By Chris D. Meletis, N.D.
Most patients have been conditioned to ask about cholesterol and to what extent it plays a role in heart health. This question often arises when recommending a bioactive complex known as Fortetropin®, derived from raw, fertilized egg yolk powder. The answer is both complex and straightforward, and I educate my patients that “excess cholesterol is a risk factor, yet I go on further to share with them that excess is not just measured most accurately by just measuring total cholesterol; rather, it is far more nuanced as I discuss below.” What about LDL particle size, inflammation levels, LDL oxidation, and so much more?
“80/20 Cholesterol Perspective”
As clinicians, we can empower our patients with what I have termed the “80/20 Cholesterol Perspective”. Only about 20% of the cholesterol in your bloodstream comes from your food. Your body makes up 80 percent of your total daily cholesterol in your circulatory system.1 The importance of having sufficient cholesterol (yet not excess should come as no surprise, as cholesterol is the building block for the trillions of cell walls that comprise the body, it is converted into vitamin D, sex hormones, adrenal hormones, and much more.
First, it’s essential to recognize that total cholesterol levels are only a small fraction of overall cardiac health risk. In clinical practice, the following additional factors need to be considered. Indeed, we don’t want circulating lipids to be excessively high, yet total cholesterol as a stand-alone risk has been unduly vilified. Sadly, many clinical studies looking at cardiac risk factors are myopic and fail to be inclusive in controlling for the cardiac risk indices below, thus leaving the savvy clinician wondering what the study proves or disproves.
Other factors besides cholesterol that impact cardiovascular health include:
• Low-density lipoprotein (LDL) particle size (small, dense LDL) 2
• High-density lipoprotein (HDL) particle size
• Triglyceride levels
• Oxidized LDL2
• Asymmetric dimethylarginine (ADMA) – This independent risk factor for major adverse cardiovascular events inhibits nitric oxide synthesis. People with high blood pressure, high cholesterol, and type 2 diabetes often have higher levels of ADMA.3
• Symmetric dimethylarginine (SDMA) – A biomarker for kidney function and cardiovascular disease risk.
• Myleoperodixase – An enzyme secreted by immune cells that promotes oxidation and atherogenesis in cardiac tissues.2
• Homocysteine – Lower levels of this amino acid are linked to better cardiac health.4
• Inflammatory markers such as C-reactive protein (CRP)2
• Apolipoprotein B (ApoB) – ApoB testing measures the concentration of particles with apolipoprotein B on their surface. Because ApoB is the main protein in LDL, this information can be used to help determine the risk of developing cholesterol-related heart conditions.
• LP PLA2 Activity -Higher levels of Lp-PLA2 activity are believed to promote atherosclerotic plaque formation.
• Lipoprotein(a) – Lp(a) levels are genetically determined. Science indicates they’re an independent risk factor for arteriosclerotic cardiovascular disease and calcific aortic valve stenosis. According to the American College of Cardiology, they should be tested at least once a lifetime.5
Do Eggs Really Raise Cholesterol?
Because of the overemphasis on cholesterol, people are often unnecessarily concerned about factors like whether eggs can raise cholesterol. Research indicates that eating eggs leads to the formation of large LDL, a size of LDL that’s associated with better heart health.6 Eating eggs may also shift people from an LDL pattern that is likely to promote heart disease to a better one for heart health.6
Doesn’t More Data Make Sense?
The typical lipid panel fails most patients in providing the complete cardiovascular picture because it neglects many of the markers listed above. For example, measuring total LDL and particle size is vitally important.
In addition, far too many clinical studies look at only the traditional Lipid/Cardiac Panel as a reflection of the impact of diet, treatment intervention efficacy, and cardiac risk. However, in far too many of those studies, the participants have additional risk factors that have not been accounted for.
|
Classical Lipid/Cardiac Panel |
Functional Medicine Cardiac Panel |
|
Total Cholesterol |
Total Cholesterol |
|
LDL |
LDL -LDL Large (protective) -LDL Small |
|
HDL |
HDL |
|
VLDL |
VLDL and IDL |
|
|
|
|
Triglycerides |
Triglycerides |
|
|
ApolipoproteinB (apoB) |
|
|
Lipoprotein(a) (Lp(a)) |
|
|
LP PLA2 Activity |
|
|
Highly Sensitive/Cardio C-Reactive Protein |
|
|
TMAO |
|
|
Myeloperoxidase
|
|
|
SDMA
|
|
|
ADMA
|
|
|
Homocysteine
|
More advanced testing can give patients a fuller picture of their cardiovascular risk. These are the tests that I offer all my patients, and I share with them that they deserve an executive wellness cardiac work-up, not the 1950s standard of care testing. Also, always looking at HA1c as it relates to blood sugar control, an independent accelerant for heart disease, and ruling out sleep apnea that can be done with a simple home sleep study, the vast majority of time can be life-saving.
Conclusion
Determining a patient’s cardiovascular risk involves more than just cholesterol. A variety of factors can play a role in cardio health. The hyper-focus on cholesterol has led patients to fear consuming foods like eggs or supplements that contain eggs because of their cholesterol content. However, research shows that eggs may raise levels of a beneficial type of LDL and are associated with better cardiovascular health.
References
1. https://my.clevelandclinic.org/health/articles/23922-what-is-cholesterol
2. Tsimikas S, Willerson JT, Ridker PM. C-reactive protein and other emerging blood biomarkers to optimize risk stratification of vulnerable patients. J Am Coll Cardiol. 2006;47(8 Suppl):C19-31.
3. Asymmetric Dimethylarginine, Plasma. Mayo Clinic Laboratories. https://endocrinology.testcatalog.org/show/ADMA. Accessed May 13, 2025.
4. Jakubowski H, Witucki Ł. Homocysteine Metabolites, Endothelial Dysfunction, and Cardiovascular Disease. Int J Mol Sci. 2025;26(2).
5. Pamela L Alebna AM. An Update on Lipoprotein(a): The Latest on Testing, Treatment, and Guideline Recommendations. American College of Cardiology. https://www.acc.org/Latest-in-Cardiology/Articles/2023/09/19/10/54/An-Update-on-Lipoprotein-a. Published 2023. Accessed May 13, 2025.
6. Fernandez ML. Dietary cholesterol provided by eggs and plasma lipoproteins in healthy populations. Curr Opin Clin Nutr Metab Care. 2006;9(1):8-12.