Did you know that approximately 50 percent of Americans who suffered heart attacks between 1993 and 1999 had "normal cholesterol numbers," as reported by The National Heart, Lung and Blood Institute? Traditional testing that measures the total concentration of cholesterol has historically been used as the key indicator for cardiovascular disease risk and may not provide an accurate assessment according to the National Cholesterol Education Program. Measuring the number and size of cholesterol-carrying particles, called lipoproteins (as well as other markers), has been shown to be crucial in interpreting the risk of heart disease.Lipoproteins are molecules that transport cholesterol through the blood. There are large and small sized lipoproteins. To illustrate, think of the large-sized molecules like a bus, the smaller-sized ones like a car and cholesterol as a passenger. As an example: If your LDL cholesterol measurement is 125mg/dL, then you might have five large busses carrying 25 cholesterol-passengers each, or 125 cars carrying one cholesterol-passenger each. The number and size of the vehicles on the road determines whether there is increased risk of a traffic jam, not the number of people traveling in the vehicles. The higher the count of small-sized lipoprotein particles (cars), the higher the risk of cardiovascular disease. Understanding your lipoprotein status is essential for determining both your risk as well as the most appropriate, targeted intervention for your body.Last year, nearly 21 million Americans were prescribed cholesterol-lowering medications; yet, cholesterol is actually a crucial element in the body necessary for brain cells, cell membranes and hormone balance. If cholesterol is so essential, then how did we come to demonize it? In the 1950s, pathologists searching for the cause of heart disease discovered that blood vessels of heart disease patients were often clogged with plaque and debris. Cholesterol was at the mushy center of this plaque and was thought to be the cause of the disease. For decades since then, the avoidance of fat intake has been prescribed, however, it has not led to decreased cholesterol levels or a reduction in cardiovascular risk. In fact, data suggests the opposite. Low-fat diets often incorporate more calories from the carbohydrate category that can elevate our blood sugar more quickly and actually contribute to increased cholesterol levels and damage to the lining of the arteries. Imbalances in food intake have also been shown to lead to the development of other chronic conditions such as Type 2 diabetes, inflammation and obesity. Understanding how your body responds to different food combinations can have a dramatic effect on reducing your cardiometabolic risk. Do you remember some of the TV commercials that showed a picture of "your grandmother," and the delicious foods she enjoyed, while the announcer mentioned that both your genes and your food can affect your cholesterol and heart disease risk? They were right. There are genetic predispositions to elevated cholesterol and triglycerides, and we can test for them. Even more important than just knowing your family's risk, genetic variations can help us customize an individualized plan targeted for your cholesterol and genetic combination. Some types respond well to changes in nutrition and lifestyle (including exercise and the elimination of alcohol), while some genetic types actually do not.Please understand that there are additional factors that affect cholesterol and heart disease risk not able to be covered here. So whether you are dealing with cholesterol issues or have other health concerns, an integrative health care practitioner can help you examine the nuances of your situation and genetic attributes to help you select, and implement, the most appropriate course of action for you.Jacqui Slavin, D.C., is a functional medicine practitioner and owner of Functional Wellness in Avon. She is a cooperative partner in the Vail Valley Partnership's Health & Wellness Initiative, led by the Vail Valley Partnership in conjunction with like-minded businesses, trade associations, consumer organizations and economic development organizations whose goal is to increase medical groups and meetings in the Vail Valley and bring greater awareness to the ample world-class health, recreation and wellness opportunities available to local residents and guests to drive economic vitality.