By symptom
High cholesterol concern.
Your last lab flagged it. You want a second opinion before you take a statin.
What’s actually going on
How I think about this.
Most “high cholesterol” conversations in conventional care use the wrong markers and reach the wrong conclusion. The standard panel reads total cholesterol, LDL-C, HDL-C, and triglycerides. That is not enough information to make a real decision about your cardiovascular risk, and it leads physicians to prescribe statins to people who don't need them and miss the patients who actually do.
The marker that matters is ApoB, the count of every atherogenic particle in your bloodstream. Two people with identical LDL-C can have completely different ApoB and completely different risk. ApoB has outperformed LDL-C in every head-to-head trial for fifteen years, and it is the marker every modern cardiology guideline now uses to drive treatment decisions. Most primary care offices still don't order it.
Lp(a) is the other missing marker. It is genetic, measured once in your life, and dramatically reshapes risk when elevated. About 20% of the population has high Lp(a) and most have no idea.
The treatment decision is also more nuanced than “statin or no statin.” The right read tells me whether your number is driven by particle count, particle size, dietary intake, insulin resistance, thyroid drift, or inflammation. Each of those calls for a different intervention.
The physician’s lens
How I read this in practice.
I read cholesterol as one piece of a cardiovascular system that includes ApoB, Lp(a), particle size, hsCRP, homocysteine, fasting insulin, HbA1c, blood pressure measured properly, and the full thyroid panel. The metabolomic panel catches the upstream nutrient and oxidative-stress patterns. The number is meaningless without that context, and it is also fixable with that context.
The systems behind it
Where this symptom comes from.
Most cases touch more than one. Open each area to read the biology underneath.
Biological pillars
Pillar
Metabolomics.
Urinary organic acids read the upstream patterns of energy production, neurotransmitter balance, detoxification, and recovery.
Read this pillarPillar
Mitochondria.
Mitochondria produce the ATP that powers every function in your body. Directly assessable. Directly correctable.
Read this pillarPillar
Exposomics.
You cannot optimize a system under continuous environmental pressure. I measure the load directly.
Read this pillarSpecialty practice areas
Specialty
Cardiovascular health.
Advanced lipidology. ApoB, Lp(a), inflammation, particle size. The panel that actually predicts events.
Read this specialtySpecialty
Metabolic health.
Insulin sensitivity, body composition, cardiorespiratory fitness. The whole-organism metabolic system, read against optimal, not disease.
Read this specialtyWhat I’d test first
The data that explains it.
Cholesterol decisions need ApoB above all else. Then Lp(a), genetic, measured once. Then the advanced lipid subfractions, insulin, inflammation, and thyroid. The cardiometabolic panel reads all of this from a single draw.
Blood work
Cardiometabolic blood panels
Reads ApoB, Lp(a), advanced lipid subfractions, fasting insulin, and inflammation. The panel that actually drives treatment decisions.
Read the panelAdvanced testing
Metabolomix+
Adds the upstream oxidative stress, fatty acid balance, and detoxification patterns standard cholesterol panels cannot see.
Read the panelWhile you wait
Moves worth making before testing.
These are the levers I’d pull while we set up the workup. Most of them produce real signal inside two weeks.
- Get an ApoB and Lp(a) before you make any decision about a statin. Most primary care offices don't order them. Ask.
- Lift heavy and add zone 2 cardio. Both shift the particle count favorably.
- Cut refined carbohydrates and ultra-processed foods for two weeks. Triglycerides move first; the rest of the panel follows.
- Check your fasting insulin. Insulin resistance is upstream of the lipid pattern most physicians treat as the problem.
If two weeks of the basics doesn’t move the needle, that is exactly the kind of presentation a Precision Call exists for. Your biology is telling you something the lifestyle layer cannot fix on its own.
More reading
What I’ve written on this system.
Article
The future of precision medicine, and the role metabolomics plays in it.
Precision medicine is where the field is going. Metabolomics is one of the most important reads it brings online. Here is what is real, what is hype, and what I think a practice will look like in ten years.
Read thisArticle
Metabolomics and weight loss: finding the blockers.
When weight loss is not responding to the right inputs, the blocker is usually metabolic. A metabolomics panel surfaces the specific blocker so the intervention can match it.
Read thisArticle
Hormone imbalances, read through a metabolomics lens.
A hormone panel tells me the levels. Metabolomics tells me what the body is doing with those levels. Together they explain symptoms a hormone panel alone misses.
Read thisBrowse other symptoms
Something else on your mind?
Fatigue and low energy
When the tank stays low no matter how much you sleep.
Brain fog
The lights are on but the signal feels weak.
Poor sleep
Either you can't fall asleep, or you can't stay asleep.
Digestive issues
Bloating, irregularity, sensitivities that keep widening.
Mood and stress
Patience runs short, recovery from stress takes longer.
Hormonal imbalance
Energy, sleep, libido, and weight stop responding to the basics.
Perimenopause
The years when the body's hormonal rhythm changes, before the period stops.
Low libido
Desire that used to be reliable is gone or muted. Both sexes, both directions.
Hair loss
Thinning, shedding, or texture changes that didn't used to happen.
Erectile dysfunction
ED is the canary. The body is telling you something about vascular and hormonal health.
Weight loss resistance
You eat well, you train, the scale doesn't move. Something deeper is in the way.
High cholesterol concern
Your last lab flagged it. You want a second opinion before you take a statin.
High blood pressure concern
The reading came back elevated. You want the full picture before you start a prescription.
Insomnia
You can't get to sleep. You can't stay asleep. Or both.
Athletic recovery problems
You train hard. You don't bounce back. Something physiological is in the way.
Headaches and migraines
Recurring headache patterns the standard workup hasn't solved.
Joint pain
Pain in one joint is often a local problem. Pain that travels, or pain in multiple joints, is usually a systemic one.
Anxiety
Some anxiety is psychological. Much of what shows up in clinic is biological with a psychological face.
Acne and skin issues
The skin is rarely the problem. It is the most visible report on what is happening one layer down.
Thyroid symptoms
Cold all the time. Hair shedding. Sluggish mornings. A 'fine' TSH that explains none of it.
PMS and cycle issues
A difficult cycle is often a window into how your body handles hormones across the rest of the month.
Food cravings
Cravings are biology pulling for what it needs, often dressed up as what it can get easily.
Chronic allergies
New or worsening allergies in adulthood usually point to a barrier and an immune tone, not a specific allergen.
Start here
Want me to read your data?
A complimentary 30-minute call by phone or video with me. You tell me what is going on. I tell you how I would approach it. You decide if I am the right physician for you.