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When you get your cholesterol checked, what numbers do you look at?
For many women, the answer is total cholesterol, LDL, and HDL. But according to lipidologist Dr. Tom Dayspring, there is more to understand if we want a clearer picture of cardiovascular risk.
In Part 2 of my conversation with Dr. Dayspring on Stronger Bones Lifestyle, we took a deeper look at lipids, how they move through the body, and why certain blood markers deserve more attention.
What Are Lipids?
Lipids are molecules that do not dissolve in water. Because our blood plasma is largely water, the body needs a way to transport fats and cholesterol through the bloodstream.
Dr. Dayspring explains that lipids travel inside structures called lipoproteins. Think of them as little delivery trucks carrying fats and cholesterol to different parts of the body.
Your standard lipid panel measures several things, including total cholesterol, LDL cholesterol, HDL cholesterol, and triglycerides. But these numbers don’t necessarily tell us how many particles are circulating.
Why ApoB Matters
One of the most important points Dr. Dayspring makes is the distinction between cholesterol amount and particle number.
ApoB is a protein found on LDL and VLDL particles. Because each of these particles carries one ApoB molecule, measuring ApoB gives clinicians an estimate of the number of potentially artery-entering particles in circulation.
Why does that matter?
Dr. Dayspring explains that these particles can enter artery walls and contribute to plaque formation, increasing the risk of atherosclerotic cardiovascular disease.
He also discusses something called discordance: sometimes LDL cholesterol and ApoB do not tell the same story. A person may have an LDL result that looks reassuring while their ApoB is elevated.
That’s why he encourages patients to ask their healthcare professionals whether ApoB testing is appropriate.
Don’t Overlook Lipoprotein(a)
Another marker discussed is lipoprotein(a), often written as Lp(a).
Dr. Dayspring describes Lp(a) as a largely genetically determined cardiovascular risk factor. He recommends that people have it measured at least once in their lifetime because levels are primarily inherited.
If your result is elevated, it is worth discussing with a knowledgeable healthcare professional, particularly because family members may share the same inherited risk.
Lifestyle and Medication Both Have a Place
We also discussed nutrition, exercise, and medication.
Dr. Dayspring identifies saturated fat as an important dietary factor that can raise LDL cholesterol and ApoB in many people. He also explains that exercise supports cardiovascular health, even though exercise alone may not substantially lower ApoB or LDL cholesterol.
When lifestyle changes are not enough to bring cardiovascular risk markers to an appropriate level, medication may be considered.
We discussed statins, ezetimibe, PCSK9 inhibitors, and bempedoic acid. These medications work in different ways, and the right approach depends on a person’s individual risk, medical history, and treatment goals.
This is not about automatically saying yes or no to medication. It’s about understanding your options and making informed decisions with your healthcare team.
Become an Informed Advocate for Your Health
My biggest takeaway is that we need to look beyond a single cholesterol number.
Ask questions. Understand what your blood tests measure. Discuss whether additional markers such as ApoB and Lp(a) are appropriate for you.
And remember that cardiovascular health, hormones, metabolism, and bone health are all important parts of the bigger picture of women’s health.
The more we understand, the better equipped we are to advocate for ourselves.
Listen to Episode 190 of Stronger Bones Lifestyle to hear my full conversation with Dr. Tom Dayspring.
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Frequently Asked Questions (FAQs)
Oxalates, also known as oxalic acid, are naturally occurring compounds found in many plants, vegetables, and fruits. They are part of a plant’s defense mechanism against predators and can be found in high concentrations in foods like spinach, rhubarb, beets, nuts, chocolate, tea, and certain beans.
Regarding bone health, oxalates can bind to minerals such as calcium in the gut, forming calcium oxalate. This compound is not easily absorbed by the body, meaning the calcium that could have been utilized for bone strengthening is instead excreted. This process can potentially lead to lower calcium availability for bone health, which can be particularly concerning for individuals at risk of osteoporosis or other bone-related issues.
However, for most women, dietary oxalates do not pose a significant threat to bone health, especially if their diet is balanced with enough calcium and they do not have a history of kidney stones.
Your gut is crucial for stronger bones for several reasons:
- Nutrient Absorption: The gut is where most nutrient absorption occurs. For bones to be healthy and strong, they need a variety of nutrients, particularly calcium, phosphorus, magnesium, and vitamin D. A healthy gut efficiently absorbs these essential nutrients from your diet and facilitates their transportation to the bones.
- Gut Microbiome and Bone Health: Research has shown that the gut microbiome (the community of bacteria living in your intestines) can influence bone density. Certain gut bacteria help in producing short-chain fatty acids (SCFAs) like butyrate, which have been shown to promote bone health. SCFAs can enhance the absorption of minerals necessary for bone strength and play a role in reducing inflammation, which can negatively affect bone health.
- Hormone Regulation: The gut helps regulate hormones that are involved in bone metabolism, including insulin, thyroid hormones, and sex hormones like estrogen. For example, estrogen is vital for bone density, and gut health can influence estrogen levels through the enterohepatic circulation, where estrogens are processed in the liver and intestines.
- Reducing Inflammation: Chronic inflammation, which can stem from poor gut health, is linked to many conditions that compromise bone strength, such as osteoporosis. A healthy gut helps to reduce systemic inflammation, protecting bones from inflammatory damage.
- Immune System Modulation: The majority of the immune system is located in the gut. An imbalance in the immune system can lead to autoimmune conditions, some of which affect the bones. Maintaining gut health helps to ensure the immune system works correctly, protecting against autoimmune reactions that could impact bone health.
In essence, maintaining a healthy gut contributes significantly to stronger bones by ensuring the effective absorption of vital nutrients, regulating hormones, reducing inflammation, and supporting a healthy immune system. Therefore, a diet rich in bone-healthy nutrients, prebiotics, and probiotics, along with lifestyle factors that promote gut health, is key to maintaining strong bones.