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For decades, "high cholesterol" has been treated as a diagnosis in itself - but Dr. Barrett breaks down why that's outdated thinking. Using advanced lab markers now available through services like Function Health, he walks through five common cholesterol myths: that high cholesterol equals heart disease, that LDL-C tells the whole story, that high HDL is automatically protective, that diet alone drives your LDL levels, and that a normal total cholesterol means low risk. He explains where ApoB, LPA, and insulin resistance fit into a modern cardiovascular risk model - and the three tests he recommends everyone over 30 get checked.
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Watch the episode on YouTube here!
DISCLAIMER
This content is strictly the opinion of Dr. Barrett Deubert and is for informational and educational purposes only. It is not intended to provide medical advice or to replace medical advice or treatment from a physician. All viewers of this content are advised to consult their doctors or qualified health professionals regarding health questions and concerns. Neither Dr. Deubert nor the Real Health Co. takes responsibility for possible health consequences of any person or persons reading or following the information in this educational content. All audience members, especially those taking prescription or over-the-counter medications, should consult their physicians before beginning any nutrition, supplement, or lifestyle program.
. . .
Watch the episode on YouTube here!
- (00:00) - Intro
- (01:14) - High Cholesterol = Heart Disease?
- (03:17) - LDL-C vs ApoB?
- (07:08) - High HDL Protects You?
- (09:12) - Diet Alone Determines LDL?
- (12:53) - Normal Cholesterol = Low Risk?
- (15:22) - Omega-3s & Cardiovascular Risk
- (17:17) - 5 Truth Statements
- (18:30) - Closing Thoughts
DISCLAIMER
This content is strictly the opinion of Dr. Barrett Deubert and is for informational and educational purposes only. It is not intended to provide medical advice or to replace medical advice or treatment from a physician. All viewers of this content are advised to consult their doctors or qualified health professionals regarding health questions and concerns. Neither Dr. Deubert nor the Real Health Co. takes responsibility for possible health consequences of any person or persons reading or following the information in this educational content. All audience members, especially those taking prescription or over-the-counter medications, should consult their physicians before beginning any nutrition, supplement, or lifestyle program.
Creators and Guests
What is The Real Health Podcast?
You've tried everything: extreme diets, expensive specialists, and medicine with side effects. Yet you're still stuck. This show is for you. The Real Health Podcast is hosted by Dr. Barrett Deubert, a practicing chiropractor and functional medicine provider who treats patients dealing with exactly what you're dealing with: weight that won't move, energy that never comes back, chronic symptoms doctors can't explain. Each week, he digs into the actual root cause behind things like weight loss resistance, hormone imbalance, autoimmune flare-ups, and metabolic dysfunction. No fad diets, no miracle supplements, no blaming you for not trying hard enough. Just real, evidence-based answers for why your body hasn't been working the way it should, and what actually helps.
Most people would say high cholesterol means you have heart disease. So let's just dispel the first myth, probably the biggest misconception over the last couple decades. High cholesterol does not mean you have heart disease. Welcome back to another episode of the Real Health Podcast. Today we are talking about cholesterol, specifically now with advanced labs that you can order yourself through companies like Function Health, you have the ability to gain information that most primary care physicians and medical doctors don't test, yet is invaluable when it comes to looking at longevity, how healthy you are.
Dr. Barrett:Today, we're going to talk about cholesterol specifically, atherogenic particles, all the way from total cholesterol to LDL to LPA to APO B, what those numbers mean, why they're important in testing, and then I'm going to give you the three tests that you must do to look at how healthy your cardiovascular system is and potentially assess your risk factors. So we are looking at cholesterol, and most people would say high cholesterol means you have heart disease. So let's just dispel the first myth, probably the biggest misconception over the last couple decades. High cholesterol does not mean you have heart disease. Your cholesterol panel is not a picture of your arteries.
Dr. Barrett:Your cholesterol panel is exactly what a cholesterol panel is. It gives you data. And that data helps you understand more about the body, but it doesn't necessarily give you a window picture of your arteries themselves, like a CT calcium score, for instance. So when you look at these risk factors of cholesterol, the first one is high cholesterol, meaning you have heart disease, is not inherently true. Elevated research shows elevated LDL containing, ApoB containing lipoproteins are causal contributors to atherosclerosis, but cholesterol, a cholesterol value elevated by itself does not diagnose existing plaque.
Dr. Barrett:And when we look at these molecules, you'll see them as total cholesterol, HDL, C, LDL, C, LPA, APOB, a lot of different letters that you might get confused about. But simply put this, if we just look at total cholesterol, we're missing so much of the picture of what's happening in the body. So the first bullet point is this, just because you have high cholesterol, it does not mean you are currently active in a state of heart disease or you are even forming atherosclerosis. This is not an independent direct risk factor. So just because you have high LDL doesn't mean you're actively forming arterio or atherosclerosis.
