I’ve sat across from thousands of patients over the last 30 years at various stages of heart disease. Each one of them has a unique health history. But many of them share some similar biomarkers, including dyslipidemia.
Studies suggest that around 80% of cardiac patients display some form of dyslipidemia after diagnosis. And while it’s not always a surefire sign of heart disease, it’s very often an indication that something is awry.
So, what does it mean when your doctor diagnoses you with dyslipidemia? And how do you manage it to protect and restore your heart health?
This guide explains the basics you should know, plus more advanced resources if you’re interested in learning more.
Article Overview
- Dyslipidemia is an imbalance of blood fats like LDL, HDL, and triglycerides.
- Contrary to popular belief, high levels of cholesterol aren’t always a bad thing, and just taking a daily pill may not protect your heart as you’d expect it to.
- You can manage dyslipidemia with whole, real foods, muscle-building exercises, and practicing better sleep and stress management
A non-technical explanation of dyslipidemia
Dyslipidemia refers to imbalances in the levels of fat in your blood. There are three different places where you could see dyslipidemia:
- LDL cholesterol, which is often attributed to plaque buildup in the arteries, and one of the biggest boogeymen in the heart health world.
- HDL cholesterol, a ‘good’ fat that helps to remove unnecessary amounts of LDL in the blood.
- Triglycerides, or energy stored in fat cells whenever you don’t burn all the calories off from your food.
What causes blood lipids to become dysregulated? Most doctors separate root causes into two categories: primary dyslipidemia and secondary dyslipidemia.
Primary dyslipidemia refers to imbalances caused by genetic mutations, specifically those that alter how the body handles fats and cholesterol in the blood. Familial hypercholesterolemia, for example, can cause very high LDL cholesterol from birth.
Secondary dyslipidemia, on the other hand, develops from lifestyle and chronic disease. It’s not inherent from birth like with primary dyslipidemia. Rather, it’s a long-term imbalance stemming from:
- Obesity
- Type 2 diabetes and prediabetes
- Kidney disease, including Cardiovascular-Kidney-Metabolic (CKM) syndrome
Sidenote: Is dyslipidemia always a bad thing?
Although dyslipidemia is a dysregulation of fats in your blood, which can (and in many cases, does) suggest some underlying concerns, there are situations in which elevated blood fats could actually point toward better health.
I’m speaking, of course, about lean mass hyperresponders (LMHRs).
If you are extremely lean and on a ketogenic diet, your LDL cholesterol might become extremely high. In some cases, as high as >500 mg/dL.
And yet, it doesn’t necessarily suggest that you’re at risk for a heart attack.
This example from Dr. Nick Norwitz provides some interesting additional detail:
“My colleague, Professor Adrian Soto Mota MD, PhD, cared for a 60-year-old male patient with type 2 diabetes. The patient adopted a ketogenic diet, and his BMI steadily decreased from 29.5 kg/m2 to 24.5g/m2. During his weight loss journey, his LDL-C remained ~95 mg/dl until he reached the “healthy” BMI range (< 25 kg/m2). Then, his LDL-C jumped to 183 mg/dl.”
In a study Dr. Norwitz performed on himself, after seven years of being an LMHR, there was no evidence to suggest his heart was at risk. There was no coronary plaque or stenosis detected in a CCTA scan. Additionally, in a Heartflow® scan, there was 0 mm3 plaque found in any vessels, which is the lowest possible percentile group for atherosclerotic plaque.
So, why isn’t dyslipidemia a danger in this case? That’s a bit too much to get into for this article, but you can learn more about the science of LMHRs in my guide covering changing biomarkers on ketogenic diets.
What dyslipidemia means for your heart
Unless you’re very lean, within a normal BMI range, and on a ketogenic diet, dyslipidemia suggests that your heart may be at risk. Countless studies point toward the dangers of dysregulated blood fats on:
- Heart attacks
- Strokes
- Other forms of cardiovascular disease
That’s because dysregulated lipid levels — alongside insulin resistance and chronic inflammation — can become oxidized in your body. Oxidized LDL can penetrate your arterial wall and trigger immune responses, which spurs on plaque formation.
Just keep in mind two people with identical LDL numbers can have very different cardiovascular outcomes. Large, buoyant LDL particles are far less of a risk than small, dense particles, and if you eat lots of saturated fat on a carnivore or keto diet, you may not necessarily be at as high a risk.
You can learn more about this in my write-up on advanced lipid metrics.
How to manage dyslipidemia in 4 areas
Contrary to what is a very popular belief, you don’t need a statin to resolve secondary dyslipidemia. Medication isn’t always the best way to manage chronic disease — and taking a pill to decrease cholesterol isn’t going to magically raise your HDL to balance your triglyceride ratio.
Thankfully, most people who fall into the secondary dyslipidemia category can address their risk factors with some lifestyle changes. These aren’t as expensive or complicated as medications. And most people see differences in 12 weeks or less.
Here’s a quick rundown of what that looks like:
- Eating whole, real foods
- Building muscle via resistance training
- Practicing proper stress management
- Receiving adequate sleep
Where to learn more about cholesterol and your heart
Cholesterol is one of the most misunderstood phenomena in the body. Fortunately, there’s now a wealth of information designed to help you understand it better.
You can learn more about the nuances of dyslipidemia in the following resources: