Understanding the Difference Between Conventional and Functional Medicine Approaches

When a blood test shows LDL cholesterol over 100 mg/dL, many patients ask, “Do I really have high cholesterol?”

At Internal Healing and Wellness MD, located in Shenandoah, TX, we often see this scenario. But the answer depends on how you interpret your numbers, through the lens of conventional medicine or functional medicine. Let’s explore how these two systems differ and why that matters for your heart health, metabolic picture, and overall wellness.

Blood test for cholesterol levels showing LDL, HDL, triglycerides, and total cholesterol results

What is Cholesterol?

Cholesterol is a waxy, fat-like substance found in every cell of your body. It’s essential for producing hormones (like estrogen and testosterone), synthesizing vitamin D, and forming cell membranes. Your liver produces most of the cholesterol your body needs, but it’s also absorbed from foods like meat, dairy, and eggs. Cholesterol travels through your bloodstream in particles called lipoproteins, primarily low-density lipoprotein (LDL) and high-density lipoprotein (HDL). While cholesterol is vital for health, imbalances, particularly high levels of LDL or low levels of HDL, can contribute to cardiovascular issues when not properly managed.

Conventional Cholesterol Guidelines: What Most Doctors Look At

Under standard cardiology and primary care guidelines, cholesterol levels are interpreted using fixed cutoffs. Here’s what they typically look at:

  • LDL-C (Low-Density Lipoprotein Cholesterol — the “bad cholesterol”)
    • <100 mg/dL → Optimal
    • 100–129 mg/dL → Above optimal, but not officially high
    • ≥130 mg/dL → Borderline or high
    • ≥190 mg/dL → Very high; may indicate familial hypercholesterolemia
  • HDL-C (High-Density Lipoprotein — the “good cholesterol”)
    • <40 mg/dL in men or <50 mg/dL in women → Increases heart disease risk
  • Triglycerides
    • ≥150 mg/dL → Elevated
  • Total cholesterol
    • ≥200 mg/dL → Elevated

In this system, you’re generally not diagnosed with hyperlipidemia unless LDL ≥130 mg/dL or your HDL, triglycerides, or total cholesterol are out of range.

Takeway: If your LDL is 110 or 120, most healthcare providers wouldn’t classify it as “high cholesterol” — yet.

Functional Medicine Perspective: Root-Cause, Not Just Ranges

In functional medicine, we move beyond labels and cutoffs. We ask why your cholesterol is behaving the way it is and whether it’s a signal of deeper issues, such as insulin resistance, inflammation, or thyroid dysfunction.

Here’s how we view things differently at Internal Healing and Wellness MD:

  • LDL >100 mg/dL may be suboptimal if:
    • You have metabolic syndrome or high blood pressure
    • You’re insulin-resistant or prediabetic (diabetes mellitus)
    • You have elevated inflammatory markers like hs-CRP
    • You have a family history of heart attack or stroke
  • We use advanced lipid markers to go beyond the basics:
    • ApoB (apolipoprotein B): Measures the number of cholesterol particles
    • LDL-P (LDL particle number): More accurate predictor of cardiovascular disease
    • hs-CRP: A marker of systemic inflammation that raises heart disease risk

Research shows that ApoB and LDL-P are better predictors of risk than LDL-C alone (Sniderman et al., JAMA Cardiology 2019; Anderson et al., Canadian Cardiovascular Society Guidelines 2021).

Does LDL Particle Size Matter?

In integrative and functional cardiology, another consideration is LDL particle size, the difference between Pattern A (large, buoyant LDL) and Pattern B (small, dense LDL particles).

What You Should Know:

  • Small, dense LDL (Pattern B) is more atherogenic:
    • Penetrates blood vessel walls more easily
    • More likely to oxidize (which promotes plaque buildup)
    • Circulates longer in the blood
  • Large, buoyant LDL (Pattern A) is less harmful.

However, Large-scale studies like the Women’s Health Study (Mora et al., Circulation, 2007) show that when ApoB or LDL-P are measured, size alone doesn’t independently predict risk as strongly.

Functional Medicine Use Case:

Despite this, many functional medicine doctors, including our team in Shenandoah, still value LDL size because:

  • Pattern B often coexists with:
    • High triglycerides
    • Low HDL cholesterol
    • Insulin resistance or pre-diabetes
  • It gives a metabolic snapshot, especially in patients with normal-looking LDL-C but abnormal lipid panels.

We offer NMR lipoprotein profiling, which includes both particle size and number, as part of your advanced cholesterol tests.

The Bigger Picture: Cholesterol and Coronary Artery Disease Risk

Cholesterol plays an essential role in your body; it helps build cell membranes, synthesize hormones, and support vitamin D metabolism. But too much cholesterol circulating in your bloodstream, especially low-density lipoprotein (LDL) can increase the risk of heart disease, particularly coronary artery disease.

When LDL cholesterol levels are high for a prolonged period, the particles can lodge in the walls of blood vessels, initiating inflammation and promoting plaque buildup. This restricts blood flow, increasing the chances of blood clots, heart attack, or stroke. Over time, this process contributes to developing coronary artery disease and other heart disease risk factors.

