High Cholesterol and Dyslipidemia

Cholesterol numbers tell a story about metabolism, thyroid, inflammation, the vessel wall, and genetics. We look past total cholesterol to particles, insulin, and the drivers beneath them.

What you may be noticing

A lab report flagged your cholesterol, and you are unsure what it means. Perhaps you eat well and exercise, yet the numbers rose. Perhaps you have a family history of heart disease and want a clearer picture than a single total cholesterol value. You may have been offered a statin and want to understand all your options.

Chest pain, pressure, or shortness of breath needs emergency evaluation. Any decision about cholesterol medication belongs with your physician; I never ask anyone to stop a prescribed medication.

Why it is rarely one thing

Cholesterol is essential for cell membranes, hormones, vitamin D, and the brain, which makes most of its own. The real question is how many cholesterol-carrying particles circulate, how long they stay, and whether the vessel wall is inflamed and receptive to them.

The inner lining of your arteries is coated with a delicate gel layer, the glycocalyx, and it releases nitric oxide to keep vessels relaxed and resistant to plaque. High blood sugar, inflammation, smoking, and toxic exposures erode that protection. Heavy metals such as lead and cadmium are linked with vascular disease, which is why the toxic burden belongs in a cardiovascular conversation.

Several patterns raise particle number. Insulin resistance raises triglycerides, lowers HDL, and creates more small, dense LDL particles. An underactive thyroid slows LDL clearance, so thyroid comes first when both are present. Menopause raises LDL. Genetics, including familial hypercholesterolemia and lipoprotein(a), can drive high levels regardless of lifestyle. A total cholesterol that looks acceptable can still hide a high particle burden, and the reverse is also true.

Patterns we look for

• ApoB and LDL particle number, which reflect atherogenic particle count.
• ApoB to ApoA1 ratio, LDL size pattern, and HDL quality.
• Lipoprotein(a), a largely inherited risk factor worth measuring once.
• Triglyceride to HDL ratio, fasting insulin, and HbA1c.
• Thyroid function, including TSH, free T4, and free T3.
• Inflammation: hs-CRP, and homocysteine as a marker of methylation.
• Omega-3 status and liver health.
• Toxic burden, including heavy metals, when the history points there.
• Menopause, sex hormones, and family history.

How I evaluate it

I review your complete history, family history, and medications, and I read your labs as patterns rather than isolated numbers. The comprehensive functional neurological exam includes autonomic and circulation findings, and I coordinate with your physician on cardiovascular risk assessment, including coronary calcium scoring when appropriate.

Functional labs may include an advanced lipid panel with ApoB, LDL particle number and size, lipoprotein(a), fasting insulin, HbA1c, a full thyroid panel, hs-CRP, homocysteine, an omega-3 index, liver enzymes, and sex hormones where relevant, with metals testing when indicated.

How we address it

• Clarify your true risk with advanced testing and coordinate with your physician.
• Address thyroid function first when it is underactive, then reassess particles.
• Restore insulin sensitivity with fiber-rich, phytonutrient-dense whole foods and fewer refined carbohydrates.
• Protect the vessel wall: nitric oxide support from vegetables and movement, omega-3 rich foods, and reduced inflammation.
• Open drainage pathways and support liver and bile flow, then reduce toxic exposures.
• Build aerobic and strength fitness, protect sleep, and calm stress physiology.
• Introduce any targeted support gradually, one change at a time, so your body shows tolerance first.

Lipoprotein(a) is largely inherited and changes little with lifestyle, so when it is high, we focus on everything else that adds to its risk. When genetics drive very high levels, medication is often an important part of protecting your heart, and this work complements it.

A clearer picture leads to better choices. Your plan should match your actual risk.

Book your Comprehensive Functional Medicine Eval/Neurological Exam today to discover what the contributing root causes are that are underlying your health concerns.