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    mr Miler's Avatar
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    Question talking to the doc

    my cholesterol results came back today, w/ a quick note fron the doctor with the standard advice. my total was 192 hdl 62 ldl 121, ratio 3.1. so she wants my ldl under 100. Does anyone have links to studies, that I can use to start a conversation w/ her to get her to realize i'm not just being irresponsible. I know I can just do what I want with my health, but it is easier with the support of the doctor.

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    cantare's Avatar
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    What are your triglycerides--45 mg/dl? The LDL is merely a calculated estimate, and the commonly used Friedewald formula isn't accurate at low TGs of <100. (I got 45 by assuming this formula was used.) In that case, the so-called Iranian formula, which is designed to correct for low and high TG, would give you an LDL estimate of just 91. It's amazing how many doctors don't even realize the LDL figure is derived, not measured. If LDL is that big a concern then what you really want is an LDL particle breakdown (VAP or NMR Lipoprofile) that directly measures the amount and type of LDL. For now, in the interest of keeping the peace you could always show her that Iranian paper and point out that your LDL is most probably below her arbitrary 100 criterion already.

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    the Iranian paper makes sense, although its a little over my head, I'm not a Rocket Surgeon" and the heart surgeon article is great, and once I get some quiet, I'll listen to the other one. thanks for your help.
    Activia, are you aware of any Massachusetts primal groups. I'm not really near Boston, but I would like to compare notes, with some people closer to home. Not sure why though, maybe just for a sense of belonging.

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    mr Miler's Avatar
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    my triglycerides, are 44 well under the recommendations of 150 my doctor gave me.

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    Then my assumption was valid--Friedewald equation was used, and with a TG way under 100 your doc is almost assuredly relying on a lousy estimate. I'd expect your LDL pattern is likely the good "Type A" fluffy kind...but I see you are T1D and I don't know how that affects interpretation of blood lipids. Still, I'd think your doc would want much more solid (not to mention accurate) information before treating an abstract number (or pressing for a major dietary shift).

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    Quote Originally Posted by cantare View Post
    What are your triglycerides--45 mg/dl? The LDL is merely a calculated estimate, and the commonly used Friedewald formula isn't accurate at low TGs of <100. (I got 45 by assuming this formula was used.) In that case, the so-called Iranian formula, which is designed to correct for low and high TG, would give you an LDL estimate of just 91. It's amazing how many doctors don't even realize the LDL figure is derived, not measured. If LDL is that big a concern then what you really want is an LDL particle breakdown (VAP or NMR Lipoprofile) that directly measures the amount and type of LDL. For now, in the interest of keeping the peace you could always show her that Iranian paper and point out that your LDL is most probably below her arbitrary 100 criterion already.
    This ^

    OP, if you want someone else to do the numbers for you, then just plug them into this calculator - LDL Cholesterol Calculator

    If you put in your numbers, it comes up with a 90.1 LDL with Iranian versus the 121 Friedewald your doctor told you. Anytime your Triglycerides are below 100, then the standard formula doesn't work. LDL is calculated from the other numbers, not measured directly, but the Friedewald formula only works for the regular guy with higher Trigs. You need to use Iranian.

    I know, I got chewed out too. My doc's nurse told me to watch my fat intake and keep eating those heart healthy whole grains. Yeah, right!
    My sorely neglected blog - http://ThatWriterBroad.com

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    My cholesterol conversation with my doctor went along the lines of his saying, "Your LDL should be lower," and then my saying, "I'm trying to eat better these days--If it makes you happy, you can keep testing every now and then and keep an eye on it, but it will take a lot of convincing for me to take statins." He shrugged and said, "We'll keep an eye on it." I said something like, "I'm not worried about it unless you are. There are bigger fish to fry." And he said something like, "If the bigger fish don't get bigger" (weight, blood pressure, glucose) "then we don't have to worry about it. We'll keep an eye on it."

    Very conventional, but very reasonable, IMO.

    Just talk to her and see what she has to say. No one's going to lose their cool over 120-something--or if they do, then you'll have learned something, too.

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