Calc (NIH) 151 My Doctor wants me to get on statins 😟

  27. Recent studies show that the level of Apo-B is the major risk factor in cardiovascular disease. Also no need to concern ourselves with ratios.

  28. Should you have your first test being off a statin to see what your true baseline istating? When would you recommend to get retested after being on a statin? Finally, what tests besides an A1C test would recommend for checking insulin resistance since there is a correlation of this with heart disease. I have one side of my family that is genics related to heart disease. Thank You!

Leave a Reply

Your email address will not be published.