Dr. Barrett:And that is a very important first point to make, which brings us into the idea that high cholesterol does not mean you currently have clogged arteries. But prolonged exposure to these particles with other risk factors, including genetics and environment, can potentially set you up for heart disease risk. This is something that with number two we've got to look at. So we're talking about really the five cholesterol mythbusters or clarity of the, know, five things that we want to create clarity on when we look at cholesterol labs. Number two is really important and that is LDL is LDL.
Dr. Barrett:This is where you can really learn and press in on something. When we look at LDL C, this measures the amount of cholesterol carried within LDL particles. And there is a marker we call APO B, and APO B, in essence, is more closely reflective of the number of circulating atherogenic particles. What I'm saying here in the medical jargon of all of that is l LDL C is not a great indicator even though people say, hey. Your your LDL levels are elevated.
Dr. Barrett:You you know, you gotta get put on this medication. LDL C is inferior to LDL P, and is and LDL P is inferior to a molecule called ApoB. And ApoB is a stand alone risk factor for atherogenic particles. ApoB is a very important molecule to look at because this tells us, are we actively in the phase of, in essence, putting calcium on arteries and hardening up your arterial system. Research shows that a quarter of a quarter million people studied, with almost twenty two thousand cardiovascular events, APO B was the strongest of the three, which is LDL C, LDL P and APO B.
Dr. Barrett:It was the strongest for cardiovascular risk. And in 2025, when we looked at over 500,000, half a million people, they found that APO B outperformed LDL C in nine out of nine studies for its risk factor associated with cardiovascular disease. ApoB inherently is the most important molecule when we're trying to assess cardiovascular risk. And the best way to put it is, you know, APO B has kind of attached itself to LDL C in a sense and how much APO B you have will tell us how much atherogenic particles you have in your body. LDL is like a is like a cargo ship.
Dr. Barrett:Okay? And so it's circulating throughout the blood and it's bringing cargo, but how much cargo is on the ship, cargo meaning calcium deposits, arteriosclerosis, how much of that is actually happening is not the is not cargo ships, it's how much cargo is on each ship. That is a better indicator than looking at your cargo carriers or LDL C. We should be looking at APO B, and when we look at LDL C, it tells me how much cholesterol is being transported, but ApoB tells me approximately how many atherogenic particles are doing the transporting, and that is a better indicator of cardiovascular disease. Number three, hey, I have high HDL.
Dr. Barrett:I must be super protected for cardiovascular disease. This is another myth, right? And this one really does have excellent research behind it. If we artificially raise HDL, the question is, if we artificially raise HDL, research would show then that there's a direct result in a reduction of cardiovascular events, heart attacks specifically. So does the data support that?
Dr. Barrett:And the answer is no, it doesn't support that. And a meta analysis done in, the British Medical Journal of over 100,000 people across 39 randomized trials of niacin, fibrates, CTP inhibitors. These therapies all increased HDL C, but raising HDL did not consistently reduce cardiovascular mortality, coronary, mortality, or even strokes. So just because you have higher HDL C, it is not a independent variable for reduction of cardiovascular events. So just because it's high doesn't mean it's necessarily helping you in any meaningful way.
Dr. Barrett:And I would say HDLC is more of a marker than like a single therapeutic target. It just gives you an idea of, hey, a high HDL may be associated with good health, but you can't use it to cancel out, for instance, like an elevated APO B, right? So if you have high HDL and you have elevated APO B, those two aren't going to wash each other out in essence. And so we don't want to just say, oh, HDL's high. I must be really, really healthy.
Dr. Barrett:We don't look at that as an independent variable. Number four, I eat super healthy. So my LDL level should be great, right? So we're biasing this to does food, healthy food, directly impact cardiovascular disease? It's a great question.
Dr. Barrett:The opposite is true too. And this is a marker that we see a lot associated with insulin resistance. It's called triglycerides. And if triglycerides are elevated, we are absolutely in a state of cardiovascular risk. Now that is more associated with metabolism, blood sugar dysregulation, but when we eat healthy, my LDL level should be normal, should be perfect.
Dr. Barrett:And the first thing to know is LDL, no matter how healthy you eat, could be elevated not because of how good you eat or how your lifestyle, the first thing and most important is genetics matter here. Genetics matter. Lipid levels, differ substantially between individuals because of genetic differences. And cholesterol synthesis and ApoB metabolism and other pathways, this gives us these factors, they directly can attribute to high LDL levels. And one of the best and clearest examples is a marker that you'll get run on a typical function health panel called LPA.
Dr. Barrett:And LPA, in essence, approximately 70 to 90% of the variability in LPA between individuals is genetically determined. So what does that mean? If your LPA levels are elevated, it is likely genetically biased. Your genetics are allowing that molecule to elevate. So why is LPA useful?
Dr. Barrett:LPA is useful because in a healthy individual it helps us understand if genetics are a factor for potential cardiovascular disease. So that's the first. Genetics matter. The second is diet absolutely can alter LDL and ApoB. And this is very important, right?
