Two lifelong friends. Same food. Same habits. Completely opposite cholesterol numbers. One was told his terrible HDL was genetic. The other believed his perfect LDL meant he could eat anything. Then a deeper health analysis revealed both of them were wrong. This story changed how they think about health forever.
We have been friends since we were thirteen years old. We went to the same boarding school in Nainital, the same college in Pune, and for the last twenty-five years we have met up in a hill station every November, where we have too much whisky and too many parathas. We are now forty-five and, in many ways, still live like teenagers.
And until last year, we believed the two of us were on completely different health trajectories.
Vikram first. For as long as I can remember, my blood markers have looked terrible. My HDL, the so-called “good cholesterol” that you generally want to be higher, has run between 4 and 7 mg/dL. Normal is usually considered above 40. I showed this to four different doctors over fifteen years. Every single one said some version of the same thing: “This is probably genetic. We rarely see numbers this low. There may not be much you can do beyond managing overall risk.”
Sameer next. My numbers have always looked enviable. LDL at 30 mg/dL and triglycerides at 26 mg/dL. I am the despair of every dietitian in the country because I eat exactly what Vikram eats, possibly worse, and my lipid profile reads like a monk’s. I have spent fifteen years congratulating myself on a body that processes ghee like a Toyota processes petrol. I have, frankly, been an insufferable dinner companion about it.
More than a month ago, we both did Mira One, a test we kept hearing about from friends. Vikram did it because he was tired of being told his fate was sealed. Sameer did it because he wanted validation that his lifestyle was not as bad as Vikram’s. What we found changed the way we thought about our health.
Vikram’s report suggested that he did not carry the more common known genetic variants typically associated with extremely low HDL. Instead, the broader picture pointed toward severe insulin resistance and metabolic dysfunction as major contributors. The clinical counselor walked me through it on a call the following week and suggested three specific interventions:
- Walk for fifteen minutes after every meal
- Start meals with fiber-rich foods
- Begin strength training consistently
Six weeks later my HDL had moved from 6 to 15 mg/dL. Still far below optimal, but for the first time in years, the trend had meaningfully reversed. More importantly, the underlying metabolic picture was improving.
Sameer’s report was, in some ways, even more confronting. He carried a rare variant in a gene called APOB. Some variants in this gene are associated with unusually low LDL cholesterol and triglyceride levels because the body clears these particles more efficiently than average. In some populations, these variants may occur in roughly 1 in 1,000 to 1 in 3,000 people.
So all those years of “my numbers are great, I can eat anything” were not necessarily proof that his lifestyle was healthy.
The report also flagged that his uric acid was 7.8, his homocysteine was 18, and his hs-CRP, a marker associated with systemic inflammation, was 4.1. While his genetics appeared protective in one area, they offered no such protection in others. He had focused so heavily on his cholesterol panel that he had overlooked several other important markers linked to long-term metabolic and cardiovascular health.
Here is the lesson we extracted from all this, and we want to share it because we think it truly matters.
A blood test alone tells you what is happening with things like cholesterol, sugar, and inflammation. But it often does not tell you why those numbers are what they are.
Vikram was told his problem was purely genetic when it may not have been. Sameer assumed his health was excellent because one part of his biology looked exceptional.
Our doctors were working with the tools they had available at the time. The encouraging part is that those tools are evolving rapidly and becoming more accessible than ever before.
We did not know that before. Now we do.
So both of us are getting our parents and children tested so they can start acting earlier with a more complete picture. And both of us, separately and together, have become deeply annoying to our old school friends, who may soon stop taking our calls.
Mira One is an integrated diagnostic that brings blood biomarkers, pharmacogenomics, and whole genome sequencing together into a single easy-to-read report. This helps your doctor understand not only what may be going wrong but also how your body is likely to respond to specific medications. It only needs to be done once. More info here.
Facebook Twitter Linkedin Email
Disclaimer
Views expressed above are the author’s own.