What You Can Do

We guide our patients to make small but powerful changes:

  • Choose healthy fat sources (like avocado, olive oil, and nuts) to support high-density lipoprotein (HDL), the “good” cholesterol that helps carry cholesterol back to the liver for elimination.
  • Limit saturated fat and avoid trans fats, which are known to raise LDL and increase the risk of coronary heart disease.
  • Follow a healthy diet rich in whole grains, leafy greens, and fiber.
  • Maintain regular exercise and ensure enough sleep for metabolic regulation.

Remember: High cholesterol isn’t just about numbers, it’s about cholesterol traveling through your body and how your lifestyle influences its behavior.

Why It Matters at Internal Healing and Wellness MD

Here’s how we personalize your cholesterol treatment journey:

1. Deeper Assessment

We look beyond standard labs and evaluate:

  • Metabolic health markers (fasting insulin, glucose, hs-CRP)
  • Thyroid function and hormone balance
  • Lifestyle factors (stress, sleep, plant-based foods, exercise)
  • Inflammation and gut health

2. Run Advanced Labs When Needed

If you’re borderline or have other risk factors (like chronic kidney disease, family history, or chest pain), we order:

  • ApoB
  • LDL-P
  • hs-CRP
  • Vitamin D (influences the immune system and lipid metabolism)

3. Tailor Interventions to YOU

  • Elimination protocols to uncover food sensitivities
  • Root-cause medicine to address insulin resistance or thyroid issues
  • Lifestyle changes for long-term heart and blood pressure health
  • Medication, when necessary, based on your overall risk

Testing, Tracking & Taking Control: How to Monitor Your Cholesterol

Understanding how much cholesterol is in your body and how it's functioning starts with proper testing. A standard blood test called a lipid panel will tell you your:

  • Total cholesterol
  • LDL (bad) cholesterol
  • HDL (good) cholesterol
  • Triglycerides

But in functional medicine, we often go beyond general guidelines. Even if your results fall within so-called “normal levels,” you could still have a higher risk if you have poor cholesterol particle quality, inflammation, or early metabolic dysfunction, especially at a young age.

We also assess whether you’re producing enough blood to deliver nutrients and oxygen efficiently, and whether there are other substances in your bloodstream (like inflammatory proteins or oxidized lipids) contributing to cardiovascular risk.

Functional Lab Options Include:

  • ApoB and LDL-P: More precise measures of cholesterol-related risk
  • hs-CRP: Identifies inflammation linked to atherosclerosis
  • Omega-3 index & micronutrient panels: To optimize cell health and support lipid balance

Get your cholesterol checked with a full-spectrum view, not just a single number. Our functional assessments allow us to uncover the root of elevated high cholesterol levels and help you lower LDL safely and effectively.

A Nuanced Diagnosis

So, do you really have high cholesterol if your LDL is 110 or 120 mg/dL?

Here’s the truth:

  • Conventional guidelines don’t flag it unless it’s ≥130 mg/dL
  • Functional medicine asks if your cholesterol is a symptom of something deeper
  • Advanced lipid markers like ApoB and LDL-P provide more precise risk assessment

At Internal Healing and Wellness MD, we believe your cholesterol deserves context, not just a label. If you’re struggling with confusing test results, elevated triglycerides, or questions about heart health, we’re here to help.

Frequently Asked Questions

Under conventional guidelines, LDL cholesterol under 130 mg/dL is not considered high. However, in functional medicine, LDL above 100 mg/dL may be seen as suboptimal if you also have metabolic syndrome, insulin resistance, or elevated inflammatory markers.

Conventional medicine uses fixed cutoffs to classify cholesterol as normal or high. Functional medicine looks deeper, asking whether cholesterol changes are linked to underlying issues such as inflammation, insulin resistance, or thyroid dysfunction.

LDL is considered “bad cholesterol” because high levels can increase plaque buildup in arteries. HDL is “good cholesterol” because it helps transport cholesterol back to the liver for elimination. Both are important in assessing cardiovascular risk.

Most clinicians diagnose high cholesterol when LDL is 130 mg/dL or higher. Levels above 190 mg/dL are considered very high and may indicate familial hypercholesterolemia.

Functional testing may include ApoB, LDL-P, hs-CRP (inflammation marker), and omega-3 index testing. These provide a fuller picture of cholesterol quality and cardiovascular risk.

Elevated hs-CRP indicates systemic inflammation, which increases the likelihood that cholesterol particles will oxidize and form plaque, raising the risk of heart attack and stroke.

Functional strategies include choosing healthy fats (olive oil, nuts, avocado), eating more fiber-rich foods, reducing saturated and trans fats, exercising regularly, and maintaining good sleep and stress management habits.

Yes. Functional medicine often investigates whether elevated LDL or triglycerides reflect insulin resistance, thyroid imbalance, or other metabolic dysfunction.

Because they better reflect the actual number of cholesterol particles circulating in the blood. A higher particle count increases the chance of cholesterol penetrating artery walls, even if LDL-C levels appear normal.

High triglycerides and low HDL are often linked with insulin resistance and are strong indicators of metabolic dysfunction. Together with LDL, they provide a clearer risk profile than LDL alone.

An NMR lipoprotein profile can provide valuable information about LDL particle size and number, especially for patients with borderline cholesterol, metabolic syndrome, or unexplained cardiovascular risk.

Take Control of Your Heart Health Today

Confused by your cholesterol numbers or concerned about long-term risk? We go beyond standard labs to uncover the root cause of elevated cholesterol and design a personalized plan for lasting health. Book Your Comprehensive Cholesterol Evaluation Online to get started.