Dr. Barrett:Dietary fat doesn't matter because your body makes cholesterol. That's not necessarily supported by evidence. There are genetic factors and there are people that inherently will absorb more cholesterol and make more cholesterol from their diet. So, it is a small part of the population, but I will tell you insulin resistance, triglycerides, leptin levels, blood sugar regulation are a great measuring stick nutritionally to affect cardiovascular outcome. So we should be mindful of insulin resistance a, which is tested on a traditional function health panel, our insulin resistance score is very good thing to look at and move the needle on.
Dr. Barrett:And if your insulin resistance score is high and we get it low, how does that impact your cardiovascular system? And oftentimes, with genetics taken out, it is a major, major factor. So you can eat a healthy diet and still have abnormal lipids because diet isn't the only driver. Genetics do matter. But that doesn't dispel the fact that even if you have dirty genes in your cardiovascular system, you should absolutely be more mindful of your nutrition, specifically within the insulin system.
Dr. Barrett:And one of the best ways to improve APOB and LDL markers or even LPA is fiber, blood sugar regulation, walking after meals. Those three things can be absolute game changers. And I was just talking to that to three patients this morning about those items. The last one. My total cholesterol is normal, so my heart is fine.
Dr. Barrett:It's the same idea that says my total cholesterol is high, so my heart is not good. I'm going to flip the switch here and say, hey, my total cholesterol looks great. I'm below 200. I'm awesome, right? So my heart must be great.
Dr. Barrett:My cardiovascular risk is nonexistent. And this is where the modern cardiovascular risk model is, it's just different. Ten, twenty years ago that was a myth that was believed so readily hence the billion dollar industry of statins. But when we look at it, the 2026 dyslipidemia guidelines specifically emphasizes a broader risk assessment of LDL C to non HDL C, APO B, LPA, blood pressure, diabetes metabolic risk, insulin resistance, smoking, family history, genetics, calcium score. All of these work together, not just, hey, let's look at cholesterol, and my cholesterol levels are normal.
Dr. Barrett:I'm healthy. My cardiovascular risk is zero. It's not telling us much of anything anymore. And when we look at these other risk factors, they provide us with so much stronger evidence for potential cardiovascular risk in our future. So when we look at our future cardiovascular risk and we're just running total cholesterol, HDL, LDL, it is virtually doing, I'm not going say nothing, but close to nothing for you to truly understand what your risk factor is in stroke, cardiovascular advanced heart attacks.
Dr. Barrett:So we need a broader, bigger picture. There are many things that can move the needle in your cardiovascular system, we just talked about with walking after meals, fiber intake. But one of the biggest things that is also looked at on function health lab evaluations is called the omega-three check, or in essence, what's your omega-three to six ratio? And most people, their omega-three to six ratio is significantly, proportionally elevated of omega-six to three. If we reverse that ratio and improve our omega-three to six ratio, we going to directly affect our cardiovascular risk.
Dr. Barrett:And so for me, when we look at the cardiovascular system, We also want to say, hey, if I do have some risk factors, what are some things to do about it? And for me, omega-three status in research, it's just, it's so strong. It's so strong. When you look at, there's a classic perspective study from the Physicians Health study measured blood, omega-three fatty acids in apparently healthy men who were followed up for over fifteen years. I think it was close to seventeen years.
Dr. Barrett:And they compared with men in the lowest, quartile of long chain omega-3s, so omega-three status in their blood. And then those in the highest quartile had a markedly lower observed risk of sudden cardiac death. And so that's a powerful association. The higher your omega-three-six ratio favoring omega-3s, the healthier you will be from a cardiovascular risk standpoint. Why aren't you looking at this, right?
Dr. Barrett:Well, we should. And I think it's a great test to assess that comes alongside of your cardiovascular molecules so you know therapeutically can we intervene in this space. So five truth statements. High cholesterol does not mean you already have heart disease. Cumulative exposure to ApoB containing particles, that drives atherosclerosis more than anything.
Dr. Barrett:LDL C, LDL isn't the entire story. Number two, ApoB can represent more understanding of your atherogenic particle burden than LDL C alone. Number three, high HDL does not mean you have a heart healthy situation and simply raising HDL doesn't really do anything for cardiovascular risk. Number four, diet matters but diet isn't the only reason why cholesterol is potentially elevated. Genetics, metabolism, thyroid function all can dictate how healthy your cholesterol levels are.
Dr. Barrett:And finally, a normal total cholesterol does not equal low cardiovascular risk. Getting more understanding of other risk factors really help us get the data we need to make informed decisions. I hope this is super valuable for you, and if you're not testing these markers and you're over 30 years old, you need to start looking at this. This is something that you can get data points through the years and see if what you're doing matters and is moving the needle at all. You could be taking ten supplements, working out twice a day, and unfortunately have a heart attack because these things were missed.
Dr. Barrett:Start testing, look at functional health as a great way of assessing your cardiovascular risk and what you could do about it. I pray this was valuable for you, added some value in your life and your health journey. Thanks for listening as always to another episode of The Real Health Podcast.